Cases Of Nosocomial Infection Research Articles

European Monitoring Plans for the management of Outbreak of Crimean Congo Haemorrhagic Fever (CCHF)

The Crimean Congo Haemorrhagic Fever (CCHF) is a viral infection caused by the CCHF virus (CCHFV), a member of the family Bunyaviridae, genus Nairovirus. This virus is transmitted by ticks of the genus Hyalomma and has been reported in more than 30 countries in Africa, Asia, South-East Europe and the Middle East [1] arising considerable public health concern in many regions of the world. The first case of CCHF was probably described by a Physician in Tajikistan in 1110 DC in a patient with hemorrhagic manifestations [2]. More recently, CCHF was described for the first time as a proper clinical entity in 1944-45 when about 200 Soviet soldiers were infected while providing assistance to farmers in the Crimea during the Second World War [3]. However the virus was first isolated from a Patient in the Democratic Republic of the Congo only in 1956 [4]. The disease is currently reported in Asia (China, Kazakhstan, Tajikistan, Pakistan, Afghanistan, Iraq, Iran, UAE, Oman, Yemen, southern Saudi Arabia), Africa (Mauritania, Senegal, Burkina Faso, Congo, Uganda, Kenya, Tanzania, Namibia, South Africa) [5] and Europe [6]. H. marginatum, the main vector of CCHF virus in Europe, is located in Albania, Bulgaria, Cyprus, France, Greece, Italy, Kosovo, Moldova, Portugal, Romania, Russia, Serbia, Spain, Turkey and Ukraine. In 2006 it was isolated for the first time in the Netherlands and in southern Germany [7,8]. As evidenced by a recent study (Estrada-Pena, 2012), favorable climate and ecological conditions present in several European countries bordering the Mediterranean Sea, could ensure a CCHFV expansion in the near future. The risk of infection is particularly high in Italy due to the presence of concomitant factors such as the wild ecological heterogeneity that characterizes its territory, and the peculiar position in the middle of the Mediterranean area. Besides, the recent raising of the average seasonal temperatures in south European countries could increase the colonization by vector populations that were not naive [9]. Typically CCHF’s clinical manifestations are high fever, malaise, severe headache and gastrointestinal symptoms. Extensive bleeding may occur in an advanced stage of the disease, with mortality rates ranging from 5% to 50%. CCHF is a disease of immediate communication to the public health authorities [4]. During the last decade the CCHFV has emerged and / or re-emerged in several countries of the Balkans, Turkey, in the regions of the south-west of the Russian Federation and Ukraine, with a significantly high mortality rates. The reasons for the re-emergence of CCHFV include climate and anthropogenic factors such as changes in agricultural practices or hunting activities and cattle movement. These factors can influence the dynamics of host-tick-virus. In the light of the dangerousness of this disease an International surveillance for the management of an outbreak of CCHF is needed. This should be carry out with an integrated approach among the countries at risk of infection in the Mediterranean area in order to design measures for prevention and control of this disease, mapping of endemic areas and assessing risk of CCHF transmission. In addition, the areas at risk of further expansion of CCHF should be identified also oversight [6]. Different elements concerning diagnosis, monitoring and treatment of CCHF should be considered in order to increase the surveillance in Europe defining appropriate measures for prevention and control. Currently there are no standard definitions regarding how to notify CCHF infection and how “contact tracing” must be carry out in different European countries. Recent cases of nosocomial infection of health care workers infected by CCHFV have been documented. These cases stress the needing for a focused education, with particular regard to transmission pathways and to preventive measures; it is also crucial providing adequate resources on contrasting the diffusion of this disease [6]. Besides, in many countries at risk of infection, standard collaboration procedures and protocols for data exchange are not settled between human and animal health services. Therefore designing and creating a surveillance system for these vector-transmitted diseases should be aimed to develop common procedures and protocols for data exchange. References

