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Matlab AA, Al-Hussami MO, Alkaid Albqoor M. Knowledge and compliance to prevention of central line-associated blood stream infections among registered nurses in Jordan. J Infect Prev 2022; 23:133-141. [PMID: 37256157 PMCID: PMC10226055 DOI: 10.1177/17571774211066778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/20/2023] Open
Abstract
Background Central line-associated bloods tream infections (CLABSIs) are among the most common healthcare-associated infections (HAIs). Aims To assess the rates of CLABSIs and to investigate predictors of knowledge and compliance of registered nurses to central venous catheters (CVCs) maintenance care bundle in intensive care units (ICUs). Methods A cross-sectional correlational design was used. A convenient sample of 114 registered nurses was selected from three hospitals in Jordan. Nurses' knowledge and compliance were measured by previously established measures and an observational checklist developed according to the Center for Disease Control and Prevention (CDC). Findings The rate of CLABSI was the lowest in the hospital that applies the CVC bundle of care. Nurses' knowledge about CLABSI prevention practices was significantly correlated with their compliance to CVCs maintenance care bundle. Nurses' knowledge differed bytheirage, income, experience in ICU, and nurse-to-patient ratio, and in multiple regressions, age was the single predictor of knowledge of CLABSI prevention. Significant differences were also found in nurses' compliance to the CVC care bundle according to the hospital and nurse-to-patient ratio. The nurse-to-patient ratio was the single significant predictor, and it attenuated the effect of age and income on nurse's compliance to the CVC care bundle. Conclusion This study indicated the need to expand the application of the CVC maintenance care bundle in hospitals. Programs that target promoting nurses' knowledge about CLABSI prevention and compliance to CVC care need to consider some factors, such as nurses' age and the circumstances of their work (nurse-to-patient ratio).
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Affiliation(s)
| | | | - Maha Alkaid Albqoor
- Department of Community Health, School of
Nursing, The University of Jordan, Jordan
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Al-Kharabsheh R, Ahmad M, Al Soudi M, Al-Ramadneh A. Wound Infection Incidence and Obesity in Elective Cesarean Sections in Jordan. Med Arch 2021; 75:138-143. [PMID: 34219874 PMCID: PMC8228642 DOI: 10.5455/medarh.2021.75.138-143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Wound infection is a challenge that face healthcare facilities. Objective: The aim of the study was to assess the effect of obesity on wound infection incidence. Methods: A prospective study involved 127 patients underwent elective Cesarean section surgeries in the first ten months of 2018 with a follow up period of 90 days. Results: The wound infection incidence was 37.8%; the suture infection was 15.7% and SSI was 22%, which divided into: the superficial SSI among 23 (82.1%) patients, and deep tissue SSI among five (17.9%) patients. Obese patients with BMI of 30 kg/m2 or more were significantly at higher risk for wound infections than those whose BMI less than 30 kg/m2 (p= 0.02, relative risk= 2.363). Conclusion: Obese patients who underwent Cesarean sections were found to have higher risk to develop wound infections. A larger scale study is needed to determine other associated risk factors.
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Affiliation(s)
| | - Muayyad Ahmad
- School of Nursing; The University of Jordan, Amman, Jordan
| | - Majdi Al Soudi
- Jordanian Royal Medical Services/ Army Forces, Amman, Jordan
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Aloush SM, Al-Rawajfa OM. Prevention of ventilator-associated pneumonia in intensive care units: Barriers and compliance. Int J Nurs Pract 2020; 26:e12838. [PMID: 32293064 DOI: 10.1111/ijn.12838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 03/22/2020] [Indexed: 12/27/2022]
Abstract
AIM The purpose of this study was to evaluate the compliance of Jordanian nurses with ventilator-associated pneumonia prevention guidelines and the barriers to compliance. METHOD A descriptive, cross-sectional design was used. A convenience sample of 294 nurses from nine hospitals in Jordan completed a self-reported questionnaire. RESULTS According to the study compliance categories, 45.6% of the participants reported 'insufficient compliance,' 24.8% 'weak compliance' and 29.6% 'sufficient compliance.' Nurses with more experience and previous education on ventilator-associated pneumonia reported higher compliance scores than their counterparts with less experience and no previous education. Nurses reported several barriers that limited their own compliance, such as lack of education, lack of policies and protocols, lack of resources and the shortage of staff. CONCLUSION The compliance of nursing staff with the prevention guidelines was poor. Applying tailored educational programs may help improve their level of compliance. These programs must target new graduate nurses and be conducted in those hospitals with limited resources.
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Affiliation(s)
- Sami M Aloush
- School of Nursing, Al al-Bayt University, Mafraq, Jordan
| | - Omar M Al-Rawajfa
- School of Nursing, Al al-Bayt University, Mafraq, Jordan.,College of Nursing, , Sultan Qaboos University, AlKhoud, Oman
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Aloush SM. Does educating nurses with ventilator-associated pneumonia prevention guidelines improve their compliance? Am J Infect Control 2017; 45:969-973. [PMID: 28526315 DOI: 10.1016/j.ajic.2017.04.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 04/05/2017] [Accepted: 04/05/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND This study aimed to compare the compliance with ventilator-associated pneumonia (VAP)-prevention guidelines between nurses who underwent an intensive educational program and those who did not, and to investigate other factors that influence nurses' compliance. METHOD A 2-group posttest design was used to examine the effect of the VAP-prevention guidelines education on nurses' compliance. Participants were randomly assigned to experimental and control groups. RESULTS The overall nurses' compliance scores were moderate. There was no statistically significant difference in compliance between the nurses who received VAP education and those who did not (t[100] = -1.43; P = .15). The number of beds in the unit and the nurse-patient ratio were found to influence nurses' compliance. CONCLUSION Education in VAP-prevention guidelines will not improve nurses' compliance unless other confounding factors, such as their workload, are controlled. It is imperative to reduce nurses' workload to improve their compliance and enhance the effectiveness of education.
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Inan D, Saba R, Yalcin AN, Yilmaz M, Ongut G, Ramazanoglu A, Mamikoglu L. Device-Associated Nosocomial Infection Rates in Turkish Medical-Surgical Intensive Care Units. Infect Control Hosp Epidemiol 2016; 27:343-8. [PMID: 16622810 DOI: 10.1086/503344] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2004] [Accepted: 09/28/2004] [Indexed: 11/03/2022]
Abstract
Objective.To describe the incidence of device-associated nosocomial infections in medical-surgical intensive care units (MS ICUs) in a university hospital in Turkey and compare it with National Nosocomial Infections Surveillance (NNIS) system rates.Design.Prospective surveillance study during a period of 27 months. Device utilization ratios and device-associated infection rates were calculated using US Centers for Disease Control and Prevention and NNIS definitions.Setting.Two separate MS ICUs at Akdeniz University Hospital, Antalya, Turkey.Patients.All patients were included who presented with no signs and symptoms of infection within the first 48 hours after admission.Results.Data on 1,985 patients with a total of 16,892 patient-days were analyzed. The mean overall infection rate per 100 patients was 29.1 infections, and the mean infection rate per 1,000 patient-days was 34.2 infections. The rate of ventilator-associated pneumonia was 20.76 infections per 1,000 ventilator-days, the rate of catheter-associated urinary tract infection was 13.63 infections per 1,000 urinary catheter–days, and the rate of catheter-associated bloodstream infection was 9.69 infections per 1,000 central line–days. The most frequently isolated pathogens were Pseudomonas species among patients with ventilator-associated pneumonias (35.8% of cases), Candida species among patients with catheter-associated urinary tract infections (37.1% of cases), and coagulase-negative staphylococci among patients with catheter-associated bloodstream infections (20.0% of cases).Conclusion.We found both higher device-associated infection rates and higher device utilization ratios in our MS ICUs than those reported by the NNIS system. To reduce the rate of infection, implementation of infection control practices and comprehensive education are required, and an appropriate nationwide nosocomial infection and control system is needed in Turkey.
