Apr 012015
 
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Nationwide study on the use of intravascular catheters in internal medicine departments.

J Hosp Infect. 2015 Feb 26;

Authors: Guembe M, Pérez-Granda MJ, Capdevila JA, Barberán J, Pinilla B, Martín-Rabadán P, Bouza E, NUVE Study Group

Abstract
BACKGROUND: The use of intravascular catheters (IVCs) in intensive care units (ICUs) has been well assessed in recent years. However, a high proportion of these devices are placed in patients outside the ICU, particularly in internal medicine departments (IMDs), where data on the quality of care are scarce.
AIM: To assess the use and management of IVCs in IMDs in Spain.
METHODS: We performed a point prevalence study of all adult inpatients on 47 IMDs from hospitals of different sizes on one day in June 2013. A local co-ordinator was appointed to assess patients and collect data from each site.
FINDINGS: Out of the 2080 adult patients hospitalized on the study day, 1703 (81.9%) had one or more IVCs (95.4% of which were peripheral devices). Infection was detected at the insertion site in 92 catheters (5.0%); 87 patients (5.2%) had signs of sepsis, but only one case was considered to be catheter-related. The local co-ordinators estimated that 19% of the catheters in place were no longer necessary. A daily record of the need for a catheter was available in only 40.6% of cases.
CONCLUSION: Our study shows clear opportunities for improvement regarding catheter use and care in Spanish IMDs. Strategies similar to those applied in ICUs should be implemented in IMDs.

PMID: 25824558 [PubMed - as supplied by publisher]

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Mar 242015
 

Controlling urinary tract infections associated with intermittent bladder catheterization in geriatric hospitals.

J Hosp Infect. 2015 Mar 5;

Authors: Girard R, Gaujard S, Pergay V, Pornon P, Martin Gaujard G, Vieux C, Bourguignon L, Urinary Tract Infection Control Group

Abstract
BACKGROUND: Controlling urinary tract infections (UTIs) associated with intermittent catheterization in geriatric patients.
AIM: After a local epidemiological study identified high rates of UTI, a multi-disciplinary working group implemented and evaluated corrective measures.
METHODS: In 2009, a one-month prospective study measured the incidence of UTI, controlled for risk factors and exposure, in six geriatric hospitals. In 2010, a self-administered questionnaire on practices was administered to physicians and nurses working in these geriatric units. In 2011, the working group developed a multi-modal programme to: improve understanding of micturition, measurement of bladder volume and indications for catheter drainage; limit available medical devices; and improve prescription and traceability procedures. Detailed training was provided to all personnel on all sites. The epidemiological study was repeated in 2012 to assess the impact of the programme.
FINDINGS: Over 1500 patients were included in the 2009 study. The incidence of acquired infection was 4.8%. The infection rate was higher in patients with intermittent catheters than in patients with indwelling catheters (29.7 vs 9.9 UTI per 100 patients, P = 0.1013) which contradicts the literature. In 2010, the 269 responses to the questionnaire showed that staff did not consider catheterization to place patients at risk of infection, staff had poor knowledge of the recommended indications and techniques, and the equipment varied widely between units. Following implementation of the programme, the study was repeated in 2012 with over 1500 patients. The frequency of UTI in patients with intermittent catheters fell to rates in the published literature.
CONCLUSION: Multi-modal programmes are an effective means to control UTI.

PMID: 25799483 [PubMed - as supplied by publisher]

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Mar 242015
 

Effect of contact precautions for MRSA on patient satisfaction scores.

J Hosp Infect. 2015 Mar 3;

Authors: Livorsi DJ, Kundu MG, Batteiger B, Kressel AB

Abstract
Contact precautions may have an adverse effect on a patient's hospital experience and the delivery of care. This case-control study compared patient satisfaction scores between 70 patients isolated for MRSA and 139 non-isolated patients. Based on an adjusted analysis, there was no difference in patient satisfaction between the two groups. Age and educational status were found to affect patient satisfaction.

PMID: 25799481 [PubMed - as supplied by publisher]

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Mar 242015
 

Detection and characterization of extended-spectrum beta-lactamase-producing Enterobacteriaceae in high-risk patients in an Irish tertiary care hospital.