Estudo da ocorrência de infecção hospitalar em cães e gatos em um centro cirúrgico veterinário universitário

Infecção hospitalar ou nosocomial é aquela adquirida durante a hospitalização do paciente, e que pode ser relacionada os procedimentos hospitalares invasivos realizados durante o internamento. O presente trabalho teve como objetivos estudar a ocorrência de infecção hospitalar em animais atendidos em um Centro Cirúrgico Veterinário Universitário de Pequenos Animais submetidos a procedimentos cirúrgicos e/ou invasivos; discutir as possíveis causas de infecção, detectar as bactérias presentes quando possível e verificar a sensibilidade antimicrobiana destes agentes. O trabalho foi desenvolvido através do acompanhamento diário de 131 animais internados neste setor e busca ativa de casos de infecção hospitalar. Em 104 animais (91 cães e 13 felinos), foram realizados 113 procedimentos cirúrgicos e em 27 animais condutas não cirúrgicas tais como acompanhamento de parto e pós-parto, desobstrução uretral e colocação de talas. Todos os animais foram submetidos à colocação de cateter para fluidoterapia e/ou aplicação de medicamentos e/ou anestésicos em algum momento durante o internamento. O índice de infecção do sítio cirúrgico foi de 7,96% sendo 4,54% nas cirurgias limpas, 4,25% nas cirurgias limpa-contaminadas, 10,53% nas cirurgias contaminadas e 16% nas cirurgias infectadas. A taxa de infecção hospitalar não cirúrgica no paciente cirúrgico foi de 2,88% e 3,7% no paciente não cirúrgico. Foram cultivados sete isolados bacterianos, sendo Pseudomonas sp. (3), Streptococcus sp. (2), Acinetobacter sp. (1) e bacilo Gram negativo (1), constatando-se multirresistência bacteriana alta em todos os isolados. A duração da cirurgia e os tempos de internamento pré e pós-operatório não influenciaram na ocorrência de infecção hospitalar, mas os fatores que provavelmente colaboraram para a ocorrência de infecções no presente trabalho foram a própria gravidade da doença que motivou o tratamento, o tipo de procedimento realizado e a gravidade das lesões concomitantes.

Drug resistance patterns of bacteria isolated from patients with nosocomial pneumonia at Tehran hospitals during 2009-2011

Nosocomial pneumonia remains an important cause of mortality and morbidity worldwide. Surveillance programs play an important role in the identification of common etiologic agents and local patterns of antimicrobial resistance. In this study we determined the frequency and antimicrobial susceptibility of pathogens isolated from patients with nosocomial pneumonia during 2009 to 2011. A total of 642 bacteria were isolated from 516 suspected samples. Acinetobacter baumannii (21.1%, n = 136), was the commonest isolated pathogen followed by Pseudomonas aeruginosa (17.4%, n = 112), Staphylococcus aureus (15.8%, n = 102) and enterococci (8.4% n = 54). The most effective therapeutic agents against A. baumannii were polymyxin B (95.5% susceptible), ceftriaxone/tazobactam (72% susceptible) and levofloxacin (52.9% susceptible). Polymixin B (89.2% susceptible), ceftriaxone/tazobactam (89.2% susceptible) and piperacillin-tazobactam (80.3% susceptible) were found to be the most active agents against P. aeruginosa. Extended-spectrum beta-lactamases were detected among isolates of K. pneumoniae (45.4%) and E. coli (20.3%). Overall, the prevalence of methicillin-resistant S. aureus and vancomycin resistant enterococci were 80.4% and 40.7% respectively. Linezolid was found to be the most active antibiotic against these pathogens. The etiology of 50% of the nosocomial infection cases was polymicrobial. The combination of ceftriaxone/tazobactam seems to be beneficial agent against multidrug-resistant Gram-negative bacilli isolated form respiratory tract infections. The results of our study can be used for guiding appropriate empiric therapy in this geographic region.

