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Qin X, Zhao H, Qin W, Qin X, Shen S, Wang H. Efficacy of expanded periurethral cleansing in reducing catheter-associated urinary tract infection in comatose patients: a randomized controlled clinical trial. Crit Care 2024; 28:162. [PMID: 38741134 DOI: 10.1186/s13054-024-04947-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2024] [Accepted: 05/08/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND The effect of the periurethral cleansing range on catheter-associated urinary tract infection (CAUTI) occurrence remains unknown. The purpose of this study was to evaluate the efficacy of expanded periurethral cleansing for reducing CAUTI in comatose patients. METHODS In this randomized controlled trial, eligible patients in our hospital were enrolled and allocated randomly to the experimental group (expanded periurethral cleansing protocol; n = 225) or the control group (usual periurethral cleansing protocol; n = 221). The incidence of CAUTI on days 3, 7, and 10 after catheter insertion were compared, and the pathogen results and influencing factors were analyzed. RESULTS The incidences of CAUTI in the experimental and control groups on days 3, 7, and 10 were (5/225, 2.22% vs. 7/221, 3.17%, P = 0.54), (12/225, 5.33% vs. 18/221, 8.14%, P = 0.24), and (23/225, 10.22% vs. 47/221, 21.27%, P = 0.001), respectively; Escherichia coli and Candida albicans were the most common species in the two groups. The incidences of bacterial CAUTI and fungal CAUTI in the two groups were 11/225, 4.89% vs. 24/221, 10.86%, P = 0.02) and (10/225, 4.44% vs. 14/221, 6.33%, P = 0.38), respectively. The incidences of polymicrobial CAUTI in the two groups were 2/225 (0.89%) and 9/221 (4.07%), respectively (P = 0.03). The percentages of CAUTI-positive females in the two groups were 9.85% (13/132) and 29.52% (31/105), respectively (P < 0.05). The proportion of CAUTI-positive patients with diabetes in the experimental and control groups was 17.72% (14/79), which was lower than the 40.85% (29/71) in the control group (P < 0.05). CONCLUSION Expanded periurethral cleansing could reduce the incidence of CAUTI, especially those caused by bacteria and multiple pathogens, in comatose patients with short-term catheterization (≤ 10 days). Female patients and patients with diabetes benefit more from the expanded periurethral cleansing protocol for reducing CAUTI.
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Affiliation(s)
- Xingsong Qin
- Intensive Care Unit, The Fifth Clinical Medical College of Henan University of Chinese Medicine, No. 33, Huanghe Road, Zhengzhou, 450053, Henan, China
| | - He Zhao
- Intensive Care Unit, The Fifth Clinical Medical College of Henan University of Chinese Medicine, No. 33, Huanghe Road, Zhengzhou, 450053, Henan, China
| | - Wei Qin
- Intensive Care Unit, The Fifth Clinical Medical College of Henan University of Chinese Medicine, No. 33, Huanghe Road, Zhengzhou, 450053, Henan, China
| | - Xinglei Qin
- Department of General Surgery, Henan Provincial People's Hospital/People's Hospital of Zhengzhou University, Zhengzhou, 450003, China
| | - Songying Shen
- Intensive Care Unit, The Fifth Clinical Medical College of Henan University of Chinese Medicine, No. 33, Huanghe Road, Zhengzhou, 450053, Henan, China
| | - Hongyu Wang
- Intensive Care Unit, The Fifth Clinical Medical College of Henan University of Chinese Medicine, No. 33, Huanghe Road, Zhengzhou, 450053, Henan, China.
- Department of Emergency Medicine, The Fifth Clinical Medical College of Henan University of Chinese Medicine, Zhengzhou, 450053, China.
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Padulles-Gaspar E, Padulles-Roig E, Cabanes G, Pérez RA, Gil J, Bosch BM. Effects of Hypochlorous Acid and Hydrogen Peroxide Treatment on Bacterial Disinfection Treatments in Implantoplasty Procedures. MATERIALS (BASEL, SWITZERLAND) 2023; 16:2953. [PMID: 37109795 PMCID: PMC10144543 DOI: 10.3390/ma16082953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 04/03/2023] [Accepted: 04/04/2023] [Indexed: 06/19/2023]
Abstract
One of the main problems in oral implantology today is peri-implantitis, which affects almost 20% of dental implants placed in patients. One of the most commonly used techniques to eliminate bacterial biofilm is the implantoplasty, that consists of the mechanical modification of the implant surface topography followed by treatments with chemical reagents for decontamination. In this study, the main aim is to evaluate the use of two different chemical treatments based on hypochlorous acid (HClO) and hydrogen peroxide (H2O2). For this purpose, 75 titanium grade 3 discs were treated with implantoplasty according to established protocols. Twenty-five discs were used as controls, 25 were treated with concentrated HClO and 25 were treated with concentrated HClO followed by treatment with 6% H2O2. The roughness of the discs was determined using the interferometric process. Cytotoxicity with SaOs-2 osteoblastic cells was quantified at 24 and 72 h, whereas bacteria proliferation using S. gordonii and S. oralis bacteria was quantified at 5 s and 1 min of treatment. The results showed an increase in the roughness values, the control discs had an Ra of 0.33 μm and those treated with HClO and H2O2 reached 0.68 μm. Cytotoxicity was present at 72 h, together with a significant proliferation of bacteria. These biological and microbiological results can be attributed to the roughness produced by the chemical agents that triggered bacterial adsorption while inhibiting osteoblast adhesion. The results indicate that even if this treatment can decontaminate the titanium surface after implantation, the produced topography will generate an environment that will not favor long-term performance.
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Affiliation(s)
- Esteban Padulles-Gaspar
- Facultad de Odontología, Universitat Internacional de Catalunya, C/Josep Trueta s/n, 08195 Barcelona, Spain
| | - Esteban Padulles-Roig
- Department of Implantology, University of La Salle, Madrid, EDE, C7Gaminedes 11, 28023 Madrid, Spain
| | - Guillermo Cabanes
- Department of Implantology, University of La Salle, Madrid, EDE, C7Gaminedes 11, 28023 Madrid, Spain
| | - Román A. Pérez
- Bioengineering Institute of Technology, Universitat Internacional de Catalunya, 08195 Barcelona, Spain
| | - Javier Gil
- Bioengineering Institute of Technology, Universitat Internacional de Catalunya, 08195 Barcelona, Spain
| | - Begoña M. Bosch
- Bioengineering Institute of Technology, Universitat Internacional de Catalunya, 08195 Barcelona, Spain
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Fischer NG, Aparicio C. Junctional epithelium and hemidesmosomes: Tape and rivets for solving the "percutaneous device dilemma" in dental and other permanent implants. Bioact Mater 2022; 18:178-198. [PMID: 35387164 PMCID: PMC8961425 DOI: 10.1016/j.bioactmat.2022.03.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/14/2022] [Accepted: 03/12/2022] [Indexed: 02/06/2023] Open
Abstract
The percutaneous device dilemma describes etiological factors, centered around the disrupted epithelial tissue surrounding non-remodelable devices, that contribute to rampant percutaneous device infection. Natural percutaneous organs, in particular their extracellular matrix mediating the "device"/epithelium interface, serve as exquisite examples to inspire longer lasting long-term percutaneous device design. For example, the tooth's imperviousness to infection is mediated by the epithelium directly surrounding it, the junctional epithelium (JE). The hallmark feature of JE is formation of hemidesmosomes, cell/matrix adhesive structures that attach surrounding oral gingiva to the tooth's enamel through a basement membrane. Here, the authors survey the multifaceted functions of the JE, emphasizing the role of the matrix, with a particular focus on hemidesmosomes and their five main components. The authors highlight the known (and unknown) effects dental implant - as a model percutaneous device - placement has on JE regeneration and synthesize this information for application to other percutaneous devices. The authors conclude with a summary of bioengineering strategies aimed at solving the percutaneous device dilemma and invigorating greater collaboration between clinicians, bioengineers, and matrix biologists.
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Affiliation(s)
- Nicholas G. Fischer
- MDRCBB-Minnesota Dental Research Center for Biomaterials and Biomechanics, University of Minnesota, 16-212 Moos Tower, 515 Delaware St. SE, Minneapolis, MN, 55455, USA
| | - Conrado Aparicio
- MDRCBB-Minnesota Dental Research Center for Biomaterials and Biomechanics, University of Minnesota, 16-212 Moos Tower, 515 Delaware St. SE, Minneapolis, MN, 55455, USA
- Division of Basic Research, Faculty of Odontology, UIC Barcelona – Universitat Internacional de Catalunya, C/. Josep Trueta s/n, 08195, Sant Cugat del Valles, Barcelona, Spain
- Institute for Bioengineering of Catalonia (IBEC), The Barcelona Institute of Science and Technology (BIST), C/. Baldiri Reixac 10-12, 08028, Barcelona, Spain
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Hooshmand MA, Toledo CS, Moghaddas R, Skordilis E. Data Analytics for Diagnosis and Prediction of Central Line-Associated Bloodstream Infections in Critical Care Units. Comput Inform Nurs 2022; 40:365-372. [PMID: 35670636 DOI: 10.1097/cin.0000000000000794] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Central line-associated bloodstream infections are among the leading causes of in-hospital deaths in the United States and are a significant factor for increased morbidity, mortality, and healthcare costs. This study integrates several hospital data systems into a case-controlled database to use data analytics for the identification of significant central line-associated bloodstream infection risk factors and develop time-varying patient risk scores for central line-associated bloodstream infections. A case-control study was performed utilizing patient data collected from various sources then gathered and organized into a case-controlled dataset for analysis examining various patient-specific attributes for central line-associated bloodstream infections. Training and testing sets were created, and multivariate logistic regressions were used to identify risk factors for central line-associated bloodstream infection. Furthermore, the Cox proportional hazards model was used to infer the hazard rate and risk score for central line-associated bloodstream infections for each individual patient during hospitalization. Significant attributes for central line-associated bloodstream infection cases were the ICU location (P = .008), time from insertion (P ≤ .001), number of surgeries (P = .003), and number of central line manipulations (P = .003). Real-time data analytics and point of care at the bedside can facilitate precision care for patients with an elevated central line-associated bloodstream infection risk, subsequently changing the way healthcare prevents hospital-acquired infections.
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Affiliation(s)
- Mary A Hooshmand
- Author Affiliations: School of Nursing & Health Studies (Dr Hooshmand) and College of Engineering (Dr Moghaddas), University of Miami, Coral Gables, Florida; Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton (Dr Toledo); and National Renewable Energy Laboratory, Golden, Colorado (Dr Skordilis)
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Fischer NG, Kobe AC, Dai J, He J, Wang H, Pizarek JA, De Jong DA, Ye Z, Huang S, Aparicio C. Tapping basement membrane motifs: Oral junctional epithelium for surface-mediated soft tissue attachment to prevent failure of percutaneous devices. Acta Biomater 2022; 141:70-88. [PMID: 34971784 PMCID: PMC8898307 DOI: 10.1016/j.actbio.2021.12.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 12/21/2021] [Accepted: 12/23/2021] [Indexed: 01/08/2023]
Abstract
Teeth, long-lasting percutaneous organs, feature soft tissue attachment through adhesive structures, hemidesmosomes, in the junctional epithelium basement membrane adjacent to teeth. This soft tissue attachment prevents bacterial infection of the tooth despite the rich - and harsh - microbial composition of the oral cavity. Conversely, millions of percutaneous devices (catheters, dental, and orthopedic implants) fail from infection yearly. Standard of care antibiotic usage fuels antimicrobial resistance and is frequently ineffective. Infection prevention strategies, like for dental implants, have failed in generating durable soft tissue adhesion - like that seen with the tooth - to prevent bacterial colonization at the tissue-device interface. Here, inspired by the impervious natural attachment of the junctional epithelium to teeth, we synthesized four cell adhesion peptide (CAPs) nanocoatings, derived from basement membranes, to promote percutaneous device soft tissue attachment. The two leading nanocoatings upregulated integrin-mediated hemidesmosomes, selectively increased keratinocyte proliferation compared to fibroblasts, which cannot form hemidesmosomes, and expression of junctional epithelium adhesive markers. CAP nanocoatings displayed marked durability under simulated clinical conditions and the top performer CAP nanocoating was validated in a percutaneous implant murine model. Basement membrane CAP nanocoatings, inspired by the tooth and junctional epithelium, may provide an alternative anti-infective strategy for percutaneous devices to mitigate the worldwide threat of antimicrobial resistance. STATEMENT OF SIGNIFICANCE: Prevention and management of medical device infection is a significant healthcare challenge. Overzealous antibiotic use has motivated alternative material innovations to prevent infection. Here, we report implant cell adhesion peptide nanocoatings that mimic a long-lasting, natural "medical device," the tooth, through formation of cell adhesive structures called hemidesmosomes. Such nanocoatings sidestep the use of antimicrobial or antibiotic elements to form a soft-tissue seal around implants. The top performing nanocoatings prompted expression of hemidesmosomes and defensive factors to mimic the tooth and was validated in an animal model. Application of cell adhesion peptide nanocoatings may provide an alternative to preventing, rather that necessarily treating, medical device infection across a range of device indications, like dental implants.
