Nosocomial Infections In Patients Research Articles

Emerging antimicrobial-resistant infections.

The emergence of antimicrobial-resistant bacterial infections has changed the recommendations for the empirical therapy of community- and hospital-acquired meningitis. In the United States, approximately 34% of pneumococcal isolates are penicillin nonsusceptible, and approximately 14% are resistant to ceftriaxone. 1 More than 50% of nosocomial infections in patients in the intensive care unit are due to methicillin-resistant Staphylococcus aureus. 2,3 The first documented case of vancomycin-resistant S aureus was reported in the United States in 2002. 4

Reducing ventilator-associated pneumonia rates through a staff education programme

Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in patients on mechanical ventilation and results in increases in mortality, prolonged hospitalization and costs. Preventive measures for VAP are well-documented and evidence-based, yet remain poorly implemented in most intensive care units. We undertook an observational pre and post-intervention study to assess whether an educational programme focusing on preventive practices for VAP could reduce the incidence. Six hundred and seventy-seven adult patients, mechanically ventilated for >48 h were included in the study population. An evidence-based guideline for preventive practices at the bedside was developed and disseminated to the intensive care unit staff. VAP incidence rates before and after implementation of the educational programme were compared. VAP infection rates reduced by 51%, from a mean of 13.2±1.2 in the pre-intervention period to 6.5±1.5/1000 device days in the post-intervention period (mean difference 6.7; 95% CI: 2.9–10.4, P=0.02). A multidisciplinary educational programme geared towards intensive care unit staff can successfully reduce the incidence rates of VAP. Further studies will be needed to assess the impact on broader outcome measures such as costs or mortality.

Reducing ventilator-associated pneumonia rates through a staff education programme

<h2>Abstract</h2> Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in patients on mechanical ventilation and results in increases in mortality, prolonged hospitalization and costs. Preventive measures for VAP are well-documented and evidence-based, yet remain poorly implemented in most intensive care units. We undertook an observational pre and post-intervention study to assess whether an educational programme focusing on preventive practices for VAP could reduce the incidence. Six hundred and seventy-seven adult patients, mechanically ventilated for >48 h were included in the study population. An evidence-based guideline for preventive practices at the bedside was developed and disseminated to the intensive care unit staff. VAP incidence rates before and after implementation of the educational programme were compared. VAP infection rates reduced by 51%, from a mean of 13.2±1.2 in the pre-intervention period to 6.5±1.5/1000 device days in the post-intervention period (mean difference 6.7; 95% CI: 2.9–10.4, <i>P</i>=0.02). A multidisciplinary educational programme geared towards intensive care unit staff can successfully reduce the incidence rates of VAP. Further studies will be needed to assess the impact on broader outcome measures such as costs or mortality.

Congenital chylothorax: lymphopenia and high risk of neonatal infections.

To describe the clinical course of patients with congenital chylothorax focusing on infectious complications. Congenital chylothorax is a common manifestation of non-immune hydrops fetalis (NIHF). The drainage of chyle leads to loss of cellular and plasmatic factors that influence the patient's immune response and increase the risk of infections. In a retrospective analysis of 24 preterm infants with NIHF treated between 1998 and 2002, congenital chylothorax was diagnosed in 7 patients. All 7 patients were treated conservatively with pleural drainage over a median period of 22 d (range 10-36 d). Lymphopenia was found in all patients (median of minimal lymphocyte counts 285/microl, range 80-770). The nadir was on day 5 (2-6 d). Lymphopenia lasted for 12 d median (range 4-39 d) and was significantly correlated with the duration of lymph drainage (p = 0.001). Cell-surface analysis of peripheral blood lymphocytes was performed in two patients. Both patients had a decreased number of total T cells. Four out of seven (57%) patients developed nosocomial infections. This incidence of nosocomial infections in patients with congenital chylothorax is about three times higher than that in other neonatal patients. None of the children suffered from fungal or viral infection. Although there was a very high incidence of infections, no correlation between lymphopenia and the occurrence of infections could be shown. Drainage of congenital chylothorax results in the loss of lymphocytes and bears a high risk of infections.