Factors Affecting the Risk of Surgical Site Infection and Methods of Reducing it

According to estimates by the National Audit Office (NAO) hospital acquired infections (HAl), in particular surgical site infections (SSls), cost the NHS on average 3200 pounds per SSI and cause a mortality rate of at least five thousand patients a year (Leaper 2010). Despite practitioners' knowledge of safe working technique and control of infection, reported cases of nosocomial infections are still high, despite a reduction in-rate from 9% in 1993/4 to 8.2% in 2006 (Roberts & Cookson 2009).

非結核性抗酸菌 （<i>Mycobacterium chelonae</i> chemovar <i>niacinogenes</i>） による院内感染事例の発生と拡大原因の考察

Mycobacteria consist of 2 large groups: one is the tuberculosis complex, and the other is nontuberculous mycobacterium (NTM). Most of the NTM are generally non-virulent bacteria, but some NTMs have pathogenicity to humans. There are many reports of nosocomial infection cases caused by common bacteria such as multidrug-resistant Pseudomonas aeruginosa. Also, some cases of in-hospital infection due to NTM were reported. Unlike common bacteria, detection of mycobacteria is affected by various factors, such as stainability, time for colony forming, temperature and nutrition Mycobacterium chelonae chemovar niacinogenes was isolated from 5 patients in 73 nosocomial infection cases (60 patients and 13 suspected cases) at a certain hospital during the period from March 2007 until January 2009. One of the reasons for the expansion of infection and difficulty in identification of the bacteria was the properties of this mycobacterium. This bacterium was very faintly stained with Gram-staining. Therefore, this mycobacterium could only be detected at a hospital when Ziehl-Neelsen stain and the cultivation at 28 degrees C for more than 5 days were performed. MICs for Cefmenoxime and Tosufloxacin of the isolates were more than 128 microg/mL. The isolates and type strasin of M. chelonae chemovar niacinogenes were also resistant to other drugs.

Association between an Incomplete Vaccination Schedule and Nosocomial Sepsis among Children with Cancer

Background: Patients with cancer constitute a special group where immunization programs are often interrupted to begin treatment with chemotherapy. Sepsis is one of the main complications in this group. Methods: A hospital-based case-control study matched by age was carried out among subjects ≤ 9 years of age with cancer diagnosis. Children with cancer without sepsis and children with surgical pathology were included as controls; children with sepsis were included as cases. A bivariate logistic regression was used to determine the factors associated to nosocomial sepsis, and odds ratios were calculated with 95% confidence intervals. The percentage of attributable risk was calculated for the variables included in the final model. Results: Nineteen children with cancer and sepsis and 83 controls were included. Twelve (44%) caseshad an incomplete vaccination schedule according to their age. The association force between incomplete schedule and sepsis was 10.1 (95% CI, 3 - 36; p Conclusions: Approximately, 20% to 65% of the cases of serious nosocomial infection can be associated to an incomplete vaccination schedule. Strategies should be implemented to improve the general pediatric population’s vaccination status before a serious disease, such as cancer or another chronic condition preventing the application of vaccines, develops.

Genotyping of gastroenteric viruses in hospitalised children: first report of norovirus GII.21 in Brazil

This retrospective study (April-September 2003) was designed to investigate the roles of the main viruses responsible for cases of acute infantile gastroenteritis in hospitalised children up to two years of age. The viruses were identified in 64.7% (88/136) of the cases and the detection rates of rotavirus A (RVA), norovirus (NoV) and astrovirus were 41.9% (57/136), 30.3% (24/79) and 12.7% (7/55), respectively. RVA and NoV were detected in 20 of the 24 reported nosocomial infection cases. This study identified the first circulation of the genotype NoV GII.21 in Brazil and highlights the need to establish differential diagnoses through active laboratorial surveillance.

