Frequent Healthcare-associated Infections Research Articles

Healthcare-associated infections must stop: a breakthrough project aimed at reducing healthcare-associated infections in an intensive-care unit

BackgroundHealthcare-associated infections are a problem for the Swedish healthcare system. In order to reduce the risk of acquiring healthcare-associated infections, the intensive-care unit attended a breakthrough project in 2004–2005, with...

Screen and clean to beat MRSA: success story from The Netherlands

Methicillin-resistant Staphylococcus aureus (MRSA) was first reported in 1961, less than 1 year after the introduction of methicillin. An increase in the problem has been observed in Europe and the USA since the 1970s. In most countries the percentage of MRSA in hospitals is now between 20–75%. Although there is high MRSA prevalence in surrounding countries in Europe like Belgium, UK and Germany, for more than 20 years the Dutch healthcare system has been able to keep the number of MRSA cases in the Netherlands extremely low (0.7% in 2008). The official Dutch MRSA guidelines from the national Working Party of Infection Prevention (WIP) have been implemented in every healthcare setting. To ensure the success of such a policy, it is important that all hospitals in the country comply with the guidelines. The most important preventive measure against MRSA is the prudent and restrictive use of antibiotics. An effective infection prevention program in every hospital is the second preventive success factor. Many Dutch laboratories for microbiology take part in the European Antimicrobial Resistance Surveillance System (EARSS), a European network of national surveillance systems, providing reference data on antimicrobial resistance. Moreover, most Dutch hospitals take part in the Dutch national surveillance network PREZIES (Dutch acronym for ‘prevention of healthcare-associated infections through surveillance’), to gain insight into the frequency of healthcare-associated infections and to take part in the national control of basic hygiene. Basic hygiene is part of regular infection prevention policy and includes disinfecting hands with hand alcohol and mechanical cleaning and disinfecting of nursing and medical devices as much as possible. The preventive strategy is called the ‘Search and Destroy’ policy. This means that every patient and all healthcare workers (HCWs) who are suspected for MRSA must be screened for MRSA. The guidelines have been written for identification into four risk groups. Most colonised patients and colonised HCWs do not develop infections; however, they can transmit MRSA to patients and contaminate the environment. To ‘Search’ MRSA, swabs have to be taken from the perineum, nose, throat and every wound, skin-lesion and or infection site. If hospital admission is necessary, category 1 or 2 patients must be cared for in strict isolation until laboratory results are known. If the patient is proved to be MRSA-positive, the infection control department starts screening every contact – both patients and HCWs. If more than two patients are found, outbreak management for MRSA starts. If MRSA has been diagnosed in HCWs, then they may not carry out any activities in departments in which patients are present. To ‘Destroy’ MRSA, the policy gives guidelines for eradication and treatment, and policies for cleaning and disinfecting. To fulfil this policy at least a 0.5 FTE infection control practitioner is needed.

Translating Health Care–Associated Urinary Tract Infection Prevention Research into Practice via the Bladder Bundle

Catheter-associated urinary tract infection (CAUTI), a frequent health care-associated infection (HAI), is a costly and common condition resulting in patient discomfort, activity restriction, and hospital discharge delays. The Centers for Medicare & Medicaid Services (CMS) no longer reimburses hospitals for the extra cost of caring for patients who develop CAUTI. The Michigan Health and Hospital Association (MHA) Keystone Center for Patient Safety & Quality has initiated a statewide initiative, MHA Keystone HAI, to help ameliorate the burden of disease associated with indwelling catheterization. In addition, a long-term research project is being conducted to evaluate the current initiative and to identify practical strategies to ensure the effective use of proven infection prevention and patient safety practices. The bladder bundle as conceived by MHA Keystone HAI focuses on preventing CAUTI by optimizing the use of urinary catheters with a specific emphasis on continual assessment and catheter removal as soon as possible, especially for patients without a clear indication. COLLABORATION BETWEEN RESEARChERS AND STATE WIDE PATIENT SAFETY ORGANIZATIONS: A synergistic collaboration between patient safety researchers and a statewide patient safety organization is aimed at identifying effective strategies to move evidence from peer-reviewed literature to the bedside. Practical strategies that facilitate implementation of the bundle will be developed and tested using mixed quantitative and qualitative methods. Simply disseminating scientific evidence is often ineffective in changing clinical practice. Therefore, learning how to implement these findings is critically important to promoting high-quality care and a safe health care environment.

Hospital-wide surveillance of catheter-related bloodstream infection: from the expected to the unexpected

Catheter-related bloodstream infections (CRBSIs) are among the most frequent healthcare-associated infections and cause considerable morbidity, mortality, and resource use. CRBSI surveillance serves quality improvement, but is often restricted to intensive care units (ICUs). We conducted a four-month prospective cohort study of all non-cuffed central venous catheters (CVCs) to design an efficient CRBSI surveillance and prevention programme. CVCs were assessed on a daily basis for ward exposure time, care parameters, and the occurrence of laboratory-confirmed CRBSI. Overall, 248 patients with 426 CVCs accounted for 3567 CVC-days (median: 5) and 15 CRBSI episodes. CVCs were inserted by anaesthetists, ICU physicians and internists in 45%, 47%, and 8% of cases, respectively. CVC utilisation rates for intensive care, internal medicine, non-abdominal surgery and abdominal surgery were 29.8, 3.8, 1.7 and 4.9 per 100 patient-days, respectively. Fourteen percent of patients changed wards while having a CVC in place, so spending CVC-days at risk within multiple departments. CRBSI incidence densities for ICU, internal medicine, surgery and abdominal surgery were 5.6, 1.9, 2.4 and 7.7 per 1000 CVC-days at risk, respectively. In a univariate Cox proportional hazards model, the high CRBSI rate in abdominal surgery was associated with longer CVC duration, frequent use of parenteral nutrition and CVC insertion by anaesthetists. CRBSI numbers were insufficient to perform a multivariate analysis. Our surveillance revealed similar CRBSI rates in both ICU and non-ICU departments, and when frequent ward transfers occurred. Hospital-wide CRBSI surveillance is advisable when a large proportion of CVC-days occur outside the ICU.

Point prevalence survey for healthcare-associated infections within Canadian adult acute-care hospitals

A survey of adult patients 19 years of age and older was conducted in February 2002 in hospitals across Canada to estimate the prevalence of healthcare-associated infections (HAIs). A total of 5750 adults were surveyed; 601 of these had 667 HAIs, giving a prevalence of 10.5% infected patients and 11.6% HAIs. Urinary tract infections (UTI) were the most frequent HAI, shown by 194 (3.4%) of the patients surveyed. Pneumonia was found in 175 (3.0%) of the patients, surgical site infections (SSI) in 146 (2.5%), bloodstream infections (BSI) in 93 (1.6%) and Clostridium difficile-associated diarrhoea (CDAD) in 59 (1%). In this first national point prevalence study in Canada, the prevalence of HAI was found to be similar to that reported by other industrialized countries.