Congenital chylothorax: lymphopenia and high risk of neonatal infections

Aim: To describe the clinical course of patients with congenital chylothorax focusing on infectious complications. Congenital chylothorax is a common manifestation of non‐immune hydrops fetalis (NIHF). The drainage of chyle leads to loss of cellular and plasmatic factors that influence the patient's immune response and increase the risk of infections. Methods: In a retrospective analysis of 24 preterm infants with NIHF treated between 1998 and 2002, congenital chylothorax was diagnosed in 7 patients. Results: All 7 patients were treated conservatively with pleural drainage over a median period of 22 d (range 10–36 d). Lymphopenia was found in all patients (median of minimal lymphocyte counts 285/μl, range 80–770). The nadir was on day 5 (2‐6 d). Lymphopenia lasted for 12 d median (range 4–39 d) and was significantly correlated with the duration of lymph drainage (p= 0.001). Cell‐surface analysis of peripheral blood lymphocytes was performed in two patients. Both patients had a decreased number of total T cells. Four out of seven (57%) patients developed nosocomial infections. This incidence of nosocomial infections in patients with congenital chylothorax is about three times higher than that in other neonatal patients. None of the children suffered from fungal or viral infection. Although there was a very high incidence of infections, no correlation between lymphopenia and the occurrence of infections could be shown. Conclusion: Drainage of congenital chylothorax results in the loss of lymphocytes and bears a high risk of infections.

Incidence and outcome of nosocomial infections in female burn patients in Shiraz, Iran

Background Burn patients are at risk for acquiring infection because of their destroyed skin barrier and suppressed immune system, compounded by prolonged hospitalization and invasive therapeutic and diagnostic procedures. Most studies on infection in burn patients focus on burn wound infection, whereas other nosocomial infections in this patient group are not described well. Objective This study attempts to assess the incidence of nosocomial infection in the Ghotbeddin burn center of Shiraz. Methods The study was conducted prospectively during a period of 11 months from December 2000 to November 2001. All patients presenting with no signs and symptoms of infection within the first 48 hours of admission were included and examined for detecting 4 types of nosocomial infection: burn infection, urinary tract infection, pneumonia, and bloodstream infection. Centers for Disease Control and Prevention National Nosocomial Infection Surveillance system criteria were applied. Results One hundred six female patients met the inclusion criteria. Ninety-one (85.8%) acquired at least 1 infection (44.7 per 1000 patient-days), including 91 with burn infection, 28 with urinary tract infection, 56 with pneumonia, and 30 with bloodstream infection, which gives 446.7, 137.5, and 275, and 147.3 infections per 1000 patient-days, respectively. Conclusions Considering the high incidence of nosocomial infections in our center, implementation of improved infection control practices and policies is required, and a comprehensive education campaign for all health care workers is urgently needed.

Detection of metallo β-lactamase production and antibiotic resistance with E-test method in pseudomonas, acinetobacter and klebsiella strains, in Turkey

The metallo beta-lactamase (MBL) mediated resistance patterns remain unknown in most countries. We aimed to investigate the existence and antimicrobial resistance of MBL-producing strains among carbapenem-resistant gram-negative bacteria that were isolated from nosocomial infections in patients in an university hospital in Turkey. Fifteen of 52 Pseudomonas aeruginosa strains (29%), 5 of 24 Acinetobacter baumanii strains (21%), and 2 of 2 Klebsiella pneumoniae strains (100%) were found to be metallo enzyme producers, with the Etest MBL technique. The in vitro antibiotic susceptibility of the MBL-positive organisms was investigated by the Etest method. Of the ten drugs tested, isepamicin was the most active agent against the MBL-producing strains. Overall, the rank order of activity of the ten antibiotics, in terms of the percentages of susceptible strains, was: isepamicin, 73%; ciprofloxacin, 64%; amikacin, 59%; aztreonam, 18%; tobramycin, 18%; meropenem, 14%; cefoperazone-sulbactam, 5%; piperacillin-tazobactam, 0%; ticarcillin-clavulanate, 0%; and cefepim, 0%. The meropenem minimum inhibitory concentrations (MICs) of the metallo enzyme-producing and nonproducing carbapenem-resistant strains were compared, and the MBL-producers were found to have higher meropenem MICs than the nonMBL-producing carbapenem-resistant strains. Early preventive measures should be taken against MBL-producing nosocomial pathogens that are associated with wide spread and high antimicrobial resistance.

