1
|
Yoo JY, Oh S, Shalish W, Maeng WY, Cerier E, Jeanne E, Chung MK, Lv S, Wu Y, Yoo S, Tzavelis A, Trueb J, Park M, Jeong H, Okunzuwa E, Smilkova S, Kim G, Kim J, Chung G, Park Y, Banks A, Xu S, Sant'Anna GM, Weese-Mayer DE, Bharat A, Rogers JA. Wireless broadband acousto-mechanical sensing system for continuous physiological monitoring. Nat Med 2023; 29:3137-3148. [PMID: 37973946 DOI: 10.1038/s41591-023-02637-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Accepted: 10/06/2023] [Indexed: 11/19/2023]
Abstract
The human body generates various forms of subtle, broadband acousto-mechanical signals that contain information on cardiorespiratory and gastrointestinal health with potential application for continuous physiological monitoring. Existing device options, ranging from digital stethoscopes to inertial measurement units, offer useful capabilities but have disadvantages such as restricted measurement locations that prevent continuous, longitudinal tracking and that constrain their use to controlled environments. Here we present a wireless, broadband acousto-mechanical sensing network that circumvents these limitations and provides information on processes including slow movements within the body, digestive activity, respiratory sounds and cardiac cycles, all with clinical grade accuracy and independent of artifacts from ambient sounds. This system can also perform spatiotemporal mapping of the dynamics of gastrointestinal processes and airflow into and out of the lungs. To demonstrate the capabilities of this system we used it to monitor constrained respiratory airflow and intestinal motility in neonates in the neonatal intensive care unit (n = 15), and to assess regional lung function in patients undergoing thoracic surgery (n = 55). This broadband acousto-mechanical sensing system holds the potential to help mitigate cardiorespiratory instability and manage disease progression in patients through continuous monitoring of physiological signals, in both the clinical and nonclinical setting.
Collapse
Affiliation(s)
- Jae-Young Yoo
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Seyong Oh
- Division of Electrical Engineering, Hanyang University ERICA, Ansan, Republic of Korea
| | - Wissam Shalish
- Neonatal Division, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada
| | - Woo-Youl Maeng
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Emily Cerier
- Division of Thoracic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Emily Jeanne
- Neonatal Division, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada
| | - Myung-Kun Chung
- School of Electrical Engineering, Korea Advanced Institute of Science and Technology, Daejeon, Republic of Korea
| | - Shasha Lv
- Neonatal Division, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada
| | - Yunyun Wu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Seonggwang Yoo
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Andreas Tzavelis
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Jacob Trueb
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Minsu Park
- Department of Polymer Science and Engineering, Dankook University, Yongin, Republic of Korea
| | - Hyoyoung Jeong
- Department of Electrical and Computer Engineering, University of California, Davis, CA, USA
| | - Efe Okunzuwa
- Division of Thoracic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Slobodanka Smilkova
- Department of Electrical and Computer Engineering, Northwestern University, Evanston, IL, USA
| | - Gyeongwu Kim
- Adlai E. Stevenson High School, Lincolnshire, IL, USA
| | - Junha Kim
- Department of Advanced Materials Engineering for Information and Electronics, Kyung Hee University, Gyeonggi-do, Republic of Korea
| | - Gooyoon Chung
- Department of Advanced Materials Engineering for Information and Electronics, Kyung Hee University, Gyeonggi-do, Republic of Korea
| | - Yoonseok Park
- Department of Advanced Materials Engineering for Information and Electronics, Kyung Hee University, Gyeonggi-do, Republic of Korea
| | - Anthony Banks
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
| | - Shuai Xu
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA
- Sibel Health, Niles, IL, USA
| | - Guilherme M Sant'Anna
- Neonatal Division, Department of Pediatrics, McGill University Health Center, Montreal, Quebec, Canada
| | - Debra E Weese-Mayer
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Division of Autonomic Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA
- Stanley Manne Children's Research Institute, Chicago, IL, USA
| | - Ankit Bharat
- Division of Thoracic Surgery, Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - John A Rogers
- Querrey Simpson Institute for Bioelectronics, Northwestern University, Evanston, IL, USA.
| |
Collapse
|
2
|
Barrett RE, Fleiss N, Hansen C, Campbell MM, Rychalsky M, Murdzek C, Krechevsky K, Abbott M, Allegra T, Blazevich B, Dunphy L, Fox A, Gambardella T, Garcia L, Grimm N, Scoffone A, Bizzarro MJ, Murray TS. Reducing MRSA Infection in a New NICU During the COVID-19 Pandemic. Pediatrics 2023; 151:190449. [PMID: 36625072 DOI: 10.1542/peds.2022-057033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/27/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Methicillin-resistant Staphylococcus aureus (MRSA) is prevalent in most NICUs, with a high rate of skin colonization and subsequent invasive infections among hospitalized neonates. The effectiveness of interventions designed to reduce MRSA infection in the NICU during the coronavirus disease 2019 (COVID-19) pandemic has not been characterized. METHODS Using the Institute for Healthcare Improvement's Model for Improvement, we implemented several process-based infection prevention strategies to reduce invasive MRSA infections at our level IV NICU over 24 months. The outcome measure of invasive MRSA infections was tracked monthly utilizing control charts. Process measures focused on environmental disinfection and hospital personnel hygiene were also tracked monthly. The COVID-19 pandemic was an unexpected variable during the implementation of our project. The pandemic led to restricted visitation and heightened staff awareness of the importance of hand hygiene and proper use of personal protective equipment, as well as supply chain shortages, which may have influenced our outcome measure. RESULTS Invasive MRSA infections were reduced from 0.131 to 0 per 1000 patient days during the initiative. This positive shift was sustained for 30 months, along with a delayed decrease in MRSA colonization rates. Several policy and practice changes regarding personnel hygiene and environmental cleaning likely contributed to this reduction. CONCLUSIONS Implementation of a multidisciplinary quality improvement initiative aimed at infection prevention strategies led to a significant decrease in invasive MRSA infections in the setting of the COVID-19 pandemic.
