Nosocomial Incidence Research Articles

Predicting nosocomial pneumonia risk in level-1 trauma patients: An external validation study using the trauma quality improvement program

BackgroundEarly identification of patients at risk of nosocomial pneumonia enables the opportunity for preventative measures, which may improve survival and reduce costs. Therefore, this study aimed to externally validate an existing prediction model (issued by Croce et al.) to predict nosocomial pneumonia in patients admitted to US level-1 trauma centers. MethodsA retrospective cohort study including patients admitted to level-1 trauma centers and registered in the TQIP, a US nationwide trauma registry, admitted between 2013–2015 and 2017–2019. The main outcome was total nosocomial pneumonia for the first period and ventilator-associated pneumonia (VAP) for the second. Model discrimination and calibration were assessed before and after recalibration. ResultsThe study comprised 902,231 trauma patients (N2013–2015 ​= ​180,601; N2017–2019 ​= ​721,630), with a median age of 52 in both periods, 64–65 ​% male, and approximately 90 ​% sustaining blunt traumatic injury. The median Injury Severity Scores were 13 (2013–2015) versus 9 (2017–2019); median Glasgow Coma Scale scores were 15. Nosocomial pneumonia incidence was 4.4 ​%, VAP incidence was 0.7 ​%. The original model demonstrated good to excellent discrimination for both periods (c-statistic2013–2015 0.84, 95%CI 0.83–0.84; c-statistic2017–2019 0.92, 95%CI 0.91–0.92). After recalibration, discriminatory capacity and calibration for the lower predicted probabilities improved. ConclusionsThe Croce model can identify patients admitted to US level-1 trauma centers at risk of total nosocomial pneumonia and VAP. Implementing (modified) Croce models in route trauma clinical practice could guide judicious use of preventative measures and prescription of additional non-invasive preventative measures (e.g., increased monitoring, pulmonary physiotherapy) to decrease the occurrence of nosocomial pneumonia in at-risk patients.

Effect of Continuous Lateral Rotation Therapy on Clinical Outcomes in Mechanically Ventilated Critically Ill Adults.

This Population, Intervention, Comparison, and Outcomes-guided systematic review assesses continuous lateral rotation therapy versus conventional position changes in mechanically ventilated critically ill adults, evaluating mortality, ICU length of stay (LOS), and hospital LOS as primary outcomes and respiratory function, mechanical ventilation duration, pulmonary complications, and adverse events as secondary outcomes. This systematic review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses criteria (International Prospective Register of Systematic Reviews CRD42022384258). Searches spanned databases MEDLINE/PubMed, Embase, Scopus, ScienceDirect, Cochrane, CINAHL, and Web of Science, without language or publication year restrictions. Inclusion criteria involved randomized controlled trials (RCTs) and quasi-randomized trials, comparing continuous lateral rotation therapy (intervention) with conventional position changes (control). Risk of bias and quality of evidence for RCTs were assessed using the Cochrane Collaboration and Grading of Recommendations Assessment, Development, and Evaluation tools. For the quasi-randomized trials, the Risk of Bias in Non-Randomized Studies-of Interventions tool was used. In 18 studies with 1,466 participants (intervention, n = 700, 47.7%; control, n = 766, 52.2%), continuous lateral rotation therapy was predominantly used for prophylactic purposes, with protocols varying from 10-24 h/d. Meta-analysis (16 RCTs) favored continuous lateral rotation therapy for reduced mechanical ventilation duration (standardized mean difference [SMD] -0.17 [CI -0.29 to -0.04] d, P = .008) and lower nosocomial pneumonia incidence (odds ratio 0.39 [CI 0.29-0.52], P < .001). Continuous lateral rotation therapy showed no significant impact on mortality (odds ratio 1.04 [CI 0.80-1.34], P = .77), ICU LOS (SMD -0.11 [CI -0.25 to 0.02] d, P = .11), hospital LOS (SMD -0.10 [CI -0.31 to 0.11] d, P = .33), and incidence of pressure ulcers (odds ratio 0.73 [CI 0.34-1.60], P = .44). Continuous lateral rotation therapy showed no significant difference in primary outcomes (mortality, ICU and hospital LOS) but revealed significant differences in secondary outcomes (consistently reduced nosocomial pneumonia, with a minor effect on mechanical ventilation duration), supported by moderate certainty. Very low certainty for other outcomes highlights the need for current studies in diverse clinical settings and protocols to assess continuous lateral rotation therapy effectiveness.