Experience in prevention of sternal wound infections in nasal carriers of Staphylococcus aureus

Nosocomial and surgical-site infections are significant burdens to the health care system that account for $5 billion and $1.6 billion each year in the United States, respectively. These infections are associated with significant morbidity and mortality rates, increased length of hospitalization, and increased treatment costs that are often not reimbursed by third-party payers. Approximately 40% of sternal wound infections in cardiac surgery patients are caused by Staphylococcus aureus and the prevalence of methicillin-resistant S aureus (MRSA) has risen dramatically in the past 2 to 3 decades. The economic burden that is associated with MRSA is significant; infections caused by MRSA cost approximately $3700 more to treat than infections caused by methicillin-sensitive S aureus, and the death rate for MRSA infection is nearly 3 times that of methicillin-sensitive S aureus. Thus, interventions to prevent nosocomial infection in patients who undergo cardiac surgery may improve outcomes and decrease costs. Advances in diagnostic testing may help to target intranasal antibiotic therapy to those patients who are most likely to receive a benefit. The LightCycler System is a fast and effective polymerase chain reaction–based diagnostic test that may be used to identify patients with nasal colonization of S aureus. Carrier status can be determined in a matter of hours rather than days as is the case with traditional culture techniques.

Assessment of a selective surveillance method for detecting nosocomial infections in patients in the intensive care department

Background: The implementation of a time- and cost-effective system for the surveillance of the nosocomial infection (NI) is a challenge for infection control practitioners. Objectives: The aim of this study was to assess the sensitivity and the time reduction using a selective surveillance method (SSM) for the detection of NIs in comparison with a reference surveillance method (RSM). Methods: During a 12-month period, surveillance was performed prospectively in 4 intensive care departments on a rotating basis. Using the RSM, NIs were identified by prospective chart reviews performed twice a week combined with weekly infectious disease ward rounds. In the SSM, surveillance was reduced to microbiologic data and participation in the weekly infectious disease ward rounds followed by selective chart review. Results: In all, 578 patients amounting to 3597 patient-days were included in the study. In total, 78 NIs among 56 patients were identified. The overall sensitivity of the SSM compared with the RSM was 93.6% (73 of 78 NIs). The sensitivity of the SSM for the most important device-associated NIs (pneumonia, bloodstream infections, and urinary tract infections) was 96.3% (52 of 54 NIs) and 87.5% (21 of 24 NIs) for other NIs. Time required using the SSM was 1.3 hours compared with 4.1 hours per 10 beds per week (P =.0001) with the RSM. Conclusions: Within our setting, a SSM with restriction to microbiology reports and participation in the infectious disease ward rounds detected NIs with a high sensitivity and a remarkable time reduction. (Am J Infect Control 2003;31:261-5.)

Prevention of nosocomial lower respiratory tract infections in patients after intracranial artery aneurysm surgery with a short course of antimicrobials

Nosocomial infections at a department of neurosurgery were followed prospectively. In 1999, a high incidence of nosocomial lower respiratory tract infections (NLRTI) was observed in patients after intracranial artery aneurysm surgery (ICAAS). From February to December 2000, a short course of ciprofloxacin and co-trimoxazole was given prophylactically to all patients with ICAAS. The incidence of nosocomial infections in patients after ICAAS fell from 78.4 to 30.9% ( P<0.0001). The incidence of NLRTI fell from 43.3 to 13.6% ( P<0.0001) and the incidence of urinary tract infections from 12.4 to 2.5% ( P=0.015). No significant change in antibiotic sensitivity at the department was observed. Antibiotic use decreased from 100.4 defined daily doses (DDD) to 85.4 DDD per 100 bed-days.

