Hospital Infection Rates Research Articles

Performance Evaluation of Community Hospitals in Thailand: An Analysis Based on the Balanced Scorecard Concept

Although the concept of the Balanced Scorecard (BSC) was designed for profit-based organisations, the application of the BSC in public and nonprofit organisations (NPOs) could be performed within the NPOs and public health sector, as the conceptual foundation of this system was developed from community hospitals performance. This study used the BSC concept to analyse the 16 key performance indicators and trends of performance during the last five years of 52 community hospitals located in upper southern Thailand in 2017 and tendency of 2013-2017. The instruments included an annual report and a questionnaire. A statistical analysis to determine percentages, means and standard deviations was performed. The major findings of the community hospitals performance were as follows: Customer perspective: 1. Patient complaint rate of 0.0097% and 2. Outpatient waiting time of 91.89 minutes, Financial perspective: 1. Ratio of total revenue to total expense at 0.9949 and 2. Cost of drugs and materials to total expense at 13.32%, Internal process perspective: 1. Bed turnover at 88.16 and 2. Hospital infection rate of 0.379 times:1,000 patient days, Learning and growth perspective: 1. Staff turnover rate of 4.69% and 2. Number of research studies at 3.77 articles. Trends and performance of hospitals in every perspective of the BSC in the last 5 years showed no differences. The community hospitals offer services such as treatment of common diseases. If the community hospitals could not assist, they will go to referral system by referring patients to secondary and tertiary care respectively.

Investigation of Nasal Staphylococcus aureus carriage in hospital employees and rapid detection of PVL and mecA genes by RT-PCR

Staphylococcus aureus (S.aureus) can cause serious fatal infections due to several enzymes and toxins that it secretes when it encounters favorable conditions.For this reason, S.aureus is one of the most important pathogens currently causing hospital and community infections.Methicillin-resistant S.aureus(MRSA) strains are resistant to many antibiotics and have the ability to rapidly develop resistance to currently used antibiotics during treatment. MRSA origins cause serious infections with high mortality and also increase the rate of hospital infections that require difficult and longer hospitalization and the use of greater quantities of antibiotics in risk-prone units in hospitals. Another factor that is as important as MRSA in S.aureus pathogenicity is the Panton-Valentine leukocidin(PVL) toxin secreted by S.aureus strains, most commonly isolated from deadly necrotizing pneumonias and community-acquired soft skin tissue infections.PVL is especially observed in community-acquired S.aureus strains. However, studies showed that PVL-positive origins began to spread rapidly to hospital environments. In this study, methicillin-sensitive S.aureus, methicillin-resistant coagulase-negative Staphylococcus (MR-CNS), and Panton-Valentine leukocidine genes were identified by real-time polymerase chain reaction (RT-PCR) by investigating the rate of nasal S.aureus carriers(NSAT) in nasal swab samples taken from hospital staff belonging to the highest risk group for staphylococcal infections, at which screening is aimed. Classical NSAT scans were performed on nasal swap samples taken from 98 healthcare professionals in Hospital. Nasal S.aureus (4 MSSA,13 MRSA) was detected in 17 samples(17.35%). During detection, 48 MR-CNS were detected. In addition, 61 mecA (+),17 nuc (+),1 pvl (+) genes were detected in RT-PCR samples directly from the nasal swabs taken in accordance with the culture method.

Spine Infections Reduced at Dedicated Orthopaedics and Spine Hospital.

