Incidence Of Hospital-acquired Infections Research Articles

Surface Micropattern Resists Bacterial Contamination Transferred by Healthcare Practitioners

Environmental contamination contributes to an estimated 20-40% of all hospital- acquired infections (HAI). Infection control practices continue to improve, but multipronged approaches are necessary to fully combat the diversity of nosocomial pathogens and emerging multidrug resistant organisms. The Sharklet™ micropattern, inspired from the microtopography of shark skin, was recently shown to significantly reduce surface contamination but has not been evaluated in a clinical setting. The focus of this study was the transfer of bacteria onto micropatterned surfaces compared to unpatterned surfaces in a clinical simulation environment involving healthcare practitioners. Physician volunteers were recruited to participate in an emergency medicine scenario involving a contact-precaution patient with an acute pulmonary embolism. Prior to scenario initiation, Staphylococcus aureus was inoculated onto the leg of a simulation mannequin and fresh micropatterned and unpatterned surface films were placed on a code cart, cardiac defibrillator shock button, and epinephrine medication vial. Six physicians interacted with micropatterned surfaces and five physicians interacted with unpatterned surfaces in separate scenarios. Bacterial load loss from the first contact location (control film over the femoral pulse) to subsequent unpatterned or micropatterned surface test locations was quantified as a log reduction (LR) for each surface type. The code cart, cardiac defibrillator button, and medication vial locations with micropatterned surfaces resulted in LRs that were larger than the unpatterned LRs by 0.64 (p=0.146), 1.14 (p=0.023), and 0.58 (p=0.083) respectively for each location. The geometric mean CFU/RODAC at the first control surface touched at the femoral pulse pads ranged from 175-250 CFU/RODAC (95% confidence interval). Thus, the micropatterned LRs were consistently greater than the unpatterned LRs, substantiating the micropattern-dependent reduction of microorganism transfer. Principal component analysis showed that the LRs for the code cart and the cardiac defibrillator button highly covaried. Thus, a single mean LR was calculated from these two locations for each surface type; 5.4 times more bacteria attached to the unpatterned surfaces compared to the micropatterned surfaces (p = 0.058). The simulated clinical scenario involving healthcare practitioners demonstrated that the micropatterned surface reduced the transfer of bacterial contamination based on the larger LRs for the micropatterned surface compared to control surfaces. Further investigation in hospital rooms where patients are receiving care will ultimately reveal the capability of micropatterned surfaces to minimize the incidence of HAIs.

Control of hospital acquired infections in the ICU: A service perspective

BackgroundThe service setting has some unique strengths and weaknesses that must be kept in mind when organizing Hospital acquired infections (HAI) prevention interventions. MethodsFollowing an initial study to gather data regarding HAI in the Surgical intensive care unit (ICU) we put into place various infection control interventions. The present study was carried out to analyse the effect of these interventions on the incidence of HAI in the ICU. ResultsThe total admissions to the ICU were 253 patients. Eighty eight patients (34.78%) were admitted for more than 48 hr, 165 patients stayed for less than 48 h. The frequency of HAI was 7.95% (95% CI 3.54, 15). Hospital acquired pneumonia was observed in 2 of the 88 patients (2.27%) (95% CI 0.38, 7.30) which amounted to 9.70 infections per 1000 ventilator days. Bloodstream infection was detected in 3 out of 88 patients (3.4%) (95% CI 0.87, 8.99) amounting to 6.54 fresh infections per 1000 Central Venous Catheter days. Urinary tract infection was observed in 2 (2.27%) (95% CI 0.38, 7.30) at 2.86 fresh infections per 1000 catheter days. As compared to the previous study we found that there was a decline of HAI ranging from 60 to 70%. ConclusionOur study demonstrated that by meticulously following infection control protocols especially tailored to the service setting the incidence of HAI's can be reduced. However, the challenge is in maintaining the gains achieved since there is a rapid turnover of manpower in the ICU and a lack of a structured ICU design model.