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Affiliation(s)
- Nicholas G Fischer
- MDRCBB-Minnesota Dental Research Center for Biomaterials and Biomechanics, University of Minnesota, 16-212 Moos Tower, 515 Delaware St. SE, Minneapolis, Minnesota 55455, United States
| | - Alexandra C Kobe
- MDRCBB-Minnesota Dental Research Center for Biomaterials and Biomechanics, University of Minnesota, 16-212 Moos Tower, 515 Delaware St. SE, Minneapolis, Minnesota 55455, United States
| | - Jinhong Dai
- Institute of Stomatology, School and Hospital of Stomatology, Department of Prosthodontics, Wenzhou Medical University, 373 Xueyuan Xi Road, Wenzhou, Zhejiang 325027, China
| | - Jiahe He
- MDRCBB-Minnesota Dental Research Center for Biomaterials and Biomechanics, University of Minnesota, 16-212 Moos Tower, 515 Delaware St. SE, Minneapolis, Minnesota 55455, United States
| | - Hongning Wang
- Institute of Stomatology, School and Hospital of Stomatology, Department of Prosthodontics, Wenzhou Medical University, 373 Xueyuan Xi Road, Wenzhou, Zhejiang 325027, China
| | - John A Pizarek
- MDRCBB-Minnesota Dental Research Center for Biomaterials and Biomechanics, University of Minnesota, 16-212 Moos Tower, 515 Delaware St. SE, Minneapolis, Minnesota 55455, United States; United States Navy Dental Corps, Naval Medical Leader and Professional Development Command, 8955 Wood Road Bethesda, MD 20889, United States
| | - David A De Jong
- MDRCBB-Minnesota Dental Research Center for Biomaterials and Biomechanics, University of Minnesota, 16-212 Moos Tower, 515 Delaware St. SE, Minneapolis, Minnesota 55455, United States
| | - Zhou Ye
- MDRCBB-Minnesota Dental Research Center for Biomaterials and Biomechanics, University of Minnesota, 16-212 Moos Tower, 515 Delaware St. SE, Minneapolis, Minnesota 55455, United States
| | - Shengbin Huang
- Institute of Stomatology, School and Hospital of Stomatology, Department of Prosthodontics, Wenzhou Medical University, 373 Xueyuan Xi Road, Wenzhou, Zhejiang 325027, China
| | - Conrado Aparicio
- MDRCBB-Minnesota Dental Research Center for Biomaterials and Biomechanics, University of Minnesota, 16-212 Moos Tower, 515 Delaware St. SE, Minneapolis, Minnesota 55455, United States.
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[Predicting prolonged length of intensive care unit stay via machine learning]. BEIJING DA XUE XUE BAO. YI XUE BAN = JOURNAL OF PEKING UNIVERSITY. HEALTH SCIENCES 2021; 53. [PMID: 34916699 PMCID: PMC8695140 DOI: 10.19723/j.issn.1671-167x.2021.06.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
OBJECTIVE To construct length of intensive care unit (ICU) stay (LOS-ICU) prediction models for ICU patients, based on three machine learning models support vector machine (SVM), classification and regression tree (CART), and random forest (RF), and to compare the prediction perfor-mance of the three machine learning models with the customized simplified acute physiology score Ⅱ(SAPS-Ⅱ) model. METHODS We used medical information mart for intensive care (MIMIC)-Ⅲ database for model development and validation. The primary outcome was prolonged LOS-ICU(pLOS-ICU), defined as longer than the third quartile of patients' LOS-ICU in the studied dataset. The recursive feature elimination method was used to do feature selection for three machine learning models. We utilized 5-fold cross validation to evaluate model prediction performance. The Brier value, area under the receiver operation characteristic curve (AUROC), and estimated calibration index (ECI) were used as perfor-mance measures. Performances of the four models were compared, and performance differences between the models were assessed using two-sided t test. The model with the best prediction performance was employed to generate variable importance ranking, and the identified top five important predictors were pre-sented. RESULTS The final cohort in our study consisted of 40 200 eligible ICU patients, of whom 23.7% were with pLOS-ICU. The proportion of the male patients was 57.6%, and the age of all the ICU patients was (61.9±16.5) years.Results showed that the three machine learning models outperformed the customized SAPS-Ⅱ model in terms of all the performance measures with statistical significance (P < 0.01). Among the three machine learning models, the RF model achieved the best overall performance (Brier value, 0.145), discrimination (AUROC, 0.770) and calibration (ECI, 7.259). The calibration curve showed that the RF model slightly overestimated the risk of pLOS-ICU in high-risk ICU patients, but underestimated the risk of pLOS-ICU in low-risk ICU patients. Top five important predictors for pLOS-ICU identified by the RF model included age, heart rate, systolic blood pressure, body tempe-rature, and ratio of arterial oxygen tension to the fraction of inspired oxygen(PaO2/FiO2). CONCLUSION The RF algorithm-based pLOS-ICU prediction model had a best prediction performance in this study. It lays a foundation for future application of the RF-based pLOS-ICU prediction model in ICU clinical practice.
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Bundle of Coated Devices to Reduce Nosocomial Infections in the Intensive Care Unit. CRITIC Pilot Randomized Controlled Trial. Ann Am Thorac Soc 2021; 17:1257-1263. [PMID: 32526149 DOI: 10.1513/annalsats.202003-206oc] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Rationale: Coated devices may reduce biofilm formation and reduce the occurrence of device-related infections in critically ill patients. A bundle of coated devices (an endotracheal tube [ETT], central venous catheter [CVC], and urinary catheter [UC]) simultaneously inserted may optimize benefits of coated devices in patients with the most severe illness.Objectives: To assess the feasibility of a randomized controlled trial on simultaneous insertion of gold/silver/palladium-coated devices versus uncoated devices in severely ill patients, which required sequential insertion of all three devices (an ETT, CVC, and UC) for support in the intensive care unit (ICU).Methods: This was a multicenter randomized controlled pilot trial. Patients who required simultaneous insertion of an ETT, CVC, and UC were randomized to treatment with coated versus uncoated devices, which were used as necessary for up to 28 days. The primary endpoint was feasibility, defined as the trial being able to enroll enough participants to have the sample size necessary for its secondary primary endpoint (estimating sepsis incidence in this population) in less than 1 year and for estimating the number of admitted patients who require simultaneous insertion of all three devices. Secondary endpoints included the incidence of sepsis and device-associated infections (ventilator-associated pneumonia, catheter-related bloodstream infection, and catheter-related urinary-tract infection) within each group as well as the number of days alive and free of antibiotics during the ICU stay. All events were adjudicated.Results: One hundred and three patients (48 in the coated-device group and 55 in the uncoated-device group) were included in the per-protocol analysis. The inclusion period was 8 months. There were 13 septic events in each group (26 in total), with an approximate incidence of sepsis of 32.3 (95% credible interval [CrI], 22.4-44.9) per 100 patient-days. The overall incidences of ventilator-associated pneumonia, catheter-related urinary-tract infection, and catheter-related bloodstream infection were 15.2 (95% CrI, 7.8-26.4), 6.3 (95% CrI, 2.4-13.7), and 7.9 (95% CrI, 3.6-15.1) per 1,000 patient-days, and incidence rates were not statistically different between groups. Patients in the coated-device group had more days alive and free of antibiotics in the ICU (28.97 d vs. 19.62 d per 100 patient-days; mean ratio, 1.48; 95% CrI, 1.16-1.89).Conclusions: Use of a bundle of coated devices as the initial treatment for of severely ill patients is feasible. Coated devices may be associated with more days alive and free of antibiotics.Clinical trial registered with www.clinicaltrials.gov (NCT03868241).
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Chuang L, Tambyah PA. Catheter-associated urinary tract infection. J Infect Chemother 2021; 27:1400-1406. [PMID: 34362659 DOI: 10.1016/j.jiac.2021.07.022] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 07/27/2021] [Indexed: 10/20/2022]
Abstract
This guideline contains updated recommendations on the management and prevention of CAUTIs by the Urological Association of Asia and the Asian Association of Urinary Tract Infection and Sexually Transmitted Infection.
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Affiliation(s)
- Leyland Chuang
- Raffles Internal Medicine Centre, Raffles Hospital, Singapore
| | - Paul Anantharajah Tambyah
- University Medicine Cluster, National University Health System, Singapore; Infectious Diseases Translational Research Programme, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
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Han J, Wan J, Cheng Y, Li D, Deng M, Wang X, Feng J, He Y, Ye Q, Wang L, Lei Y, Wang J. A hospital-wide reduction in central line-associated bloodstream infections through systematic quality improvement initiative and multidisciplinary teamwork. Am J Infect Control 2019; 47:1358-1364. [PMID: 31277999 DOI: 10.1016/j.ajic.2019.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 05/03/2019] [Accepted: 05/03/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Few data are available on hospital-wide incidence of central line-associated bloodstream infection (CLABSI) rates in patients with central venous catheter (CVC) in China, where many systemic obstacles holding back evidence-based guidelines implementation exist. METHODS This study was conducted prospectively in 2 phases. The baseline and intervention phases were performed in a teaching hospital in China, between January 2017 and October 2018. A systematic quality improvement (SQI) and multidisciplinary teamwork (MDT) CLABSI infection control program was introduced in the intervention phase. In the intensive care units (ICUs) and non-ICUs, CLABSIs were continuously monitored, data collected, then analyzed. RESULTS After intervention, the CLABSI rate decreased from 2.84-0.56 per 1,000 CVC days in ICUs (P < .001), and from 0.82-0.47 per 1,000 CVC days in non-ICUs (P = .003). The length of time until CLABSI occurrence increased from 8.72-13.60 days in ICUs (P = .046), and from 10.00-12.00 days in non-ICUs (P = .048). The number of multidrug-resistant bacteria isolated from CLABSI episodes decreased both in ICUs and in non-ICUs. CONCLUSIONS The SQI and MDT CLABSI infection control program is effective in reducing hospital-wide CLABSI in patients with CVC, both in ICUs and in non-ICUs.
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Affiliation(s)
- Jingjing Han
- Department of Infection Control, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jun Wan
- Department of Cardiology Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yujia Cheng
- Department of Infection Control, Renmin Hospital of Wuhan University, Wuhan, China
| | - Dan Li
- Department of Pharmacy, Renmin Hospital of Wuhan University, Wuhan, China
| | - Min Deng
- Department of Infection Control, Xiehe Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Xuefen Wang
- Department of Nursing, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jiarui Feng
- Department of Medicine, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yuhong He
- Department of Infection Control, Renmin Hospital of Wuhan University, Wuhan, China
| | - Qing Ye
- Department of Infection Control, Renmin Hospital of Wuhan University, Wuhan, China
| | - Li Wang
- Department of Infection Control, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yourong Lei
- Department of Infection Control, Renmin Hospital of Wuhan University, Wuhan, China
| | - Jianmiao Wang
- Department of Infection Control, Department of Respiratory Medicine, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
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A systematic review of central-line-associated bloodstream infection (CLABSI) diagnostic reliability and error. Infect Control Hosp Epidemiol 2019; 40:1100-1106. [PMID: 31362804 DOI: 10.1017/ice.2019.205] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To establish the reliability of the application of National Health and Safety Network (NHSN) central-line-associated bloodstream infection (CLABSI) criteria within established reporting systems internationally. DESIGN Diagnostic-test accuracy systematic review. METHODS We conducted a search of Medline, SCOPUS, the Cochrane Library, CINAHL (EbscoHost), and PubMed (NCBI). Cohort studies were eligible for inclusion if they compared publicly reported CLABSI rates and were conducted by independent and expertly trained reviewers using NHSN/Centers for Disease Control (or equivalent) criteria. Two independent reviewers screened, extracted data, and assessed risk of bias using the QUADAS 2 tool. Sensitivity, specificity, negative and positive predictive values were analyzed. RESULTS A systematic search identified 1,259 publications; 9 studies were eligible for inclusion (n = 7,160 central lines). Publicly reported CLABSI rates were more likely to be underestimated (7 studies) than overestimated (2 studies). Specificity ranged from 0.70 (95% confidence interval [CI], 0.58-0.81) to 0.99 (95% CI, 0.99-1.00) and sensitivity ranged from 0.42 (95% CI, 0.15-0.72) to 0.88 (95% CI, 0.77-0.95). Four studies, which included a consecutive series of patients (whole cohort), reported CLABSI incidence between 9.8% and 20.9%, and absolute CLABSI rates were underestimated by 3.3%-4.4%. The risk of bias was low to moderate in most included studies. CONCLUSIONS Our findings suggest consistent underestimation of true CLABSI incidence within publicly reported rates, weakening the validity and reliability of surveillance measures. Auditing, education, and adequate resource allocation is necessary to ensure that surveillance data are accurate and suitable for benchmarking and quality improvement measures over time. REGISTRATION Prospectively registered with International prospective register of systematic reviews (PROSPERO ID CRD42015021989; June 7, 2015). https://www.crd.york.ac.uk/PROSPERO/display_record.php?ID%3dCRD42015021989.