Analysis on the results of 2011 hospitalized patients with nosocomial infection surveillance

Objective To understand the risk factors of nosocomial infection and distribution pattern of reducing infection.Methods Retrospective method of investigation and analysis was used to investigate 22,345 cases of hospitalized patients in 2011 hospitals infections.Results 686 cases of nosocomial infection were found,with the infection rate of 3.07％; led by the site of infection to the respiratory system,accounting for 54.4％; the infection rate of Critical Care Medicine of 19.9％ was the highest,detected a total of 217 pathogens,including Gram-negative bacteria that accounted for 53.00％ positive bacteria accounted for 35.02％,fungi accounted for 11.98％.Conclusions Infection control awareness of the medical staff should be increased,and the hand hygiene system,strictly enforcing the sterile operating procedures,the rational use of antimicrobial drugs are important measurements for control of hospital infection. Key words: Hospital infection; Monitor; Analysis; Control

Fate of airborne Coagulase negative Staphylococci

Hospital indoor air can be a source for transmitting nosocomial infections in resource limited settings. This study was undertaken over two months period (February – March 2010) in Chennai, India, to 1) characterise bacteria isolated from indoor air of healthcare facility; and 2) establish whether environmental and clinical isolates are similar by molecular typing methods. Daily visits were made to microbiology laboratory to determine clustering of cases of nosocomial infections. Patients with illnesses related to respiratory tract and skin and soft tissues were included. Clinical strains (from laboratory) with similar antibiogram patterns were systematically stocked. Indoor air samples were collected from such locations by exposed plate method for 30 minutes. Growth was identified by standard microbiological procedures. Phenotypically similar strains were further subjected to genotyping by polymerase chain reaction and pulsed field gel electrophoresis (PFGE) to confirm similarity. Coagulase-negative staphylococci (CNS) were only isolated from both environmental and clinical samples during the study period. Totally, 15 clinical and six environmental strains of CNS were isolated over two months. One airborne and one clinical strain, isolated subsequently from a patient in the same location, had similar phenotypic (biochemical and antibiogram) characteristics. Isolates were identified Corresponding Author Ms. Suchithra Sudharsanam Sri Ramachandra Medical College & Research Institute, Sri Ramachandra University, Porur, Chennai 600116, India. Email: suchisanam@gmail.com

Pathogenic bacteria analysis and countermeasures for nosocomial infection in neonatal wards

Objective To analyze the nosocomial infection characteristics,pathogenic bacteria and relative risk factors,in order to provide the basis for preventing and controlling nosocomial infection,and to reduce the incidence of nosocomial infection in neonatal wards.Methods The study enrolled 603 neonatal patients hospitalized between July 2009 to July 2011.Results There were 58 nosocomial infection cases found in 603 neonatal patients, and the infection rate was 9.62 ％.The most common infections were respiratory tract infection,oral infections and gastrointestinal tract infection,with proportion rate of 53.45％,31.03％ and 15.52％ respectively.The main pathogenic bacteria was Klebsiella pneumoniae,accounting for 36％.Conclusions The lower gestational age and birth weight,bigger length of hospital stay and invasive operation are risk factors of nosocomial infection.We can reduce nosocomial infections through strengthening education,enhancing respiratory tract management,primary care,reasonable use of antibiotics,emphasizing washing hands,and strengthening comprehensive disinfection measures,. Key words: Neonatal ward; Nosoeomial infection; Incidence; Risk factors; Pathogenic bacteria analysis; Early stage intervention

Continuous and automated measuring of compliance of hand-hygiene procedures using finite state machines and RFID

Health care associated infections (HAIs) affect up to one in twenty hospitalizations or 1.7 million persons annually in the U.S., exceeding four billion dollars in costs [1] and resulting in approximately 100,000 deaths. In Europe, there are an estimated five million annual cases of general nosocomial infections, infections acquired in a hospital, with 2.7% of cases (135,000 annually) being a contributor to death [2]. Although many factors contribute to the development of HAIs, hand hygiene is considered the single most important measure for limiting nosocomial transmission of pathogens [3]. Hand hygiene compliance is generally considered to be suboptimal and remains a constant challenge for infection control programs. Health regulatory and advisory agencies, such as the World Health Organization (WHO), the Centers for Disease Control and Prevention (CDC), and The Joint Commission, all recommend or demand that hospitals monitor hand hygiene compliance.