Investigation of single-use versus reusable infectious waste containers as potential sources of microbial contamination

Background: Laws require that infectious waste be segregated from noninfectious waste. Companies certified to dispose of infectious waste offer both reusable and single-use containers. The focus of this study was to determine if there would be a microbiologic advantage to the use of one type of container over another in a burn hospital. Methods: Monthly swab cultures were taken from the tops of >250 infectious waste containers during 2 years. Bacteria and fungi were identified. In a substudy swab cultures were taken from an area of reusable tops before and after cleaning to evaluate the efficacy of cleaning on both the number and type of microbes present. Infection rates for acute patients were compared before and after control measures were instituted to decrease microbial transfer from infectious waste containers to patients. Results: Cultures taken from reusable boxes when received from the container company showed that >99% were contaminated with bacteria or fungi; most were normal environmental or skin flora, but some cultures showed microorganisms that can be potentially harmful to patients with compromised immunity. Wiping the lids with a phenolic disinfectant decreased both the total microbial load (P <.001) and the variety of microbes present (P <.001). In contrast, only 10% of the incoming single-use boxes showed any contamination. Infection rates dropped from 5.8 to 3.2 per 100 burn patients (P <.05) after the institution of cleaning and other changes made to decrease the possibility of microbial transfer from the infectious waste boxes to the patients. Conclusions: Upon delivery, significantly fewer single-use infectious waste boxes were contaminated than reusable ones (P <.001). Extra infection control measures were needed when reusable infectious waste boxes were used in areas housing patients with compromised immunity. Facilities need be aware of the possible contamination of reusable infectious waste containers with microorganisms capable of causing nosocomial infections in patients who are compromised. (Am J Infect Control 2003;31:13-7.)

Effect of a glutamine-enriched enteral diet on intestinal permeability and infectious morbidity at 28 days in critically ill patients with Systemic Inflammatory Response Syndrome: A randomized, single-blind, prospective, multicenter study

Objectives We investigated the effect of a glutamine-enriched enteral diet on intestinal permeability and infectious morbidity and mortality in critically ill patients who developed systemic inflammatory response syndrome after an acute event. Methods Eleven intensive care units in tertiary-care hospitals participated in a prospective, randomized, single blind, multicenter trial. Eighty-four patients with systemic inflammatory response syndrome of any etiology were randomly allocated to receive a glutamine-enriched enteral diet or a control diet without glutamine. Results Most patients received the planned caloric intake. The number of infected patients was smaller in the glutamine group than in the control group (11 versus 17 patients, P < 0.05), with a relative risk of 0.5 (95% confidence interval = 0.3–0.9). The most frequent infection was nosocomial pneumonia, with 11 (33%) patients in the control group and 6 (14%) in the glutamine group. There were no differences with respect to other infections, mortality, or length of stay. Intestinal permeability as assessed by the lactulose-mannitol test was unchanged in both groups. Conclusion Glutamine-enriched enteral diets can decrease nosocomial infections in patients with systemic inflammatory response syndrome.