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Wang J, Liu F, Tan JBX, Harbarth S, Pittet D, Zingg W. Implementation of infection prevention and control in acute care hospitals in Mainland China - a systematic review. Antimicrob Resist Infect Control 2019; 8:32. [PMID: 30792854 PMCID: PMC6371478 DOI: 10.1186/s13756-019-0481-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2018] [Accepted: 01/30/2019] [Indexed: 01/15/2023] Open
Abstract
Background Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) affect patients in acute-care hospitals worldwide. No systematic review has been published on adoption and implementation of the infection prevention and control (IPC) key components. The objective of this systematic review was to assess adoption and implementation of the three areas issued by the “National Health Commission of the People’s Republic of China” in acute-care hospitals in Mainland China, and to compare the findings with the key and core components on effective IPC, issued by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO). Methods We searched PubMed and the Chinese National Knowledge Infrastructure for reports on the areas “structure, organisation and management of IPC”, “education and training in IPC”, and “surveillance of outcome and process indicators in IPC” in acute-care facilities in Mainland China, published between January 2012 and October 2017. Results were stratified into primary care hospitals and secondary/tertiary care hospitals. Results A total of 6580 publications were retrieved, of which 56 were eligible for final analysis. Most of them were survey reports (n = 27), followed by observational studies (n = 17), and interventional studies (n = 12), either on hand hygiene promotion and best practice interventions (n = 7), or by applying education and training programmes (n = 5). More elements on IPC were reported by secondary/tertiary care hospitals than by primary care hospitals. Gaps were identified in the lack of detailing on organisation and management of IPC, education and training activities, and targets of surveillance such as central line-associated bloodstream infections, ventilator associated pneumonia, catheter-associated urinary tract infections, and Clostridium difficile infections. Information was available on adoption and implementation of 7 out of the 10 ECDC key components, and 7 out of the 8 WHO core components. Conclusion To variable degrees, there is evidence on implementation of all NHCPRC areas and of most of the ECDC key components and the WHO core components in acute care hospitals in Mainland China. The results are encouraging, but gaps in effective IPC were identified that may be used to guide future national policy-making in Mainland China. Electronic supplementary material The online version of this article (10.1186/s13756-019-0481-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jiancong Wang
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Switzerland.,2Institute of Global Health, Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Department of Infection Control, Dong Guan Hospital of Traditional Chinese Medicine, Dong Guan City, Guang Dong Province China
| | - Fangfei Liu
- 4Department of Nosocomial Infection Management, The Second Affiliated Hospital, Xi'an Jiaotong University, Xi'an, Shaanxi Province China
| | - Jamie Bee Xian Tan
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Switzerland.,5Department of Microbiology, Singapore General Hospital, Singapore, Singapore
| | - Stephan Harbarth
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Switzerland
| | - Didier Pittet
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Switzerland
| | - Walter Zingg
- Infection Control Program and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle Perret-Gentil 4, 1211 Geneva 14, Switzerland.,6National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College of London, London, UK
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Costs of hospital-acquired infection for patients hospitalized in intensive care unit of an Iranian referral hospital. Med J Islam Repub Iran 2019; 32:67. [PMID: 30643742 PMCID: PMC6325278 DOI: 10.14196/mjiri.32.67] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Indexed: 11/23/2022] Open
Abstract
Background: Hospital infections have affected millions of people around the world and are considered as one of the most important issues related to patient safety. Therefore, this study was conducted to estimate the extra costs caused by hospital-acquired infections in
hospitals.
Methods: This retrospective cohort study was conducted in Tehran province, Iran, in 2017. Medical records of 235 patients hospitalized in one of Tehran hospitals were reviewed for the study. They were divided into case (90 patients) and control (145 patients) groups. Data were analyzed using SPSS and STATA software.
Results: Results revealed no significant relationship between age and gender with the incidence of nosocomial infection (p>0.05). However, the chance of nosocomial infection is most affected by length of hospital stay and costs paid by patients. Moreover, nosocomial infection increases the length of hospital stay up to 25 days. Our results revealed that the mean±SD hospital stay of infected and non-infected patients were 15.8±17.2 and 40.8±19.1 days, respectively. Furthermore, the total cost of patients without any hospital infection was 2451±3098 USD (83 674 480±105 765 500 Rials). On the other hand, the cost for infected patients was 3264±6078 USD (207 497 500±111 430 700 Rials).
Conclusion: Hospital-acquired infections can impose great costs on both patients and the health system. The results of this study indicated the importance of taking specific measures for infection control in hospitals.
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Karagiannidou S, Zaoutis T, Maniadakis N, Papaevangelou V, Kourlaba G. Attributable length of stay and cost for pediatric and neonatal central line-associated bloodstream infections in Greece. J Infect Public Health 2019; 12:372-379. [PMID: 30616938 DOI: 10.1016/j.jiph.2018.12.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 12/14/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Central line-associated bloodstream infections (CLABSIs) are the most frequent pediatric hospital-acquired infections and are associated with significant morbidity and healthcare costs. The aim of our study was to determine the attributable length of stay (LOS) and cost for CLABSIs in pediatric patients in Greece, for which there is currently a paucity of data. METHODS A retrospective matched-cohort study was performed in two tertiary pediatric hospitals. Inpatients with a central line in neonatal and pediatric intensive care units, hematology/oncology units, and a bone marrow transplantation unit between June 2012 and June 2015 were eligible. Patients with confirmed CLABSI were enrolled on the day of the event and were matched (1:1) to patients without CLABSI (non-CLABSIs) by hospital, unit, and LOS prior to study enrollment (188 children enrolled, 94 CLABSIs). The primary outcome measure was the attributable LOS and cost. Baseline demographic and clinical characteristics were recorded. Attributable outcomes were calculated as the differences in estimates of outcomes between CLABSIs and non-CLABSIs, after adjustment for propensity score and potential confounders. RESULTS There were no differences between the two groups regarding their baseline characteristics. After adjustment for age, gender, matching characteristics, central line management after study enrollment, and propensity score, the mean LOS and cost were 57.5days and €31,302 in CLABSIs versus 36.6days and €17,788 in non-CLABSIs. Overall, a CLABSI was associated with a mean (95% CI) adjusted attributable LOS and cost of 21days (7.3-34.8) and €13,727 (5,758-21,695), respectively. No significant difference was detected in LOS and cost by hospitalization unit. CONCLUSIONS CLABSIs were found to impose a significant economic burden in Greece, a finding that highlights the importance of implementing CLABSI prevention strategies.
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Affiliation(s)
- Sofia Karagiannidou
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Civil Partnership, Athens, Greece.
| | - Theoklis Zaoutis
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Civil Partnership, Athens, Greece; Division of Infectious Diseases, Department of Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Nikolaos Maniadakis
- Department of Health Services Management, National School of Public Health, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, National and Kapodistrian University of Athens, School of Medicine, University General Hospital ATTIKON, Athens, Greece
| | - Georgia Kourlaba
- Center for Clinical Epidemiology and Outcomes Research (CLEO), Non-Profit Civil Partnership, Athens, Greece
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Torres-García M, Pérez Méndez BB, Sánchez Huerta JL, Villa Guillén M, Rementería Vazquez V, Castro Diaz AD, López Martinez B, Laris González A, Jiménez-Juárez RN, de la Rosa-Zamboni D. Healthcare-Associated Pneumonia: Don't Forget About Respiratory Viruses! Front Pediatr 2019; 7:168. [PMID: 31157191 PMCID: PMC6532533 DOI: 10.3389/fped.2019.00168] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2019] [Accepted: 04/12/2019] [Indexed: 11/13/2022] Open
Abstract
Introduction: Healthcare-associated infections are an important cause of morbidity and mortality, are among the most common adverse events in healthcare, and of them, pneumonia is the most commonly reported. Our objective was to evaluate the incidence and clinical outcome of respiratory viruses in hospital-acquired pneumonia (HAP). Methods: This was a prospective cohort study, include patients aged between 0 and 18 who fulfilled Centers for Diseases Control and Prevention (CDC) criteria for HAP. Demographic and clinical data were obtained, and a nasopharyngeal swab specimen was taken for the detection of respiratory viruses. All included patients were monitored until discharge to collect data on the need for mechanical ventilation, intensive care unit (ICU) admission, and mortality. All-cause 30-day mortality was also ascertained. Results: Four thousand three hundred twenty-seven patients were followed for 42,658 patient-days and 5,150 ventilator-days. Eighty-eight patients (2.03%) met the CDC criteria for HAP, 63 patients were included, and clinical and epidemiological characteristics showed no statistically significant differences between patients with virus associated healthcare-associated pneumonia (VAHAP) and those with non-viral healthcare-associated pneumonia (NVHAP). At least one respiratory virus was detected in 65% [95% CI (53-77)] of episodes of HAP, with a single viral pathogen observed in 53.9% and coinfection with 2 viruses in 11.1% of cases. The outcome in terms of ICU admission, mechanical ventilation and the 30-day mortality did not show a significant difference between groups. Conclusions: In two-thirds of the patients a respiratory virus was identified. There was no difference in mortality or the rest of the clinical outcome variables. About half of the patients required mechanical ventilation and 10% died, which emphasizes the importance of considering these pathogens in nosocomial infections, since their identification can influence the decrease in hospital costs and be taken into account in infection control policies.
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Affiliation(s)
| | | | | | | | | | | | - Briceida López Martinez
- Diagnostic Auxiliary Services, Federico Gomez Children's Hospital of Mexico, Mexico City, Mexico
| | | | - Rodolfo Norberto Jiménez-Juárez
- Infectious Diseases Department, Federico Gómez Children's Hospital of Mexico, Mexico City, Mexico.,Department of Pediatrics, National Medical Center La Raza, Infectious Diseases Hospital, Mexican Institute of Social Security, Mexico City, Mexico
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Abstract
This retrospective study tried to find the potential approach for reducing the urinary tract infection (UTI) in intensive care patients (ICPs) among adult population.In total, 96 eligible ICP cases were included. Of these, 48 cases received 10% povidone-iodine and were assigned to the intervention group, while the other 48 cases underwent sterile water, and were assigned to the control group for the prevention of catheter-associated UTI before indwelling urinary catheter insertion in ICP. The primary outcome was the occurrence of an UTI after the indwelling catheter. The secondary outcome was the identification of pathogenic species. The outcomes were assessed after catheter removed.After catheter removal, the occurrence of an UTI did not differ significantly between the 2 groups (P = .34). In addition, no significant differences regarding the pathogenic species were detected between the 2 groups (Escherichia coli, P = .73; Candida albicans, P = .57; Enterococcus, P = .65; Proteus mirabilis, P = .50; Citrobacter, P = .50; Klebsiella pneumoniae, P = .57).The use of 10% povidone-iodine may not help reducing UTI in ICP.