Preventing hospital acquired infections: A challenge we must accept

Preventing hospital acquired infections: A challenge we must accept

The most frequent hospital-acquired infections related to medical interventions in hospitals in Vojvodina province

Infections associated with medical procedures, or hospital-acquired infections (HAIs), occur in all hospitals worldwide. An integrated infection-control program with HAI surveillance as its cornerstone can reduce the incidence of HAIs and contribute to economic benefits. The aim of this paper was to report the prevalence and epidemiological features of HAI in hospitals in Vojvodina, Serbia. The study population examined herein was compromised of all of the patients present in the ward at least 48 hours before the day of surveillance. It also included patients that were scheduled for discharge or transfer, and those temporarily absent from the ward for examinations or diagnostic procedures. Data were collected using uniform questionnaires, created by the scientific board of the study. Data from paper questionnaires were entered into a specially created electronic database and analyzed using standard statistical methods. A total of 2 435 patients were included in the study. The frequency of patients with HAI was 6.6% (95% CI: 5.6%-7.6%), and the prevalence of infection was 7.1% (95% CI: 6.1%-8.1%). HAI prevalence was significantly different depending on the ward, ranging from 1.7% in the gynecology department to 18.1% in intensive care departments. The most common type of HAI was pneumonia, representing 20.9% of all reported HAIs. The second most frequently reported type of HAI was surgical site infection (19.8%), followed by urinary tract infection (17.4%), gastro-intestinal infection (14.5%) and bloodstream infection (11.0%). The most commonly found microorganisms were Enterococcus spp. (14.5%), Klebsiella pneumoniae (14.5%), Acinetobacter spp. (13.7%), coagulase-negative Staphylococcus spp. (12.1%), Pseudomonas aeruginosa (10.5%) and Clostridium difficile (7.3%). The most frequently used antibiotics in therapy were third generation cephalosporins to which most of the isolates showed resistance. Although the consumption of carbapenems in this sample was only 8%, the registered carbapenem resistance in some bacteria indicates more frequent and longer use of carbapenems in hospitals with the side effect of selective pressure.

Inpatient Alcohol Withdrawal: Time to Prevent the Preventable?

Inpatient Alcohol Withdrawal: Time to Prevent the Preventable?

Analysis of hospital acquired infection in neonatal intensive care unit

Objective To analyze the prevalence of hospital acquired infection and the associated risk factors.Methods Nine hundred and three hospitalized preterm infants in our neonatal intensive care unit from August 2006 to October 2010 were retrospectively studied.Risk factors of hospital acquired infection were analyzed by single factor analysis and logistic regression analysis method.Site and pathogen of infection were also analyzed.Results One hundred and ten preterm infants developed 123 times of hospital acquired infection.The incidence of hospital acquired infection was 12.2％,and hospital acquired infection patient-day rates was 7.3‰.The mortality was 2.7％.Gestational age less than 32 weeks,birth weight less than 1500 gram,non-invasive ventilation,tracheal intubation,umbilical vein catheter(UVC),peripherally inserted central catheter(PICC),parenteral nutrition were the risk factors of hospital acquired infection.Logistic regression analysis showed mechanical ventilation,UVC and PICC were the main risk factors.The main sites of infection were sepsis(45.5％),low respiratory infection and conjunctivitis.Seventy positive culture samples were obtained.Bacteria were the main pathogen.Fifty percent was gram-staining positive,while 46％ was gram-staining negative.Conclusion It is very important to identify the high risk factors for hospital acquired infection.Standardized management of preterm infants,standardized usage of umbilical vein catheter and peripherally inserted central catheter,minimized usage of intubation would be conductive to reduce the incidence of hospital acquired infection. Key words: Preterm infant; Hospital acquired infection; Risk factors

A combined culture-based methodology for surveillance of hospital-acquired infections and timely remedial action in a tertiary care hospital in Delhi, India