Screening for Methicillin-Resistant Staphylococcus aureus.

Methicillin-resistant Staphylococcus aureus (MRSA) has become less common in Germany in recent years. In this paper, we report data from the MRSA module of the Hospital Infection Surveillance System (Krankenhaus-Infektionen- Surveillance-System, KISS) for the years 2006-2021. We also describe the association of MRSA rates with the frequency of patient screening for MRSA and discuss the findings. Participation in the MRSA KISS module is voluntary. Once a year, the participating hospitals submit structural data, information on cases in which MRSA was detected (both colonizations and infections; both detected on admission and nosocomially acquired), and the number of nasal swabs taken for the detection of MRSA to the German National Reference Center for the Surveillance of Nosocomial Infections. Statistical analyses were performed with R software. The number of hospitals participating in the MRSA module rose from 110 in 2006 to 525 in 2021. From 2006 onward, the overall MRSA prevalence in German hospitals increased, reaching a maximum of 1.04 cases per 100 patients in 2012. The prevalence on admission fell by 44% from 0.96 in 2016 to 0.54 in 2021. The incidence density of nosocomial MRSA fell by an average of 12% per year, from 0.27 per 1000 patient-days in 2006 to 0.06 in 2021, while MRSA screening frequency increased sevenfold by 2021. The nosocomial incidence density was stable, independently of the screening frequency. MRSA rates in German hospitals fell markedly from 2006 to 2021, reflecting a general trend. The incidence density was no higher in hospitals with a low or moderate screening frequency than in those with a high one. Thus, a targeted, riskadapted MRSA screening strategy on hospital admission can be recommended.

Unintended impact of COVID-19 pandemic on the rate of catheter related nosocomial infections and incidence of multiple drug resistance pathogens in three intensive care units not allocated to COVID-19 patients in a large teaching hospital

BackgroundThe prevalence of resistant hospital infections in the intensive care unit (ICU) increases mortality and antibiotic resistance. COVID-19 pandemic may have unintended impact on nosocomial infections (NI) and the prevalence of resistant microorganism.MethodologyThe present non-interventional study was performed by a pre and a post survey each lasting 8 months before (March–October 2019) and after (March–October 2020) the onset of COVID-19 pandemic in three ICU’s, not allocated to COVID-19 patients, in Nemazee Hospital, Shiraz, Iran. The rates of the following nosocomial infections were compared at pre- and post-pandemic period: ventilator associated pneumonia (VAP), central line associated blood stream infection (CLABSI), catheter-associated urinary tract infections (CAUTI) and incidence of multiple drug resistance (MDR) pathogens.ResultsPre-pandemic and pandemic incidence of VAP was 23.5 and 17.2 cases per 1000 device-days, respectively; an absolute decrease of 27%. The main reason for the decrease in the rate of VAP during the pandemic was a significant decrease in the rate of VAP caused by Acinetobacter baumannii; from 39 to 17% in total VAP episodes. The rate of VAP associated with other microorganisms remained relatively unchanged from 14.2 cases in pre-pandemic period to 14.3 cases per 1000 MV-days during the pandemic (P = 0.801). Pre-pandemic incidence of CLABSI was 7.3 cases and, in pandemic period, was 6.5 cases per 1000 device-days (IRR = 0.88, 95% CI 0.43–1.73, P = 0.703). Pre-pandemic incidence of CAUTI was 2 and in pandemic period, was 1.4 cases per 1000 device-days (IRR = 0.70, 95% CI 0.22–1.98, P = 0.469).ConclusionThe results of the present study showed a decrease in the incidence of VAP in critically ill non-COVID-19 patients during the pandemic compared to before the pandemic, especially regarding Acinetobacter baumannii.