Trauma Severity Scoring Systems as Predictors of Nosocomial Infection

To describe the patterns of nosocomial infections in patients with traumatic injuries and to compare the associations between injury severity, derived from various severity scoring systems, and subsequent nosocomial infections. Prospective observational study. A 750-bed university hospital serving as a medical school and referral center for the southern part of Thailand. All trauma patients admitted to the hospital for more than 3 days during 1996 to 1999 were eligible for this study. The severity of injuries was measured in terms of injury severity score (ISS), revised trauma score (RTS), new injury severity score (NISS), and trauma injury severity score (TRISS). Infections acquired during hospitalization were categorized using Centers for Disease Control and Prevention criteria. The association between severity of injury and nosocomial infection was examined with Poisson regression models. There were 222 nosocomial infections identified among 146 patients, yielding an infection rate of 0.8 infections per 100 patient-days. Surgical-site infection was the most common site-specific infection, accounting for 31.1% of all infections. The incidence of intravenous catheter-related bloodstream infection was 1.6 infections per 100 catheter-days. The bladder catheter-related urinary tract infection rate was 2.8 infections per 100 catheter-days. The rate of ventilator-associated pneumonia was 3.2 infections per 100 ventilator-days. The incidence of infection correlated well with injury severity. The infection incidence rate ratios for one severity category increment of ISS, NISS, RTS, and TRISS were 1.65 (95% confidence interval [CI95], 1.42 to 1.92), 1.79 (CI95, 1.55 to 2.05), 1.64 (CI95 1.43 to 1.88), and 1.32 (CI95, 1.14 to 1.52), respectively. Surgical-site infection was the most common site-specific nosocomial infection. The NISS might be the most appropriate severity scoring system for adjustment of infection rates in trauma patients.

Prevalence of nosocomial infections in neonatal intensive care unit patients: Results from the first national point-prevalence survey

Objectives: Patients admitted to neonatal intensive care units (NICUs) are at high risk of nosocomial infection. We conducted a national multicenter assessment of nosocomial infections in NICUs to determine the prevalence of infections, describe associated risk factors, and help focus prevention efforts. Study design: We conducted a point prevalence survey of nosocomial infections in 29 Pediatric Prevention Network NICUs. Patients present on the survey date were included. Data were collected on underlying diagnoses, therapeutic interventions/treatments, infections, and outcomes. Results: Of the 827 patients surveyed, 94 (11.4%) had 116 NICU-acquired infections: bloodstream (52.6%), lower respiratory tract (12.9%), ear-nose-throat (8.6%), or urinary tract infections (8.6%). Infants with infections were of significantly lower birth weight (median 1006 g [range 441 to 4460 g] vs 1589 g [range 326 to 5480 g]; P < .001) and had longer median durations of stay than those without infections (88 days [range 8 to 279 days] vs 32 days [range 1 to 483 days]; P < .001). Most common pathogens were coagulase-negative staphylococci and enterococci. Patients with central intravascular catheters (relative risk = 3.81, CI 2.32-6.25; P < .001) or receiving total parenteral nutrition (relative risk = 5.72, CI 3.45-9.49; P < .001) were at greater risk of bloodstream infection. Conclusions: This study documents the high prevalence of nosocomial infections in patients in NICUs and the urgent need for more effective prevention interventions. (J Pediatr 2001;139:821–7)

Management of antimicrobial use in the intensive care unit.

Indications for the use of antimicrobials in critically ill patients are similar to those for other hospitalised patients. However, the selection of agents depends on the particular characteristics of patients in the intensive care unit (ICU), the form of presentation of infection, the type of infection and the bacteriological features of the causative pathogens. The use of antimicrobials in patients admitted to medical-surgical ICUs varies between 33 and 53%. The selection of empirical antimicrobials to be included in treatment protocols of the most common infections depends on the strong interrelationship between patient characteristics, predominant pathogens in each focus. and antimicrobials used for treatment. Epidemiological studies carried out in the past have identified the microorganisms most frequently responsible for community-acquired and nosocomial infections in patients admitted to ICUs. Susceptibility to antimicrobial agents may be different between each geographical area, between each hospital and even within the same hospital service. In addition, susceptibility patterns may change temporarily in relation to the use of particular antimicrobials or in association with other unknown factors so that assessment of endemic antimicrobial resistance patterns is very useful in order to tailor the antimicrobial regimens of therapeutic protocols. Antimicrobial use should not be a routine procedure. The clinical course of the patient (an indicator of effectiveness) should be closely monitored as well as the possible appearance of adverse effects and/or multiresistant pathogens. Controls are based on the assessment of plasma drug concentrations and microbiological surveillance to detect the presence of multiresistant strains or new antibacterial-resistant pathogens. Prevention of the development of multiresistant pathogens is the main goal of the ICU antimicrobial policy. Although a series of general strategies to reduce the presence of multiresistant pathogens have been proposed, the implementation of these recommendations in ICUs requires the cooperation of a member of the intensive care team.