The mortality, morbidity and economic loss accompanying hospital acquired infection (HAI) needs constant surveillance. The usefulness of an integrated culture-based watch on the incidence of HAI was established at a tertiary care, multidisciplinary hospital in Delhi. Isolates from all culture-positive hospitalized cases including antibiotic susceptibility profiles were shared instantly with clinicians and nursing personnel. HAI categorization was based on the interval between hospital admission and isolation of a pathogen. The monthly incidence of HAI was calculated as episodes per 100 admissions, while the nature of HAI isolates including infection sites were computed annually. During 2008 to 2010, the monthly HAI rates ranged from 0 to 0.9 per 100 admissions, with no significant difference in annual incidence (P = 0.45, Kruskal Wallis). There was a subtle but insignificant change in HAI localization in urine, blood, pulmonary tissues or surgical sites of the patients (P = 0.104). While 197 of the 229 isolates were Gram-negative, Klebsiella species, E Coli, Pseudomonas aeroginosa, there were 32 methicillin-sensitive Staphylococcus aureus (P < 0.0001). The combined strategy of constant surveillance of all culture-positive hospitalized cases and dialogues with clinicians, and nursing personnel enabled a monitoring of HAI incidence and ensured freedom from any spikes of HAI episodes or their cross infection, it was possible to monitor the incidence of HAI and to ensure there were no episodes on any spikes or a cross-infection. An identical nonstop approach should result in an earlier detection and management of HAI.

A competing risks approach for nonparametric estimation of transition probabilities in a non-Markov illness-death model

Competing risks model time to first event and type of first event. An example from hospital epidemiology is the incidence of hospital-acquired infection, which has to account for hospital discharge of non-infected patients as a competing risk. An illness-death model would allow to further study hospital outcomes of infected patients. Such a model typically relies on a Markov assumption. However, it is conceivable that the future course of an infected patient does not only depend on the time since hospital admission and current infection status but also on the time since infection. We demonstrate how a modified competing risks model can be used for nonparametric estimation of transition probabilities when the Markov assumption is violated.

HOSPITAL-ACQUIRED INFECTIONS IN BELGIAN ACUTE-CARE HOSPITALS: FINANCIAL BURDEN OF DISEASE AND POTENTIAL COST SAVINGS

Introduction: Hospital Acquired Infections (HAIs) are considered to be one of the most serious patient safety issues in healthcare today. It has been shown that HAIs contribute significantly not only to morbidity and mortality, but also to excessive costs for the health care system and for hospitalized patients. Since possibilities of prevention and control exist, hospital quality can be improved while simultaneously the cost of care is reduced. The objectives of this study were to examine the prevalence and the excess costs associated with HAIs.Methods: A retrospective observational study was performed to estimate costs associated with hospital– acquired infections in Belgian hospitals, both in procedural admissions and in medical admissions. Hospital, diagnosisrelated group, age and gender were used as matching factors to compare stays associated with HAIs and stays without HAIs. Data were obtained from the Minimum Basic Data Set 2008 used by Belgian hospitals to register casemix data for each admission to obtain reimbursement from the authorities. Data included information from 45 hospitals representing 16,141 beds and 2,467,698 patient stays. Using the 2008 national feedback programme of the Belgian government, cost data were collected (prolonged length of stay, additional pharmaceuticals and procedures) and subsequently linked to the data set. By means of a sensitivity analysis we estimated potential monetary savings when a reduction in the incidence of HAIs in hospitals having a higher rate of hospital-acquired infections in comparison to other hospitals would be realized.Results: In our sample 5.9% of the hospital stays were associated with a hospital-acquired infection. In the procedural admission subset this was the case for 4.7% of the hospital stays. The additional mean cost of the hospital-acquired infection was € 2,576 for all stays (P < 0.001) and € 3,776 for procedural stays (P < 0.001). The total burden of disease in Belgium is estimated at € 533,076,110 for all admissions and € 235,667,880 for the subset of procedural admissions. The excess length of stay varied between hospitals from 2.52 up to 8.06 days (Md 4.58, SD 1.01), representing an associated cost of € 355,060,174 (66,61% of the total cost). The cost of additional medical procedures and additional pharmaceutical products was estimated at € 62,864,544 (11.97%) and € 115,151,939 (21.60%) respectively. Overall, our results showed that considerable variability between hospitals regarding the incidence of HAIs (3.77-9.78%) for all hospital stays is present, indicating a potential for improvement. We provide a full overview of the potential monetary savings when reductions in HAIs are realized by applying different thresholds. For instance, if all Belgian hospitals having a higher rate of hospital-acquired infections improve their rate to the level of the hospital corresponding to percentile 75 (= 7.5% HAI) savings would be € 17,799,326.Conclusion: HAIs are associated with important additional healthcare costs. Although not all hospital-acquired infections can be prevented, an opportunity to increase cost-effectiveness of hospital care delivery presents itself. This study is the first to estimate the annual economic burden of HAIs for Belgium at a national level, incorporating all associated hospital costs. Apart from the fact that the cost of prolonged length of stay is of major importance, we have also shown that the cost of additional procedures and pharmaceutical products cannot be neglected when estimating the financial burden of HAIs.