Safety, efficacy, and pharmacokinetics of gremubamab (MEDI3902), an anti-Pseudomonas aeruginosa bispecific human monoclonal antibody, in P. aeruginosa-colonised, mechanically ventilated intensive care unit patients: a randomised controlled trial

BackgroundVentilator-associated pneumonia caused by Pseudomonas aeruginosa (PA) in hospitalised patients is associated with high mortality. The effectiveness of the bivalent, bispecific mAb MEDI3902 (gremubamab) in preventing PA nosocomial pneumonia was assessed in PA-colonised mechanically ventilated subjects.MethodsEVADE (NCT02696902) was a phase 2, randomised, parallel-group, double-blind, placebo-controlled study in Europe, Turkey, Israel, and the USA. Subjects ≥ 18 years old, mechanically ventilated, tracheally colonised with PA, and without new-onset pneumonia, were randomised (1:1:1) to MEDI3902 500, 1500 mg (single intravenous dose), or placebo. The primary efficacy endpoint was the incidence of nosocomial PA pneumonia through 21 days post-dose in MEDI3902 1500 mg versus placebo, determined by an independent adjudication committee.ResultsEven if the initial sample size was not reached because of low recruitment, 188 subjects were randomised (MEDI3902 500/1500 mg: n = 16/87; placebo: n = 85) between 13 April 2016 and 17 October 2019. Out of these, 184 were dosed (MEDI3902 500/1500 mg: n = 16/85; placebo: n = 83), comprising the modified intent-to-treat set. Enrolment in the 500 mg arm was discontinued due to pharmacokinetic data demonstrating low MEDI3902 serum concentrations. Subsequently, enrolled subjects were randomised (1:1) to MEDI3902 1500 mg or placebo. PA pneumonia was confirmed in 22.4% (n = 19/85) of MEDI3902 1500 mg recipients and in 18.1% (n = 15/83) of placebo recipients (relative risk reduction [RRR]: − 23.7%; 80% confidence interval [CI] − 83.8%, 16.8%; p = 0.49). At 21 days post-1500 mg dose, the mean (standard deviation) serum MEDI3902 concentration was 9.46 (7.91) μg/mL, with 80.6% (n = 58/72) subjects achieving concentrations > 1.7 μg/mL, a level associated with improved outcome in animal models. Treatment-emergent adverse event incidence was similar between groups.ConclusionsThe bivalent, bispecific monoclonal antibody MEDI3902 (gremubamab) did not reduce PA nosocomial pneumonia incidence in PA-colonised mechanically ventilated subjects.Trial registration Registered on Clinicaltrials.gov (NCT02696902) on 11th February 2016 and on EudraCT (2015-001706-34) on 7th March 2016.

Nosocomial COVID-19 Incidence and Secondary Attack Rates among Patients of Tertiary Care Center, Zurich, Switzerland.

Of 1,118 patients with COVID-19 at a university hospital in Switzerland during October 2020–June 2021, we found 83 (7.4%) had probable or definite healthcare-associated COVID-19. After in-hospital exposure, we estimated secondary attack rate at 23.3%. Transmission was associated with longer contact times and with lower cycle threshold values among index patients.

Multidrug-resistant organisms in paediatric palliative care patients - Prevalence, risk factors and the impact of a liberal hygiene concept.

Multidrug-resistant organisms (MDRO) deserve special attention in health-care facilities for children with life-limiting conditions because these children have an increased risk for colonisation. To avoid nosocomial transmissions to other inpatients, single-room isolation is usually recommended. In the context of paediatric palliative care (PPC), such isolation counters the aim of participation in social activities for the patients. This study aimed to determine the prevalence of MDRO, the predictive value of risk factors and the incidence of nosocomial infections and nosocomial colonisations on a PPC inpatient unit applying a special hygiene concept that enables participation in social activities through risk-adaption and barrier nursing. Two-year surveillance with MDRO screening of all intakes (N=386) of a PPC unit on the day of admission and discharge. To determine the predictive value of pre-defined risk factors, logistic regression analyses were calculated. Receiver operating characteristic analyses were performed to determine the predictive power of the number of risk factors on the presence of MDRO. The rate of MDRO colonisation at admission was 12.7%; previous positive MDRO screening was the only significant individual risk factor. Over the 2-year period, no MDRO-related nosocomial infections occurred; nosocomial colonisation incidence density was 0.6. Results demonstrate that patients with at least one risk factor have to be cared for by barrier nursing until MDRO screening results are negative. Following these guidelines prevents nosocomial MDRO transmission.