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Wang H, Tong H, Liu H, Wang Y, Wang R, Gao H, Yu P, Lv Y, Chen S, Wang G, Liu M, Li Y, Yu K, Wang C. Effectiveness of antimicrobial-coated central venous catheters for preventing catheter-related blood-stream infections with the implementation of bundles: a systematic review and network meta-analysis. Ann Intensive Care 2018; 8:71. [PMID: 29904809 PMCID: PMC6002334 DOI: 10.1186/s13613-018-0416-4] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 06/01/2018] [Indexed: 11/29/2022] Open
Abstract
Background Catheter-related blood-stream infections (CRBSIs) are the most common complication when using central venous catheters (CVCs). Whether coating CVCs under bundles could further reduce the incidence of CRBSIs is unclear. We aimed to assess the effectiveness of implementing the use of bundles with antimicrobial-coated CVCs for preventing catheter-related blood-stream infections. Methods In this systematic review and network meta-analyses, we searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library in addition to the EMBASE, MEDLINE, CINAHL, and Web of Science databases for studies published before July 2017. The primary outcome was the rate of CRBSIs per 1000 catheter-days, and the secondary outcome was the incidence of catheter colonization. Results Twenty-three studies revealed significant differences in the rate of CRBSIs per 1000 catheter-days between antimicrobial-impregnated and standard CVCs (RR 0.70, 95% CI 0.53–0.91, p = 0.008). Thirty-three trials were included containing 10,464 patients who received one of four types of CVCs. Compared with a standard catheter, chlorhexidine/silver sulfadiazine- and antibiotic-coated catheters were associated with lower numbers of CRBSIs per 1000 catheter-days (ORs and 95% CrIs: 0.64 (0.40–0.955) and 0.53 (0.25–0.95), respectively) and a lower incidence of catheter colonization (ORs and 95% CrIs: 0.44 (0.34–0.56) and 0.30 (0.20–0.46), respectively). Conclusions Outcomes are superior for catheters impregnated with chlorhexidine/silver sulfadiazine or other antibiotics than for standard catheters in preventing CRBSIs and catheter colonization under bundles. Compared with silver ion-impregnated CVCs, chlorhexidine/silver sulfadiazine antiseptic catheters resulted in fewer cases of microbial colonization of the catheter but did not reduce CRBSIs. Electronic supplementary material The online version of this article (10.1186/s13613-018-0416-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hongliang Wang
- Department of Critical Care Medicine, The Second Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Hongshuang Tong
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Haitao Liu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Yao Wang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Ruitao Wang
- Department of Internal Medicine, Harbin Medical University Cancer Hospital, Harbin, China
| | - Hong Gao
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Pulin Yu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Yanji Lv
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Shuangshuang Chen
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Guiyue Wang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Miao Liu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Yuhang Li
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China
| | - Kaijiang Yu
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China.
| | - Changsong Wang
- Department of Critical Care Medicine, Harbin Medical University Cancer Hospital, No. 150 Haping Rd., Nangang District, Harbin, 150081, China.
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Wang S, Chen S, Feng W, Sun F, Wang Q, Zhu K, Song J. Clinical Characteristics of Nosocomial Bloodstream Infections in Neonates in Two Hospitals, China. J Trop Pediatr 2018; 64:231-236. [PMID: 28985401 DOI: 10.1093/tropej/fmx054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND The improvement of medical condition requires prolonged hospital stays, which increase the risk of nosocomial bloodstream infections (BSIs). METHODS All nosocomial BSI newborns in two hospitals were included, and the demographic and clinical characteristics of bacteremia patients were obtained from the information systems. Isolates were identified by biochemical assays. Antimicrobial susceptibility was determined using disk diffusion method. RESULTS Except for three same risk factors, intubation with mechanical ventilation was a risk factor in Chongqing, while low birth weight was a risk factor in Henan. Klebsiella pneumoniae was the predominant strain in Chongqing, and Escherichia coli was the most prevalent strain in Henan. The resistance rate of gram-negative bacteria in Henan was higher than that of strains in Chongqing. CONCLUSIONS The risk factors and resistance rate of pathogens were different in different areas. Therefore, treatment protocols should be established based on the trends of drug resistance and bacterial spectrum.
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Affiliation(s)
- Shanmei Wang
- Laboratory of Medical Microbiology, Henan Provincial People's Hospital, Zhengzhou 450003, China
| | - Sheng Chen
- Department of Pediatrics, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Wei Feng
- Department of Pharmacy, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Fengjun Sun
- Department of Pharmacy, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Qian Wang
- Department of Pharmacy, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Ke Zhu
- Department of Prevention and Health Care, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
| | - Jie Song
- Department of Prevention and Health Care, Southwest Hospital, Third Military Medical University, Chongqing 400038, China
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Spicer KB, Green J, Dhada B. Hospital-acquired infections in paediatric medical wards at a tertiary hospital in KwaZulu-Natal, South Africa. Paediatr Int Child Health 2018; 38:53-59. [PMID: 28300495 DOI: 10.1080/20469047.2017.1299897] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Hospital-acquired infections (HAIs) impact care and costs in hospitals across the globe. There are minimal data on HAIs in sub-Saharan Africa and data specific to paediatrics are especially limited. OBJECTIVE To describe the incidence of HAIs in the paediatric medical units at Grey's Hospital, a tertiary government hospital in KwaZulu-Natal, South Africa. METHODS The Infection Prevention and Control (IPC) team collects data on all laboratory-confirmed infections, including from paediatric patients in two medical units (52 beds), the paediatric intensive/high-care unit (PICU, 8 beds) and the neonatal intensive care unit (NICU, 23 beds). HAIs are defined as infections: (i) not present (active or incubating) at the time of admission, and (ii) with onset >48 h after hospital admission. Daily patient statistics allow calculation of infections per 100 admissions and infections per 1000 patient days. RESULTS In the non-ICU setting, there were 7.1 and 7.0 HAIs per 100 admissions in 2013 and 2014, respectively. In the PICU, there were 20.4 and 15.3 HAIs per 100 admissions, while in the NICU there were 23.9 and 21.6 HAIs per 100 admissions in 2013 and 2014, respectively. In the non-ICU setting, there were 6.8 HAIs per 1000 patient days in both 2013 and 2014. In the PICU, there were 27.5 and 33.0 HAIs per 1000 patient days, while in the NICU, there were 20.3 and 21.5 HAIs per 1000 patient days in 2013 and 2014, respectively. CONCLUSION HAIs in non-ICU paediatric wards were consistent with a number of point-prevalence studies performed outside Africa (e.g. Canada, Russia, U.K.). Rates of HAIs in the ICUs were higher than rates reported from the International Nosocomial Infection Control Consortium, and were substantially higher than rates reported in the United States. HAIs are serious and important, especially in ICUs, and may be relatively neglected in low- and middle-income settings. Improved surveillance will allow the development and evaluation of targeted interventions to improve care of patients.
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Affiliation(s)
- Kevin B Spicer
- a Department of Health , Grey's Hospital , Pietermaritzburg , South Africa.,b Department of Paediatrics , Pietermaritzburg Metropolitan Hospitals Complex , Pietermaritzburg , South Africa.,c Department of Paediatrics , Nelson R. Mandela School of Medicine, University of KwaZulu-Natal , Durban , South Africa.,d Department of Pediatrics , Section of Infectious Diseases at the University of Oklahoma Health Sciences Center , Oklahoma City , OK , USA
| | - Jennifer Green
- a Department of Health , Grey's Hospital , Pietermaritzburg , South Africa
| | - Barnesh Dhada
- a Department of Health , Grey's Hospital , Pietermaritzburg , South Africa.,b Department of Paediatrics , Pietermaritzburg Metropolitan Hospitals Complex , Pietermaritzburg , South Africa.,c Department of Paediatrics , Nelson R. Mandela School of Medicine, University of KwaZulu-Natal , Durban , South Africa
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Shuping LL, Kuonza L, Musekiwa A, Iyaloo S, Perovic O. Hospital-associated methicillin-resistant Staphylococcus aureus: A cross-sectional analysis of risk factors in South African tertiary public hospitals. PLoS One 2017; 12:e0188216. [PMID: 29145465 PMCID: PMC5690649 DOI: 10.1371/journal.pone.0188216] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Accepted: 11/02/2017] [Indexed: 12/27/2022] Open
Abstract
Introduction Hospital-associated methicillin-resistant S. aureus (HA-MRSA) remains a significant cause of morbidity and mortality worldwide. We conducted a study to determine risk factors for HA-MRSA in order to inform control strategies in South Africa. Methods We used surveillance data collected from five tertiary hospitals in Gauteng and Western Cape provinces during 2014 for analysis. A case of HA-MRSA was defined as isolation of MRSA from a blood culture 48 hours after admission and/or if the patient was hospitalised in the six months prior to the current culture. Multivariable logistic regression modelling was used to determine risk factors for HA-MRSA. Results Of the 9971 patients with positive blood cultures, 7.7% (772) had S. aureus bacteraemia (SAB). The overall prevalence of MRSA among those with SAB was 30.9% (231/747; 95% confidence interval [CI] 27.6%– 34.3%). HA-MRSA infections accounted for 28.3% of patients with SAB (207/731; 95% CI 25.1%– 31.7%). Burns (adjusted odds ratio [aOR] 12.7; 95% CI 4.7–34.4), age ≤1 month (aOR 8.7; 95% CI 3.0–24.6), residency at a long-term care facility (aOR 5.2; 95% CI, 1.5–17.4), antibiotic use within two months of the current SAB episode (aOR 5.1; 95% CI 2.8–9.1), hospital stay of 13 days or more (aOR 2.8; 95% CI 1.3–5.6) and mechanical ventilation (aOR 2.2; 95% CI 1.07–4.6), were independent risk factors for HA-MRSA infection. Conclusion The prevalence of MRSA remains high in South African tertiary public hospitals. Several identified risk factors of HA-MRSA infections should be considered when instituting infection and prevention strategies in public-sector hospitals, including intensifying the implementation of antimicrobial stewardship programmes. There is an urgent need to strengthen infection prevention and control in burn wards, neonatal wards, and intensive care units which house mechanically ventilated patients.
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Affiliation(s)
- Liliwe L. Shuping
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Lazarus Kuonza
- School of Health Systems and Public Health, University of Pretoria, Pretoria, South Africa
- South African Field Epidemiology Training Programme, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
| | - Alfred Musekiwa
- Centers for Disease Control and Prevention, Pretoria, South Africa
| | - Samantha Iyaloo
- National Institute for Occupational Health, National Health Laboratory Service, Johannesburg, South Africa
| | - Olga Perovic
- Centre for Healthcare-Associated Infections, Antimicrobial Resistance and Mycoses, National Institute for Communicable Diseases, National Health Laboratory Service, Johannesburg, South Africa
- Department of Clinical Microbiology and Infectious Diseases, University of Witwatersrand, Johannesburg, South Africa
- * E-mail:
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Device-associated nosocomial infection in general hospitals, Kingdom of Saudi Arabia, 2013-2016. J Epidemiol Glob Health 2017; 7 Suppl 1:S35-S40. [PMID: 29801591 PMCID: PMC7386443 DOI: 10.1016/j.jegh.2017.10.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Revised: 09/23/2017] [Accepted: 10/24/2017] [Indexed: 12/02/2022] Open
Abstract
Healthcare-associated infections (HAIs) including device-associated HAI (DA-HAI) are a serious patient safety issue in hospitals worldwide, affecting 5–10% of hospitalized patients and deadly for patients in intensive care units (ICUs). (Vincent, 2003; Al-Tawfiq et al., 2013; Hu et al., 2013). DA-HAIs account for up to 23% of HAIs in ICUs and about 40% of all hospital infections (i.e. central line-associated blood stream infections [CLABSI], ventilator-associated pneumonia [VAP], and catheter-associated urinary tract infections [CAUTI]). This study aims to identify DA-HAI rates among a group of selected hospitals in the Kingdom of Saudi Arabia (KSA), 2013–2016. Secondary data was analyzed from 12 medical/surgical intensive care units (M/SICUs) and two cardiac care units (CCUs) from 12 Ministry of Health (MoH) hospitals from different regions in KSA. These data were reported by infection control practitioners to the MoH via electronic International Nosocomial Infection Control Consortium (INICC) systems in each hospital. Among 6178 ICU patients with 13,492 DA-HAIs during 2013–2016, the average length of stay (LOS) was 10.7 days (range 0–379 days). VAP was the most common DA-HAI (57.4%), followed by CAUTI (28.4%), and CLABSI (14.2%). In CCUs there were no CLABSI cases; CAUTI was reported from 1 to 2.6 per 1000 device-days; and VAP did not occur in Hospital B but occurred 8.1 times per 1000 device-days in the CCU in Hospital A. In M/SICUs, variations occurred among time periods, hospitals, and KSA provinces. CLABSI varied between hospitals from 2.2 to 10.5 per 1000 device-days. CAUTI occurred from 2.3 to 4.4 per 1000 device-days, while VAP had the highest rates, from 8.9 to 39.6 per 1000 device-days. Most hospitals had high device-utilization ratios (DURs) (from the 75th to 90th percentile of National Healthcare Safety Network (NHSN)’s standard and the 50th to 75th percentile of INICC’s). This study showed higher device-associated infection rates and higher device-utilization ratios in the study’s CCUs and M/SICUs than NHSN benchmarks. To reduce the rates of infection, ongoing monitoring of infection control practices and comprehensive education are required. Furthermore, a sensitive and specific national healthcare safety network is needed in KSA.