Epidemiological Studies on Proteeae Isolates from Clinical Specimens in the Laquintinie Hospital in Douala, Cameroon

The tribe Proteeae is a group of bacteria within the family Enterobacteriaceae and is responsible for most cases of nosocomial infections in hospital settings. The objective of this study was to determine the prevalence of members of Proteeae from clinical specimens in Laquintinie hospital in Douala. Specimens were collected from patients and screened for Proteeae using standard microbiological and biochemical methods (API 20 Enterobacteriaceae gallery). Of the 3414 clinical specimens made of 2712 urine, 264 blood, 243 CSF and 195 wounds and burns, 1136 (33.3%) yielded a positive bacterial growth, of which 230 (20.2%) were Gram positive and 906 (79.7%) were Gram negative. 164 (14.4%) isolates were identified as members of Proteeae of which 110 (67.1%) were from urine, 37( 22.6%) from wounds and burns, 10(6.1%) from blood and 7( 4.3%) from CSF. Speciation of the Proteeae isolates showed that 111 (67.7%) were Proteus mirabilis , 21(12.8%) Proteus vulgaris , 11 (6.7%) Providencia alcalifaciens , 6 (3.6%) Providencia stuartii , 4 (2.4%) Morganella morganii and 5 (3.0%) Proteus penneri and Providencia rettgeri . There was a significant difference between the type of clinical specimens and the age of patients (X2 = 52.623 p<0.05). Most Proteeae isolates where susceptible to imipemen, ceftazidine, chloramphenicol, gentamicin, nalidixic acid, ofloxacin and amikacin. These findings have significant clinical and epidemiological implications. Keywords: Proteeae isolates, Clinical specimens, Laquintinie Hospital, Cameroon

Multidrug-resistant nosocomial infections among private hospital patients in the North West province

AbstractThis article reports on severe clinical cases of nosocomial infections that were caused by multidrug-resistant (MDR) isolates of Acinetobacter baumannii and Pseudomonas aeruginosa in an intensive care unit (ICU). Globally, patients in ICUs have encountered an increasing emergence and spread of MDR pathogens. A retrospective case study was conducted to investigate the possible causes and occurrence of nosocomial infections linked to reported cases thereof in a private hospital in the North West province between December 2009 and August 2010. This followed an enquiry from a concerned community member about two patient deaths and a patient who was in the hospital's ICU between July and August 2010 with an infection by an unknown “superbug” Of the 24 adult patients who were admitted to the ICU in the study period, 22 presented with isolates of A. baumannii, one with P. aeruginosa, and one with presumed A. baumannii for which there was no laboratory test confrmation. Of those who were infected with A. ...

Incidence and clinical implication of nosocomial infections associated with implantable biomaterials - catheters, ventilator-associated pneumonia, urinary tract infections.