Collapse
Affiliation(s)
| | - Noa Fleiss
- Yale School of Medicine, New Haven, Connecticut
| | | | | | | | | | | | - Meaghan Abbott
- Yale New Haven Children's Hospital, New Haven, Connecticut
| | - Terese Allegra
- Yale New Haven Children's Hospital, New Haven, Connecticut
| | - Beth Blazevich
- Yale New Haven Children's Hospital, New Haven, Connecticut
| | - Louise Dunphy
- Yale New Haven Children's Hospital, New Haven, Connecticut
| | - Amy Fox
- Yale New Haven Children's Hospital, New Haven, Connecticut
| | | | - Lindsey Garcia
- Yale New Haven Children's Hospital, New Haven, Connecticut
| | - Natalie Grimm
- Yale New Haven Children's Hospital, New Haven, Connecticut
| | - Amy Scoffone
- Yale New Haven Children's Hospital, New Haven, Connecticut
| | | | - Thomas S Murray
- Yale School of Medicine, New Haven, Connecticut.,Yale New Haven Children's Hospital, New Haven, Connecticut
| |
Collapse
|
3
|
Queiroz Júnior JRAD, Melo IO, Calado GHDS, Cavalcanti LRC, Sobrinho CRW. Identification and resistance profile of bacteria isolated on stethoscopes by health care professionals: Systematic review. Am J Infect Control 2021; 49:229-237. [PMID: 32653560 DOI: 10.1016/j.ajic.2020.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Evaluate the presence of bacteria and resistance profile in stethoscopes used by health care professionals and its consequences within the hospital environment. METHODS It is a systematic review, in which articles indexed in the BVS, CAPES-Periódicos, Cochrane Library, PubMed, Scientific Electronic Library Online, and ScienceDirect databases were searched. RESULTS Twenty-two articles were selected for this study. The significant majority of professionals does not perform hygiene of the stethoscope, either due to the lack of instructions or the lack of knowledge about the contamination's risks. In addition, over these 22 articles evaluated, only 10 demonstrated that more than 50% of the analyzed samples were contaminated with some type of bacteria. Coagulase-negative Staphylococcus spp., Staphylococcus aureus, Acinetobacter spp., Pseudomonas spp., and Klebsiella pneumoniae were the most recurrent pathogens. Besides that, multiresistant strains were also isolated, highlighting resistance to Ampicillin and Clindamycin. CONCLUSIONS Indeed, the stethoscope is a potential disseminator of bacterial infections. The contamination is explained by the possible cross reactions that make the transmission of infectious agents possible. Cleaning before and after each auscultate is an efficient alternative to minimize these pathogens.
Collapse
Affiliation(s)
| | - Isadora Oliveira Melo
- Medical Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| | | | | | - Carlos Roberto Weber Sobrinho
- Department of Tropical Medicine, Medical Sciences Center, Federal University of Pernambuco, Recife, Pernambuco, Brazil
| |
Collapse
|
4
|
Moore DL. La prévention et le contrôle des infections au cabinet du pédiatre. Paediatr Child Health 2018. [PMCID: PMC6241950 DOI: 10.1093/pch/pxy118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
La transmission d’infections au cabinet du pédiatre est une source de préoccupation croissante. Le présent document traite des voies de transmission des infections et des principes de contrôle des infections actuellement en vigueur. La prévention englobe un aménagement du cabinet et des politiques administratives appropriés, le triage, les pratiques de soins habituelles pour tous les patients (p. ex., hygiène des mains; port de gants, de masques, d’un dispositif de protection oculaire et de blouses pour certaines interventions; nettoyage, désinfection et stérilisation des surfaces et de l’équipement, y compris les jouets; technique d’asepsie pour les interventions invasives), ainsi que les précautions additionnelles en cas d’infections particulières. Les membres du personnel doivent avoir reçu les vaccins nécessaires, et ceux qui sont atteints d’une infection doivent respecter les politiques de restriction au travail.