O083: Prohibit (preventing hospital-acquired infections by intervention and training): preliminary results of a European multi-center study on the effectiveness of a hand hygiene campaign and a central venous catheter bundle

Differences in the incidence of hospital-acquired infections among European hospitals are due to a range of factors such as case mix, variable infection control policies and practices, and culture. The PROHIBIT study aims at inventorying and analysing national and local infection prevention policies and practices in Europe. The aim of this study is to test two interventions of proven efficacy, a hand hygiene (HH) improvement campaign and an extensive central venous catheter (CVC) bundle, in reducing CVC-related bloodstream infection (CRBSI).

Impact of a hand hygiene educational programme on hospital-acquired infections in medical wards

Improvement in hand hygiene (HH) compliance has been associated with a decrease in the incidence of hospital-acquired infection (HAI) and hospital-acquired methicillin-resistant Staphylococcus aureus (HA-MRSA) infection/colonization. We aimed to evaluate the impact of a multimodal intervention in medical wards on HH compliance, alcohol-based hand rub (AHR) consumption and incidence of HAI and HA-MRSA. A before-after intervention study and an assessment 1 year later were conducted in three internal medicine wards. HH compliance during routine patient care was monitored using the WHO HH observation method. AHR consumption was registered. HAI incidence was actively sought during the PRE and POST periods. HAI risk factors were prospectively recorded and incidence density was calculated. A total of 825 patients were prospectively followed in the PRE period and 868 patients in the POST period. We observed 1531 opportunities for HH in PRE and POST periods and 450 1 year later. HH compliance improved from 54.3% to 75.8% (p 0.005) and remained 75.8% at follow-up. AHR consumption increased from 10.5 to 27.2 L/1000 hospital-days and 31.5 L/1000 hospital-days at follow-up. Incidence density of HAI was 6.93 and 6.96/1000 hospital-days in the PRE and POST intervention periods, respectively. HA-MRSA incidence density was 0.92 in the PRE period vs. 0.25/1000 hospital-days in the POST period (p 0.2) and 0.15/1000 hospital-days (p 0.1) 1 year later. A sustained increase in AHR consumption was followed by an improvement in HH compliance after a multimodal campaign. A trend for lower incidence density of new hospital-acquired MRSA was detected in the POST intervention and follow-up periods.