Rapid antigen testing as a reactive response to surges in nosocomial SARS-CoV-2 outbreak risk

Healthcare facilities are vulnerable to SARS-CoV-2 introductions and subsequent nosocomial outbreaks. Antigen rapid diagnostic testing (Ag-RDT) is widely used for population screening, but its health and economic benefits as a reactive response to local surges in outbreak risk are unclear. We simulate SARS-CoV-2 transmission in a long-term care hospital with varying COVID-19 containment measures in place (social distancing, face masks, vaccination). Across scenarios, nosocomial incidence is reduced by up to 40-47% (range of means) with routine symptomatic RT-PCR testing, 59-63% with the addition of a timely round of Ag-RDT screening, and 69-75% with well-timed two-round screening. For the latter, a delay of 4-5 days between the two screening rounds is optimal for transmission prevention. Screening efficacy varies depending on test sensitivity, test type, subpopulations targeted, and community incidence. Efficiency, however, varies primarily depending on underlying outbreak risk, with health-economic benefits scaling by orders of magnitude depending on the COVID-19 containment measures in place.

A strict mask policy for hospital staff effectively prevents nosocomial influenza infections and mortality: monocentric data from five consecutive influenza seasons

Influenza infections acquired in hospital show increased mortality, especially in elderly patients with risk factors. Nevertheless, vaccination rates are low among both high-risk patients and healthcare workers (HCWs). To more effectively prevent influenza infections in the hospital during the influenza season, a strict mouth-nose protection (MNP) requirement was introduced for all staff throughout the shift on the affected wards as an intervention and its effect on nosocomial infection rates was studied. The present data were obtained in a retrospective, monocentric analysis over a period of four consecutive influenza seasons from 2015 to 2019. MNP for all staff during the whole shift as an intervention was introduced in 2017 and for the following seasons if at least three influenza patients were in the ward at the same time. Data from hospitalized influenza patients before and after intervention were compared with regard to nosocomial incidences and mortality. In the years with strict mandatory MNP (2017-2019), the nosocomial influenza incidence fell nearly 50% (odds ratio: 0.40; 95% confidence interval: 0.28-0.56; P < 0.001) accompanied by a significant reduction in nosocomial mortality by 85% (0.15; 0.02-0.70; P= 0.007). The infectious pressure indicated by influenza incidences and patient-days at risk were comparable before and after intervention, as was the low rate of vaccine uptake by nurses. Mandatory MNP for HCWs effectively protects patients from nosocomial influenza infections and mortality.

Experience of the department of surgical treatment of bone and soft tissue tumors during COVID-19 pandemic period

Since December 2019 the new coronavirus disease (COVID-19) has hit the world, causing the World Health Organization to declare it a pandemic. With the emergence and spread of the new infection, there has been unprecedented pressure on health care systems around the world. The time constraints associated with receiving routine care also affected the risk group cancer patients, as some hospitals were quarantined. Violation of the terms of both systemic drug, radiation and surgical treatment of cancer patients could lead to the progression of the tumor process and lead to the death of the patient. In connection with the current situation, doctors had to quickly change the tactics of managing cancer patients, due to the lack of accurate data on the basis of which it is possible to determine the optimal approach to the use of therapy, they had to make decisions in conditions of lack of data. The article shows an example of the treatment of 113 patients being treated in the department of surgical treatment of bone and soft tissue tumors in National Medical Research Radiological Center of the Ministry of Health of Russia during the first wave of the pandemic from March 30 to July 1, 2020. Surgical treatment was performed in 103 patients. During the period of stay in the hospital, 11 patients showed signs of coronavirus infection. Of these, 10 patients were diagnosed with coronavirus infection in the postoperative period. According to the study, the nosocomial incidence of COVID-19 is 10%. With timely diagnosis and specialized treatment, the survival rate was 100% in the given example. Consequently, if epidemiological measures are observed at all stages of hospitalization, it is possible to carry out planned surgical treatment for patients with primary and secondary lesions of bones and soft tissues. However, the decision to carry out a planned operation during a pandemic should be individual for each patient.