Previous studies stratified postoperative infection risk by patient comorbidities. However, it is unclear whether the incidence varies by surgical approach in a specialized orthopaedic setting. This study aims to compare infection rates and microbiologic characteristics of postoperative spine infections requiring return to the operating room for debridement by hospital setting: a dedicated orthopaedic and spine hospital versus a general hospital serving multiple surgical specialties. The study is a retrospective review of prospectively collected data. Procedures performed between March 2006 and August 2008 at the multispecialty university hospital were compared with cases at an orthopaedic specialty hospital from September 2008 through August 2016. The surgeons, residents, and patients were similar, but the operative venue changed in 2008. The overall general university hospital infection rate was 2.03%, higher than the overall infection rate at the dedicated orthopaedic and spine hospital of 1.31% (P < .0104). The general university infection rate was 2.27% in the final years of practice, compared with 0.91% at the dedicated orthopaedic and spine hospital (P < .0001) during a recent 2-year time frame. Demographic variables did not significantly differ between the 2 settings. The overall proportion of Gram-negative infection rates was not statistically different (21.7% vs 18.6%), despite an increased proportion of Gram-negative infections at the general university hospital following surgery from an anterior approach. Most of the organisms isolated in both facilities were Staphylococcus species. There was no difference in the seasonality of postoperative spine infections in either setting. In transitioning from a multispecialty university hospital to a dedicated orthopaedic hospital, the incidence of postoperative spine infections was significantly reduced to 0.91%. Despite the change in venue, the proportion of Gram-negative infections (∼20%) following spine surgery did not significantly change. These results suggest improved infection rates during the course of the last 10 years with consistent proportions of Gram-negative infections. 3.

Changes in intravenous immunoglobulin (IVIG) usage for hypogammaglobulinemia (HG) after implementation of a stewardship program.

e19225 Background: IVIG is used to replenish immunoglobulins in HG due to hematologic malignancies (HM) or their treatment (stem cell transplantation (ASCT) and chimeric antigen receptor T-cell therapy (CAR-T)), in an effort to reduce the risk of infections. There is limited high-level evidence to support this use, and IVIG supplies are limited with a recent shortage leading to restricted allotments. We report the results of a stewardship program designed to safely reduce IVIG usage. Methods: An IVIG stewardship plan (ISP) was implemented with the following requirements for IVIG administration: IgG level &lt; 400 mg/dL (corrected for paraprotein) for post-ASCT and post-CAR-T patients, or IgG &lt; 400 mg/dL with evidence of a bacterial infection within the last 3 months that required hospitalization or an emergency department encounter for those with HM. We evaluated the amount of IVIG administered, the incidence of infections, and antibiotic administration before and after implementation of an ISP. Results: In the 3 months pre-ISP, HG accounted for 38% (72/188) of total IVIG orders. 86 pts received IVIG for HG in the 3 months pre-ISP. The amount of IVIG given decreased from 1907 g/month pre-ISP to 670 g/month post-ISP; estimated cost savings in IVIG was $57,561/month. The pre-ISP median IgG level prior to dosing of IVIG was 550 (range 40-1189) mg/dL. Compared to pre-ISP, pts who stopped receiving IVIG post-ISP had lower median pre-dose IgG (444, range 93-819 mg/dL, p&lt;0.05), infections/patient-months (14/141 vs 56/255, p&lt;0.001), antibiotic usage (12/47 vs 44/86, p&lt;0.05), and hospitalization rate for infection (4/55 vs 21/86, p&lt;0.05); no deaths occurred. For those receiving IVIG post-ISP, adherence to guidelines was 64%. Compared to pre-ISP, median pre-dose IgG was lower (328, range 51-1011 mg/dL, p&lt;0001), infections/patient-months decreased (27/163 vs 56/255, p&lt;0.001), and antibiotic usage, hospitalization rate for infection, and deaths from infection all remained stable. Conclusions: An ISP for HG led to a dramatic and sustainable decrease in IVIG usage, primarily by selecting out patients who are low risk for infection after discontinuation of IVIG. Such an ISP is replicable and warrants adoption.