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Affiliation(s)
- Dilara Inan
- Department of Infectious Diseases and Clinical Microbiology, Tip Fakultesi, Infeksiyon Hastaliklari AD, University of Adkeniz, 07050 Antalya, Turkey.
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Hieda M, Sata M, Nakatani T. The Importance of the Management of Infectious Complications for Patients with Left Ventricular Assist Device. Healthcare (Basel) 2015; 3:750-6. [PMID: 27417794 PMCID: PMC4939583 DOI: 10.3390/healthcare3030750] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 07/31/2015] [Accepted: 08/18/2015] [Indexed: 12/04/2022] Open
Abstract
A left ventricular assist device (LVAD) therapy is the viable option for patients with advanced heart failure as a bridge to transplantation, bridge to recovery, or destination therapy. Although application of LVAD support has become a standard option, serious complications or adverse events related with LVAD remain a concern. LVAD-related infection including driveline infection (DLI) and bloodstream infection (BSI) is one of the serious clinical matters for LVAD patients, and especially BSI leads to the high incidence of mortality. The LVAD-related infections negatively impact patient’s quality of life. Therefore, control of infection is one of the primary goals of management in LVAD patients. Several efforts including early and appropriate intervention including antibiotics and wound care may contribute to avert the progress into BSI from localized DLI. Particularly, there are clinical secrets in how to use antibiotics and how to treat wound care in LVAD patients. The rational way of thinking for wound care will be introduced in this review.
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Affiliation(s)
- Michinari Hieda
- Departments of Transplantation, National Cerebral and Cardiovascular Center, Osaka 565-0873, Japan.
| | - Makoto Sata
- Pulmonology and Infection Control, National Cerebral and Cardiovascular Center, Osaka 565-0873, Japan.
| | - Takeshi Nakatani
- Departments of Transplantation, National Cerebral and Cardiovascular Center, Osaka 565-0873, Japan.
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Kanafani ZA, Kara L, Hayek S, Kanj SS. Ventilator-Associated Pneumonia at a Tertiary-Care Center in a Developing Country: Incidence, Microbiology, and Susceptibility Patterns of Isolated Microorganisms. Infect Control Hosp Epidemiol 2015; 24:864-9. [PMID: 14649777 DOI: 10.1086/502151] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AbstractObjective:Ventilator-associated pneumonia (VAP) complicates the course of up to 24% of intubated patients. Data from the Middle East are scarce. The objective of this study was to evaluate the incidence, microbiology, and antimicrobial susceptibility patterns of isolated microorganisms in VAP in a developing country.Design:Prospective observational cohort study.Setting:The American University of Beirut Medical Center, a tertiary-care center that serves as a major referral center for Lebanon and neighboring countries.Patients:All patients admitted to the intensive care and respiratory care units from March to September 2001, and who had been receiving mechanical ventilation for at least 48 hours, were included in the study. Results of samples submitted for culture were recorded and antimicrobial susceptibility testing of isolated pathogens was performed.Results:Seventy patients were entered into the study. The incidence of VAP was 47%. Gram-negative bacilli accounted for 83% of all isolates. The most commonly identified organism was Acinetobacter anitratus, followed by Pseudomonas aeruginosa. Fifty percent of all gram-negative bacterial isolates were classified as antibiotic resistant. Compared with patients without VAP, patients with VAP remained intubated for a longer period and stayed in the intensive care unit longer. VAP was not associated with an increased mortality rate.Conclusion:Compared with other studies, the results from this referral center in Lebanon indicate a higher incidence of VAP and a high prevalence of resistant organisms. These data are relevant because they direct the choice of empiric antibiotic therapy for VAP.
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Affiliation(s)
- Zeina A Kanafani
- Department of Medicine, Division of Infectious Diseases, American University of Beirut Medical Center, Beirut, Lebanon
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Yilmaz G, Caylan R, Aydin K, Topbas M, Koksal I. Effect of Education on the Rate of and the Understanding of Risk Factors for Intravascular Catheter–Related Infections. Infect Control Hosp Epidemiol 2015; 28:689-94. [PMID: 17520542 DOI: 10.1086/517976] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2006] [Accepted: 10/10/2006] [Indexed: 11/03/2022]
Abstract
Objective.Intravascular catheters are indispensable tools in modern medical therapy. In spite of their great benefits, however, the widespread use of catheters leads to several complications, including infections that cause significant morbidity, mortality, and economic losses for hospitalized patients.Design.This study was conducted at Farabi Hospital, a 495-bed facility at Karadeniz Technical University Medical School in Trabzon, Turkey, and involved 3 separate periods: preeducation, education, and posteducation. Patients with intravascular catheters were monitored daily, as were the results of their physical examinations. The information acquired was recorded in a questionnaire.Results.During the preeducation period (October 2003 through March 2004), 405 intravascular catheters inserted into 241 patients were observed for 5,445 catheter-days. Seventy-one cases of intravascular catheter-related infection (CRI) were identified, giving a CRI rate of 13.04 infections per 1,000 catheter-days. The catheter-related bloodstream infection (CRBSI) rate was 8.3 infections per 1,000 catheter-days, and the exit-site infection (ESI) rate was 3.5 infections per 1,000 catheter-days. During the posteducation period (June through November 2004), 365 intravascular catheters inserted into 193 patients were observed for 5,940 catheter-days. Forty-five cases of CRI were identified, giving a rate of 7.6 infections per 1,000 catheter-days. The CRBSI rate was 4.7 infections per 1,000 catheter-days, and the ESI rate was 2.2 infections per 1,000 catheter-days. When findings from the 2 periods were compared, it was determined that education reduced CRI incidence by 41.7%.Conclusion.CRI can be prevented when hospital personnel are well informed about these infections. We compared the knowledge levels of the relevant personnel in our hospital before and after theoretical and practical training and identified a significant increase in knowledge after training (P < .0001 ). Parallel to this, although still below ideal levels, we identified a significant improvement in the incidence of CRI during the posteducation period (P = .004). The rate was low for the first 3 months of this period but increased 2.08 times after the third month. In conclusion, regular training for the residents in charge of inserting intravascular catheters and the nurses and interns who maintain the catheters is highly effective in reducing the rate of CRI in large teaching hospitals.
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Affiliation(s)
- G Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey.