Combined epidemiological and genomic analysis of nosocomial SARS-CoV-2 infection early in the pandemic and the role of unidentified cases in transmission

ObjectivesTo analyse nosocomial transmission in the early stages of the coronavirus 2019 (COVID-19) pandemic at a large multisite healthcare institution. Nosocomial incidence is linked with infection control interventions. MethodsViral genome sequence and epidemiological data were analysed for 574 consecutive patients, including 86 nosocomial cases, with a positive PCR test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the first 19 days of the pandemic. ResultsForty-four putative transmission clusters were found through epidemiological analysis; these included 234 cases and all 86 nosocomial cases. SARS-CoV-2 genome sequences were obtained from 168/234 (72%) of these cases in epidemiological clusters, including 77/86 nosocomial cases (90%). Only 75/168 (45%) of epidemiologically linked, sequenced cases were not refuted by applying genomic data, creating 14 final clusters accounting for 59/77 sequenced nosocomial cases (77%). Viral haplotypes from these clusters were enriched 1–14x (median 4x) compared to the community. Three factors implicated unidentified cases in transmission: (a) community-onset or indeterminate cases were absent in 7/14 clusters (50%), (b) four clusters (29%) had additional evidence of cryptic transmission, and (c) in three clusters (21%) diagnosis of the earliest case was delayed, which may have facilitated transmission. Nosocomial cases decreased to low levels (0–2 per day) despite continuing high numbers of admissions of community-onset SARS-CoV-2 cases (40–50 per day) and before the impact of introducing universal face masks and banning hospital visitors. ConclusionGenomics was necessary to accurately resolve transmission clusters. Our data support unidentified cases—such as healthcare workers or asymptomatic patients—as important vectors of transmission. Evidence is needed to ascertain whether routine screening increases case ascertainment and limits nosocomial transmission.

Effect of a strict hygiene bundle for the prevention of nosocomial transmission of SARS-CoV-2 in the hospital: a practical approach from the field

BackgroundDuring the novel coronavirus disease (COVID-19) pandemic it is crucial for hospitals to implement infection prevention strategies to reduce nosocomial transmission to the lowest possible number. This is all the more important because molecular tests for identifying SARS-CoV-2 infected patients are uncertain, and the resources available for them are limited. In this view, a monocentric, retrospective study with an interventional character was conducted to investigate the extent to which the introduction of a strict hygiene bundle including a general mask requirement and daily screening for suspicious patients has an impact on the SARS-CoV-2 nosocomial rate in the pandemic environment. MethodsAll inpatients from a maximum care hospital in Regensburg (Bavaria) between March 1st and June 10th 2020 were included. Patient with respiratory symptoms were tested for SARS-CoV-2 at admission, patients were managed according to a standard hygiene protocol. At the end of March a strict hygiene bundle was introduced including a general mask obligation and a daily clinical screening of inpatients for respiratory symptoms. Nosocomial infection rate for COVID-19 and the risk for infection transmission estimated by the nosocomial incidence density before and after introduction the hygiene bundle were compared. The infection pressure for the hospital during the entire observational period was characterized by the infection reports in the region in relation to the number of hospitalized COVID-19 patients and the number of infected employees. ResultsIn fact, after the introduction of a strict hygiene bundle including a general mouth and nose protection obligation and a daily clinical screening of suspicious patients, a significant reduction of the nosocomial rate from 0.28 to 0.06 (p = 0.026) was observed. Furthermore, the risk of spreading hospital-acquired infections also decreased dramatically from 0.0007 to 0.00018 (p = 0.031; rate ratio after/before 0.25 (95%CI 0.06, 1.07) despite a slow decrease of the hospital COVID 19-prevalence and an increase of infected employees. ConclusionThe available data underline that a strict hygiene bundle seem to be associated with a decrease of nosocomial SARS-CoV-2 transmission in the pandemic situation.

Universal Masking to Prevent Nosocomial Respiratory Viral Infections in Malignant Hematology Inpatient Units