Health care associated infections, the fourth leading cause of disease in industrialised countries, are a major health issue. One part of this condition is based on the increasing insertion and implantation of prosthetic medical devices, since presence of a foreign body significantly reduces the number of bacteria required to produce infection. The most significant hospital-acquired infections, based on frequency and potential severity, are those related to procedures e.g. surgical site infections and medical devices, including urinary tract infection in catheterized patients, pneumonia in patients intubated on a ventilator and bacteraemia related to intravascular catheter use. At least half of all cases of nosocomial infections are associated with medical devices.Modern medical and surgical practices have increasingly utilized implantable medical devices of various kinds. Such devices may be utilized only short-time or intermittently, for months, years or permanently. They improve the therapeutic outcome, save human lives and greatly enhance the quality of life of these patients. However, plastic devices are easily colonized with bacteria and fungi, able to be colonized by microorganisms at a rate of up to 0.5 cm per hour. A thick biofilm is formed within 24 hours on the entire surface of these plastic devices once inoculated even with a small initial number of bacteria.The aim of the present work is to review the current literature on causes, frequency and preventive measures against infections associated with intravascular devices, catheter-related urinary tract infection, ventilator-associated infection, and infections of other implantable medical devices. Raising awareness for infection associated with implanted medical devices, teaching and training skills of staff, and establishment of surveillance systems monitoring device-related infection seem to be the principal strategies used to achieve reduction and prevention of such infections. The intelligent use of suitable antiseptics in combination with medical devices may further support reduction and prevention of such infections. In addition to reducing the adverse clinical outcomes related with these infections, such reduction may substantially decrease the economic burden caused by device-related infection for health care systems.

Investigation and analysis of nosocomial infection in neonates

To investigate the incidence of nosocomial infections of newborn infants in neonates and to explore the risk factors and strategies of infection control. There were 433 confirmed cases of nosocomial infection in the neonatal ward of the authors' hospital from January 2007 to December 2009. Their data of epidemiological and clinical characteristics, results of etiological examinations and antibiotic resistance were retrospectively analyzed. During the study, the number of hospitalizations were 6437. Nosocomial infection occurred in 433 patients 513 times. The overall nosocomial infection rate was 6.82%. The overall hospitalization days were 73 663 and nosocomial infection patient-day rates were 6.96‰. The VAP infection rate was 28.7‰. The CRBSI rate was 3.5‰. Gestational age (OR = 1.049), mechanical ventilation (OR = 1.810), umbilical vein catheter (OR = 1.106), hospitalization days (OR = 1.081), premature rupture of membrane (OR = 1.433) were the risk factors for the development of nosocomial infection. There were 197 (38.4%) cases of pneumonia, which was the most common nosocomial infection in Neonatal Ward. There were 129 cases of ventilator-associated pneumonia (VAP), which accounts for 65.5% of pneumonia and 24.4% of cases treated with ventilator. The next was sepsis, 124 cases (24.2%) and 64 cases of diarrheal disease (12.7%). One hundred and eighty two (54.4%) strains of isolates were Gram-negative bacteria, which accounted for the highest proportion. The predominant pathogens of Gram-negative bacteria were Klebsiella pneumoniae (19.6%), followed by Acinetobacter baumannii (8.1%), Pseudomonas aeruginosa (7.2%), Stenotrophomonas maltophilia (4.8%) and Escherichia coli (4.8%). The isolation rates of Klebsiella pneumoniae and Escherichia coli with positive extended-spectrum beta-lactamases (ESBLs) were 91.4% and 75%, respectively. Those two bacteria were universally resistant to cephalosporins. The rate of resistance to imipenem of Klebsiella pneumoniae, Acinetobacter baumannii and Pseudomonas aeruginosa were 1.5%, 11.1% and 41.7%. The isolation rates of methicillin-resistant Staphylococcus aureus and methicillin-resistant coagulase-negative Staphylococcus were 28.6% and 95.5%. It is important to identify the high risk factors for nosocomial infections in newborn infants. To shorten time for mechanical ventilation and hospitalization days, removal of the central venous catheter as early as possible would be conducive to reducing the morbidity of nosocomial infection. The main pathogens were Gram-negative bacteria. The multidrug resistance of Enterobacteriaceae and Non-fermenters is serious.