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O'grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, Mccormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA; Healthcare Infection Control Practices Advisory Committee. Guidelines for the Prevention of Intravascular Catheter–Related Infections. Infect Control Hosp Epidemiol 2002; 23:759-69. [DOI: 10.1017/s0195941700080577] [Citation(s) in RCA: 157] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background:Although many catheter-related blood-stream infections (CRBSIs) are preventable, measures to reduce these infections are not uniformly implemented.Objective:To update an existing evidenced-based guideline that promotes strategies to prevent CRBSIs.Data Sources:The MEDLINE database, conference proceedings, and bibliographies of review articles and book chapters were searched for relevant articles.Studies Included:Laboratory-based studies, controlled clinical trials, prospective interventional trials, and epidemiologic investigations.Outcome Measures:Reduction in CRBSI, catheter colonization, or catheter-related infection.Synthesis:The recommended preventive strategies with the strongest supportive evidence are education and training of healthcare providers who insert and maintain catheters; maximal sterile barrier precautions during central venous catheter insertion; use of a 2% chlorhexidine preparation for skin antisepsis; no routine replacement of central venous catheters for prevention of infection; and use of antiseptic/antibiotic-impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (ie, education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis).Conclusion:Successful implementation of these evidence-based interventions can reduce the risk for serious catheter-related infection.
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Chen CH, Huang CC. Tracing the emergence of multidrug-resistant Acinetobacter baumannii in a Taiwanese hospital by evaluating the presence of integron gene intI1. J Negat Results Biomed 2014; 13:15. [PMID: 25123361 PMCID: PMC4155391 DOI: 10.1186/1477-5751-13-15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Accepted: 08/08/2014] [Indexed: 11/16/2022] Open
Abstract
Background In Changhua County, Taiwan, the number of clinical Acinetobacter baumannii isolates has risen since 2002, and multidrug-resistant Acinetobacter baumannii (MDRAB) has spread rapidly throughout Taiwan. In this study, to reveal the mechanism involved with the rapid dissemination of MDRAB emergence, the utility of the class 1 integron, intI1 integrase gene, as an MDRAB-associated biomarker was examined. A cross-sectional, clinical epidemiological study was performed at Changhua Christian Hospital between January 1st, 2001 and December 31st, 2004. Besides the existence of intI1 gene was examined, the pulse-field gel electrophoresis (PFGE) was also performed to determine the epidemiological characteristics of the isolates. Findings The overall hospital infection rate was 5–6%, while the infection rate of the intensive care unit (ICU) fluctuated. No positive correlation was observed between MDRAB isolates and the presence of intI1 (r = 0.168, P = 0.254). Additionally, no positive correlation was observed between the infection rate in the ICU and the presence of intI1 (r = -0.107, P = 0.468) or between the hospital infection rate and the presence of intI1 (r = -0.189, P = 0.199). However, two predominant clones among the MDRAB isolates were identified by PFGE. Conclusions Although the presence of the intI1 gene does not seem suitable for tracing MDRAB emergence in Changhua County, two predominant clones were identified by PFGE, and subsequent studies to identify whether these clones were responsible for original nosocomial infection are needed.
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Affiliation(s)
| | - Chieh-Chen Huang
- College of Life Science, National Chung Hsing University, 250 Kuo-Kuang Road, Taichung 402, Taiwan.
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Hieda M, Sata M, Seguchi O, Yanase M, Murata Y, Sato T, Sunami H, Nakajima S, Watanabe T, Hori Y, Wada K, Hata H, Fujita T, Kobayashi J, Nakatani T. Importance of Early Appropriate Intervention Including Antibiotics and Wound Care for Device-Related Infection in Patients With Left Ventricular Assist Device. Transplant Proc 2014; 46:907-10. [DOI: 10.1016/j.transproceed.2013.11.106] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Accepted: 11/15/2013] [Indexed: 11/16/2022]
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AL-Rawajfah OM, Cheema J, Hewitt JB, Hweidi IM, Musallam E. Laboratory-confirmed, health care-associated bloodstream infections in Jordan: a matched cost and length of stay study. Am J Infect Control 2013; 41:607-11. [PMID: 23332723 DOI: 10.1016/j.ajic.2012.08.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2012] [Revised: 08/22/2012] [Accepted: 08/23/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND No studies have been carried out in Jordan to examine length of stay (LOS) and extra cost associated with health care-associated bloodstream infections (HCABSIs). This study aims to estimate the extra LOS and cost associated with HCABSIs among adult hospitalized Jordanian patients. METHODS Five-year data were retrieved from 1 large university-affiliated hospital in Jordan. Matched case-control design was used in this study. Cases were determined based on confirmed positive blood culture after 48 hours of admission. Matching criteria were age (±5 years), gender, admission diagnosis, and LOS in comparison group equal to the LOS (±5%) before blood culture for the case group. RESULTS Of the total 445 infected patients 125 (28.1%) were matched with uninfected patients. The mean LOS after infection for cases was 12.1 days (standard deviation [SD] = 17.2) compared with 8.3 (SD = 7.9) days for the controls (P = .02). The total mean inflation-adjusted charges for cases was M (mean) = US $7,426, SD = $7,252 compared with M = $3,274, SD = $4,209 for controls, P < .001. Using multiple regression modeling, LOS after acquiring HCABSIs, admission to critical care units, and being infected with HCABSIs were significant predictors of patients' total charges. CONCLUSION Figures generated from this can be used to inform health care researchers, policy makers, and professionals about the impact of HCABSIs.
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AL-Rawajfah OM, Cheema J, Hweidi IM, Hewitt JB, Musallam E. Laboratory confirmed health care-associated bloodstream infections: A Jordanian study. J Infect Public Health 2012; 5:403-11. [DOI: 10.1016/j.jiph.2012.08.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2012] [Revised: 07/08/2012] [Accepted: 08/09/2012] [Indexed: 02/06/2023] Open
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Trethon A, Prinz G, Varga A, Kocsis I. Characteristics of nosocomial bloodstream infections at a Hungarian cardiac surgery centre. Acta Microbiol Immunol Hung 2012; 59:271-83. [PMID: 22750787 DOI: 10.1556/amicr.59.2012.2.12] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Nosocomial bloodstream infection (BSI) is a common finding in cardiac surgery intensive care units and is associated with excess mortality and hospital costs. Additional data are needed about incidence, characteristics, predictors, associated microorganisms of nosocomial BSI in cardiac surgical patients in order to refine measures to prevent nosocomial infections and to improve recovery outcomes in this patient population. The 3912 cardio-thoracic surgery patients from all age groups were admitted to the study at the Gottsegen György Hungarian Institute of Cardiology between January 1999 and December 2000. In each patient with BSI demographic, epidemiological and clinical variables were recorded along with potential risk factors. Incidence of associated pathogens and their possible sources were evaluated and outcome and mortality risk factors were assessed. There were a total of 134 episodes of BSI. The incidence was 34.25 per 1000 admissions. The leading microorganisms were staphylococci (37.7%). Bacteremic episodes developed secondary to an identifiable source in 27.6% of the cases, or were catheter-related (16.4%). In 56% of the cases the source was not identified. The crude mortality rate was 33.3%. Higher mortality rate was associated with intracardial grafts (p < 0.05), low left ventricular ejection fraction (p < 0.04), diabetes mellitus (p < 0.05), an age above 16 years (p < 0.02), severe sepsis (p < 0.001) and high APACHE II score (p < 0.001). As the identified main sources of BSI were intravascular lines, mortality from BSI could probably be reduced by paying more attention to the prevention, early recognition and prompt management of intravascular device associated infections.