Background: Patients with hematologic malignancies are at increased risk for respiratory virus infections (RVIs) and may experience prolonged asymptomatic viral shedding contributing to transmission. In response to 2 extensive RVI outbreaks in our adult cancer center, a universal masking policy was implemented whereby inpatients on malignant hematology units and their visitors were required to wear procedure masks whenever they were walking outside their rooms. Visitors were required to mask when inside patient rooms. Staff were not included in the policy. Here, we describe the impact of universal masking on the incidence of nosocomial RVI in malignant hematology patients. Methods: In this before-and-after study, we examined the effects of universal masking in malignant hematology units of a 170-bed adult cancer hospital in Toronto, Canada, between January 1, 2015, and September 30, 2019. Nosocomial RVI incidence, RVI outbreak descriptions, and hand hygiene compliance rates were collected from hospital infection control databases. Mask utilization was extracted from hospital purchasing records. Staff influenza vaccination rates were obtained from occupational health records. RVI incidence rates before and after the intervention were compared using Wilcoxon rank-sum test. Results: The preimplementation phase ran from January 1, 2015, to February 28, 2017, and the postimplementation phase spanned March 1, 2017, to September 30, 2019. Monthly mask utilization on malignant hematology units increased by 105% after implementing the universal masking policy. Nosocomial RVI incidence decreased significantly after implementing the universal masking policy, and the number of cases involved in RVI outbreaks also decreased (Table 1). There was a 14% increase in nasopharyngeal swab orders after implementation. Staff influenza vaccination rates, hand hygiene compliance and infection control policies remained stable throughout the study. Conclusions: A reduction in the incidence of nosocomial RVI and number of RVI cases in outbreaks was observed after implementing the universal masking policy. Although we were unable to directly measure compliance with the intervention, increased mask utilization after the intervention implied adherence to the policy. Our experience suggests that universal masking in malignant hematology inpatients may be an effective RVI prevention strategy. Further rigorous study is warranted.Funding: NoneDisclosures: Susy Hota reports contract research for Finch Therapeutics.

The impact of healthcare worker influenza vaccination on nosocomial influenza in a tertiary hospital: an ecological study

BackgroundTo protect hospitalized patients, who are more susceptible to complications of influenza, seasonal influenza vaccination of healthcare workers (HCW) has been recommended internationally. However, its effectiveness is still being debated. To assess the effectiveness of HCW influenza vaccination, we performed an ecological study to evaluate the association between healthcare worker influenza vaccination and the incidence of nosocomial influenza in a tertiary hospital within Singapore between 2013 and 2018.MethodsNosocomial influenza was defined as influenza among inpatients diagnosed 7 days or more after admission by laboratory testing, while healthcare worker influenza vaccination rate was defined as the proportion of healthcare workers that was vaccinated at the end of each annual seasonal vaccination exercise. A modified Poisson regression was performed to assess the association between the HCW vaccination rates and monthly nosocomial influenza incidence rates.ResultsNosocomial influenza incidence rates followed the trend of non-nosocomial influenza, showing a predominant mid-year peak. Across 2,480,010 patient-days, there were 256 nosocomial influenza cases (1.03 per 10,000 patient-days). Controlling for background influenza activity and the number of influenza tests performed, no statistically significant association was observed between vaccination coverage and nosocomial influenza incidence rate although a protective effect was suggested (IRR 0.89, 95%CI:0.69–1.15, p = 0.37).ConclusionNo significant association was observed between influenza vaccination rates and nosocomial influenza incidence rates, although a protective effect was suggested. Aligning local HCW vaccine timing and formulation to that of the Southern Hemisphere may improve effectiveness. HCW vaccination remains important but demonstrating its effectiveness in preventing nosocomial influenza is challenging.

The influence of hospital antimicrobial use on carbapenem-non-susceptible Enterobacterales incidence rates according to their mechanism of resistance: a time-series analysis

Carbapenem non-susceptible Enterobacterales (CNSE) can be broadly divided into those that produce carbapenemases (carbapenemase-producing Enterobacterales (CPE)), and those that harbour other mechanisms of resistance (non-carbapenemase-producing CNSE (NCP-CNSE)). To determine the predictors of CNSE nosocomial incidence rates according to their mechanism of resistance. A time-series analysis was conducted (July 2013 to December 2018) to evaluate the relationship in time between hospital antibiotic use and the percentage of adherence to hand hygiene with the CNSE rates. In all, 20,641 non-duplicated Enterobacterales isolates were identified; 2.2% were CNSE. Of these, 48.1% and 51.9% were CPE and NCP-CNSE, respectively. Of the CPE, 78.3% possessed a blaOXA-232 gene. A transfer function model was identified for CNSE, CPE, and OXA-232 CPE that explained 20.8%, 19.3%, and 24.2% of their variation, respectively. According to the CNSE and CPE models, an increase in piperacillin-tazobactam (TZP) use of 1 defined daily dose (DDD) per 100 hospital patient-days (HPD) would lead to an increase of 0.69 and 0.49 CNSE and CPE cases per 10,000 HPD, respectively. The OXA-232 CPE model estimates that an increase of 1 DDD per 100 HPD of TZP use would lead to an increase of 0.43 OXA-232 CPE cases per 10,000 HPD. A transfer function model was not identified for NCP-CNSE, nor was there an association between the adherence to handhygiene and the CNSE rates. The use of TZP is related in time with the CPE nosocomial rates, mostly explained by its effect on OXA-232 CPE.