Trajectories of hospital infection control: Using non-representational theory to understand and improve infection prevention and control

In this paper we undertake an innovative analysis of infection prevention and control (IPC) activities in hospitals, using non-representational theory of space (2005). We deployed video-reflexive ethnography in three wards in two metropolitan teaching hospitals involving 252 healthcare workers as participants. We analysed our data iteratively using non-representational theory, which showed hospital space being constantly produced from varied, intersecting, and sometimes competing trajectories of hospital work, objects and people. The approach enabled multiple material factors impinging on routine IPC (including objects such as rolls of surgical tape), and habitual or prioritised actions (such as safeguarding patient privacy) to be included in analysis. The analysis also included the role of time which has been absent from other discussions of IPC, highlighting the transience of spaces produced through IPC practices and the need to continually re-make them. We found many situations in which the complexity of practice, rather than failures of compliance, contributed to potential microbial transmission. We show how inconsistency and confusion about IPC practice often can only be resolved through action. Our findings suggest that further reduction in preventable hospital infection rates will require better integration of IPC with other work trajectories; a shift in emphasis from compliance monitoring to collaborative practice; and greater use of in situ risk assessment and judgment.

Rates of hospitalization for urinary tract infections among medicaid-insured individuals by spina bifida status, Tennessee 2005–2013

BackgroundIndividuals with spina bifida are at increased risk for urinary tract infection (UTI), however there are few population-based investigations of the burden of UTI hospitalizations. ObjectiveWe assessed rates and risk factors for UTI hospitalization in individuals with and without spina bifida. MethodsWe conducted a retrospective cohort study to estimate rates of UTI hospitalization by spina bifida status. We included individuals enrolled in Tennessee Medicaid who lived in one of the Emerging Infections Program’s Active Bacterial Surveillance counties between 2005 and 2013. Spina bifida was primarily defined and UTI hospitalizations were identified using International Classification of Diseases, Ninth Revision diagnoses. We also studied a subset without specific health conditions potentially associated with UTI. We used Poisson regression to calculate rate ratios (RR) of UTIs for individuals with versus without spina bifida, adjusting for race, sex and age group. ResultsOver the 9-years, 1,239,362 individuals were included and 2,493 met criteria for spina bifida. Individuals with spina bifida had over a four-fold increased rate of UTI hospitalization than those without spina bifida-in the overall study population and in the subset without specific, high-risk conditions (adjusted rate ratios: 4.41, 95% confidence intervals: 3.03, 6.43) and (4.87, 95% CI: 2.99, 7.92), respectively. We detected differences in rates of UTI hospitalization by race and sex in individuals without spina bifida that were not seen among individuals with spina bifida. ConclusionsIndividuals with spina bifida had increased rates of UTI hospitalizations, and associated demographic patterns differed from those without spina bifida.

Intravenous Iron Dosing and Infection Risk in Patients on Hemodialysis: A Prespecified Secondary Analysis of the PIVOTAL Trial

Experimental and observational studies have raised concerns that giving intravenous (IV) iron to patients, such as individuals receiving maintenance hemodialysis, might increase the risk of infections. The Proactive IV Iron Therapy in Haemodialysis Patients (PIVOTAL) trial randomized 2141 patients undergoing maintenance hemodialysis for ESKD to a high-dose or a low-dose IV iron regimen, with a primary composite outcome of all-cause death, heart attack, stroke, or hospitalization for heart failure. Comparison of infection rates between the two groups was a prespecified secondary analysis. Secondary end points included any infection, hospitalization for infection, and death from infection; we calculated cumulative event rates for these end points. We also interrogated the interaction between iron dose and vascular access (fistula versus catheter). We found no significant difference between the high-dose IV iron group compared with the lose-dose group in event rates for all infections (46.5% versus 45.5%, respectively, which represented incidences of 63.3 versus 69.4 per 100 patient years, respectively); rates of hospitalization for infection (29.6% versus 29.3%, respectively) also did not differ. We did find a significant association between risk of a first cardiovascular event and any infection in the previous 30 days. Compared with patients undergoing dialysis with an arteriovenous fistula, those doing so via a catheter had a higher incidence of having any infection, hospitalization for infection, or fatal infection, but IV iron dosing had no effect on these outcomes. The high-dose and low-dose IV iron groups exhibited identical infection rates. Risk of a first cardiovascular event strongly associated with a recent infection.