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Affiliation(s)
- András Trethon
- 1 Egyesített Szent István és Szent László Kórház Budapest Hungary
| | - Gyula Prinz
- 1 Egyesített Szent István és Szent László Kórház Budapest Hungary
| | - Andrea Varga
- 2 Gottsegen György Hungarian Institute of Cardiology Budapest Hungary
| | - István Kocsis
- 3 Semmelweis University of Medicine Department of Anaesthesiology and Intensive Care Budapest Hungary
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Allegranzi B, Bagheri Nejad S, Combescure C, Graafmans W, Attar H, Donaldson L, Pittet D. Burden of endemic health-care-associated infection in developing countries: systematic review and meta-analysis. Lancet 2011; 377:228-41. [PMID: 21146207 DOI: 10.1016/s0140-6736(10)61458-4] [Citation(s) in RCA: 1255] [Impact Index Per Article: 96.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Health-care-associated infection is the most frequent result of unsafe patient care worldwide, but few data are available from the developing world. We aimed to assess the epidemiology of endemic health-care-associated infection in developing countries. METHODS We searched electronic databases and reference lists of relevant papers for articles published 1995-2008. Studies containing full or partial data from developing countries related to infection prevalence or incidence-including overall health-care-associated infection and major infection sites, and their microbiological cause-were selected. We classified studies as low-quality or high-quality according to predefined criteria. Data were pooled for analysis. FINDINGS Of 271 selected articles, 220 were included in the final analysis. Limited data were retrieved from some regions and many countries were not represented. 118 (54%) studies were low quality. In general, infection frequencies reported in high-quality studies were greater than those from low-quality studies. Prevalence of health-care-associated infection (pooled prevalence in high-quality studies, 15·5 per 100 patients [95% CI 12·6-18·9]) was much higher than proportions reported from Europe and the USA. Pooled overall health-care-associated infection density in adult intensive-care units was 47·9 per 1000 patient-days (95% CI 36·7-59·1), at least three times as high as densities reported from the USA. Surgical-site infection was the leading infection in hospitals (pooled cumulative incidence 5·6 per 100 surgical procedures), strikingly higher than proportions recorded in developed countries. Gram-negative bacilli represented the most common nosocomial isolates. Apart from meticillin resistance, noted in 158 of 290 (54%) Staphylococcus aureus isolates (in eight studies), very few articles reported antimicrobial resistance. INTERPRETATION The burden of health-care-associated infection in developing countries is high. Our findings indicate a need to improve surveillance and infection-control practices. FUNDING World Health Organization.
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Hassan ZM, Pryor ER, Autrey PS, Turner JG. Hand Hygiene Compliance and Nurse-Patient Ratio Using Videotaping and Self Report. Infectious Diseases in Clinical Practice 2009; 17:243-7. [DOI: 10.1097/ipc.0b013e318195e1bf] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hassan ZM, Wahsheh MA, Hindawi OS. Understanding Hand Hygiene Behavior Among Jordanian Registered Nurses. Infectious Diseases in Clinical Practice 2009; 17:150-156. [DOI: 10.1097/ipc.0b013e31818cd65f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Arabi Y, Al-Shirawi N, Memish Z, Anzueto A. Ventilator-associated pneumonia in adults in developing countries: a systematic review. Int J Infect Dis. 2008;12:505-512. [PMID: 18502674 DOI: 10.1016/j.ijid.2008.02.010] [Citation(s) in RCA: 90] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2007] [Revised: 01/03/2008] [Accepted: 02/04/2008] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Ventilator-associated pneumonia (VAP) is a leading cause of death in hospitalized patients, but there has been no systematic analysis of the incidence, microbiology, and outcome of VAP in developing countries or of the interventions most applicable in that setting. METHODS We reviewed MEDLINE (January 1966-April 2007) and bibliographies of the retrieved articles for all observational or interventional studies that examined the incidence, microbiology, outcome, and prevention of VAP in ventilated adults in developing countries. We evaluated the rates of VAP using the National Healthcare Safety Network (NHSN) definitions and the impact of VAP on the intensive care unit (ICU) length of stay (LOS) and mortality, and the impact of interventions used to reduce VAP rates. RESULTS The rates of VAP varied from 10 to 41.7 per 1000 ventilator-days and were generally higher than NHSN benchmark rates. Gram-negative bacilli were the most common pathogens (41-92%), followed by Gram-positive cocci (6-58%). VAP was associated with a crude mortality that ranged from 16% to 94% and with increased ICU LOS. Only a small number of VAP intervention studies were performed; these found that staff education programs, implementation of hand hygiene, and VAP prevention practice guidelines, and/or implementation of sedation protocol were associated with a significant reduction in VAP rates. Only one interventional study was a randomized controlled trial comparing two technologies, the rest were sequential observational. This study compared a heat and moisture exchanger (HME) to a heated humidifying system (HHS) and found no difference in VAP rates. CONCLUSIONS Based on the existing literature, the rate of VAP in developing countries is higher than NHSN benchmark rates and is associated with a significant impact on patient outcome. Only a few studies reported successful interventions to reduce VAP. There is a clear need for additional epidemiologic studies to better understand the scope of the problem. Additionally, more work needs to be done on strategies to prevent VAP, probably with emphasis on practical, low-cost, low technology, easily implemented measures.
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Turgut H, Sacar S, Okke D, Kavas ST, Asan A, Kutlu SS. Evaluation of Device Associated Infection Rates in Intensive Care Units of Pamukkale University Hospital. Infection 2008; 36:262-5. [DOI: 10.1007/s15010-008-6346-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2007] [Accepted: 01/29/2008] [Indexed: 11/27/2022]
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Zimmerman PA. Help or hindrance? Is current infection control advice applicable in low- and middle-income countries? A review of the literature. Am J Infect Control 2007; 35:494-500. [PMID: 17936139 DOI: 10.1016/j.ajic.2007.07.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2006] [Revised: 07/02/2007] [Accepted: 07/03/2007] [Indexed: 11/20/2022]
Abstract
BACKGROUND High-income countries with established infection control programs have demonstrated effective control of infection transmission in health care settings. The guidelines and advice underlying these effective control programs have been produced by high-income countries for their own social, economic, and health environments. These have also been adopted by low- and middle-income (LMI) countries, but these countries appear to have a limited ability to apply these principles using the same methods. METHODS A systematic search for literature published in English was conducted exploring the relationship between the available infection prevention and control advice and the capacity of LMI countries to apply this guidance in their health care settings. Articles relevant to this exploration were identified and subsequently informed further search terms and identified other significant documents. RESULTS Infection control guidelines designed for high-income countries are being utilized by LMI countries, with varying degrees of success mainly because of physical, environmental, and socioeconomic factors. There is a lack of published studies exploring the implementation of comprehensive infection control advice and programs, including the minimal advice, which is designed specifically for resource-limited settings. CONCLUSION What is evident from the literature is that there is a need for the development of infection control and prevention guidelines based on evidence but adapted to the specific needs of health care workers in LMI countries. This must be done in collaboration with those same LMI countries' health care workers. Equally, because of finance and health priorities, health care facilities should choose those interventions most relevant to the needs of their population and workers to prevent infection transmission. Opportunities for further research into application of available infection control advice in LMI countries are identified. Through such research, more appropriate advice may be devised to assist with the development of infection control programs in these settings.