Collapse
Affiliation(s)
- Dorothy L Moore
- Société canadienne de pédiatrie, comité des maladies infectieuses et d’immunisation, Ottawa (Ontario)
- Correspondance : Société canadienne de pédiatrie, 100–2305, boul. St. Laurent, Ottawa (Ontario) K1G 4J8 Courriel : ; site Web : www.cps.ca
| |
Collapse
|
5
|
Affiliation(s)
- Dorothy L Moore
- Canadian Paediatric Society, Infectious Diseases and Immunization Committee, Ottawa, Ontario
| |
Collapse
|
6
|
Rathore MH, Jackson MA, Byington CL, Maldonado YA, Barnett ED, Davies HD, Edwards KM, Lynfield R, Munoz FM, Nolt D, Nyquist AC, Sawyer MH, Steinbach WJ, Tan TQ, Zaoutis TE. Infection Prevention and Control in Pediatric Ambulatory Settings. Pediatrics 2017; 140:peds.2017-2857. [PMID: 29061869 DOI: 10.1542/peds.2017-2857] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Since the American Academy of Pediatrics published its statement titled "Infection Prevention and Control in Pediatric Ambulatory Settings" in 2007, there have been significant changes that prompted this updated statement. Infection prevention and control is an integral part of pediatric practice in ambulatory medical settings as well as in hospitals. Infection prevention and control practices should begin at the time the ambulatory visit is scheduled. All health care personnel should be educated regarding the routes of transmission and techniques used to prevent the transmission of infectious agents. Policies for infection prevention and control should be written, readily available, updated every 2 years, and enforced. Many of the recommendations for infection control and prevention from the Centers for Disease Control and Prevention for hospitalized patients are also applicable in the ambulatory setting. These recommendations include requirements for pediatricians to take precautions to identify and protect employees likely to be exposed to blood or other potentially infectious materials while on the job. In addition to emphasizing the key principles of infection prevention and control in this policy, we update those that are relevant to the ambulatory care patient. These guidelines emphasize the role of hand hygiene and the implementation of diagnosis- and syndrome-specific isolation precautions, with the exemption of the use of gloves for routine diaper changes and wiping a well child's nose or tears for most patient encounters. Additional topics include respiratory hygiene and cough etiquette strategies for patients with a respiratory tract infection, including those relevant for special populations like patients with cystic fibrosis or those in short-term residential facilities; separation of infected, contagious children from uninfected children when feasible; safe handling and disposal of needles and other sharp medical devices; appropriate use of personal protective equipment, such as gloves, gowns, masks, and eye protection; and appropriate use of sterilization, disinfection, and antisepsis. Lastly, in this policy, we emphasize the importance of public health interventions, including vaccination for patients and health care personnel, and outline the responsibilities of the health care provider related to prompt public health notification for specific reportable diseases and communication with colleagues who may be providing subsequent care of an infected patient to optimize the use of isolation precautions and limit the spread of contagions.
Collapse
Affiliation(s)
- Mobeen H. Rathore
- University of Florida Center for HIV/AIDS Research, Education and Service (UF CARES) and Infectious Diseases and Immunology, Wolfson Children’s Hospital, Jacksonville, Florida; and
| | - Mary Anne Jackson
- Division of Infectious Diseases, Department of Pediatrics, University of Missouri–Kansas City School of Medicine and Children’s Mercy Kansas City, Kansas City, Missouri
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Winckworth LC, McLaren E, Lingeswaran A, Kelsey M. Neonatal resuscitation equipment: A hidden risk for our babies? J Paediatr Child Health 2016; 52:518-22. [PMID: 27329905 DOI: 10.1111/jpc.13150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2015] [Revised: 11/01/2015] [Accepted: 12/21/2015] [Indexed: 11/30/2022]
Abstract
AIM Neonatal infections carry a heavy burden of morbidity and mortality. Poor practice can result in unintentional colonisation of medical equipment with potentially pathogenic organisms. This study will determine the prevalence and type of bacterial contamination on exposed neonatal resuscitation equipment in different clinical settings and explore simple measures to reduce contamination risk. METHODS A survey determined the rates of resuscitation equipment usage. All environmentally exposed items were identified on resuscitaires hospital-wide and swabbed for bacterial contamination. A new cleaning and storage policy was implemented and the prevalence of environmentally exposed equipment re-measured post-intervention. RESULTS Resuscitation equipment was used in 28% of neonatal deliveries. Bacterial colony forming units were present on 44% of the 236 exposed equipment pieces swabbed. There was no significant difference in contamination rates between equipment types. Coagulase negative staphylococcus was the most prevalent species (59 pieces, 25%) followed by Escherichia coli and Enterobacter cloacae (20 pieces, 9% each). Opened items stored inside plastic remained sterile, whilst those in low-use areas had significantly less contamination than those in high-use areas (22% vs. 51%, P < 0.05). Implementing a simple educational programme led to a significant reduction in environmentally exposed equipment (79% reduction, P < 0.01). CONCLUSIONS Pathogenic bacteria can colonise commonly used pieces of neonatal resuscitation equipment. Whilst the clinical significance remains uncertain, equipment should be kept packaged until required and discarded once open, even if unused. Standardising cleaning policies results in rapid and significant improvements in equipment storage conditions, reducing microbial colonisation opportunities.