Antimicrobial Resistance Patterns Among Urine Isolates from Patients in a Geriatric Hospital and from Older Patients in a General Hospital in Jerusalem

Urinary tract infection is the most common cause of nosocomial infections in patients hospitalized in chronic care facilities. The changing spectrum of microorganisms involved in urinary tract infections and the emerging resistance require continuous monitoring to provide crucial information to guide empirical therapy and encourage prudent use of antibiotics. The aim of this survey was to assess the antimicrobial resistance profile of urine isolates from patients hospitalized in a geriatric hospital and from elderly patients hospitalized in an acute care hospital in order to guide empirical therapy of urinary tract infections. The survey was performed in two hospitals in Jerusalem: a university-affiliated geriatric hospital- Herzog -and an acute secondary- and tertiary-care university hospital- Hadassah. We performed a retrospective analysis of antimicrobial resistance of all positive urine cultures obtained from patients in the geriatric division of Herzog Hospital and from patients aged 65 years and older hospitalized in the Internal Medicine departments in Hadassah Hospital during a 1-year period. The most common bacteria isolated from urine specimens in Herzog Hospital were, in order of frequency, Escherichia coli, Proteus mirabilis, and Pseudomonas aeruginosa. We demonstrated a high rate of antimicrobial resistance of those bacteria in both hospitals. The pattern we observed necessitates recommending ceftazidime as the most appropriate empirical therapy for urinary tract infection in Herzog Hospital. In Hadassah Hospital we recommend cefuroxime for those patients in good general condition and ceftazidime for those who present with clinical sepsis. Antimicrobial resistance patterns should be assessed periodically and recommendations modified accordingly. Infection control guidelines should be implemented in order to try to decrease the rate of antimicrobial resistance. Further research is requested to assess the efficacy of such interventions in long-term care facilities.

Waiting for microbiologic data to direct therapy against nosocomial infections in febrile surgical patients: are outcomes worsened?

Allowing adequate time for laboratory and culture results before initial treatment may be associated with a worse outcome in nosocomial infections. Cohort study of all episodes of nosocomial infection from December 10, 1996, to October 28, 1998. Surgical services at a university hospital. In surgical patients presenting with fever, 372 episodes of nosocomial infection were evaluated. Nosocomial infections were divided by time from fever to intervention (< or =12, 13-24, and >24 hours). These groups were subdivided by Acute Physiology and Chronic Health Evaluation II (APACHE II) scores into low (< or =10 [n = 114]), moderate (11-20 [n = 169]), and high severity of illness (>20 [n = 89]). Pneumonia and bloodstream infections were divided by APACHE II scores into low (< or =15 [n = 55 and n = 56, respectively]) or high severity of illness (>15 [n = 84 and n = 77, respectively]). Mortality, length of stay. No difference in outcome was seen between different time intervals from fever to intervention for nosocomial infections in patients with APACHE II scores of no more than 10. Patients treated more than 24 hours after fever were significantly younger than those treated at no more than 12 and 13 to 24 hours with APACHE II scores of 11 to 20 (P<.05) and more than 20 (P<.05). Mortality and length of stay for patients treated at later time intervals were comparable with those of patients treated earlier with similar APACHE II scores. There was no difference in outcome for patients with pneumonia or bloodstream infection. Episodes of infection in which treatment was withheld until initial microbiologic data were available (24 hours) did not have worse outcomes compared with those treated earlier. Waiting for laboratory and culture results to direct antibiotic therapy for nosocomial infections does not appear harmful and may be potentially beneficial.

Risk assessment for surgical-site infections in orthopedic patients.