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Brown S, Kurtsikashvili G, Alonso-Echanove J, Ghadua M, Ahmeteli L, Bochoidze T, Shushtakashvili M, Eremin S, Tsertsvadze E, Imnadze P, O'Rourke E. Prevalence and predictors of surgical site infection in Tbilisi, Republic of Georgia. J Hosp Infect 2007; 66:160-6. [PMID: 17513010 DOI: 10.1016/j.jhin.2007.03.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2006] [Accepted: 03/07/2007] [Indexed: 10/23/2022]
Abstract
Surgical site infections (SSIs) are a serious problem worldwide. Little is known about the epidemiology of SSI in the former Soviet Union. In order to determine the prevalence and predictors of SSI in the Republic of Georgia, we undertook a multicentre observational study of SSIs in three urban hospitals in the capital, Tbilisi. Point prevalence studies (PPS) were performed every 3-5 weeks from September 2000 to January 2002 using the National Nosocomial Infections Surveillance (NNIS) System definitions. All patients who had undergone surgery and were present in participating departments at study hospitals on the day of PPS were included. Of 872 surgical procedures, 146 (16.7%) were complicated by SSI. The prevalence of SSI varied by procedure and risk category. On multivariate regression analysis, age, wound class, one hospital (B) and urological surgery were predictive of SSI. In a separate model, NNIS risk index was highly predictive of SSI. Antibiotic prophylaxis was rare (29.5% of operations), while postoperative antibiotic use was common. SSI is an important problem in the Republic of Georgia. Potential areas for intervention include antibiotic prophylaxis and shaving practices for skin preparation.
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Affiliation(s)
- S Brown
- Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA.
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Ohara H, Viet Hung N, Anh Thu T, Quy T. Report on Japan-Vietnam collaboration in nosocomial infection control at Bach Mai Hospital, Hanoi from 2000 to 2006. Trop Med Health 2007. [DOI: 10.2149/tmh.35.253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Abstract
OBJECTIVE To give critical care clinicians in Western nations a general overview of intensive care medicine in less developed countries and to stimulate institutional or personal initiatives to improve critical care services in the least developed countries. DATA SOURCE In-depth PubMed search and personal experience of the authors. DATA SYNTHESIS In view of the eminent burden of disease, prevalence of critically ill patients in the least developed countries is disproportionately high. Despite fundamental logistic (water, electricity, oxygen supply, medical technical equipment, drugs) and financial limitations, intensive care medicine has become a discipline of its own in most nations. Today, many district and regional hospitals have units where severely ill patients are separately cared for, although major intensive care units are only found in large hospitals of urban or metropolitan areas. High workload, low wages, and a high risk of occupational infections with either the human immunodeficiency virus or a hepatitis virus explain burnout syndromes and low motivation in some health care workers. The four most common admission criteria to intensive care units in least developed countries are postsurgical treatment, infectious diseases, trauma, and peripartum maternal or neonatal complications. Logistic and financial limitations, as well as insufficiencies of supporting disciplines (e.g., laboratories, radiology, surgery), poor general health status of patients, and in many cases delayed presentation of severely sick patients to the intensive care unit, contribute to comparably high mortality rates. CONCLUSION More studies on the current state of intensive care medicine in least developed countries are needed to provide reasonable aid to improve care of the most severely ill patients in the poorest countries of the world.
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Affiliation(s)
- Martin W Dünser
- Division of General and Surgical Intensive Care Medicine, Department of Anesthesiology and Critical Care Medicine, Innsbruck Medical University, Austria
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Almuneef MA, Memish ZA, Balkhy HH, Hijazi O, Cunningham G, Francis C. Rate, risk factors and outcomes of catheter-related bloodstream infection in a paediatric intensive care unit in Saudi Arabia. J Hosp Infect 2006; 62:207-13. [PMID: 16307822 DOI: 10.1016/j.jhin.2005.06.032] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2005] [Accepted: 06/30/2005] [Indexed: 11/26/2022]
Abstract
The aim of this study was to determine the rate, risk factors and outcomes of catheter-related bloodstream infections (CRBSIs) in patients in a paediatric intensive care unit (PICU). A prospective cohort study was performed in King Abdulaziz Medical City, Riyadh, Saudi Arabia; a 650-bed academic/tertiary care centre with a combined 10-bed medical and surgical PICU. All patients admitted to the PICU from July 2000 to February 2003 who had a central line placed were monitored for the development of bloodstream infection (BSI) from insertion until 48 h after removal. Four hundred and forty-six patients with 2493 central-line-days were documented; 273 (55%) were male and the mean age was 2.6 years. Of the 446 patients, 278 (56%) had congenital heart disease, 108 (22%) had genetic disorders and/or congenital malformations, 55 (11%) had respiratory disease, and 42 (8%) had trauma. There were 50 episodes of CRBSI in 46 patients with a rate of 20.06 per 1,000 central-line-days and a device-utilization rate of 57%. Of these 50 episodes, 24 (48%) were polymicrobial, 16 (32%) were due to Gram-negative organisms, five (10%) were due to Gram-positive organisms, and five (10%) were fungal. The most common organisms isolated were Klebsiella pneumoniae (N=12, 16%), coagulase-negative staphylococci (N=10, 14%) and Pseudomonas aeruginosa (N=8, 11%). The mean duration of line insertion was 11.8 days for CRBSI patients and 4.22 days for non-BSI patients (P<0.0001). The mean PICU stay was 30.20 days for CRBSI patients and 6.35 days for non-BSI patients (P<0.0001). BSI occurred more often in catheters inserted in the PICU compared with the operating room, and in the femoral site compared with jugular or subclavian sites (P<0.001). In multiple logistic regression analysis of the risk factors, CRBSI patients were more likely to have multiple central lines [odds ratio (OR) 9.19; 95% confidence intervals (CI): 3.76-22.43), the line was more likely to be used for total parenteral nutrition (OR: 8.69; 95% CI: 3.5-21.4), and guidewire exchange was more likely to be performed on the line. CRBSI was not associated with a higher mortality rate. The CRBSI rate in our hospital is high compared with that reported by the National Nosocomial Infection Surveillance system. This study has established a benchmark for future comparisons. Additional studies from Saudi Arabia are necessary for national comparison and development of preventive measures.
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Affiliation(s)
- M A Almuneef
- Department of Infection Prevention and Control, King Abdulaziz Medical City/King Fahad National Guard Hospital, Riyadh, Saudi Arabia
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Almuneef M, Memish ZA, Balkhy HH, Alalem H, Abutaleb A. Ventilator-associated pneumonia in a pediatric intensive care unit in Saudi Arabia: a 30-month prospective surveillance. Infect Control Hosp Epidemiol 2004; 25:753-8. [PMID: 15484800 DOI: 10.1086/502472] [Citation(s) in RCA: 76] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To describe the rate, risk factors, and outcome of ventilator-associated pneumonia (VAP) in pediatric patients. METHODS This prospective surveillance study of VAP among all patients receiving mechanical ventilation for 48 hours or more admitted to a pediatric intensive care unit (PICU) in Saudi Arabia from May 2000 to November 2002 used National Nosocomial Infections Surveillance (NNIS) System definitions. RESULTS Three hundred sixty-one eligible patients were enrolled. Most were Saudi with a mean age of 28.6 months. Thirty-seven developed VAP. The mean VAP rate was 8.87 per 1,000 ventilation-days with a ventilation utilization rate of 47%. The mean duration of mechanical ventilation was 21 days for VAP patients and 10 days for non-VAP patients. The mean PICU stay was 34 days for VAP patients and 15 days for non-VAP patients. Among VAP patients, Pseudomonas aeruginosa was the most common organism, followed by Staphylococcus aureus. Other gram-negative organisms were also encountered. There was no significant difference between VAP and non-VAP patients regarding mortality rate. Witnessed aspiration, reintubation, prior antibiotic therapy, continuous enteral feeding, and bronchoscopy were associated with VAP. On multiple logistic regression analysis, only prior antibiotic therapy, continuous enteral feeding, and bronchoscopy were independent predictors of VAP. CONCLUSIONS The mean VAP rate in this hospital was higher than that reported by NNIS System surveillance of PICUs. This study has established a benchmark for future studies of VAP in the pediatric intensive care population in Saudi Arabia. Additional studies from the region are necessary for comparison and development of preventive measures.