Collapse
Affiliation(s)
| | - Emma McLaren
- Centre for IH&D, UCL Institute of Child Health, London, UK
| | | | - Michael Kelsey
- Microbiology Department, The Whittington Hospital, London, UK
| |
Collapse
|
8
|
Lestari T, Ryll S, Kramer A. Microbial contamination of manually reprocessed, ready to use ECG lead wire in intensive care units. GMS HYGIENE AND INFECTION CONTROL 2013; 8:Doc07. [PMID: 23967393 PMCID: PMC3746603 DOI: 10.3205/dgkh000207] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: A number of studies have shown that non-critical medical devices can be contaminated with pathogens, including those resistant to antibiotics and thus become a potential vector for transmission. Electrocardiography (ECG) lead wire are non-critical medical device which are always attached on patient skin during their stay in intensive care unit (ICU). In view of the patient’s critical conditions and exposure to invasive procedures, identification and prevention of possible risks are important to prevent infection in ICUs. Objective: The objective of this study was to determine the presence of bacterial and fungal contamination on cleaned and disinfected reusable ECG lead wires in intensive care units in a hospital. Methods: A total of 408 cleaned ECG lead wires from 93 bed-side ECG devices and 43 ECG lead wires from 5 portable ECG devices from 4 intensive care units (ICUs) and 1 post-anaesthesia care unit (PACU) were sampled. ECG lead wires were stirred in 0.89% NaCl with added neutralizer for 30 seconds. Samples of the solutions were cultured directly on blood agar. The remaining solution was cultured on blood agar after sterile filtration. The number of colony forming units (CFUs) was counted and the microorganisms were identified. Results: More than half of examined ECG lead wires (n=232; 51.4%) were contaminated with >30 CFUs/mL sample of bacteria or with risk pathogens. Gram-positive bacteria were the most frequently isolated organisms; particularly, coagulase negative staphylococci (96%) and aerobic spore forming bacteria (71.2%). Compared to ICUs, PACU had significantly lower proportion of contaminated ECG lead wires (p<0.05). The proportion of contaminated ECG lead wires, as well as mean number of cfus per ECG lead wire, was also significantly lower among multi-wire ECG leads compared to single-wire ECG leads. Conclusions: Manually cleaned ECG lead wires may serve as a vector for transmission of nosocomial pathogens. The current reprocessing technique for ECG lead wires needs to be improved.
Collapse
Affiliation(s)
- Trisasi Lestari
- Hospital Management Graduate Program, Gadjah Mada University, Yogyakarta, Indonesia
| | | | | |
Collapse
|
9
|
Herbert VG, Schlumm P, Kessler HH, Frings A. Knowledge of and Adherence to Hygiene Guidelines among Medical Students in Austria. Interdiscip Perspect Infect Dis 2013; 2013:802930. [PMID: 23690765 PMCID: PMC3649164 DOI: 10.1155/2013/802930] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2013] [Accepted: 03/19/2013] [Indexed: 11/18/2022] Open
Abstract
Background. Adherence to hygiene guidelines is of utmost importance for healthcare professionals. The aim of this study was to evaluate the knowledge on and the adherence to hygiene guidelines among medical students in Austria. Additionally, a possible difference between female and male students was investigated. Methods. An open paper-based survey among third-year medical students at the Medical University of Graz was conducted. The questionnaire consisted of 20 single-choice questions covering compliance with basic hygiene standards, self-rated knowledge of hygiene guidelines, and satisfaction with current hygiene education, equipment, and quality standards. Results. Of 192 medical students, 70% judged their knowledge of hygiene standards as "excellent" or "good"; however, only 49% reported adherence to hygiene guidelines and only 43% performed hygienic hand disinfection according to WHO guidelines. Of the respondents, 79% voted for a mandatory course on hygiene standards in medical education. No significant gender differences were observed. Conclusion. While the knowledge on hygiene guidelines appears to be good among medical students, adherence is limited and requires improvement. The need for an optimum education in hygiene is high.
Collapse
Affiliation(s)
| | | | - Harald H. Kessler
- Institute for Hygiene, Microbiology and Environmental Medicine, Medical University of Graz, 8010 Graz, Austria
| | - Andreas Frings
- Department of Ophthalmology, University Medical Center Hamburg-Eppendorf, 20246 Hamburg, Germany
| |
Collapse
|
10
|
Fujita H, Hansen B, Hanel R. Bacterial Contamination of Stethoscope Chest Pieces and the Effect of Daily Cleaning. J Vet Intern Med 2013; 27:354-8. [DOI: 10.1111/jvim.12032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2012] [Revised: 08/25/2012] [Accepted: 11/14/2012] [Indexed: 11/29/2022] Open
Affiliation(s)
- H. Fujita
- Department of Clinical Studies; Ontario Veterinary College; University of Guelph; Guelph Ontario Canada N1G 2W1
| | - B. Hansen
- North Carolina State University College of Veterinary Medicine Veterinary Health Complex; Raleigh NC
| | - R. Hanel
- North Carolina State University College of Veterinary Medicine Veterinary Health Complex; Raleigh NC
| |
Collapse
|
11
|
Halcomb EJ, Griffiths R, Fernandez R. Role of MRSA reservoirs in the acute care setting. INT J EVID-BASED HEA 2012; 6:50-77. [PMID: 21631814 DOI: 10.1111/j.1744-1609.2007.00096.