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Yallew WW, Kumie A, Yehuala FM. Risk factors for hospital-acquired infections in teaching hospitals of Amhara regional state, Ethiopia: A matched-case control study. PLoS One 2017; 12:e0181145. [PMID: 28719665 PMCID: PMC5515417 DOI: 10.1371/journal.pone.0181145] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 06/26/2017] [Indexed: 12/29/2022] Open
Abstract
Background Hospital-acquired infection affects hundreds of millions of people worldwide. It is a major global issue for patient safety. Understanding the potential risk factors is important to appreciate the local context. A matched case control study design, which is the first of its kind in the study region, was undertaken to identify risk factors in teaching hospitals of Amhara regional state, Ethiopia. Method A matched case control study design matched with age and hospital type was used. The study was conducted in University of Gondar and Felege-Hiwot medical teaching hospital. Cases were patients who fulfilled the criteria based on CDC definition of hospital-acquired infection and controls were patients admitted to the hospital that stayed for more than 48 hours in the ward in the study period, but who did not develop infection. For one case, four controls were selected. Of 545 patients, 109 were cases and 436 were controls. Conditional logistic regression using STATA 13 was used for data analysis. Result The median length of stay for cases and controls was 7 and 8 days, respectively. Patients admitted in wards with the presence of medical waste container in the room had 82% less chance of developing hospital-acquired infection (AOR 0.18; 95% CI, 0.03–0.98). The odds of developing hospital-acquired infection among immune deficient patients were 2.34 times higher than their counterparts (95% CI; 1.17–4.69). Patients received antimicrobials, central vascular catheter and surgery since admission had 8.63, 6.91 and 2.35 higher odds of developing hospital-acquired infection, respectively. Conclusion Health providers and mangers should consider the provision and availability of healthcare materials and facilities in all of the ward rooms, follow appropriate safe medical procedures for use of external devices on patients, and give attention to the immunocompromised patients for the prevention and control of hospital-acquired infections.
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Affiliation(s)
- Walelegn Worku Yallew
- Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- * E-mail:
| | - Abera Kumie
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Feleke Moges Yehuala
- Department of Medical Microbiology, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Povidone-Iodine, 0.05% Chlorhexidine Gluconate, or Water for Periurethral Cleaning Before Indwelling Urinary Catheterization in a Pediatric Intensive Care. J Wound Ostomy Continence Nurs 2017; 44:84-88. [DOI: 10.1097/won.0000000000000280] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Prospective observational study to compare oral topical metronidazole versus 0.2% chlorhexidine gluconate to prevent nosocomial pneumonia. Am J Infect Control 2016; 44:1116-1122. [PMID: 27317405 DOI: 10.1016/j.ajic.2016.03.054] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2016] [Revised: 03/08/2016] [Accepted: 03/08/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND Nosocomial pneumonia is one of the most common health care-associated infections in intensive care units (ICUs) worldwide, attributing to high morbidity and mortality. Our study aim is to investigate the effectiveness of oral hygiene with 0.2% chlorhexidine gluconate (CHX) and 0.08% metronidazole (MDE) influencing the microbiologic epidemiology and incidence of nonintubation pneumonia (NIP) and ventilator-associated pneumonia (VAP). METHODS Patients who stayed >48 hours in the emergency ICU between 2008 and 2012 were enrolled and provided oral hygiene by swabbing with 0.08% MDE twice daily until discharge or death during the first year (period M), whereas CHX was applied during the following 3 years (period C). The incidence and microbiologic epidemiology of NIP and VAP were studied. RESULTS There were 873 patients enrolled. There were 44 episodes of NIP and 25 episodes of VAP that occurred among 212 patients in period M, and 84 episodes of NIP and 49 episodes of VAP occurred among 661 patients in period C. Overall, the rate of NIP and VAP decreased year by year. Acinetobacter baumannii was the most frequently identified bacteria for NIP (22.9%) and VAP (25.3%), with an annual ascent. Few changes were observed on bacteria distribution for NIP and VAP. CONCLUSIONS Oral hygiene with CHX, having reduced the incidence of nosocomial pneumonia among critical ill patients, suggests a benefit of oral hygiene in decreasing the incidence of nosocomial pneumonia, including VAP in ICUs, but not bacterial epidemiology.
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Rosenthal VD. International Nosocomial Infection Control Consortium (INICC) resources: INICC multidimensional approach and INICC surveillance online system. Am J Infect Control 2016; 44:e81-90. [PMID: 26975716 DOI: 10.1016/j.ajic.2016.01.005] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/21/2015] [Accepted: 01/04/2016] [Indexed: 12/24/2022]
Abstract
BACKGROUND The International Nosocomial Infection Control Consortium (INICC) is an international, nonprofit, multicentric health care-associated infection (HAI) cohort surveillance network with a methodology based on the U.S. Centers for Disease Control and Prevention's National Healthcare Safety Network (CDC-NHSN). The INICC was founded in 1998 to promote evidence-based infection control in limited-resource countries through the analysis of surveillance data collected by their affiliated hospitals. The INICC is comprised of >3,000-affiliated infection control professionals from 1,000 hospitals in 67 countries and is the only source of aggregate standardized international data on HAI epidemiology. Having published reports on device-associated (DA) HAI (HAI) and surgical site infections (SSIs) from 43 countries and several reports per individual country, the INICC showed DA HAI and SSI rates in limited-resources countries are 3-5 times higher than in high-income countries. METHODS The INICC developed the INICC Multidimensional Approach (IMA) for HAI prevention with 6 components, bundles with 7-13 elements, and the INICC Surveillance Online System (ISOS) with 15 modules. RESOURCES In this article the IMA, the ISOS for outcome surveillance of HAIs and process surveillance of bundles to prevent HAIs, and the use of surveillance data feedback are described. COMMENTS Remarkable features of the IMA and ISOS are INICC's applying of the latest published CDC-NHSN HAI definitions, including their updates and revisions in 2008, 2013, 2015 and 2016; INICC's informatics system to check accuracy of fulfillment of CDC-NHSN HAI criteria; and INICC's system to check compliance with each bundle element.
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Ider BE, Baatar O, Rosenthal VD, Khuderchuluun C, Baasanjav B, Donkhim C, Batsuur B, Jambiimolom M, Purevdorj SE, Tsogtbaatar U, Sodnomdarjaa B, Gendaram B, Mendsaikhan N, Begzjav T, Narankhuu B, Ariungerel BE, Tumendemberel B, Orellano PW. Multicenter study of device-associated infection rates in hospitals of Mongolia: Findings of the International Nosocomial Infection Control Consortium (INICC). Am J Infect Control 2016; 44:327-31. [PMID: 26684368 DOI: 10.1016/j.ajic.2015.10.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 10/06/2015] [Accepted: 10/07/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND To report the results of the International Nosocomial Infection Control Consortium (INICC) multicenter study conducted in Mongolia from September 2013-March 2015. METHODS A device-associated health care-associated infection prospective surveillance study in 3 adult intensive care units (ICUs) from 3 hospitals using the U.S. Centers for Disease Control and Prevention (CDC) and National Healthcare Safety Network (NHSN) definitions and INICC methods. RESULTS We documented 467 ICU patients for 2,133 bed days. The central line-associated bloodstream infection (CLABSI) rate was 19.7 per 1,000 central line days, the ventilator-associated pneumonia (VAP) rate was 43.7 per 1,000 mechanical ventilator days, and the catheter-associated urinary tract infection (CAUTI) rate was 15.7 per 1,000 urinary catheter days; all of the rates are higher than the INICC rates (CLABSI: 4.9; VAP: 16.5; and CAUTI: 5.3) and CDC-NHSN rates (CLABSI: 0.8; VAP: 1.1; and CAUTI: 1.3). Device use ratios were also higher than the CDC-NHSN and INICC ratios, except for the mechanical ventilator device use ratio, which was lower than the INICC ratio. Resistance of Staphylococcus aureus to oxacillin was 100%. Extra length of stay was 15.1 days for patients with CLABSI, 7.8 days for patients with VAP, and 8.2 days for patients with CAUTI. Extra crude mortality in the ICUs was 18.6% for CLABSI, 17.1% for VAP, and 5.1% for CAUTI. CONCLUSION Device-associated health care-associated infection rates and most device use ratios in our Mongolian hospitals' ICUs are higher than the CDC-NSHN and INICC rates.
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Affiliation(s)
| | - Otgon Baatar
- First State Central Hospital, Ulaanbaatar, Mongolia
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Pablo Wenceslao Orellano
- International Nosocomial Infection Control Consortium, Buenos Aires, Argentina; Universidad Tecnológica Nacional, Facultad Regional San Nicolás and Consejo Nacional de Investigaciones Científicas y Técnicas, San Nicolás, Argentina
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Liu WP, Tian YQ, Hai YT, Zheng ZN, Cao QL. Prevalence survey of nosocomial infections in the Inner Mongolia Autonomous Region of China [2012-2014]. J Thorac Dis 2015; 7:1650-7. [PMID: 26543614 DOI: 10.3978/j.issn.2072-1439.2015.09.41] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND To investigate the prevalence of nosocomial infections, the distribution of nosocomial infection sites, the use of antibiotic and the situation of detected nosocomial infection pathogens in the Inner Mongolia Autonomous Region of China from 2012 to 2014, to grasp the current conditions of regional nosocomial infections in timely, for the development of infection prevention and control measures to provide a basis for effective hospital. METHODS A survey of the prevalence of nosocomial infections was conducted in target hospitals using the combination of a bedside survey and medical record review. RESULTS In total, 101,907 inpatients were surveyed from 2012 to 2014. There were 1,997 cases of nosocomial infections, accounting for an average prevalence of 1.96%. The infection site was mainly the lower respiratory tract. Higher prevalence of nosocomial infections occurred in the comprehensive intensive care unit (ICU), Neurosurgery Department, and Hematology Department. The average rate of antibiotic use was 33.72%, and the average submission rate for bacterial cultures for patients who received therapeutic treatment with antibiotics was 28.26%. The most common pathogens associated with nosocomial infections were Gram-negative (G(-)) bacteria, and frequently detected bacterial pathogens included Escherichia coli, Pseudomonas aeruginosa, Klebsiella pneumoniae, Acinetobacter baumannii, and Staphylococcus aureus. CONCLUSIONS The survey of the prevalence of nosocomial infections helped to identify problems in the control process of nosocomial infections and to develop targeted measures for the prevention and control of these infections accordingly.
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Affiliation(s)
- Wei-Ping Liu
- 1 Public Health School of Central South University, Changsha 410078, China ; 2 Inner Mongolia Autonomous Region People's Hospital, Hohhot 010010, China
| | - Yong-Quan Tian
- 1 Public Health School of Central South University, Changsha 410078, China ; 2 Inner Mongolia Autonomous Region People's Hospital, Hohhot 010010, China
| | - Yun-Ting Hai
- 1 Public Health School of Central South University, Changsha 410078, China ; 2 Inner Mongolia Autonomous Region People's Hospital, Hohhot 010010, China
| | - Zhi-Nan Zheng
- 1 Public Health School of Central South University, Changsha 410078, China ; 2 Inner Mongolia Autonomous Region People's Hospital, Hohhot 010010, China
| | - Qing-Ling Cao
- 1 Public Health School of Central South University, Changsha 410078, China ; 2 Inner Mongolia Autonomous Region People's Hospital, Hohhot 010010, China
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Merchant N, Smith K, Jeschke MG. An Ounce of Prevention Saves Tons of Lives: Infection in Burns. Surg Infect (Larchmt) 2015. [PMID: 26207399 DOI: 10.1089/sur.2013.135] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Modern day burn care continues to wage an uphill battle against an enemy that evolves faster than we can develop weapons. Bacteria (bioburden) are everywhere and can infiltrate anywhere within our susceptible population of burn patients. This is why prevention of infection is key to improving their survival and outcome. PURPOSE To reduce the incidence of infection in the burn patient population. MATERIALS Review of pertinent recent literature regarding infection prevention and control in the intensive care unit setting. RESULTS We propose that bioburden is one of the central elements in the infectious cycle that is ever-present in burn units. The mechanism of bacterial entry into the unit and subsequent transmission and infection are delineated. Recommendations for mitigating this risk are provided to guide future clinicians in their care of burn patients. CONCLUSIONS The treatment of infection and sepsis against highly adaptable bacteria is often insurmountable by ill patients. In this process, bioburden needs to be corralled to have any success. Thus, preventing organisms from entering the unit and transferring onto other patients, and eliminating the bacteria dwelling in the unit are all necessary actions in this battle. Ultimately, maintaining a culture that is constantly wary of this risk only can achieve this goal.