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Affiliation(s)
- Maha Almuneef
- Department of Infection Prevention and Control, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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Khilnani P, Sarma D, Singh R, Uttam R, Rajdev S, Makkar A, Kaur J. Demographic profile and outcome analysis of a tertiary level pediatric intensive care unit. Apollo Medicine 2004. [DOI: 10.1016/s0976-0016(11)60242-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
OBJECTIVE To study the profile and outcome of children admitted to a tertiary level pediatric intensive care unit (PICU) in India. METHODS Prospective study of patient demographics, PRISM III scores, diagnoses, treatment, morbidity and mortality of all PICU admissions. RESULTS 948 children were admitted to the PICU. Mean age was 41.48 months. Male to female ratio was 2.95:1. Mean PRISM III score on admission was 18.50. Diagnoses included respiratory (19.7%), cardiac (9.7%), neurological (17.9%), infectious (12.5%), trauma (11.7%), other surgical (8.8%).196 children (20.68%) required mechanical ventilation. Average duration of ventilation was 6.39 days. 27 children (30.7 children /1000 admissions) had acute respiratory distress syndrome. Gross mortality was 6.7% (59 patients). PRISMIII adjusted mortality was directly proportional to PRISMIII scores. 49.5% of nonsurvivors had multiorgan failure. Average length of PICU stay was 4.52 +/- 2.6 days. Complications commonly encountered were atelectasis (6.37%), accidental extubation (2%), and pneumothorax (0.9%). Incidence of nosocomial infections was 16.86%. CONCLUSION Our data appears to be similar with regards to PRISMIII scores and adjusted mortality, length of the PICU stay, and duration of ventilation, to previously published western data. Multiorgan failure remains a major cause of death. As expected, Dengue and malaria were common. Incidence of nosocomial infections was somewhat high. Interestingly, more boys got admitted to the PICU as compared to girls. Clearly more studies are required to assess the overall outcomes of critically ill children in India.
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Affiliation(s)
- Praveen Khilnani
- Apollo Center for Advanced Pediatrics, I P Apollo Hospital, New Delhi, India.
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Ohara H. Contribution of technical guidance on nosocomial infection control to the containment of Severe Acute Respiratory Syndrome in Vietnam. Int Congr Ser 2004; 1267:79-87. [PMID: 32288147 PMCID: PMC7126823 DOI: 10.1016/j.ics.2004.01.086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
When Severe Acute Respiratory Syndrome (SARS) spread in Vietnam in March 2003, Bach Mai Hospital (BMH) contributed greatly to putting SARS under control by conducting strict nosocomial infection control. At BMH, technical guidance on nosocomial infection control had been implemented by Japanese experts since 2000. In addition, after the SARS outbreak, the Japan Disaster Relief Team was dispatched to assist in SARS control at BMH. SARS control in Vietnam was reviewed in reference to this technical guidance to investigate effective control measures. Major subjects of the technical guidance included the establishment of a control system, development of manuals and teaching materials, training of medical staff, and supplying protective attire. BMH provided medical care for 35 SARS cases; however, no nosocomial infection cases occurred leading to SARS containment. A swift reaction, effective nosocomial infection control, proper advice by the Ministry of Health and other elements are considered important factors in the success of SARS containment at BMH. In addition, the fruit of technical cooperation conducted under the project is regarded, to no small extent, as having formed the basis for this. Nosocomial infection control is a crucial factor in achieving high-quality medical care, as well as SARS control at the hospital level.
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Affiliation(s)
- Hiroshi Ohara
- Bureau of International Cooperation, International Medical Center of Japan, 1-21-1, Toyama, 162-8655, Shinjuku, Tokyo, Japan
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Rosenthal VD, Guzman S, Orellano PW. Nosocomial infections in medical-surgical intensive care units in Argentina: attributable mortality and length of stay. Am J Infect Control 2003; 31:291-5. [PMID: 12888765 DOI: 10.1067/mic.2003.1] [Citation(s) in RCA: 125] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Nosocomial infections are an important public health problem in many developing countries, particularly in the intensive care unit (ICU). Limited data exists on the incidence and burden of nosocomial infection in the ICU in Argentina. METHODS We performed baseline prospective nosocomial infection surveillance of all patients for 6 months in 3 medical-surgical ICUs (MS-ICUs) in Argentina (2 months in each ICU). Nosocomial infections were identified using the Centers for Disease Control and Prevention National Nosocomial Infections Surveillance definitions. Overall and site-specific nosocomial infection rates, attributable mortality, and excess length of hospital stay were calculated. RESULTS The overall nosocomial infection rate was 27% and 90 per 1000 patient-days. The most common site of infection was catheter-related bloodstream infection (32%), followed by ventilator-associated pneumonia (25%), and catheter-associated urinary tract infection (23%). The rate of central catheter-associated bloodstream infection in the MS-ICU was 44.61 per 1000 device-days, with an attributable mortality of 25%, and 12 attributable extra days of hospital stay. The urinary catheter-associated urinary tract infection rate in the MS-ICU was 22.55 per 1000 urinary catheter-days, with an attributable mortality of 5%, and 5 excess extra days of hospital stay. The ventilator-associated pneumonia rate in the MS-ICU was 50.87 per 1000 ventilator-days with an attributable mortality of 35%, and 10 attributable extra days of hospitalization. CONCLUSION Our study finds high rates of nosocomial infections in ICUs in Argentina, associated with a considerable attributable mortality and excess length of stay. Ongoing targeted surveillance and implementation of infection control strategies is necessary to control this growing problem.