The therapeutic effect of glucocorticoids on children with sepsis: A Meta-analysis

Objective To evaluate the effect of glucocorticoid therapy in children with sepsis. Methods Databases including PubMed, EMbase, The Cochrane Library, Wanfang Data, VIP and CNKI were searched from inception to July 2019 to collect randomized controlled trials(RCTs)about glucocorticoid for children with sepsis.Two independent researchers screened the literature, extracted data, and assessed the risk of bias in the included studies.Data results were analyzed by RevMan5.3 software for Meta-analysis. Results A total of 7 RCTs, involving 1 359 patients were included.The results of Meta-analysis showed that, compared with the control group, the corticosteroid treatment group did not improve mortality(OR=1.09, 95%CI 0.61, 1.97, P=0.76), length of stay(MD=-3.13, 95%CI -8.29, 2.03, P=0.23), PICU stay time(MD=-2.33, 95%CI -5.03, 0.37, P=0.09), mechanical ventilation time(MD=-2.01, 95%CI -4.66, 0.65, P=0.14), in hospital infection rate(OR=1.58, 95%CI 0.27, 9.21, P=0.61). Conclusion The existing evidence shows that glucocorticoid adjuvant therapy can not effectively reduce the mortality, hospital stay, PICU stay time, mechanical ventilation time, hospital infection rate of children with sepsis, but it is limited by the number and quality of the included studies, which needs further large-scale, multicenter, double-blind, randomized controlled trials to verify. Key words: Glucocorticoid; Sepsis; Children; Meta-analysis

Corrigendum: BCG Vaccination at Birth and Rate of Hospitalization for Infection Until 15 Months of Age in Danish Children: A Randomized Clinical Multicenter Trial.

Background The bacillus Calmette-Guerin (BCG) vaccine against tuberculosis might reduce the non-tuberculosis-related child mortality rate in low-income settings. We tested the hypothesis that BCG vaccination at birth would reduce early childhood hospitalization for infection in Denmark, a high-income setting. Hospitalization for infection was a secondary outcome in a randomized trial with the primary aim to estimate the potential non-specific effects of BCG vaccination at birth on all-cause hospitalization. Methods A total of 4262 children included in the Danish Calmette Study were assigned randomly to either receive the BCG vaccine or not and were followed through the Danish National Patient Register. The outcome was number of hospitalizations for infection until the age of 15 months. Data were analyzed by Cox regression in intention-to-treat (ITT) and per-protocol (PP) analyses. Results In the ITT analysis, we observed 588 hospitalizations for infection (mean, 0.28 hospitalization per child) among the 2129 children allocated to receive the BCG vaccine and 595 hospitalizations for infection (mean, 0.28 hospitalization per child) among the 2133 children allocated to the control group (hazard ratio [HR], 0.99 [95% confidence interval (CI), 0.85-1.15]). The PP analysis yielded an HR of 1.00 (95% CI, 0.86-1.16).Predefined interaction ITT analyses showed that among 740 children with a BCG-vaccinated mother, the HR for BCG-vaccinated children was 0.65 (95% CI, 0.45-0.94); the HR for children who had a non-BCG-vaccinated mother was 1.10 (95% CI, 0.93-1.29) (P = .01, test of no interaction). Cesarean delivery modified the effect of BCG vaccination (HRs, 0.73 [95% CI, 0.54-0.99] in children born by cesarean section vs 1.10 [95% CI, 0.92-1.30] in other children; P = .02). When the outcome was defined as time to first hospitalization, the HR for premature children after BCG vaccination was 1.81 (95% CI, 0.95-3.43), whereas the HR was 0.94 (95% CI, 0.82-1.08) for children born at term (P = .05). Conclusion BCG vaccination did not affect the rate of hospitalization for infection up to the age of 15 months in Danish children. In future studies, the role of maternal BCG-vaccination, premature birth, and cesarean delivery needs further exploration.