J Hosp Infect. 2015 Feb 21;

Authors: O'Connell N, Keating D, Kavanagh J, Schaffer K

Abstract
BACKGROUND: Extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) are Gram-negative, multi-drug-resistant organisms that are of major clinical significance among immunocompromised patients in high-risk areas in hospital settings. In Ireland, the number of ESBL-E bloodstream infections is increasing.
AIMS: To conduct a prevalence study of ESBL-E among immunocompromised patients in high-risk areas [intensive care unit (ICU), liver transplantation and haematology/oncology wards], characterize any ESBL genes detected by polymerase chain reaction (PCR), and perform epidemiological typing using pulsed-field gel electrophoresis (PFGE).
METHODS: In total, 317 non-duplicate rectal swabs from patients in high-risk wards were screened anonymously for ESBL-E carriage. Positive isolates were characterized using PCR to detect blaCTX-M, blaTEM, blaOXA-1 and blaSHV ESBL-E genes. Clonal relationships of these isolates were investigated using PFGE.
FINDINGS: Fifty (15.8%) high-risk patients were found to harbour ESBL-E. Prevalence rates of 21.9% (N = 28), 14.3% (N = 15) and 8.3% (N = 7) of ESBL-E were isolated from patients on the liver transplantation, ICU and haematology/oncology wards, respectively. Seventy percent of ESBL-E isolates carried more than one resistance gene. Of the 25 ESBL-producing Escherichia coli isolates typed by PFGE, two pairs of two isolates demonstrated >80% homology, and four of the five ESBL-producing Enterobacter cloacae isolates typed by PFGE demonstrated >80% homology, suggesting clonal relatedness and potential cross-transmission from individual patients.
CONCLUSION: A significant proportion of the patients screened were found to be colonized with ESBL-E. Typing revealed three incidents of potential cross-infection. Therefore, timely detection of ESBL-E among patients in high-risk wards is critical for treatment and infection control.

PMID: 25799484 [PubMed - as supplied by publisher]

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Feb 182015
 
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Rapid bedside tests for diagnosis, management, and prevention of nosocomial influenza.

J Hosp Infect. 2015 Jan 24;

Authors: Bouscambert M, Valette M, Lina B

Abstract
Like other respiratory viruses, influenza is responsible for devastating nosocomial epidemics in nursing homes as well as in conventional wards and emergency departments. Patients, healthcare workers, and visitors may be the source of nosocomial influenza. Despite their limited sensitivity, rapid diagnostic tests for influenza can be of real value; they enable early introduction of measures to prevent spread and early specific antiviral treatment of cases. However, these tests cannot detect oseltamivir resistance, susceptibility testing being carried out only in specialist laboratories. Although resistance is rare, it can emerge during treatment, especially of very young children or immunocompromised patients. In the latter, the shedding of resistant influenza virus can last several weeks. Sporadic instances of nosocomial transmission among immunocompromised patients have been reported. The limitations of bedside tests for influenza make them unsuitable for use as stand-alone diagnostic tools. However, their limitations do not preclude their use for detection and subsequent management of nosocomial influenza, for which they are rapid, easy, and cost-effective. Recent developments in these tests look promising, offering prospects of increased sensitivity, increased specificity, and screening for antiviral susceptibility.

PMID: 25687248 [PubMed - as supplied by publisher]

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Feb 112015
 
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Impact of infection control interventions on rates of Staphylococcus aureus bacteraemia in National Health Service acute hospitals, East Midlands, UK, using interrupted time-series analysis.

J Hosp Infect. 2015 Jan 15;

Authors: Newitt S, Myles PR, Birkin JA, Maskell V, Slack RC, Nguyen-Van-Tam JS, Szatkowski L

Abstract
BACKGROUND: Reducing healthcare-associated infection (HCAI) is a UK national priority. Multiple national and regional interventions aimed at reduction have been implemented in National Health Service acute hospitals, but assessment of their effectiveness is methodologically challenging.
AIM: To assess the effectiveness of national and regional interventions undertaken between 2004 and 2008 on rates of meticillin-resistant Staphylococcus aureus (MRSA) and meticillin-sensitive Staphylococcus aureus (MSSA) bacteraemia within acute hospitals in the East Midlands, using interrupted time-series analysis.
METHODS: We used segmented regression to compare rates of MRSA and MSSA bacteraemia in the pre-intervention, implementation, and post-intervention phases for combined intervention packages in eight acute hospitals.
FINDINGS: Most of the change in MSSA and MRSA rates occurred during the implementation phase. During this phase, there were significant downward trends in MRSA rates for seven of eight acute hospital groups; in four, this was a steeper quarter-on-quarter decline compared with the pre-intervention phase, and, in one, an upward trend in the pre-intervention phase was reversed. Regarding MSSA, there was a significant positive effect in four hospital groups: one upward trend during the pre-intervention phase was reversed, two upward trends plateaued, and in one hospital group an indeterminate trend decreased significantly. However, there were significant increasing trends in quarterly MSSA rates in four hospital groups during the implementation or post-intervention periods.
CONCLUSION: The impact of interventions varied by hospital group but the overall results suggest that national and regional campaigns had a beneficial impact on MRSA and MSSA bacteraemia within the East Midlands.

PMID: 25659447 [PubMed - as supplied by publisher]

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