Effect of a “handshake” stewardship program versus a formulary restriction policy on High-End antibiotic use, expenditure, antibiotic resistance, and patient outcome

This study reports the effect of implementing an antibiotic stewardship program (ASP) based on the “handshake” strategy for 2 years on multiple endpoints compared with that in a preceding period when an antimicrobial restriction policy was only applied in the absence of a complete program in a tertiary-care Lebanese hospital. The studied endpoints were broad-spectrum antibiotic consumption, antibiotic expenditure, nosocomial bacteremia incidence rate, and patient outcome.An interrupted time series analysis was undertaken to assess the changes in the trend (ΔT) and level (ΔL) of the aforementioned endpoints among adult inpatients before (October 2013 to September 2015) and after the introduction of the ASP (October 2016 to September 2018).After the implementation of the “handshake” ASP, marked changes were observed in the consumption of broad-spectrum antibiotics. The mean use density levels for imipenem and meropenem decreased by 13.72% (P = 0.017), coupled with a decreasing rate of prescription (ΔT = −24.83 defined daily dose [DDD]/1,000 patient days [PD]/month; P = 0.02). Tigecycline use significantly decreased in level by 69.19% (P < 0.0001) and in trend (ΔT = −25.63 DDD/1,000 PD/month; P < 0.0001). A reduction in the use of colistin was also documented but did not reach statistical significance (ΔL = −8.71%, P = 0.56; ΔT = −5.51 DDD/1,000 PD/month = −5.5; P = 0.67). Antibiotic costs decreased by 24.6% after ASP implementation (P < 0.0001), and there was a distinct change from an increasing rate to a decreasing rate of expenditure (ΔT = −12.19 US dollars/PD/month; P = 0.002). The incidence rate of nosocomial bacteremia caused by carbapenem-resistant gram-negative bacteria (CRGNB) decreased by 34.84% (P = 0.13) coupled with a decreasing trend (ΔT = −0.23 cases/1,000 PD/month, P = 0.08). Specifically, a noticeable reduction in the incidence rate of bacteremia due to carbapenem-resistant Acinetobacter baumannii was documented (ΔL = −54.34%, P = 0.01; ΔT = −0.24 cases/1000 PD/month, P = 0.01). Regarding patient outcome, all-cause mortality rates did not increase in level or in rate (ΔL = −3.55%, P = 0.59; ΔT = −0.29 deaths/1000 PD/month, P = 0.6). The length of stay and 7-day readmission rate remained stable between the two periods.In conclusion, the “handshake” ASP succeeded in controlling the prescription rates of antibiotics and in decreasing the nosocomial bacteremia rates caused by CRGNB without compromising patient outcome in our facility. It also had an economic effect in reducing antibiotic costs compared with the previous restriction policy on antimicrobial dispensing.

Nozokomiyal Diyarelerdeki Clostridium difficile İnsidansı Atlanıyor mu?

Clostridium difficile (C. difficile) is a Gram-positive, obligatory anaerobe, spore-forming microorganism and is highly associated with the nosocomial infections. The incidince of nosocomial diarrhoea and C. difficile-associated nosocomial diarrhoea rates are not clear in our country. To determine the C. difficile-associated nosocomial diarrhoea incidence, to review the current resistance status of C. difficile, and to evaluate diagnostic and therapeutic approaches for this pathogen were the aims of the present study. This prospective clinical study included 100 diarrhoea samples from hospitalized patients in Istanbul University Cerrahpasa Medical Faculty of. The diarrhoea samples were investigated by culture, card test and ELISA methods and bacterial resistance profiles were shown with the E-test method. Toxin A/B was found positive at 30/100 patients (30%) by ELISA. The duration of hospitalization and diarrhoea period were significantly longer in Toxin A/B positive patients than negative patients (p<0.05). Recurrences detected in 41% of Toxin A/B positive patients (statistically not significant but clinically may be important). When ELISA was accepted as the main test, the sensitivity and specificity of culture and card test methods were found as 56%, 75% and 76%, 80%, respectively. The C. difficile resistance rates were determined for metronidazole as 29.4%, for vancomycin and teikopilanin as 2.9%. Our results support that the C. difficile is still an important factor in nosocomial diarrhoea. Furthermore, highness of antibiotic resistance for metronidazole may be caused by difficulties in treatment. The results indicate the necessity of further studies to develop control measures and effective treatment options for patients.