Risk Factors for Infections Involving Cardiac Implanted Electronic Devices

BackgroundCardiac implantable electronic device infection is a major complication that usually requires device removal. PADIT (Prevention of Arrhythmia Device Infection Trial) was a large cluster crossover trial of conventional versus incremental antibiotics. ObjectivesThis study sought to investigate independent predictors of device infection in PADIT and develop a novel infection risk score. MethodsIn brief, over 4 6-month periods, 28 centers used either conventional or incremental prophylactic antibiotic treatment in all patients. The primary outcome was hospitalization for device infection within 1 year (blinded endpoint adjudication). Multivariable logistic prediction modeling was used to identify the independent predictors and develop a risk score for device infection. The prediction models were internally validated with bootstrap methods. ResultsDevice procedures were performed in 19,603 patients, and hospitalization for infection occurred in 177 (0.90%) within 1 year of follow-up. The final prediction model identified 5 independent predictors of device infection (prior procedures [P], age [A], depressed renal function [D], immunocompromised [I], and procedure type [T]) with an optimism-corrected C-statistic of 0.704 (95% confidence interval: 0.660 to 0.744). A PADIT risk score ranging from 0 to 15 points classified patients into low (0 to 4), intermediate (5 to 6) and high (≥7) risk groups with rates of hospitalization for infection of 0.51%, 1.42%, and 3.41%, respectively. ConclusionsThis study identified 5 independent predictors of device infection and developed a novel infection risk score in the largest cardiac implantable electronic device trial to date, warranting validation in an independent cohort. The 5 independent predictors in the PADIT score are readily adopted into clinical practice. (Prevention of Arrhythmia Device Infection Trial [PADIT Pilot]; NCT01002911)

Patient Satisfaction in the Spanish National Health Service: Partial Least Squares Structural Equation Modeling.

The aim of this article was to determine which key indicators influence patient satisfaction with the Spanish NHS to provide useful information for policy decision-making. A total of 33 variables for each of the 17 Spanish autonomous communities were collected from the statistical portal of the Spanish Ministry of Health, Social Services, and Equality between 2005 and 2016. A cross-sectional study was applied using Partial Least Squares to a Structural Equation Model (PLS-SEM). The influence of expenditures, resource allocation, and safety were hypothesized about patient satisfaction. Gross Domestic Product (GDP) and life expectancy were used as control variables. Moreover, the influence of resource allocation on use was tested. The model explained 57.1% of patient satisfaction with the Spanish NHS. It was positively influenced mainly by resource allocation and expenditures, followed by safety and life expectancy. Additionally, resources directly influenced the level of use. The number of hospital beds, hemodialysis equipment, rate of adverse drug reactions, and expenditure positively influenced patient satisfaction. In contrast, the number of posts in day hospitals, the hospital infection rate, and the percentage of pharmacy spending negatively influenced patient satisfaction.

Effect of camera monitoring and feedback along with training on hospital infection rate in a neonatal intensive care unit

BackgroundIn terms of pediatric healthcare-associated infections (HAI), neonatal intensive care units (NICU) constitute the greatest risk. Contacting a health care personnel, either directly or indirectly, elevates NICU occurrence rate and risks other infants in the same unit. In this study, it is aimed to retrospectively analyze the effect of the training along with camera monitoring and feedback (CMAF) to control the infection following a small outbreak.MethodsESBL producing Klebsiella pneumoniae was detected on three infants in May 2014 at the isolation room of Sakarya University Hospital NICU. Precautions were taken to prevent further spread of the infection. The infected infants were isolated and the decolonization process was initiated. For this aspect, health care workers (HCWs) in NICU were trained for infection control measures. An infection control committee has monitored the HCWs. Before monitoring, an approval was obtained from the hospital management and HCWs were informed about the CMAF, who were then periodically updated. On a weekly basis, NICU workers were provided with the feedbacks. Epidemic period and post-epidemic control period (June–July–August 2014) were evaluated and p value < 0.05 was considered statistically significant.ResultsHealthcare-associated infection (HAI) density was 9.59% before the onset of the CMAF, whereas it was detected as 2.24% during the CMAF period (p < 0.05). Following the precautions, HAI and HAI density rates have reduced to 76.6% and 74.85%, respectively. Moreover, hand hygiene compliance of health care workers was found 49.0% before the outbreak, whereas this rate has elevated to 62.7% after CMAF.ConclusionsHealthcare workers should be monitored in order to increase their compliance for infection control measures. Here, we emphasized that that CMAF of health workers may contribute reducing the HAI rate in the NICU.