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Memish ZA, Arabi Y, Cunningham G, Kritchevsky S, Braun B, Richards C, Weber S, Pereira CR. Comparison of US and non-US central venous catheter infection rates: evaluation of processes and indicators in infection control study. Am J Infect Control 2003; 31:237-42. [PMID: 12806362 DOI: 10.1067/mic.2003.5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE We sought to identify the presence or absence of international variation in central venous catheter-associated bloodstream infection (BSI) rates and to examine associated infection control practices that might underlie the differences. DESIGN The Evaluation of Processes and Indicators in Infection Control (EPIC) study was conducted as a prospective surveillance study. SETTINGS The study took place in intensive care units (ICUs) from 14 countries, which were from the Asian Pacific (3), Europe (7), Middle East (2), and South America (2), in addition to 41 US hospitals. METHODS We compared the National Nosocomial Infections Surveillance catheter-associated BSI rate between the non-US and US units. We also compared the following organization factors between the 2 groups: hospital factors (ownership, average daily census of patients); ICU type (medical vs surgical); number of beds; and infection control-related factors (number of staff, number of hours spent on study ICU surveillance, years of experience, number of inservice sessions on line infection, number of blood cultures drawn/1000 patients). RESULTS We found no significant difference in catheter-associated BSI rates between non-US and US hospitals (5.02 +/- 0.75 vs 3.82 +/- 0.42/1000 days, respectively; P =.27). Non-US hospitals were more likely to be government-owned (10/14 vs 7/41;P <.001) and to have larger daily patient census (795 +/- 84 vs 276 +/- 47 patients; P <.001). There was no difference in ICU type or number of beds. Infection control committees were present in all US and non-US hospitals. No significant differences were found in the number of staff involved in surveillance in the study ICU, years of experience, hours spent on surveillance, or the provision of inservices on line care. The use of barriers during line insertion also did not differ. CONCLUSIONS Catheter-associated BSIs in patients in the ICU were not significantly different between non-US and US hospitals. All hospitals had infection control committees, and there were no significant differences in time spent and numbers of persons involved in ICU surveillance activities. These findings suggest that many aspects of the standards of care do not differ between the 2 groups.
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Affiliation(s)
- Ziad A Memish
- King Abdulaziz Medical City, King Fahad National Guard Hospital, PO Box 22490, Riyadh 11426, Saudi Arabia
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O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA. Guidelines for the prevention of intravascular catheter-related infections. Infect Control Hosp Epidemiol 2002; 23:759-69. [PMID: 12517020 DOI: 10.1086/502007] [Citation(s) in RCA: 248] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Although many catheter-related bloodstream infections (CRBSIs) are preventable, measures to reduce these infections are not uniformly implemented. OBJECTIVE To update an existing evidenced-based guideline that promotes strategies to prevent CRBSIs. DATA SOURCES The MEDLINE database, conference proceedings, and bibliographies of review articles and book chapters were searched for relevant articles. STUDIES INCLUDED Laboratory-based studies, controlled clinical trials, prospective interventional trials, and epidemiologic investigations. OUTCOME MEASURES Reduction in CRBSI, catheter colonization, or catheter-related infection. SYNTHESIS The recommended preventive strategies with the strongest supportive evidence are education and training of healthcare providers who insert and maintain catheters; maximal sterile barrier precautions during central venous catheter insertion; use of a 2% chlorhexidine preparation for skin antisepsis; no routine replacement of central venous catheters for prevention of infection; and use of antiseptic/antibiotic-impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (ie, education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis). CONCLUSION Successful implementation of these evidence-based interventions can reduce the risk for serious catheter-related infection.
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Affiliation(s)
- Naomi P O'Grady
- Clinical Center, National Institutes of Health, Bethesda, Maryland, USA
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O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA. Guidelines for the Prevention of Intravascular Catheter–Related Infections. Clin Infect Dis 2002. [DOI: 10.1086/344188] [Citation(s) in RCA: 161] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
AbstractThese guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatric medicine, and nursing. The working group was led by the Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) and is intended to replace the Guideline for Prevention of Intravascular Device–Related Infections published in 1996. These guidelines are intended to provide evidence-based recommendations for preventing catheter-related infections. Major areas of emphasis include 1) educating and training health-care providers who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a 2% chlorhexidine preparation for skin antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e., education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis). These guidelines also identify performance indicators that can be used locally by health-care institutions or organizations to monitor their success in implementing these evidence-based recommendations.
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Affiliation(s)
| | | | | | - Julie L. Gerberding
- Office of the Director, Centers for Disease Control and Prevention (CDC), CDC, Atlanta, Georgia
| | | | | | - Henry Masur
- National Institutes of Health, Bethesda, Maryland
| | | | - Leonard A. Mermel
- Rhode Island Hospital and Brown University School of Medicine, Providence, Rhode Island
| | - Michele L. Pearson
- Division of Healthcare Quality Promotion, National Center for Infectious Diseases, CDC, Atlanta, Georgia
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O'grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA. Guidelines for the prevention of intravascular catheter-related infections. Am J Infect Control 2002; 30:476-89. [PMID: 12461511 DOI: 10.1067/mic.2002.129427] [Citation(s) in RCA: 162] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Although many catheter-related bloodstream infections (CR-BSIs) are preventable, measures to reduce these infections are not uniformly implemented. OBJECTIVE To update an existing evidenced-based guideline that promotes strategies to prevent CR-BSIs. DATA SOURCES The MEDLINE database, conference proceedings, and bibliographies of review articles and book chapters were searched for relevant articles.Studies Included: Laboratory-based studies, controlled clinical trials, prospective interventional trials, and epidemiological investigations. OUTCOME MEASURES Reduction in CR-BSI, catheter colonization, or catheter-related infection. SYNTHESIS The recommended preventive strategies with the strongest supportive evidence are education and training of healthcare providers who insert and maintain catheters; maximal sterile barrier precautions during central venous catheter insertion; use of a 2% chlorhexidine preparation for skin antisepsis; no routine replacement of central venous catheters for prevention of infection; and use of antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (i.e. education and training, maximal sterile barrier precautions and 2% chlorhexidine for skin antisepsis). CONCLUSION Successful implementation of these evidence-based interventions can reduce the risk for serious catheter-related infection.
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Affiliation(s)
- Naomi P O'grady
- Clinical Center, National Institutes of Health, Bethesda, MD, USA
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O'Grady NP, Alexander M, Dellinger EP, Gerberding JL, Heard SO, Maki DG, Masur H, McCormick RD, Mermel LA, Pearson ML, Raad II, Randolph A, Weinstein RA. Guidelines for the prevention of intravascular catheter-related infections. The Hospital Infection Control Practices Advisory Committee, Center for Disease Control and Prevention, U.S. Pediatrics 2002; 110:e51. [PMID: 12415057 DOI: 10.1542/peds.110.5.e51] [Citation(s) in RCA: 202] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
These guidelines have been developed for practitioners who insert catheters and for persons responsible for surveillance and control of infections in hospital, outpatient, and home health-care settings. This report was prepared by a working group comprising members from professional organizations representing the disciplines of critical care medicine, infectious diseases, health-care infection control, surgery, anesthesiology, interventional radiology, pulmonary medicine, pediatric medicine, and nursing. The working group was led by the Society of Critical Care Medicine (SCCM), in collaboration with the Infectious Disease Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), Surgical Infection Society (SIS), American College of Chest Physicians (ACCP), American Thoracic Society (ATS), American Society of Critical Care Anesthesiologists (ASCCA), Association for Professionals in Infection Control and Epidemiology (APIC), Infusion Nurses Society (INS), Oncology Nursing Society (ONS), Society of Cardiovascular and Interventional Radiology (SCVIR), American Academy of Pediatrics (AAP), and the Healthcare Infection Control Practices Advisory Committee (HICPAC) of the Centers for Disease Control and Prevention (CDC) and is intended to replace the Guideline for Prevention of Intravascular Device-Related Infections published in 1996. These guidelines are intended to provide evidence-based recommendations for preventing catheter-related infections. Major areas of emphasis include 1) educating and training health-care providers who insert and maintain catheters; 2) using maximal sterile barrier precautions during central venous catheter insertion; 3) using a 2% chlorhexidine preparation for skin antisepsis; 4) avoiding routine replacement of central venous catheters as a strategy to prevent infection; and 5) using antiseptic/antibiotic impregnated short-term central venous catheters if the rate of infection is high despite adherence to other strategies (ie, education and training, maximal sterile barrier precautions, and 2% chlorhexidine for skin antisepsis). These guidelines also identify performance indicators that can be used locally by health-care institutions or organizations to monitor their success in implementing these evidence-based recommendations.