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Nosocomial infection remains the most common complication of hospitalisation. Despite infection control efforts, nosocomial methicillin-resistant Staphylococcus aureus (MRSA) transmission continues to rise. The associated costs of increased hospital stay and patient mortality cause considerable burden to the health system. Objectives This review sought to evaluate the role of reservoirs, particularly the environment and equipment commonly found in the clinical area, in the transmission of MRSA within the acute hospital. This review updates a review previously completed by the authors and published by the Joanna Briggs Institute (2002). Search strategy A systematic search for relevant published or unpublished literature was undertaken using electronic databases, the reference lists of retrieved papers and the Internet. This extended the search published in the original review. Databases searched included Medline (1966-August Week 1 2005), CINAHL (1982-August Week 1 2005), EMBASE (1996-Week 33), as well as the Cochrane Library (Issue 3, 2005) and the Joanna Briggs Institute Evidence Library (August 2005). Selection criteria All research reports published between 1990 and August 2005 in the English language that focused on the role of the environment and equipment commonly found in the clinical area on the nosocomial MRSA transmission in adult, paediatric or neonatal acute care settings were considered. Data collection and analysis Two reviewers assessed each paper against the inclusion criteria and a validated quality scale. Studies that scored less than the mean quality score were excluded from the review. Data extraction was undertaken using a tool designed specifically for this review. Statistical comparisons of findings were not possible, so findings are presented in a narrative form. Results Forty-two papers met the review inclusion criteria, of which 18 obtained a quality score above the threshold and are included in this review. Seven studies reported general investigations of MRSA in the clinical environment and 11 studies explored specific environmental aspects. All studies used exploratory, descriptive or comparative designs. The evidence suggests that MRSA strains within the environment often match those found in patients within that environment. MRSA can be found in the air around MRSA colonised or infected patients. The degree of airborne contamination is significantly increased by activities that promote airflow. Although the site of MRSA colonisation or infection can influence the degree of environmental contamination, these data are inconsistent. Therefore, there is limited evidence for tailoring infection control interventions based on the sites of MRSA colonisation or infection. The evidence suggests that the type of materials used in clinical equipment can influence the effectiveness of cleaning techniques. Current routine cleaning practices, including conventional terminal cleaning, do not necessarily effectively eradicate MRSA from the environment. This review demonstrates that there is a link between the environment and hospital equipment and the transmission of MRSA within the acute hospital setting. Further well-designed research is urgently required to explore the efficacy of specific cleaning and decontamination methods, staff compliance with infection control practices and the range of factors that affect the incidence of MRSA contamination of the environment and equipment commonly found in the clinical area.
Collapse
Affiliation(s)
- Elizabeth J Halcomb
- School of Nursing, University of Western Sydney, Sydney, New South Wales, Australia, Centre for Applied Nursing Research, New South Wales Centre for Evidence-Based Health Care (a collaborating centre of the Joanna Briggs Institute), Liverpool, New South Wales, Australia
| | | | | |
Collapse
|
12
|
Lawlor D, Cannon K, Duan Q, Jensen K. Filmcards Used in Radiation Therapy: Are They a Potential Source of Cross-infection? J Med Imaging Radiat Sci 2011; 43:52-59. [PMID: 31052021 DOI: 10.1016/j.jmir.2011.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2011] [Revised: 10/15/2011] [Accepted: 10/18/2011] [Indexed: 10/14/2022]
Abstract
INTRODUCTION Industrial radiographic film (exposed to light and then cut into a filmcard) is a tool used by radiation therapists (RTs) in the setup of patients before delivering external beam radiation therapy. At the Tom Baker Cancer Center (TBCC), filmcards are reused throughout the day on multiple patients and multiple body sites; thus the risk of cross-contamination exists. The primary objective of this study was to assess the risk of cross-contamination by determining the potential for bacteria to survive on filmcards, in an effort to reduce the risk of cross-infection. METHODS AND MATERIALS This control study evaluated the potential of the following to survive on filmcards: coliforms, Pseudomonas, Staphylococcus spp. (specifically S. aureus and methicillin-resistant S. aureus [MRSA]), Enterococcus, and hemolytic streptococcus species. Thirty filmcards used by RTs throughout the day were collected and voluntarily placed in individual collection bags. Thirty control cards (unused filmcards) were also collected. Collection bags were stored at 4°C until cultured. A reference strain of MRSA (38591) was used in the MRSA survival assay, along with methicillin-sensitive S. aureus (MSSA) isolate (pure form). The MRSA survival experiment required eight larger, unused filmcards (four designated as negative controls and four positive control cards) to be cut into 28.5 × 6.5 cm. Microbiological plates were used to identify and select for bacteria. The various selective and differential plates contain growth factors, antimicrobials, and color indicators that can selectively allow some groups of bacteria to grow on the plate while inhibiting other types of bacteria. RESULTS This study provides evidence to support that filmcards are a source of cross-contamination. 58% (17/29) of the used filmcards tested positive for pathogenic bacteria, compared to only 20% (6/30) of the control cards (P = 0.003). Staphylococcus aureus bacteria were present on 11/29 (38%) of the used filmcards, compared to 2/30 (6.7%) on the control filmcards (P = 0.005). Other colonies found on the used filmcards included strep bacteria (P = 0.24), entero bacteria (P = 0.24), and skin flora (P = 0.36); and although reported as statistically insignificant, these bacteria were viable and thus hold a level of clinical significance. In addition, this experiment provides evidence that certain bacteria (including MRSA found to survive on filmcards for at least 21 days) were viable on filmcards, but an incidental finding reports that fungi is also able to survive on filmcards. CONCLUSION Filmcards used by RTs can harbor a number of pathogenic bacteria, including MRSA, and are therefore a source of cross-contamination. We recommend that the TBCC external beam radiation treatment program-and any other facilities providing external beam radiation therapy-adopt infection control policies that support discarding filmcards after each use (one-time per patient use) or adopt policies that endorse the elimination of filmcards entirely.