Application and effect evaluation of clohexidine wipes in patients with liver transplantation

Objective To investigate the application of clohexidine wipes in patients after liver transplantation and the effect of infection prevention. Methods A total of 279 patients who received orthotopic liver transplantation in the first affiliated hospital of sun yat-sen university from January 2017 to December 2018 and were transferred to the intensive care department of our hospital after the surgery were selected as subjects. Among them, 145 patients who received liver transplantation between January and December 2017 were selected as the control group. From January to December, 2018, 134 patients after liver transplantation were enrolled as the intervention group, and were treated with clohexidine 2% gluconate wet wipes, and the hospital infection rate, infection rate, multiple drug-resistant bacteria infection rate, bath time consumption, and adverse reaction rate were compared between the two groups. Results The hospital infection rate of the control group was 20.00% (29/145), the infection rate of patients was 37.93%(55/145), the infection rate of multiple drug-resistant bacteria was 25.52%(37/145), and the infection rate of the intervention group was 11.19% (15/134), 24.63% (33/134), 14.93% (20/134). The differences were statistically significant (χ2=4.065, 5.709, 4.806, P<0.05). The bath time of the control group was (16.70±1.42) minutes, and the intervention group was (14.07±1.53) minutes. Compared with the control group, the bath time of the intervention group was saved, and the difference was statistically significant (t=9.637, P<0.01).No discomfort symptoms such as disinfectant allergy were found in both groups. Conclusion The application of clohexidine 2% gluconate wet wipes in the wiping bath of patients after liver transplantation had a good effect, significantly reducing the hospital infection rate, saving the time of wiping bath. Key words: Clohexidine; Clean bath; Liver transplantation; Intensive care; Infection

454. Perinatal Risk Factors Associated with Skin Infection Hospitalisation in Western Australian Aboriginal and Non-Aboriginal Children

BackgroundHospitalisation with skin infection in Western Australian (WA) Aboriginal children is common, with the highest rates in infants and children from remote WA. We aimed to quantify infant, maternal, and sociodemographic risk factors for skin infection hospitalization in WA children, focusing on Aboriginal children aged <17 years.MethodsWe conducted a retrospective population-based cohort study with linked perinatal and hospitalization data on WA-born children (1996–2012), of whom 31,348 (6.7%) were Aboriginal. We used Cox regression to calculate adjusted hazard ratios and associated population attributable fractions (PAFs) for perinatal factors attributed to the first hospitalization with skin infection. To identify specific risk factors for early-onset infection, we further restricted the cohort to infants aged <1 year.ResultsOverall, 5,439 (17.4%) Aboriginal and 6,750 (1.5%) non-Aboriginal children were hospitalized at least once with a skin infection. Aboriginal infants aged <1 year had the highest skin infection hospitalization rate (63.2/1,000 child-years). The strongest risk factors in Aboriginal children aged <17 years were socio-economic disadvantage, very remote location at birth and multi-parity (≥3 previous pregnancies) accounting for 24%, 23% and 15% of skin infection hospitalizations, respectively. Other risk factors included maternal age <20 years, maternal smoking during pregnancy and low birthweight.ConclusionWe have quantified the relative influence of perinatal risk factors associated with skin infection hospitalizations in WA children, providing measures indicating which factors have the potential to reduce the most hospitalizations. Our evidence supports existing calls for substantial government investment in addressing underlying social and environmental barriers to healthy skin in WA Aboriginal children but also identifies potential areas to target health promotion messaging at individuals/families on maternal smoking during pregnancy and skin hygiene for families.Disclosures All authors: No reported disclosures.