Incidence of nosocomial infection in the pediatric intensive care unit of a teaching hospital delivering tertiary level care

Background: Nosocomial infections are generally a chain of events whereby a source or reservoir of microorganisms is transmitted by some method to a susceptible host. The organisms causing infections can come from either the patient’s own endogenous flora or from external sources including hospital staff, equipment or even food, water, walls, floor, and some other surfaces.Methods: Children in age group of one month to twelve years are admitted to our PICU. All the patients admitted in PICU with PICU stay of more than 48 hours were daily monitored for fever or any other symptoms or sign suggestive of any infection. The patients who developed the same 48 hours after admission, which was not present at the time of admission, were included. Centers for Disease Control and Prevention definitions of nosocomial infections, as described later, are used as criteria for diagnosis of infections.Results: During study period, 466 patients were admitted to PICU with their PICU stay for more than 48 hours. Out of 466 patients, 35 patients had 49 episodes of nosocomial infections. Nosocomial incidence rate = 10.51 per 100 admissions. Nosocomial infection incidence density = 19.37 per 1000 patient days.Conclusions: In patients with nosocomial infection, the mean PICU stay was 17.31 days and mean hospital stay was 23.95 days.

Nosocomial sepsis: evaluation of the efficacy of preventive measures in a level-III neonatal intensive care unit

Objective: To evaluate nosocomial infections preventive bundle, implemented in April 2010 in Centro Hospitalar de São João (CHSJ) Neonatal Intensive Care Unit (NICU) effectiveness. Methods: Newborns admitted to level-III NICU of CHSJ, between 1 April 2007 and 31 March 2013, with sepsis as discharge diagnosis, were selected and divided into two periods (Period 1 and 2, before and after new preventive bundle introduction). Data from the two periods were compared. Results: Nosocomial sepsis incidence density decreased significantly from 8.6 to 4.8 per 1000 patient days from Period 1 to 2. Nosocomial infections preventive bundle implementation led to a significant decrease in central line-associated bloodstream infections (CLABSI) rates from 14.1 to 10.4 per 1000 catheter days. Conclusions: Nosocomial infections preventive bundle implemented revealed efficient in decreasing the incidence density of nosocomial sepsis. However, CLABSI rates remain high. Physicians should be alert to the need to adhere to strict infection control protocols and institute effective measures for nosocomial infection surveillance.

Nursing Care Model Based on Knowledge Management in Preventing Nosocomial Infection After Caesarean Section in Hospital

Introduction: Nosocomial infection is one indicator of the quality of health services in the community, which also determines the image of health care institutions becauseit was a major cause of morbidityand death rate (mortality) in hospital. Nursing care based on knowledge management is established from identification knowledge which is required, prevention performance of nosocomial infections post section caesarea. Nosocomial infections component consists of wound culture result. Method: This study was an observational study with a quasi experimental design. The population was all of nursing staff who working in obstetrics installation in hospitals A and B as much as 46 people. Sample was the total population. Data was collected through questionnaire, observation sheets and examination of the wound culture. Data was analyzed using t test B 1.274 dan p=0.028 Result: The result showed that 1) there was difference in knowledge management implementation before and after training; 2) there was difference in nurse’s performance in preventing nosocomial infection before and after training; 3) there is significant relationship between nurse’s performance in preventing nosocomial infection and infection incidence; 4) there is no significant difference of nursing care impementation on nosocomial incidence. Discussion: In conclusion, the development of nursing care based on knowledge management as a synthesis or induction of findings directed at 1) nurses’ knowledge does not affect the performance of the prevention of nosocomial infections; 2) knowledge management has a positive effect on the performance of the prevention of nosocomial infections; 3) implementation of infection prevention is integrated capabilities between knowledge, skills and attitudes of nurses in implementing performance in care.Keywords: model prevention, nosocomial infections, nursing care, knowledge management, sectio Caesarea