Collapse
Affiliation(s)
- Diane Lawlor
- Tom Baker Cancer Center, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada
| | - Kris Cannon
- Alberta Health Services, Calgary, Alberta, Canada
| | - Qiuli Duan
- Tom Baker Cancer Center, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada
| | - Katherine Jensen
- Tom Baker Cancer Center, Calgary, Alberta, Canada; Alberta Health Services, Calgary, Alberta, Canada
| |
Collapse
|
13
|
Abstract
Transmission of infection in the paediatric office is of increasing concern. The present document discusses routes of transmission of infection and the principles of current infection control measures. Prevention includes appropriate office design and administrative policies, triage, routine practices for the care of all patients (eg, hand hygiene; use of gloves, masks, eye protection and gowns for specific procedures; adequate cleaning, disinfection and sterilization of surfaces and equipment including toys, and aseptic technique for invasive procedures), and additional precautions for specific infections. Personnel should be adequately immunized, and those infected should follow work-restriction policies.
Collapse
|
14
|
Xavier MS, Ueno M. Contaminação bacteriana de estetoscópios das unidades de pediatria em um hospital universitário. Rev Soc Bras Med Trop 2009; 42:217-8. [DOI: 10.1590/s0037-86822009000200026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2008] [Accepted: 01/27/2009] [Indexed: 11/22/2022] Open
Abstract
A avaliação da contaminação, de estetoscópios utilizados em setores pediátricos de hospital e emergência, mostrou que 87% dos estetoscópios apresentaram diafragmas contaminados. O microrganismo mais freqüentemente isolado foi Staphylococcus coagulase negativo. A resistência aos antibióticos mostra que o estetoscópio deve ser considerado um importante veículo de bactérias resistentes aos antibióticos.
Collapse
|
15
|
Youngster I, Berkovitch M, Heyman E, Lazarovitch Z, Goldman M. The stethoscope as a vector of infectious diseases in the paediatric division. Acta Paediatr 2008; 97:1253-5. [PMID: 18554272 DOI: 10.1111/j.1651-2227.2008.00906.x] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM Nosocomial infections are of great concern in hospital settings, and even more so in the paediatric ward. Health professionals and their medical equipment have long been known to act as vectors of infectious diseases. This study aimed at evaluating the presence of bacterial pathogens on the stethoscopes of medical personnel in the paediatric division. METHODS Forty-three stethoscopes belonging to senior physicians, residents, interns and medical students at the paediatric ward were sampled. Bacterial cultures and antibiotic sensitivity testing were carried out. RESULTS All but six bacterial cultures were positive (85.7%). Staphylococcal species were the most common contaminants (47.5%). One case of methicillin-resistant Staphylococcus aureus was encountered. Gram-negative organisms were isolated in nine different samples (21%) including one case of Acinetobacter baumannii in the neonatal intensive care unit. CONCLUSION Most stethoscopes harbour potential pathogens. The isolation of Gram-negative organisms pose a real risk of spreading potentially serious infections, especially in the setting of intensive care departments. Apparently, the current recommendations of regular disinfection of stethoscopes are not carried out by health personnel that participated in the study.
Collapse
Affiliation(s)
- I Youngster
- Division of Paediatrics, Assaf Harofeh Medical Center, Zerifin, Israel.
| | | | | | | | | |
Collapse
|
16
|
Role of MRSA reservoirs in the acute care setting. INT J EVID-BASED HEA 2008. [DOI: 10.1097/01258363-200803000-00004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
17
|
MRSA and the environment: implications for comprehensive control measures. Eur J Clin Microbiol Infect Dis 2008; 27:481-93. [PMID: 18273652 DOI: 10.1007/s10096-008-0471-0] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2007] [Accepted: 01/23/2008] [Indexed: 11/25/2022]
Abstract
Environmental contamination with methicillin-resistant Staphylococcus aureus (MRSA) is established soon after colonized or infected patients become resident. There are many studies that detail the mechanisms of spread and environmental survival of methicillin-susceptible Staphylococcus aureus (MSSA); this knowledge translates directly into the same findings for MRSA. The potential ubiquity of MRSA in a health-care setting poses challenges for decontamination. Whereas patients and medical staff are important sources for MRSA spread, the environmental burden may contribute significantly in various contexts. Effective control measures must therefore include consideration for MRSA in the environment.