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Affiliation(s)
- Nishant Merchant
- 1 Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre , Toronto, Ontario, Canada .,2 Department of Surgery, Division of Plastic Surgery, Department of Immunology, University of Toronto , Ontario, Canada .,3 TECC Program Sunnybrook Health Sciences Centre, University of Toronto , Toronto, Ontario, Canada
| | - Karen Smith
- 1 Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre , Toronto, Ontario, Canada .,2 Department of Surgery, Division of Plastic Surgery, Department of Immunology, University of Toronto , Ontario, Canada .,3 TECC Program Sunnybrook Health Sciences Centre, University of Toronto , Toronto, Ontario, Canada
| | - Marc G Jeschke
- 1 Ross Tilley Burn Centre, Sunnybrook Health Sciences Centre , Toronto, Ontario, Canada .,2 Department of Surgery, Division of Plastic Surgery, Department of Immunology, University of Toronto , Ontario, Canada .,3 TECC Program Sunnybrook Health Sciences Centre, University of Toronto , Toronto, Ontario, Canada
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Ling ML, Apisarnthanarak A, Madriaga G. The Burden of Healthcare-Associated Infections in Southeast Asia: A Systematic Literature Review and Meta-analysis. Clin Infect Dis 2015; 60:1690-9. [DOI: 10.1093/cid/civ095] [Citation(s) in RCA: 112] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 02/01/2015] [Indexed: 11/13/2022] Open
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Loo CY, Lee WH, Young PM, Cavaliere R, Whitchurch CB, Rohanizadeh R. Implications and emerging control strategies for ventilator-associated infections. Expert Rev Anti Infect Ther 2015; 13:379-93. [DOI: 10.1586/14787210.2015.1007045] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Zhang Y, Yao Z, Zhan S, Yang Z, Wei D, Zhang J, Li J, Kyaw MH. Disease burden of intensive care unit-acquired pneumonia in China: a systematic review and meta-analysis. Int J Infect Dis 2014; 29:84-90. [PMID: 25449241 DOI: 10.1016/j.ijid.2014.05.030] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Revised: 05/28/2014] [Accepted: 05/30/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Intensive care unit (ICU)-acquired pneumonia and ventilator-associated pneumonia (VAP) are associated with poor clinical and economic outcomes. Data regarding ICU-acquired pneumonia and VAP are not readily available from developing countries, including China. The objective of this meta-analysis was to evaluate the incidence, mortality rate, length of stay, and pathogens associated with ICU-acquired pneumonia in China. METHODS A meta-analysis and systematic review of 334 publications published between January 2007 and May 2012 and retrieved from the Chinese BioMedical database, China National Knowledge Infrastructure, VIP Chinese Science and Technique Journals database, Wanfang database, and PubMed was conducted. RESULTS The incidences of ICU-acquired pneumonia and VAP were 16.2% (95% confidence interval (CI) 12.8-20.4%) and 33.7% (95% CI 31.4-36.1%), respectively; mortality rates were 37.4% (95% CI 24.6-52.2%) and 34.5% (95% CI 29.2-40.1%), respectively. The durations of stay in the ICU and hospital were 12.4 (95% CI 9.6-15.3) and 17.7 (95% CI 15.6-19.7) days and 18.0 (95% CI 16.5-19.6) and 30.5 (95% CI 26.4-34.7) days for ICU-acquired pneumonia and VAP, respectively. Pseudomonas aeruginosa (19.9%) and Acinetobacter baumannii (13.9%) were the most frequently isolated pathogens, followed by Klebsiella pneumoniae (11.9%) and Staphylococcus aureus (10.4%); 82.9% of S. aureus isolates were reported to be methicillin-resistant. CONCLUSIONS ICU-acquired pneumonia/VAP remains a major cause of morbidity and mortality in patients in the ICU in China. Data on organisms causing disease in this population could help guide appropriate prevention strategies and treatment.
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Affiliation(s)
- Yaowen Zhang
- Infection Management and Disease Prevention Department, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Zhiyuan Yao
- Infection Management and Disease Prevention Department, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Siyan Zhan
- Department of Epidemiology and Bio-statistics, Peking University Health Science Center, Beijing, P.R. China
| | - Zhirong Yang
- Department of Epidemiology and Bio-statistics, Peking University Health Science Center, Beijing, P.R. China
| | - Dong Wei
- Infection Management and Disease Prevention Department, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Jing Zhang
- Infection Management and Disease Prevention Department, China-Japan Friendship Hospital, Beijing, P.R. China
| | - Jingyi Li
- MedImmune, Gaithersburg, Maryland, USA
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Bukhari S, Banjar A, Baghdadi S, Baltow B, Ashshi A, Hussain W. Central line associated blood stream infection rate after intervention and comparing outcome with national healthcare safety network and international nosocomial infection control consortium data. Ann Med Health Sci Res 2014; 4:682-6. [PMID: 25328774 PMCID: PMC4199155 DOI: 10.4103/2141-9248.141499] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: Benchmarking of central line associated blood stream infection (CLABSI) rates remains a problem in developing countries due to the variations in surveillance practices and/or infection risk as non-availability of national data. Aim: The aim of the following study was to find out the CLABSI rate before and after central line (CL) bundle intervention and compare the outcome with international surveillance data. Subjects and Methods: This prospective longitudinal cohort study on adult intensive care unit patients was conducted at Hera General Hospital, Makkah Saudi Arabia from January 1 to December 31, 2012. Five key components of bundle were selected; hand hygiene, maximal barrier precautions upon insertion, skin antisepsis, optimum site selection and daily review of line necessity with prompt removal of unnecessary lines. Post-intervention CLABSI rate was compared with National Healthcare Safety Network (NHSN) and International Nosocomial Infection Control Consortium (INICC) rates. Statistical Package for the Social Sciences (SPSS) 14.0 software (SPSS Inc., 233 South Wacker Drive, 11th floor Chicago, USA) was used for statistical analysis included regression analysis for correlation. Statistical significance was set at P < 0.05. Results: CLABSI rate was reduced from 10.1 to 6.5 per 1000 CL days after interventions and had significant correlation with overall bundle compliance rate 87.6% (P = 0.02) On benchmarking, CLABSI rate after the intervention was similar to mean pool value of INICC (6.8) while higher than NHSN (3.1). The most common microorganisms isolated were; methicillin-resistant Staphylococcus aureus (30.8%), Acinetobacter baumanii (23.3%) and Enterococcus faecalis (15.4%). Conclusion: We found that INICC data was a better benchmarking tool comparative to NHSN because it represents the countries that are developing the surveillance system. A multicenter national study is recommended.
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Affiliation(s)
- Sz Bukhari
- Department of Infection Prevention and Control, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - A Banjar
- Department of Pediatrics, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Ss Baghdadi
- Department of Obstetrics and Gynecology, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Ba Baltow
- Department of Laboratory, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Am Ashshi
- Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
| | - Wm Hussain
- Department of Rheumatology, Hera General Hospital, Makkah, Kingdom of Saudi Arabia
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Hongsuwan M, Srisamang P, Kanoksil M, Luangasanatip N, Jatapai A, Day NP, Peacock SJ, Cooper BS, Limmathurotsakul D. Increasing incidence of hospital-acquired and healthcare-associated bacteremia in northeast Thailand: a multicenter surveillance study. PLoS One 2014; 9:e109324. [PMID: 25310563 PMCID: PMC4195656 DOI: 10.1371/journal.pone.0109324] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/31/2014] [Indexed: 02/06/2023] Open
Abstract
Background Little is known about the epidemiology of nosocomial bloodstream infections in public hospitals in developing countries. We evaluated trends in incidence of hospital-acquired bacteremia (HAB) and healthcare-associated bacteremia (HCAB) and associated mortality in a developing country using routinely available databases. Methods Information from the microbiology and hospital databases of 10 provincial hospitals in northeast Thailand was linked with the national death registry for 2004–2010. Bacteremia was considered hospital-acquired if detected after the first two days of hospital admission, and healthcare-associated if detected within two days of hospital admission with a prior inpatient episode in the preceding 30 days. Results A total of 3,424 patients out of 1,069,443 at risk developed HAB and 2,184 out of 119,286 at risk had HCAB. Of these 1,559 (45.5%) and 913 (41.8%) died within 30 days, respectively. Between 2004 and 2010, the incidence rate of HAB increased from 0.6 to 0.8 per 1,000 patient-days at risk (p<0.001), and the cumulative incidence of HCAB increased from 1.2 to 2.0 per 100 readmissions (p<0.001). The most common causes of HAB were Acinetobacter spp. (16.2%), Klebsiella pneumoniae (13.9%), and Staphylococcus aureus (13.9%), while those of HCAB were Escherichia coli (26.3%), S. aureus (14.0%), and K. pneumoniae (9.7%). There was an overall increase over time in the proportions of ESBL-producing E. coli causing HAB and HCAB. Conclusions This study demonstrates a high and increasing incidence of HAB and HCAB in provincial hospitals in northeast Thailand, increasing proportions of ESBL-producing isolates, and very high associated mortality.
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Affiliation(s)
- Maliwan Hongsuwan
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Pramot Srisamang
- Department of pediatrics, Sappasithiprasong Hospital, Ubon Ratchathani, Thailand
| | - Manas Kanoksil
- Department of pediatrics, Udon Thani Hospital, Udon Thani, Thailand
| | - Nantasit Luangasanatip
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Anchalee Jatapai
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
| | - Nicholas P Day
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Center for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Sharon J Peacock
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Microbiology and Immunology, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Medicine, Cambridge University, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Ben S Cooper
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Center for Tropical Medicine, Nuffield Department of Clinical Medicine, University of Oxford, Oxford, United Kingdom
| | - Direk Limmathurotsakul
- Mahidol-Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand; Department of Tropical Hygiene, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand
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Patrick SW, Kawai AT, Kleinman K, Jin R, Vaz L, Gay C, Kassler W, Goldmann D, Lee GM. Health care-associated infections among critically ill children in the US, 2007-2012. Pediatrics 2014; 134:705-12. [PMID: 25201802 DOI: 10.1542/peds.2014-0613] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Health care-associated infections (HAIs) are harmful and costly and can result in substantial morbidity for hospitalized children; however, little is known about national trends in HAIs in neonatal and pediatric populations. Our objective was to determine the incidence of HAIs among a large sample of hospitals in the United States caring for critically ill children from 2007 to 2012. METHODS In this cohort study, we included NICUs and PICUs located in hospitals reporting data to the Centers for Disease Control and Prevention's National Healthcare Safety Network for central line-associated bloodstream infections (CLABSIs), ventilator-associated pneumonias, and catheter-associated urinary tract infections. We used a time-series design to evaluate changes in HAI rates. RESULTS A total of 173 US hospitals provided data from NICUs, and 64 provided data from PICUs. From 2007 to 2012, rates of CLABSIs decreased in NICUs from 4.9 to 1.5 per 1000 central-line days (incidence rate ratio (IRR) per quarter = 0.96, 95% confidence interval 0.94-0.97) and in PICUs from 4.7 to 1.0 per 1000 central-line days (IRR per quarter = 0.96 [0.94-0.98]). Rates of ventilator-associated pneumonias decreased in NICUs from 1.6 to 0.6 per 1000 ventilator days (IRR per quarter = 0.97 [0.93-0.99]) and PICUs from 1.9 to 0.7 per 1000 ventilator-days (IRR per quarter = 0.95 [0.92-0.98]). Rates of catheter-associated urinary tract infections did not change significantly in PICUs. CONCLUSIONS Between 2007 and 2012 there were substantial reductions in HAIs among hospitalized neonates and children.