To assess the relative importance of risk factors for surgical-site infections (SSIs) in orthopedic patients and thereby determine which risk factors to monitor in the national surveillance of SSI in The Netherlands. Reanalysis of data on SSI and associated risk factors from two surveillance projects on nosocomial infections, carried out in 1992 and 1993 in The Netherlands: Project Surveillance Nosocomial Infections in the region of Utrecht (PSZU) and the first Project Surveillance Surgical Wound Infections (SWIFT-1). Odds ratios (ORs) were calculated for age, gender, preoperative stay, and the number of operations. In addition, in PSZU, other nosocomial infections, and, in SWIFT-1, prophylactic antibiotics, acute surgery, and wound contamination were studied. The study was confined to hospitalized orthopedic patients (PSZU, 4,872; SWIFT-1, 6,437). In PSZU, the following ORs were significant in a multivariate model: age 0-44 years, 1.0; 45-64 years, 1.6; 65-74 years, 4.7; and 75-99 years, 6.0. For a preoperative stay over 4 days, the OR was 3.3 (95% confidence interval [CI95], 2.5-4.0), and for multiple surgery, 2.5 (CI95, 1.9-3.0). For females, the OR was 0.8 (not significant). The same model applied to SWIFT-1 gave similar ORs. Adjustment for additional nosocomial infections (PSZU) decreased the ORs for ages over 65 years remarkably. The OR for additional nosocomial infections in patients under 65 years of age was 15.6 (CI95, 4.3-57.4). Adjustment for prophylactic antibiotics, acute surgery, and wound-contamination class (SWIFT-1) did not influence the ORs of the original model, but showed that wound-contamination class was an important risk factor. Age, additional nosocomial infections, wound-contamination class, preoperative stay, and the number of operations were identified as important risk factors for SSI in Dutch orthopedic patients.

Nurses and hospital infection control: knowledge, attitudes and behaviour of Italian operating theatre staff

This study examined the disinfection and sterilization practices used by hospital operating theatres and evaluated the knowledge, attitude and behaviour of nursing staff with regard to infection control. Of the 216 nurses responding, knowledge concerning such practices was not consistent since 10% did not believe that items should be rinsed in water after contact with glutaraldehyde and more than 25% thought that 10 min contact time provided sterilization. Almost all were aware that improper practices increased the risk of nosocomial infections in patients. Nurses in orthopaedic surgery had a significantly lower level of knowledge compared with others. The great majority of nurses agreed that guidelines for disinfection and sterilization practice should be maintained and applied. With regard to the use of surgical instruments, the majority used steam or dry heat sterilizers for the appropriate time and temperature. Glutaraldehyde was used by 95% to sterilize endoscopes, but at different temperatures and times of exposure. Similar procedures were reported as used for laryngoscopes, though a higher percentage used heat sterilization. Only 38% routinely used all barrier techniques (gloves, masks, and protective eye-wear). Predictors for the routine use of all barrier techniques included attendance at continuing education courses on nosocomial infections, and nurses who were male and those involved in orthopaedic operations. Data support the need for finding and implementing interventions related to the prevention of hospital infection activities, in order to motivate nurses to use the correct procedures as a routine.

Nosocomial infections in adult patients undergoing extracorporeal membrane oxygenation.

The use of extracorporeal membrane oxygenation (ECMO) for adult patients has increased in recent years. A retrospective cohort study of adult patients undergoing ECMO was performed between 19 February 1985 and 10 October 1995 to evaluate nosocomial infections. Seventy-one evaluable patients underwent ECMO for a total of 799 days. Forty-six infections were identified in 32 (45%) of 71 patients. There were 15 bloodstream infections, 13 lower respiratory infections, 11 urinary tract infections, and 7 miscellaneous infections. The rates of bloodstream infection (18.8 cases per 1,000 ECMO days) and urinary tract infection (13.8 cases per 1,000 ECMO days) were significantly higher than those reported through the Centers for Disease Control and Prevention / National Nosocomial Infection Surveillance System (P < .0001 and P < .001, respectively). The rate of bloodstream infection increased with the duration of ECMO cannulation. This study highlights the increased risk for nosocomial infections in this patient population. Infection may not be apparent, and increased physician awareness of infection risk is imperative.