Risk Factors of Nosocomial Infection in 383 Children with Hypospadias after Operation and Nursing Countermeasures

Objective To explore the main risk factors of hospital infection in children with hypospadias after operation and to formulate targeted nursing measures so as to provide accurate nursing strategies for effective prevention and control of hospital infection after operation. Methods Totally 383 children who underwent hypospadias surgery in the hospital from January 2016 to December 2017 were selected as the research objects. The clinical data of all cases were reviewed and sorted out. The hospital infection rate, infection site and main risk factors of hospital infection after operation were analyzed to formulate prevention strategies. Results 71 of 383 children suffered from hospital infection, and the incidence rate of hospital infection was 18.5%.The distribution of infection sites was: respiratory tract infection in 30 cases, accounting for 42.25%;Urinary tract infection was found in 25 cases (35.21%). Incision infection was found in 14 cases (19.72%).Gastrointestinal infection occurred in 2 cases (2.82%). Logistic multivariate analysis showed that age, length of hospital stay after operation were closely related to hospital infection. Conclusions The major risk factors for postoperative nosocomial infection in children with hypospadias are age and postoperative hospital stay.Nursing measures: The hospital stay of children after operation can be shortened as much as possible by reminding and standardizing the routine maintenance of urinary catheter and strengthening the cooperation between doctors and nurses through charts. Strict implementation of visiting and accompanying system, good environmental control, strengthening hand hygiene, standardization of preoperative skin preparation and other nursing measures are adopted to protect children to the greatest extent. Key words: Children after operation; Hypospadias; Hospital infection; Risk factors; Nursing countermeasures

Analysis of multisite intervention studies using generalized linear mixed models.

Multisite intervention studies have become increasingly common in infection control, for example, looking for a change in hospital infection rates after a regional policy change. The design of these studies can take various forms, from pre-post observational studies to randomized trials, in which sites are randomly assigned to the intervention or in which the intervention is sequentially introduced to different sites over time. Data collected under these settings are clustered by hospital and/or ward, consist of repeated measurements and, in some cases, exhibit temporal and/or seasonal patterns. Failure to account for these features in data analysis could well result in biased estimates of intervention effectiveness and impact on the generalizability of model results.

Infection control measures to reduce hospital infection rates in the medical city burn center

Background: The most serious problem in burn units is nosocomial infection (NI). In extensive burn patients, sepsis is considered the main cause of death; infection control program will help to lower NI and its subsequent high mortality rate.&#x0D; Objective: To achieve the lowering of NI in burn units, by effect of infection control measures (ICMs).&#x0D; Patients and methods: This is a prospective study conducted on patients admitted in Burn Center/Medical City in Baghdad from May 2012 to April 2015. A total of 1977 hospitalized patients were included in this study. This center receives burn patients with different severity. In around April 2012 an infection control program was started in the center by the infection control team ICT.Results: The rate of NI was reduced; the mortality rates declined, and mean hospital stay of NI patients decreased. The number of cases with burn wound infection (BWI), bacteremia sepsis and subsequent mortality were decreased.&#x0D; Conclusion: ICMs helped to reduce NIs in the burn center .Rational usage of antibiotic and baths, new dressing, early excision and grafting are vital and recommended.