The accuracy and validity of a weekly point-prevalence survey for evaluating the trend of hospital-acquired infections in a university hospital in Turkey

To evaluate the validity of a weekly point-prevalence survey (WPS) by comparing it with a prospective-active incidence survey (PIS). WPS and PIS were conducted at a tertiary referral hospital between January and December 2006. Each Wednesday, an infection control team reviewed all clinical records of patients with hospital-acquired infections (HAIs) by WPS. Routine PIS was conducted with daily visits by the same team. The Rhame and Sudderth formula was used for converting the data between WPS and PIS. During the study period, 1287 HAIs were detected in 37 466 patients by WPS. The mean observed prevalence and calculated prevalence were 5.42% and 5.45%, respectively. The reanimation intensive care unit (ICU) (49.4%) and burns unit (27.6%) had the highest prevalence rates. Pneumonia (0.94%) and urinary tract infections (0.37%) were the most frequent infections. Overall 602 HAIs were detected in 545 patients by PIS. The mean observed incidence and calculated incidence were 2.42/1000-admissions and 2.41/1000-admissions, respectively. The Critical care ICU (37.0/1000-admissions) and burns unit (24.8/1000-admissions) had the highest incidences of HAI. Pneumonia (0.64/1000-admissions) and urinary tract infections (0.37/1000-admissions) were the most frequent infections. This study confirms a close relationship between prevalence and incidence data. WPS may be a useful method for following HAIs when PIS cannot be performed.

Hospital acquired infections (HAI) in the elderly: Comparison with the younger patients

The aim of this retrospective study is to determine the frequency, type, microbiological characteristics and outcome of HAIs in the elderly (age ≥ 65) and to compare the data with younger patients in a Turkish Training and Research Hospital. From January 2008 to December 2009, the infection control team analyzed HAIs among 60,585 hospitalized patients (20,109 aged ≥ 65 and 40,747 aged between 18 and 64 years) with a total number of 419,017 patient days. A total of 825 HAIs episodes were detected in 607 patients, of which 395 episodes were in 301 elderly patients. The incidence of HAIs per 1000 patient days was 2.49 in the elderly and 1.64 in the younger patients’ group ( p < 0.001). The most common site of infection in the elderly patients was the urinary tract, whereas in non-elderly group this was the lower respiratory tract. The incidence density of urinary tract infections, respiratory tract infections, surgical site, skin and soft tissue infections, primary bacteremia, and prosthesis infections were significantly higher in the elderly group ( p < 0.05). Gram-negative species were the most frequently isolated agents in both groups. There were no significant differences between the groups in the frequency of isolated pathogens or antibiotic susceptibility patterns. Overall, the fatality rate was found 16.8%. The elderly patients were more likely to have crude mortality rates (22% vs. 12%; p < 0.01). The death was most often related to pneumonia, primary bacteremia or intravascular catheter infections in both groups.

Increases in Mortality, Length of Stay, and Cost Associated With Hospital-Acquired Infections in Trauma Patients

To explore the clinical impact and economic burden of hospital-acquired infections (HAIs) in trauma patients using a nationally representative database. Retrospective study. The Healthcare Cost and Utilization Project Nationwide Inpatient Sample. Trauma patients. We examined the association between HAIs (sepsis, pneumonia, Staphylococcus infections, and Clostridium difficile- associated disease) and in-hospital mortality, length of stay, and inpatient costs using logistic regression and generalized linear models. After controlling for patient demographics, mechanism of injury, injury type, injury severity, and comorbidities, we found that mortality, cost, and length of stay were significantly higher in patients with HAIs compared with patients without HAIs. Patients with sepsis had a nearly 6-fold higher odds of death compared with patients without an HAI (odds ratio, 5.78; 95% confidence interval, 5.03-6.64; P < .001). Patients with other HAIs had a 1.5- to 1.9-fold higher odds of mortality compared with controls (P < .005). Patients with HAIs had costs that were approximately 2- to 2.5-fold higher compared with patients without HAIs (P < .001). The median length of stay was approximately 2-fold higher in patients with HAIs compared with patients without HAIs (P < .001). Trauma patients with HAIs are at increased risk for mortality, have longer lengths of stay, and incur higher inpatient costs. In light of the preventability of many HAIs and the magnitude of the clinical and economic burden associated with HAIs, policies aiming to decrease the incidence of HAIs may have a potentially large impact on outcomes in injured patients.