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Affiliation(s)
- Stephen W Patrick
- Department of Pediatrics, and Mildred Stahlman Division of Neonatology, Vanderbilt University, Nashville, Tennessee; Vanderbilt Center for Health Services Research, Nashville, Tennessee;
| | - Alison Tse Kawai
- Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts
| | - Ken Kleinman
- Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts
| | - Robert Jin
- Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts
| | - Louise Vaz
- Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts; Division of Infectious Diseases, Departments of Medicine and Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Charlene Gay
- Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts
| | - William Kassler
- Centers for Medicare and Medicaid Services, Boston, Massachusetts; and
| | - Don Goldmann
- Institute for Healthcare Improvement, Boston, Massachusetts
| | - Grace M Lee
- Center for Child Health Care Studies, Department of Population Medicine, Harvard Pilgrim Health Care Institute & Harvard Medical School, Boston, Massachusetts; Division of Infectious Diseases, Departments of Medicine and Laboratory Medicine, Boston Children's Hospital, Boston, Massachusetts
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Rosenthal VD, Maki DG, Mehta Y, Leblebicioglu H, Memish ZA, Al-Mousa HH, Balkhy H, Hu B, Alvarez-Moreno C, Medeiros EA, Apisarnthanarak A, Raka L, Cuellar LE, Ahmed A, Navoa-Ng JA, El-Kholy AA, Kanj SS, Bat-Erdene I, Duszynska W, Van Truong N, Pazmino LN, See-Lum LC, Fernández-Hidalgo R, Di-Silvestre G, Zand F, Hlinkova S, Belskiy V, Al-Rahma H, Luque-Torres MT, Bayraktar N, Mitrev Z, Gurskis V, Fisher D, Abu-Khader IB, Berechid K, Rodríguez-Sánchez A, Horhat FG, Requejo-Pino O, Hadjieva N, Ben-Jaballah N, García-Mayorca E, Kushner-Dávalos L, Pasic S, Pedrozo-Ortiz LE, Apostolopoulou E, Mejía N, Gamar-Elanbya MO, Jayatilleke K, de Lourdes-Dueñas M, Aguirre-Avalos G, Maurizi DM, Montanini A, Spadaro ML, Marcos LS, Botta P, Jerez FM, Chavez MC, Ramasco L, Colqui MI, Olivieri MS, Rearte AS, Correa GE, Juarez PD, Gallardo PF, Brito MP, Mendez GH, Valdez JR, Cardena LP, Harystoy JM, Chaparro GJ, Rodriguez CG, Toomey R, Caridi M, Viegas M, Bernan ML, Romani A, Dominguez CB, Davalos LK, Richtmann R, Silva CA, Rodrigues TT, Filho AM, Seerig Palme ED, Besen A, Lazzarini C, Cardoso CB, Azevedo FK, Pinheiro APF, Camacho A, De Carvalho BM, De Assis MJM, Carneiro APV, Canuto MLM, Pinto Coelho KH, Moreira T, Oliveira AA, Sousa Colares MM, De Paula Bessa MM, Gomes Bandeira TDJP, De Moraes RA, Campos DA, De Barros Araújo TML, Freitas Tenório MT, Amorim S, Amaral M, Da Luz Lima J, Pino Da Silva Neta L, Batista C, De Lima Silva FJ, Ferreira De Souza MC, Arruda Guimaraes K, Marcia Maluf Lopes J, Nogueira Napoles KM, Neto Avelar LLS, Vieira LA, Gustavo De Oliveira Cardo L, Takeda CF, Ponte GA, Eduardo Aguiar Leitão F, De Souza Kuchenbecker R, Pires Dos Santos R, Maria Onzi Siliprandi E, Fernando Baqueiro Freitas L, Martins IS, Casi D, Maretti Da Silva MA, Blecher S, Villins M, Salomao R, Oliveira Castro SR, Da Silva Escudero DV, Andrade Oliveira Reis M, Mendonca M, Furlan V, Claudio do Amaral Baruzzi A, Sanchez TE, Moreira M, Vasconcelos de Freitas W, Passos de Souza L, Velinova VA, Hadjieva N, Petrov MM, Karadimov DG, Kostadinov ED, Dicheva VJ, Wang C, Guo X, Geng X, Wang S, Zhang J, Zhu L, Zhuo S, Guo C, Lili T, Ruisheng L, Kun L, Yang X, Yimin L, Pu M, Changan L, Shumei Y, Kangxiong W, Meiyi L, Ye G, Ziqin X, Yao S, Liqiang S, Marino Cañas Giraldo L, Margarita Trujillo Ramirez E, Rios PA, Carlos Torres Millan J, Giovanny Chapeta Parada E, Eduardo Mindiola Rochel A, Corchuelo Martinez AH, Marãa Perez Fernandez A, Guzman NB, Guzman AL, Ferrer MR, Vega YL, Munoz HJ, Moreno GC, Romero Torres SL, Hernandez HT, Valderrama MarquezClaudia Linares IA, Valencia ME, Corrales LS, Bonilla SM, Ivan Marin Uribe J, Gomez DY, Martinez JO, Dary Burgos Florez L, Osorio J, Santofimio D, Cortes LM, Villamil-Gomez W, Gutierrez GM, Ruiz AA, Fuentes CG, Chinchilla AS, Hernandez IC, Ugalde OC, Garcell HG, Perez CM, Bardak S, Ozkan S, Mejia N, Puello Guerrero Glenny Mirabal AM, Delgado M, Severino R, Lacerda E, Tolari G, Bovera MM, Pinto DB, González PF, Santacruz G, Alquinga N, Zaruma C, Remache N, Morocho D, Arboleda M, Zapata MC, Garcia MF, Picoita F, Velez J, Valle M, Yepez ES, Tutillo DM, Mora RA, Padilla AP, Chango M, Cabezas K, Tenorio López S, Lucía Bonilla Escudero A, Sánchez GT, Alberto Gonzalez Flores H, Garcia MF, Ghazi IA, Hassan M, Ismail GA, Hamed R, Abdel-Halim MM, El-Fattah MA, Abdel-Aziz D, Seliem ZS, Elsherif RH, Dewdar RA, Mohmed AA, Abdel-Fatteh Ahmed L, De Jesus Machuca L, Bran De Casares C, Kithreotis P, Daganou M, Veldekis D, Kartsonaki M, Gikas A, Luque Torres MT, Padgett D, Rivera DM, Jaggi N, Rodrigues C, Shah B, Parikh K, Patel J, Thakkar R, Chakravarthy M, Gokul B, Sukanya R, Pushparaj L, Vini T, Rangaswamy S, Patnaik SK, Venkateshwar V, John B, Dalal S, Sahu S, Sahu S, Ray B, Misra S, Mohanty N, Mishra BM, Sahoo P, Parmar N, Mishra S, Pati BK, Singh S, Pati BS, Panda A, Banergee S, Padhihari D, Samal S, Sahu S, Varma K, Suresh Kumar VP, Gopalakrishnan R, Ramakrishnan N, Abraham BK, Rajagopal S, Venkatraman R, Mani AK, Devaprasad D, Ranganathan L, Francis T, Cherain KM, Ramachandran B, Krupanandan R, Muralidharan S, Karpagam M, Padmini B, Saranya S, Kumar S, Pandya N, Kakkar R, Zompa T, Saini N, Samavedam S, Jagathkar G, Nirkhiwale S, Gehlot G, Bhattacharya S, Sood S, Singh S, Singh S, Todi SK, Bhattacharyya M, Bhakta A, Basu S, Agarwal A, Agarwal M, Kharbanda M, Sengupta S, Karmakar A, Gupta D, Sarkar AK, Dey R, Bhattacharya C, Chandy M, Ramanan V, Mahajan A, Roy M, Bhattacharya S, Sinha S, Roy I, Gupta U, Mukherjee S, Bej M, Mukherjee P, Baidya S, Azim A, Sakle AS, Sorabjee JS, Potdar MS, Subhedar VR, Udwadia F, Francis H, Dwivedy A, Binu S, Shetty S, Nair PK, Khanna DK, Chacko F, Blessymole S, Mehta PR, Singhal T, Shah S, Kothari V, Naik R, Patel MH, Aggarwal DG, Jawadwala BQ, Pawar NK, Kardekar SN, Manked AN, Myatra S, Divatia J, Kelkar R, Biswas S, Raut V, Sampat S, Thool A, Karlekar A, Nandwani S, Gupta S, Singhal S, Gupta M, Mathur P, Kumar S, Sandhu K, Dasgupta A, Raha A, Raman P, Wadhera A, Badyal B, Juneja S, Mishra B, Sharma S, Mehrotra M, Shelgaonkar J, Padbidri V, Dhawale R, Sibin SM, Mane D, Sale HK, Mukhit Abdul Gaffar Kazi M, Chabukswar S, Mathew A, Gaikwad D, Harshe A, Nadimpalli G, Bhamare S, Thorat S, Sarda O, Nadimpalli P, Mendonca A, Malik S, Kamble A, Kumari N, Arora S, Munshi N, Divekar DG, Kavathekar MS, Kulkarni AK, Kavathekar MS, Suryawanshi MV, Bommala ML, Bilolikar A, Joshi KL, Pamnani C, Wasan H, Khamkar S, Steephen L, Rajalakshmi A, Thair A, Mubarak A, Sathish S, Kumar S, Sunil H, Sujith S, Dinesh, Sen N, Thool A, Shinde N, Alebouyeh M, Jahani-Sherafat S, Zali MR, Sarbazi MR, Mansouri N, Tajeddin E, Razaghi M, Seyedjavadi S, Tajeddin E, Rashidan M, Razaghi M, Masjedi M, Maghsudi B, Sabetian G, Sanaei A, Yousefipour A, Alebouyeh M, Assiri AM, Furukawa-Cinquini EM, Alshehri AD, Giani AF, Demaisip NL, Cortez EL, Cabato AF, Gonzales Celiz JM, Al-Zaydani Asiri IA, Mohammed YK, Abdullah Al Raey M, Omer Abdul Aziz A, Ali Al Darani S, Aziz MR, Basri RH, Al-Awadi DK, Bukhari SZ, Aromin RG, Ubalde EB, Molano AM, Abdullah Al Enizy H, Baldonado CF, Al Adwani FM, Marie Casuyon Pahilanga A, Tan AM, Joseph S, Nair DS, Al-Abdullah NA, Sindayen G, Malificio AA, Mohammed DA, Mesfer Al Ghamdi H, Silo AC, Valisto MBV, Foteinakis N, Ghazal SS, Joseph MV, Hakawi A, Hasani A, Jusufi I, Spahija G, Baftiu N, Gecaj-Gashi A, Aly NY, El-Dossoky Noweir M, Varghese ST, Ramapurath RJ, Mohamed AM, George SM, Kurian A, Sayed AF, Salama MF, Omar AA, Rebello FM, Narciso DM, Zahreddine NK, Kanafani Z, Kardas T, Molaeb B, Jurdi L, Al Souheil A, Ftouni M, Ayash H, Mahfouz T, Kondratas T, Grinkeviciute D, Kevalas R, Gailiene G, Dagys A, Petrovska M, Popovska K, Bogoevska-Miteva Z, Jankovska K, Guroska ST, Anguseva T, Wan Yusoff WN, Shiham Zainal Abidin A, Gan CS, Zainol H, Rai V, Kwong WK, Hasan MS, Sri La Sri Ponnampala S, Veerakumaran J, Assadian O, Phuong DM, Binh NG, Kaur K, Lim J, Tan LH, Manikavasagam J, Cheong YM, Magaña HC, Cesar Mijangos Méndez J, Jiménez FC, Esparza-Ahumada S, Morfin-Otero R, Rodriguez-Noriega E, Gutierrez-Martinez S, Perez-Gomez HR, León-Garnica G, Mendoza-Mujica C, Cecilia Culebro Burguet M, Portillo-Gallo JH, Almazán FA, Miramontes GI, Olivas MDRV, Aguilar Angel LA, Vargas MS, Orlando Flores Alvarado A, Carlos Mares Morales R, Carlos Fernandez Alvarez L, Armando Rincon Leon H, Navarro Fuentes KR, Mariela Perez Hernandez Y, Falcon GM, Vargas AG, Trujillo Juarez MA, Mulia AM, Alma Ulloa Camacho P, Martinez-Marroquin MY, Garcia MM, Martinez AM, Sanchez EL, Flores GG, Martínez MDRG, Alfonso Galindo Olmeda J, Olivarez G, Rodriguez EB, Magdalena Gutierrez Castillo M, Guadalupe Villa González M, Beatriz Sauceda Castañeda I, Rodriguez JM, Baatar O, Batkhuu B, Meryem K, Amina B, Abouqal R, Zeggwagh AA, Dendane T, Abidi K, Madani N, Mahmood SF, Memon BA, Bhutto GH, Paul N, Parveen A, Raza A, Mahboob A, Nizamuddin S, Sultan F, Nazeer H, Khan AA, Hafeez A, Lara L, Mapp T, Alvarez B, Rojas-Bonilla MI, Castano E, De Moros DA, Atarama RE, Calisto Pazos ME, Paucar A, Ramos MT, Jurado J, Moreno D, Cruz Saldarriaga ME, Ramirez E, La Hoz Vergara CE, Enrique Prudencio Leon W, Isidro Castillo Bravo L, Fernanda Aibar Yaranga K, Pichilingue Chagray JE, Marquez Mondalgo VA, Zegarra ST, Astete NS, Guevara FC, Pastrana JS, Enrique Prudencio Leon W, Linares Calderon CF, Jesus Mayorga Espichan M, Martin Santivanez Monge L, Changano Rodriguez MV, Rosa Diaz Tavera Z, Martin Ramirez Wong F, Chavez SM, Rosa Diaz Tavera Z, Martin Ramirez Wong F, Atencio-Espinoza T, Villanueva VD, Blanco-Abuy MT, Tamayo AS, Bergosa LD, Llames CMJP, Trajano MF, Bunsay SA, Amor JC, Berba R, Sg Buenaflor MC, Labro E, Mendoza MT, Javellana OP, Salvio LG, Rayco RG, Bermudez V, Kubler A, Zielinska M, Kosmider-Zurawska M, Barteczko-Grajek B, Szewczyk E, Dragan B, Mikaszewska-Sokolewicz MA, Lazowski T, Cancel E, Licker MS, Dragomirescu LA, Dumitrascu V, Sandesc D, Bedreag O, Papurica M, Muntean D, Kotkov I, Kretov V, Shalapuda V, Molkov A, Puzanov S, Utkin I, Tchekulaev A, Tulupova V, Nikolic L, Ristic G, Eremija J, Kojovic J, Lekic D, Vasiljevic S, Lesnakova A, Marcekova A, Furova K, Gamar Elanbya MO, Ali MA, Kadankunnel SK, Somabutr S, Pimathai R, Wanitanukool S, Luxsuwong M, Supa N, Prasan P, Thamlikitkul V, Jamulitrat S, Suwalak N, Phainuphong P, Asma B, Aida B, Sarra BH, Ammar K, Ertem GT, Bulut C, Hatipoglu CA, Erdinc FS, Demiroz AP, Ozcelik M, Meco BC, Oral M, Unal N, Guclu CY, Kendirli T, İnce E, Çiftçi E, Yaman A, Ödek Ç, Karbuz A, Kocabaş BA, Altın N, Cesur S, Atasay B, Erdeve O, Akduman H, Kahvecioglu D, Cakir U, Yildiz D, Kilic A, Arsan S, Arman D, Unal S, Gelebek Y, Zengin H, Sen S, Cabadak H, Erbay A, Yalcin AN, Turhan O, Cengiz M, Dursun O, Gunasan P, Kaya S, Ramazanoglu A, Ustun C, Yasayacak A, Akdeniz H, Sirmatel F, Otkun AM, Sacar S, Sener A, Turgut H, Sungurtekin H, Ugurcan D, Necan C, Yilmaz C, Ozdemir D, Geyik MF, Ince N, Danis A, Erdogan SY, Erben N, Usluer G, Ozgunes I, Uzun C, Oncul O, Gorenek L, Erdem H, Baylan O, Ozgultekin A, Inan A, Bolukcu S, Senol G, Ozdemir H, Gokmen Z, Ozdemir SI, Kaya A, Ersoz G, Kuyucu N, Karacorlu S, Kaya Z, Guclu E, Kaya G, Karabay O, Esen S, Aygun C, Ulger F, Dilek A, Yilmaz H, Sunbul M, Engin A, Bakir M, Elaldi N, Koksal I, Yildizdas D, Horoz OO, Willke A, Koç MM, Azak E, Elahi N, Annamma P, El Houfi A, Pirez Garcia MC, Vidal H, Perez F, Empaire GD, Ruiz Y, Hernandez D, Aponte D, Salinas E, Diaz C, Guzmán Siritt ME, Gil De Añez ZD, Bravo LM, Orozco N, Mejías E, Hung NV, Anh NQ, Chau NQ, Thu TA, Phuong DM, Binh NG, Thi Diem Tuyet L, Thi Van Trang D, Hong Thoa VT, Tien NP, Anh Thu LT, Hang PT, My Hanh TT, Thuy Hang TT, Phuong Anh DP. International Nosocomial Infection Control Consortium (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module. Am J Infect Control 2014; 42:942-56. [PMID: 25179325 DOI: 10.1016/j.ajic.2014.05.029] [Citation(s) in RCA: 172] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2014] [Revised: 05/07/2014] [Accepted: 05/07/2014] [Indexed: 12/14/2022]
Abstract
We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care-associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line-associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN.