Collapse
|
18
|
[Recommendation for the prevention of nosocomial infections in neonatal intensive care patients with a birth weight less than 1,500 g. Report by the Committee of Hospital Hygiene and Infection Prevention of the Robert Koch Institute]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2008. [PMID: 18041117 PMCID: PMC7080031 DOI: 10.1007/s00103-007-0337-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
|
19
|
Halcomb EJ, Griffiths R, Fernandez R. Role of MRSA reservoirs in the acute care setting. ACTA ACUST UNITED AC 2008; 6:633-685. [PMID: 27819853 DOI: 10.11124/01938924-200806160-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
BACKGROUND Nosocomial infection remains the most common complication of hospitalisation. Despite infection control efforts, nosocomial methicillin-resistant Staphylococcus aureus (MRSA) transmission continues to rise. The associated costs of increased hospital stay and patient mortality cause considerable burden to the health system. OBJECTIVES This review sought to evaluate the role of reservoirs, particularly the environment and equipment commonly found in the clinical area, in the transmission of MRSA within the acute hospital. This review updates a review previously completed by the authors and published by the Joanna Briggs Institute (2002). SEARCH STRATEGY A systematic search for relevant published or unpublished literature was undertaken using electronic databases, the reference lists of retrieved papers and the Internet. This extended the search published in the original review.Databases searched included Medline (1966-August Week 1 2005), CINAHL (1982-August Week 1 2005), EMBASE (1996-Week 33), as well as the Cochrane Library (Issue 3, 2005) and the Joanna Briggs Institute Evidence Library (August 2005). SELECTION CRITERIA All research reports published between 1990 and August 2005 in the English language that focused on the role of the environment and equipment commonly found in the clinical area on the nosocomial MRSA transmission in adult, paediatric or neonatal acute care settings were considered. DATA COLLECTION AND ANALYSIS Two reviewers assessed each paper against the inclusion criteria and a validated quality scale. Studies that scored less than the mean quality score were excluded from the review. Data extraction was undertaken using a tool designed specifically for this review. Statistical comparisons of findings were not possible, so findings are presented in a narrative form. RESULTS Forty-two papers met the review inclusion criteria, of which 18 obtained a quality score above the threshold and are included in this review. Seven studies reported general investigations of MRSA in the clinical environment and 11 studies explored specific environmental aspects. All studies used exploratory, descriptive or comparative designs. The evidence suggests that MRSA strains within the environment often match those found in patients within that environment. MRSA can be found in the air around MRSA colonised or infected patients. The degree of airborne contamination is significantly increased by activities that promote airflow. Although the site of MRSA colonisation or infection can influence the degree of environmental contamination, these data are inconsistent. Therefore, there is limited evidence for tailoring infection control interventions based on the sites of MRSA colonisation or infection. The evidence suggests that the type of materials used in clinical equipment can influence the effectiveness of cleaning techniques. Current routine cleaning practices, including conventional terminal cleaning, do not necessarily effectively eradicate MRSA from the environment. This review demonstrates that there is a link between the environment and hospital equipment and the transmission of MRSA within the acute hospital setting. Further well-designed research is urgently required to explore the efficacy of specific cleaning and decontamination methods, staff compliance with infection control practices and the range of factors that affect the incidence of MRSA contamination of the environment and equipment commonly found in the clinical area.
Collapse
Affiliation(s)
- Elizabeth J Halcomb
- 1. School of Nursing, University of Western Sydney, Sydney, New South Wales, Australia 2. Centre for Applied Nursing Research, New South Wales Centre for Evidence-Based Health Care (a collaborating centre of the Joanna Briggs Institute), Liverpool, New South Wales, Australia 3 Originally published in the International Journal of Evidence-based Healthcare in 2008
| | | | | |
Collapse
|
20
|
[Recommendation for the prevention of nosocomial infections in neonatal intensive care patients with a birth weight less than 1,500 g. Report by the Committee of Hospital Hygiene and Infection Prevention of the Robert Koch Institute]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2007; 50:1265-303. [PMID: 18041117 PMCID: PMC7080031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2023]
|
21
|
Schabrun S, Chipchase L, Rickard H. Are therapeutic ultrasound units a potential vector for nosocomial infection? PHYSIOTHERAPY RESEARCH INTERNATIONAL 2006; 11:61-71. [PMID: 16808087 DOI: 10.1002/pri.329] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND AND PURPOSE Nosocomial infections present a widespread problem in today's healthcare environment, with a significant number of patients acquiring an infection annually. With the contemporary transition of immunocompromised and high-risk patients to community-based care, therapeutic ultrasound has the potential to be a vector of infection in the physiotherapy setting. The purpose of the present study was to determine the degree of contamination on therapeutic ultrasound transducer heads and ultrasound gel after routine clinical use, and to evaluate the efficacy of recommended infection control procedures. METHOD The study consisted of two phases. Using a prospective cross-sectional design, microbiological cultures were obtained from 44 transducer heads and 43 gels. Subjects were drawn from a variety of physiotherapy practice settings. All samples containing more than five colony forming units per cm2 were considered contaminated. Following these measurements, a repeated-measures design was used to re-evaluate the 44 transducer heads for the amount and type of bacteria present after cleaning with a 70% alcohol wipe. RESULTS Twenty-seven per cent of transducer heads and 28% of gels were contaminated. Transducer heads showed fairly low levels of contamination across the sample, with the majority of organisms isolated found in normal skin and environmental flora. Gels were heavily contaminated with opportunistic and potentially pathogenic organisms, including Stenotrophomonas maltophilia, Staphylococcus aureus, Acinetobacter baumannii and Rhodotorula mucilaginosa. No multi-resistant organisms were identified. Cleaning with 70% alcohol significantly reduced the level of contamination on transducer heads (p < 0.01). CONCLUSIONS Therapeutic ultrasound equipment is a potential vector for nosocomial infection in physiotherapy patients. The risk of infection from transducer heads can be effectively removed by cleaning with 70% alcohol between patients. Further research into possible strategies to reduce the risk of infection from ultrasound gels is needed.