In Vitro Efficacy of Antimicrobial-Treated Drainage Catheters in Preventing Bacterial Colonization in Biological Fluids

Device-associated infections, which account for about half of the 2 million annual cases of nosocomial infections in the United States,1 can result in severe complications, impede quality of life, prolong hospital stay, and be fatal.2 Not only is the cost of managing such infections staggering, but recent US Medicare policy changes prohibit reimbursement of hospitals for the cost of managing certain healthcare-acquired complications, including catheter-associated infections.3 Although the protective capacity of surface-modified vascular and urinary catheters has been extensively studied, there is a paucity of information on antimicrobial-coated percutaneously-placed catheters that are used to drain body fluids. Organisms that cause infection of percutaneously-placed drainage catheters can originate from either the patient’s skin or the body fluids that drain through these catheters. Since catheter colonization is a prelude to clinical infection, effective antimicrobial modification of medical devices has the potential of preventing clinical infection.4 However, the activity of antimicrobial-coated drainage catheters has not been previously assessed while placed in body fluids that would simulate clinical scenarios. Since previous studies have demonstrated that central venous catheters impregnated with the combination of minocycline and rifampin (MR) protect against catheter-related bloodstream infection,4 we elected to investigate the in-vitro efficacy of pigtail Fuhrman polyurethane drainage catheters impregnated with MR against both Gram-positive and -negative bacteria in three different body fluids collected from patients.

Nosocomial outbreak of hepatitis B virus infection involving two hospitals in the Republic of Ireland

The routes of nosocomial hepatitis B virus (HBV) transmission have changed over the years. Initiatives to prevent transfusion-associated HBV and healthcare worker-to-patient transmission have had a positive impact on these transmission routes. Recent reports of outbreaks of nosocomial HBV have implicated breaches in standard precautions as important causes of HBV transmission. This report describes a nosocomial outbreak of HBV infection in the Republic of Ireland, which occurred between January 2005 and March 2006. The outbreak was detected following identification of a case of acute HBV infection in a patient whose only risk factor was a recent surgical procedure. The extensive multi-agency investigation that followed revealed that the patient was one of five cases of acute HBV infection and that four separate transmission events between infectious cases had occurred in two different hospitals over a 15-month period. A definitive cause for each transmission event was not identified, although lapses in adherence to standard precautions, safe injection and phlebotomy practices could not be ruled out. Two secondary cases of acute HBV infection in community contacts of two of the nosocomial cases were identified. Phylogenetic analysis proved a useful tool in confirming infection with a pre-core HBV mutant and viral transmission between the seven patients. Apatient notification exercise involving 1028 potentially exposed patients found no evidence of additional cases of nosocomial HBV infection. These findings highlight the importance of consistent application of standard precautions.

Intérêt de l’utilisation des données du Programme médicalisé des systèmes d’information (PMSI) pour la surveillance des infections nosocomiales aux Hospices Civils de Lyon

Background Surveillance is an effective element in the fight against nosocomial infections, but the monitoring methods are often cumbersome and time consuming. The detection of infection in computerized databases is a means to alleviate the workload of health care teams. The objective of this study was to evaluate the performance of using discharge summaries in medico-administrative databases (PMSI) for the identification of nosocomial infections in surgery, intensive care and obstetrics. Methods The retrospective assessment study included patients who were hospitalized in general surgery, intensive care and obstetrics at different periods of time in 2006 and 2007 depending on the wards. Patients were monitored according to standard protocols which are coordinated at the regional level by the Southeast coordinating centre (CCLIN). The performance of identifying cases of nosocomial infection from discharge diagnoses coded by using the International Classification of Diseases (tenth revision) was evaluated by a study of sensitivity, specificity, positive and negative predictive values with their 95% confidence intervals. Results Using a limited number of diagnostic codes, the sensitivity and specificity were, respectively, 26.3% (95% CI 13.2–42.1) and 99.5% (95% 98.8–100.0) for the identification of surgical site infections. By expanding the number of diagnostic codes, the sensitivity and specificity were 78.9% (95% CI 65.8–92.1) and 65.7% (95% CI 61.0–70.3). The sensitivity and specificity for case identification of nosocomial infections in intensive care were 48.8% (95% CI 42.6–55.0) and 78.4% (95% CI 76.1–80.1), and were 42.9% (95% CI 25.0–60.7) and 87.3% (95% CI 85.2–89.3) for identification of postpartum infections. Conclusion The PMSI is not a sufficiently efficient method in terms of sensitivity to be used in surveillance of nosocomial infections. A reassessment of the PMSI must be considered, with changes in coding of comorbidity that occurred in 2009.