دراسة اجراءات السيطرة في تقليل معدلات عدوى المستشفيات في مركز الحروق التابع لمدينة الطب

الخلفية العلمية: استنادا الى ان عدوى المستشفيات هي من المضاعفات الخطيرة في وحدات الحروق، فيكون تسمم الدم الجرثومي في المرضى الذين يعانون من الحروق الشديدة هو السبب الرئيسي للوفاة، وان تطبيق برنامج السيطرة على العدوى يساعد في خفض معدلات عدوى المستشفيات ومعدل الوفيات اللاحقة في مركز الحروق. الهدف: إظهار تأثير تدابير السيطرة على العدوى في خفض معدل عدوى المستشفيات في مركز الحروق التابع لمدينة الطب. المرضى والطريقة: دراسة اعتمدت مراجعة ملفات المرضى أجريت في مركز الحروق التابع لمدينة الطب في بغداد خلال ثلاث سنوات من مايو 2012 إلى مايو 2015. راجع المركز 1977 مريضا خلال مدة الدراسة. تمثل هذه المستشفى مركز الحروق المرجعي الثالثي في بغداد، وبالتالي فانه يستقبل المرضى الذين يعانون من حروق شديدة. وقد تم تطبيق برنامج مكافحة العدوى من قبل فريق السيطرة على العدوى في أبريل 2012. وخلال فترة الدراسة تم الامتثال لتعليمات فريق السيطرة على العدوى بصورة تامة. النتائج: انخفضت&nbsp; معدلات الاصابة بعدوى المستشفيات، كما انخفضت معدلات الوفيات، وانخفض متوسط فترة الرقود في المستشفى للمرضى الذين يعانون من عدوى المستشفيات، وانخفضت أعداد الإصابات بالتهاب جرح الحرق وتسمم الدم، وانخفضت معدلات المقاومة للمضادات الحيوية من البكتيريا السالبة والسلالات المقاومة للحمى الزنجارية. الاستنتاج: يمكن تقليل معدلات الاصابة بعدوى المستشفيات من خلال إجراءات السيطرة على العدوى في وحدات الحروق. ينبغي أن يكون استخدام المضادات الحيوية عقلانيا. يجب عدم استخدام الحمامات إذا أمكن. استخدام الضمادات الحديثة، والهندمة المبكرة لجرح الحرق، وعمليات ترقيع الجلد هي الدعائم الأساسية للعلاج. &nbsp

Gender Differences in Pre-Transplant Characteristics and Short-Term Clinical Outcomes Post Heart Transplantation

Purpose Women comprise 1 in 4 of all heart transplant (HT) recipients. Sex/gender differences affect cardiovascular disease burden and outcomes with important potential to impact patient care. As an initial step towards developing personalized therapy, we evaluated differences in HT clinical characteristics and outcomes between men and women. Methods A retrospective review was performed of consecutive adult patients who underwent HT at the University of Ottawa Heart Institute (Ontario, Canada) between 2012 and 2016. We determined patient characteristics in women and men at transplant and outcomes post transplant including death, graft function, rejection, infection and hospitalization. Results A total of 121 HT patients were evaluated: 29 (24%) female, mean age 53.6±12.3 years, 39 (32%) for ischemic cardiomyopathy (Table). Compared to men, women had lower body mass index, increased donor-recipient sex mismatch, and higher sensitization. There were no differences in the use or dose of induction or maintenance immunotherapy, however, women received a higher mean dose of Valganciclovir for cytomegalovirus (CMV) prophylaxis: 12.1±4.1 vs. 9.5±4.2 mg/kg/day, p=0.05. Over a mean follow-up of 3.0±1.9 years, there were 12 (10%) deaths, and no difference in survival or graft function between men and women. Compared to men, women had significantly higher rates of infection (62% vs. 41%, p=0.05) and hospitalization for infection (31% vs. 13%, p=0.03). Leukopenia (white cell count Conclusion Clinical characteristics and short-term outcomes post HT differ among women and men. Prospective evaluation and long-term follow-up of larger cohorts are needed to determine strategies to improve care in women following HT.

The Effect of Carbapenem Restriction Policy on the Rate of Hospital Infections Due To Resistant Microorganisms in the Intensive Care Unit

The Effect of Carbapenem Restriction Policy on the Rate of Hospital Infections Due To Resistant Microorganisms in the Intensive Care Unit