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Rello J, Lisboa T, Koulenti D. Respiratory infections in patients undergoing mechanical ventilation. THE LANCET RESPIRATORY MEDICINE 2014; 2:764-74. [PMID: 25151022 DOI: 10.1016/s2213-2600(14)70171-7] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Lower respiratory tract infections in mechanically ventilated patients are a frequent cause of antibiotic treatment in intensive-care units. These infections present as severe sepsis or septic shock with respiratory dysfunction in intubated patients. Purulent respiratory secretions are needed for diagnosis, but distinguishing between pneumonia and tracheobronchitis is not easy. Both presentations are associated with longlasting mechanical ventilation and extended intensive-care unit stay, providing a rationale for antibiotic treatment initiation. Differentiation of colonisers from true pathogens is difficult, and microbiological data show Staphylococcus aureus and Pseudomonas aeruginosa to be of great concern because of clinical outcomes and therapeutic challenges. Key management issues include identification of the pathogen, choice of initial empirical antibiotic, and decisions with regard to the resolution pattern.
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Affiliation(s)
- Jordi Rello
- Critical Care Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red Enfermedades Respiratorias, Barcelona, Spain; Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Thiago Lisboa
- Critical Care Department and Infection Control Committee, Programa de Pós-Graduação Pneumologia, Hospital de Clinicas de Porto Alegre, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; Rede Institucional de Pesquisa e Inovação em Medicina Intensiva, Complexo Hospitalar Santa Casa, Porto Alegre, Brazil
| | - Despoina Koulenti
- 2nd Critical Care Department, Attikon University Hospital, Athens, Greece; Burns Trauma and Critical Care Research Centre, The University of Queensland, Brisbane, QLD, Australia
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Stevens V, Geiger K, Concannon C, Nelson R, Brown J, Dumyati G. Inpatient costs, mortality and 30-day re-admission in patients with central-line-associated bloodstream infections. Clin Microbiol Infect 2014; 20:O318-24. [DOI: 10.1111/1469-0691.12407] [Citation(s) in RCA: 107] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Revised: 09/04/2013] [Accepted: 09/19/2013] [Indexed: 11/27/2022]
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Lee KC, Chao YFC, Wang YM, Lin PC. A nurse-family partnership intervention to increase the self-efficacy of family caregivers and reduce catheter-associated urinary tract infection in catheterized patients. Int J Nurs Pract 2014; 21:771-9. [DOI: 10.1111/ijn.12319] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Kwo-Chen Lee
- School of Nursing; China Medical University and Hospital; China Medical University; Taipei Taiwan
| | | | - Yueh-Mien Wang
- Department of Nursing; Taipei Medical University Hospital; Taipei Taiwan
| | - Pi-Chu Lin
- School of Nursing and Master Program in Long-Term Care; College of Nursing; Taipei Medical University; Taipei Taiwan
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Lee H, Chung KS, Park MS, Na S, Kim YS. Relationship of delayed parenteral nutrition protocol with the clinical outcomes in a medical intensive care unit. Clin Nutr Res 2014; 3:33-8. [PMID: 24527418 PMCID: PMC3921293 DOI: 10.7762/cnr.2014.3.1.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2013] [Revised: 12/19/2013] [Accepted: 12/27/2013] [Indexed: 01/15/2023] Open
Abstract
Although parenteral nutrition (PN) is an important treatment for patients who are unable to tolerate enteral nutrition (EN), recent international guidelines recommended that PN should be reserved and initiated only after 7 days in well-nourished patients. This retrospective study was conducted to analyze the effect on clinical outcomes of a PN protocol with PN starting 4 days after admission to the intensive care unit (ICU). Eighty-one patients who were admitted from January to March of 2012 were included in the pre-protocol group, and 74 patients who were admitted from April to June of 2012 were included in the post-protocol group. There were no significant differences between the two groups when the age, gender, and admission Acute Physiology and Chronic Health Evaluation (APACHE) II scores were compared. Significantly fewer patients in the post-protocol group were provided PN (58.1% vs. 81.3%, p = 0.002), which was initiated significantly later than in the pre-protocol group (2.7 ± 2.2 days vs. 1.9 ± 2.0 days, p = 0.046). Five patients (6.2%) in the pre-protocol group acquired central line-associated bloodstream infection (CLA-BSI) in the ICU, yet none of the patients in the post-protocol group developed CLA-BSI (p = 0.03). The duration of antibiotic therapy and ICU stay were significantly shorter in the post-protocol group than in the pre-protocol group. By delaying initiation of PN, short-term clinical outcomes including incidence of CLA-BSI, antibiotic use, and ICU stay might be improved. Further research should be conducted to investigate the long-term effects of the decreased nutrient intake resulting from delayed PN.
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Affiliation(s)
- Hosun Lee
- Department of Nutrition and Dietetics, Severance Hospital, Yonsei University Health System, Seoul 120-752, Korea
| | - Kyung Soo Chung
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Moo Suk Park
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Sungwon Na
- Department of Pain and Anesthesiology, Yonsei University College of Medicine, Seoul 120-752, Korea
| | - Young Sam Kim
- Department of Internal Medicine, Yonsei University College of Medicine, Seoul 120-752, Korea
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Erdem H, Dizbay M, Karabey S, Kaya S, Demirdal T, Koksal I, Inan A, Erayman I, Ak O, Ulu-Kilic A, Karasahin O, Akbulut A, Elaldi N, Yilmaz G, Candevir A, Gul HC, Gonen I, Oncul O, Aslan T, Azak E, Tekin R, Kocak Tufan Z, Yenilmez E, Arda B, Gungor G, Cetin B, Kose S, Turan H, Akalin H, Karabay O, Dogan-Celik A, Albayrak A, Guven T, Celebi G, Ozgunes N, Ersoy Y, Sirmatel F, Oztoprak N, Balkan II, Bayazit FN, Ucmak H, Oncu S, Ozdemir D, Ozturk-Engin D, Bitirgen M, Tabak F, Akata F, Willke A, Gorenek L, Ahmed SS, Tasova Y, Ulcay A, Dayan S, Esen S, Leblebicioglu H, Altun B, Unal S. Withdrawal of Staphylococcus aureus from intensive care units in Turkey. Am J Infect Control 2013; 41:1053-8. [PMID: 23663858 DOI: 10.1016/j.ajic.2013.01.041] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 01/23/2013] [Accepted: 01/24/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND In the past, Staphylococcus aureus infections have displayed various patterns of epidemiologic curves in hospitals, particularly in intensive care units (ICUs). This study aimed to characterize the current trend in a nationwide survey of ICUs in Turkey. METHODS A total of 88 ICUs from 36 Turkish tertiary hospitals were included in this retrospective study, which was performed during the first 3 months of both 2008 (period [P] 1) and 2011 (P2). A P value ≤.01 was considered significant. RESULTS Although overall rates of hospital-acquired infection (HAI) and device-associated infection densities were similar in P1 and P2, the densities of HAIs due to S aureus and methicillin-resistant S aureus (MRSA) were significantly lower in P2 (P < .0001). However, the proportion of HAIs due to Acinetobacter was significantly higher in P2 (P < .0001). CONCLUSIONS The incidence of S aureus infections is declining rapidly in Turkish ICUs, with potential impacts on empirical treatment strategies in these ICUs.
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Affiliation(s)
- Hakan Erdem
- Department of Infectious Diseases and Clinical Microbiology, GATA Haydarpasa Training Hospital, Istanbul, Turkey.
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Leblebicioglu H, Öztürk R, Rosenthal VD, Akan ÖA, Sirmatel F, Ozdemir D, Uzun C, Turgut H, Ersoz G, Koksal I, Özgültekin A, Esen S, Ulger F, Dilek A, Yilmaz H, Dikmen Y, Aygún G, Tulunay M, Oral M, Ünal N, Cengiz M, Yilmaz L, Geyik MF, Şahin A, Erdogan S, Sacar S, Sungurtekin H, Uğurcan D, Kaya A, Kuyucu N, Yýlmaz G, Kaya S, Ulusoy H, İnan A. Impact of a multidimensional infection control approach on central line-associated bloodstream infections rates in adult intensive care units of 8 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC). Ann Clin Microbiol Antimicrob 2013; 12:10. [PMID: 23641950 PMCID: PMC3674978 DOI: 10.1186/1476-0711-12-10] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Accepted: 02/23/2013] [Indexed: 02/07/2023] Open
Abstract
Background Central line-associated bloodstream infections (CLABs) have long been associated with excess lengths of stay, increased hospital costs and mortality attributable to them. Different studies from developed countries have shown that practice bundles reduce the incidence of CLAB in intensive care units. However, the impact of the bundle strategy has not been systematically analyzed in the adult intensive care unit (ICU) setting in developing countries, such as Turkey. The aim of this study is to analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce the rates of CLAB in 13 ICUs of 13 INICC member hospitals from 8 cities of Turkey. Methods We conducted active, prospective surveillance before-after study to determine CLAB rates in a cohort of 4,017 adults hospitalized in ICUs. We applied the definitions of the CDC/NHSN and INICC surveillance methods. The study was divided into baseline and intervention periods. During baseline, active outcome surveillance of CLAB rates was performed. During intervention, the INICC multidimensional approach for CLAB reduction was implemented and included the following measures: 1- bundle of infection control interventions, 2- education, 3- outcome surveillance, 4- process surveillance, 5- feedback of CLAB rates, and 6- performance feedback on infection control practices. CLAB rates obtained in baseline were compared with CLAB rates obtained during intervention. Results During baseline, 3,129 central line (CL) days were recorded, and during intervention, we recorded 23,463 CL-days. We used random effects Poisson regression to account for clustering of CLAB rates within hospital across time periods. The baseline CLAB rate was 22.7 per 1000 CL days, which was decreased during the intervention period to 12.0 CLABs per 1000 CL days (IRR 0.613; 95% CI 0.43 – 0.87; P 0.007). This amounted to a 39% reduction in the incidence rate of CLAB. Conclusions The implementation of multidimensional infection control approach was associated with a significant reduction in the CLAB rates in adult ICUs of Turkey, and thus should be widely implemented.
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