Impact of Chlorhexidine Bathing on Hospital-Acquired Infections among General Medical Patients

A paucity of data exists regarding the effectiveness of daily chlorhexidine gluconate (CHG) bathing in non-intensive care unit (ICU) settings. To evaluate the effectiveness of daily CHG bathing in a non-ICU setting to reduce methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enteroccocus (VRE) hospital-acquired infections (HAIs), compared with daily bathing with soap and water. Quasi-experimental study design; the primary outcome was the composite incidence of MRSA and VRE HAIs. Clostridium difficile HAI incidence was measured as a nonequivalent dependent variable with which to assess potential confounders. Four general medicine units, with a total of 94 beds, at a 719-bed academic tertiary-care facility in Providence, Rhode Island. A total of 7,102 and 7,699 adult patients were admitted to the medical service in the control and intervention groups, respectively. Patients admitted from January 1 through December 31, 2008, were bathed daily with soap and water (control group), and those admitted from February 1, 2009, through March 31, 2010, were bathed daily with CHG-impregnated cloths (intervention group). Daily bathing with CHG was associated with a 64% reduced risk of developing the primary outcome, namely, the composite incidence of MRSA and VRE HAIs (hazard ratio, 0.36 [95% CI, 0.2-0.8]; P = .01). There was no change in the incidence of C. difficile HAIs (P = .6). Colonization with MRSA was associated with an increased risk of developing a MRSA HAI (hazard ratio, 8 [95% CI, 3-19]; P < .001). Daily CHG bathing was associated with a reduced HAI risk, using a composite endpoint of MRSA and VRE HAIs, in a general medical inpatient population.

History of SHEA-Sponsored Research: Time to Pass the Torch

Since its inception, the Society for Healthcare Epidemiology of America (SHEA) has promoted research into prevention of adverse events in hospitals. In 1995, SHEA made this mission concrete by initiating a collaborative research project with the Joint Commission on the Accreditation of Health Care Organization (now known as the Joint Commission). In the early 1990s, the Joint Commission was implementing its “Agenda for Change” and associated Indicator Monitoring System. At the time, there were numerous competing measurement systems that used different definitions, all aimed at measuring the quality of patient care, and many had indicators measuring the incidence of hospital-acquired infections. Some of these indicators used administrative data, such as International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) codes, to measure adverse events.

A cost-effective protocol for screening patients for methicillin-resistant Staphylococcus aureus

The incidence of hospital-acquired infection with methicillin-resistant Staphylococcus aureus (MRSA) is rising worldwide. Rapid identification of MRSA carriers is an important step in reducing the risk of transmission to other patients. Molecular methods are increasingly popular but are technically demanding and expensive. This study assesses the modification of one of the commercially available latex agglutination tests (Mastalex-MRSA) for the identification of penicillin-binding protein 2’ on known strains of MRSA as well as other organisms identified from chromogenic agar plates. A total of 3050 patients with unknown MRSA status were processed through the routine laboratory during the investigation period and 73 of these were presumptive positive following overnight incubation. Of 70 patients who could be evaluated, 32 (43.8%) specimens would be suitable for use with the kit directly from overnight incubation on chromogenic agar, and the other 38 (52.1%) would be suitable following four hours’ incubation on blood agar. The cost of one positive MRSA test with the inclusion of this test is e15.15 compared with published reports of e35.00 for a commercial polymerase chain reaction (PCR) test. This protocol would allow the reporting of presumptive positive MRSA results approximately 24 hours earlier than currently achieved.