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Affiliation(s)
- Naomi P O'Grady
- National Institutes of Health, Department of Critical Care Medicine, Bethesda, Maryland 20892, USA
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Abstract
Nosocomial pneumonia is a common hospital-acquired infection in children, and is often fatal. Risk factors for nosocomial pneumonia include admission to an intensive care unit, intubation, burns, surgery, and underlying chronic illness. Viruses, predominantly respiratory syncytial virus (RSV), are the most common cause of pediatric nosocomial respiratory tract infections. Gram-negative bacteria (Escherichia coli, Klebsiella pneumoniae, and Pseudomonas aeruginosa) are the predominant bacterial pathogens, and are associated with a high mortality rate. Staphylococcus aureus and Staphylococcus epidermidis are the most common Gram-positive bacteria causing nosocomial pneumonia; infections with these organisms have a better outcome than those with Gram-negative organisms. An increasing problem is the emergence of multiresistant Gram-positive and Gram-negative nosocomial pathogens. Distinguishing nosocomial pneumonia from other pulmonary processes may be difficult; diagnosis is based on clinical signs, radiological findings, and microbiological results. Recommended empiric therapy should consider factors such as the time of onset of illness, severity of disease, and specific risk factors for nosocomial pneumonia, including use of mechanical ventilation, underlying disease, or recent use of antibacterials. The resident local hospital flora should be considered when selecting therapy for nosocomial pneumonia. Early initiation of appropriate empiric therapy reduces morbidity and mortality. For empiric treatment of bacterial nosocomial pneumonia, an intravenous antibacterial regimen that includes coverage of Gram-negative bacilli and Gram-positive organisms should be used. A carbapenem or ureidopenicillin derivative (piperacillin) plus a beta-lactamase inhibitor should be used where extended spectrum beta-lactamase-producing Enterobacteriaceae are endemic. Therapy should be modified when a specific pathogen and its antimicrobial susceptibility are identified. Effective prevention of nosocomial pneumonia requires infection control measures that affect the environment, personnel, and patients. Of these, hand hygiene, appropriate infection control policies, and judicious use of antibacterials are essential.
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Affiliation(s)
- Heather J Zar
- Department of Paediatrics and Child Health, Faculty of Health Sciences, University of Cape Town, 46 Sawkins Road, Cape Town, South Africa.
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Abstract
Nosocomial pneumonias are recognized as an important cause of morbidity and mortality in industrialized nations. Emerging data show that they play a similar role in the developing world. A host of extrinsic and intrinsic factors predispose individuals to the development of pneumonias, and a modification of some of these factors provides a low cost solution to prevention of pneumonias. The ideal modality for microbiologic diagnosis of pneumonia remains to be determined. Recent data suggest that there is no difference in outcome when noninvasive techniques are compared with invasive techniques. Antimicrobial resistance is a rapidly increasing problem globally, and combating this with appropriate antibiotic policies, close surveillance, and physician education is essential.
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Affiliation(s)
- Rumina Hasan
- Department of Microbiology and Pathology, Aga Khan University, Karachi, Pakistan.
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Abstract
Nosocomial infections (NIs) now concern 5 to 15% of hospitalized patients and can lead to complications in 25 to 33% of those patients admitted to ICUs. The most common causes are pneumonia related to mechanical ventilation, intra-abdominal infections following trauma or surgery, and bacteremia derived from intravascular devices. This overview is targeted at ICU physicians to convince them that the principles of infection control in the ICU are based on simple concepts and that the application of preventive strategies should not be viewed as an administrative or constraining control of their activity but, rather, as basic measures that are easy to implement at the bedside. A detailed knowledge of the epidemiology, based on adequate surveillance methodologies, is necessary to understand the pathophysiology and the rationale of preventive strategies that have been demonstrated to be effective. The principles of general preventive measures such as the implementation of standard and isolation precautions, and the control of antibiotic use are reviewed. Specific practical measures, targeted at the practical prevention and control of ventilator-associated pneumonia, sinusitis, and bloodstream, urinary tract, and surgical site infections are detailed. Recent data strongly confirm that these strategies may only be effective over prolonged periods if they can be integrated into the behavior of all staff members who are involved in patient care. Accordingly, infection control measures are to be viewed as a priority and have to be integrated fully into the continuous process of improvement of the quality of care.
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Affiliation(s)
- P Eggimann
- Medical Intensive Care Unit, Department of Internal Medicine, University of Geneva Hospitals, Geneva, Switzerland
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Nguyen D, MacLeod WB, Phung DC, Cong QT, Nguy VH, Van Nguyen H, Hamer DH. Incidence and predictors of surgical-site infections in Vietnam. Infect Control Hosp Epidemiol 2001; 22:485-92. [PMID: 11700875 DOI: 10.1086/501938] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the incidence of, and risk factors for, surgical-site infections (SSIs). DESIGN Prospective observational study of all patients undergoing surgery during a 3-month period. SETTING Two urban hospitals in Hanoi, Vietnam. PATIENTS All 697 patients admitted for emergent and elective surgery. METHODS Data were collected on all patients undergoing surgery during a 3-month period at each hospital. We stratified the data by type of surgery, wound class, and Study on the Efficacy of Nosocomial Infection Control (SENIC) risk index. The analysis was done with the data sets from each hospital separately and with the combined data. The risk factors for SSI were identified using a logistic-regression model. RESULTS During the period of observation, 10.9% of 697 patients had SSI. The SSI rate was 8.3% for clean wounds, 8.6% for clean-contaminated, 12.2% for contaminated, and 43.9% for dirty wounds. The lowest rate of SSI (2.4%) was found in obstetric-gynecologic procedures and the highest rate (33.3%) in cardiothoracic operations. Using the SENIC risk index, the incidence of SSI in low-risk patients was 5.1%; for medium-risk patients, 13.5%, and high-risk patients, 24.2%. In a logistic-regression model, abdominal surgery (odds ratio [OR], 4.46; P<.01) and wound class IV (OR, 5.67; P<.01) were significant predictors of SSI. All patients were treated with prolonged courses of perioperative antibiotics. Overall infection control practices were poor as a result of deficient facilities, limited surgical instruments, and a lack of proper supplies for wound care and personal hygiene. CONCLUSIONS There was a higher incidence of SSI in low-risk patients in Vietnam compared with developed countries. Excessive reliance on antimicrobial therapy as a means to limit SSI places patients at higher risk of adverse effects from treatment and also may contribute to worsening problems with antimicrobial resistance. Establishment of an infection control program with guidelines for antimicrobial use should improve the use of prophylactic antibiotics and attention to proper surgical and wound-care techniques. These interventions also should reduce the incidence of SSI and its associated morbidity and costs.
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Affiliation(s)
- D Nguyen
- Department of Medicine, New England Medical Center-Tufts University School of Medicine, Medford, Massachusetts, USA
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