Rotavirus Nosocomial Infection in Children under 5 years of age: A Preliminary study in Nepal

Introduction: Rotavirus is one of the most common causes of acute gastroenteritis among infants and young children. The spread of rotavirus infection in pediatric wards can cause acute diarrhoea during hospitalization, and in turn, prolong hospitalization or need, rehospitalization. The aim of the study was to determine the prevalence of nosocomial infection due to rotavirus and other causal organisms among children less than 5 years of age. Methodology: A cross-sectional study between November 2009 and May 2010 was conducted among 96 pediatric patients in children hospital, Nepal. Stool samples were collected during hospitalization and up to 3 days after discharge from the hospital. Rotavirus antigens were detected by EIA and standard microbiological procedure were applied for other enteric pathogens. Results: The prevalence of nosocomial infection due to rotavirus was 30.2% (29/96). Of them, 16 (55.17%) of the 29 children with nosocomial infection during hospitalization and/or up to 72 hours after discharge developed diarrhoea. The prevalence of symptomatic cases of nosocomial infection was 55.17% (16/29), which involved 16.7% (16/96) of the study subjects, showing a prevalence of 44.82% (13/29) for asymptomatic nosocomial infection consisted of 13.54% (13/96) of the total subjects. Eleven of the 16 symptomatic subjects of nosocomial infection were affected by diarrhoea during hospitalization and five subjects after discharge. Bacteria (8.3%) and protozoa (5.2%) agents were also causing nosocomial infection in children. Conclusions: Children attending hospital may asymptomatically carry enteric pathogens and potentially act as source of nosocomial infection. Due to the relatively high frequency of nosocomial infection in the Children Hospital of Nepal, it is necessary to follow strictly hygienic rules such as isolation of patients with diarrhoea and hand-washing before and after the examination of each patient and cleaning the examination instruments after use in each patient. Key words: Diarrhoea; children; Rotavirus infection; Cross-sectional study; Nepal DOI: 10.3126/jnps.v31i1.3540J Nep Paedtr Soc 2010;31(1):30-34

Vigilancia epidemiológica en el Servicio de Terapia Intensiva de un hospital pediátrico de tercer nivel

Introduction. Intensive care units (ICU) have the largest number of nosocomial infections because of the severity of the patients’ illness as well as of the use of invasive procedures which predispose to longer hospitalization and to increase the risk of acquiring an infection. Consequently it is necessary to conduct a more comprehensive active surveillance in those units. Objective. To determine the methodology to conduct ICU surveillance and to identify the indicators. Material and methods. The study design was cross sectional; it took place from 12 to 14 April 2010 in the ICU of the National Institute of Pediatrics as a part of the Intensive Course on Infection Prevention and Control. The first step was to determine the tools to conduct surveillance in the service. Cases of nosocomial infection (NI) were those meeting international diagnostic criteria established by the Center for Infection Control (CDC). The second stage included monitoring the Intensive Care Unit including hospitalized patients in that period, regardless of the cause of admission and length of hospital stay. Results. A total of 14 patients were hospitalized with an average age of 5.2 years (1-17). 57% (8 patients) of them acquired a nosocomial infection with an attack rate of 50%. Three of them had pneumonia (37.5%), 2 of which were not ventilator-associated; 3 had urinary tract infections (37.5%), 2 of whom were associated with urinary catheter; and 2 had bacteremia (25%); 1 had catheter-related bacteremia. Discussion. Although the study period was short it supports the need for a close surveillance program that includes monitoring prevention by hand hygiene and proper aseptic management of invasive procedures to reduce nosocomial infection rates