Measuring the Externality of Antibacterial Use from Promoting Antimicrobial Resistance

The emergence and spread of antimicrobial resistance (AMR) has become a serious public health threat. Rational antibacterial policy, combined with enforcement of infection control practices are key strategies to combat AMR in the hospital setting. Loss of antibacterial activity as a direct result of antibacterial consumption can be modelled via the economic approach of a negative externality. To determine the externalities of antibacterial consumption and alcohol-based hand rub use for hand disinfection. A simple model was built, combining the results of a recently conducted cost-of-illness study with the results of a multivariate time-series analysis, which determined the impact of antibacterial consumption and alcohol-based hand rub use on the incidence of hospital-acquired infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Consumption of a single defined daily dose of second-generation cephalosporins, third-generation cephalosporins, fluoroquinolones and lincosamides is associated with a negative externality of about €5, €15, €11 and €12, respectively. In contrast, use of 1 litre of alcohol-based hand rub solution for hand disinfection is associated with a positive externality of about €61. In other words, a single disinfection of the hands (use of 3 mL alcohol-based hand rub solution) saves an average €0.18 of the potential cost incurred by MRSA-related infections. Quantifying the externalities of antibacterial use and alcohol-based hand rub use may lead to changes in prescribing behaviour and increase compliance with hand disinfection. Furthermore, the presented methodology of relating the cost of resistance to specific factors such as antibacterial use and hand disinfection provides information that may be useful for prioritizing prevention methods.

Decontamination of the digestive tract and oropharynx: hospital acquired infections after discharge from the intensive care unit

ObjectiveTo determine the incidence rates of hospital acquired infections (HAI) during the first 14 days after ICU discharge after treatment during ICU-stay with Selective Decontamination of the Digestive tract (SDD), Selective Oropharyngeal Decontamination (SOD) or Standard Care (SC).DesignProspective observational study.SettingICUs in two tertiary care hospitals.PatientsPatients discharged from the ICU to the ward.InterventionsNone.Measurements and resultsPost-ICU incidences of HAI per 1,000 days at risk were 11.2, 12.9 and 8.3 for patients that had received SDD (n = 296), SOD (n = 286) or SC (n = 289) respectively in ICU, yielding relative risks, as compared to SC, of 1.49 (CI95 0.9–2.47) for SOD and 1.44 (CI95 0.87–2.39) for SDD. Incidences of surgical site infections (per 100 surgical procedures) were 4 after SC and 11.8 and 8 after SOD and SDD (p = 0.04). Among patients that succumbed in the hospital after ICU-stay (n = 58) eight (14%) had developed HAI after ICU discharge; 3 of 21 after SDD, 3 of 15 after SOD and 2 of 22 after SC.ConclusionsIncidences of HAI in general wards tended to be higher in patients that had received either SDD or SOD during ICU-stay, but it seems unlikely that these infections have an effect on hospital mortality rates.

Antimicrobial surfaces and their potential in reducing the role of the inanimate environment in the incidence of hospital-acquired infections

Environmental surfaces and their role in the epidemiology of hospital-acquired infections (HAIs) have become an area of great scientific interest, particularly in light of the much publicised cases of infections due to methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile in UK hospitals. This feature article sets out to examine the role of surfaces and the inanimate environment in the spread of HAIs, and looks at various antimicrobial techniques being researched to reduce microbial contamination of surfaces. Preventative measures such as coatings which reduce initial microbial adhesion to surfaces will be considered alongside actively antimicrobial measures which inactivate microorganisms already adherent to a surface. The principal focus of this feature article will be given to light-activated antimicrobial surfaces such as the photocatalyst TiO2 and surfaces with embedded photosensitisers. Surfaces which release antimicrobial compounds or metal ions such as silver and copper are also examined, alongside materials which kill microbes upon contact. The widespread research and development of these antimicrobial surfaces is of great importance in maintaining acceptable levels of hygiene in hospitals and will help to fight the spread of HAIs via the contamination of inanimate surfaces in the healthcare environment.