Collapse
Affiliation(s)
- Siobhan Schabrun
- School of Health Sciences, University of South Australia, North Terrace, Adelaide, Australia
| | | | | |
Collapse
|
22
|
Cimiotti JP, Wu F, Della-Latta P, Nesin M, Larson E. Emergence of resistant staphylococci on the hands of new graduate nurses. Infect Control Hosp Epidemiol 2004; 25:431-5. [PMID: 15188851 PMCID: PMC2094722 DOI: 10.1086/502418] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To describe the aerobic microbial flora on the hands of experienced and new graduate nurses over time. DESIGN A prospective cohort design that examined the relationship between duration of employment in an intensive care unit (ICU) and the microbial flora on the hands of experienced and new graduate nurses during a 23-month period. SETTING A 50-bed, level III-IV neonatal ICU in New York City. PARTICIPANTS Twelve experienced nurses and 9 new graduate nurses working full time in the NICU. INTERVENTION One hundred fifty samples were obtained from the clean, dominant hands of the nurses. Cultures were performed at baseline and then quarterly for each experienced and new graduate nurse. Baseline and final cultures of Staphylococcus epidermidis were further examined using pulsed-field gel electrophoresis. RESULTS At baseline, a significantly larger proportion of the experienced nurses had methicillin-resistant, coagulase-negative staphylococci isolated from their hands compared with the new graduate nurses (95% and 33%, respectively; P = .0004). For a second culture, performed 1 to 4 months later, there were no longer significant differences between the two groups (82% and 54%, respectively; P = .12). By the last culture, all staphylococcal isolates were methicillin resistant in both groups of nurses; 3 were methicillin-resistant S. aureus. CONCLUSIONS Colonization with methicillin-resistant staphylococci occurred after brief exposure to the hospital environment, despite the use of antiseptic hand hygiene agents. Furthermore, at final culture, the two groups shared one dominant hospital-acquired strain of S. epidermidis.
Collapse
|
23
|
Hanrahan KS, Lofgren M. Evidence-based practice: examining the risk of toys in the microenvironment of infants in the neonatal intensive care unit. Adv Neonatal Care 2004; 4:184-201, quiz 202-5. [PMID: 15368211 DOI: 10.1016/j.adnc.2004.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Toys placed in the bed or microenvironment of infants in the neonatal intensive care unit (NICU) demonstrate high rates of colonization (92%). As with other fomites, toys may be one potential source of nosocomial infection (NI). This project critically evaluated the practice of placing toys in the microenvironment of critically ill infants by using the Iowa Model of Evidence-Based Practice to Promote Quality Care. With the model as a guide for decision making, the existing evidence was explored using a systematic review of the literature, case studies, scientific principles, theory, and expert opinion. A comprehensive review of the literature did not clearly identify a causal relationship between toys in the NICU microenvironment and NI. Levels of evidence suggesting an association between toys and NI were determined to be moderately strong and consistent. A plausible relationship between the practice of placing toys in the beds of NICU patients and risk for infection was found. These findings prompted a pilot practice change, eliminating toys in the NICU, to test the potential impact of this intervention. Pre- and postintervention infection rates were compared. NI rates decreased from 4.6 to 1.99 per 1,000 patient days over a 6-month evaluation period. Although this decrease was not statistically significant, it was the lowest rate recorded in 5 years. Ongoing evaluation of NI rates is in progress. Individual NICUs must determine if the evidence warrants a practice change in their setting.
Collapse
Affiliation(s)
- Kirsten Sueppel Hanrahan
- Department of Pediatrics, Division of Neonatology, University of Iowa Health Care, Iowa City, IA 52242, USA.
| | | |
Collapse
|
24
|
Solís A, Brown D, Hughes J, Van Saene HKF, Heaf DP. Methicillin-resistant Staphylococcus aureus in children with cystic fibrosis: An eradication protocol. Pediatr Pulmonol 2003; 36:189-95. [PMID: 12910579 DOI: 10.1002/ppul.10231] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A retrospective 12-year study (May 1988-July 2000) was undertaken in children with cystic fibrosis (CF) to evaluate 1) the magnitude of methicillin-resistant Staphylococcus aureus (MRSA) in these children; 2) the clinical impact of MRSA on CF; and 3) the efficacy of an MRSA protocol aimed at the eradication of the carrier state. The study maneuver comprised of 1) surveillance cultures of throat/rectum to detect the MRSA carrier state; 2) life-long cephradine rather than flucloxacillin to lift selection pressure; 3) topical application of oral and nebulized vancomycin for 5 days to clear the carriage of MRSA; and 4) a strict antistaphylococcal hygiene program, including handwashing and device policy. Fifteen children with CF (11 boys, with median age 117 months) positive for MRSA were enrolled. The current prevalence of MRSA among children with CF in our hospital is 6.5%. Of 15 children identified, only 12 (18 episodes of MRSA colonization) were treated according to protocol. Median age of MRSA acquisition was 73 months (interquartile range, 43-134 months). In 7 patients (55%), MRSA was eradicated. Of a total of 18 MRSA episodes, the protocol was successful in 10 episodes. The mean period of MRSA-free status was 12 months (range, 6-36 months). Pulmonary function (measured by FEV(1)) was not affected (68% of predicted before treatment, and 68% of predicted after treatment). All children were oropharyngeal carriers of both MRSA and ceftazidime-resistant P. aeruginosa. We believe that an effort has to be made to limit MRSA in CF clinics for the following reasons: 1) MRSA carriage in any individual is an abnormal condition; 2) limitation of systemic vancomycin use is desirable; 3) MRSA carriage may be a contraindication for lung transplantation; and 4) epidemiologically, a CF unit with a substantial MRSA problem functions as a source of dissemination for other patients.
Collapse
Affiliation(s)
- A Solís
- Respiratory Unit, Royal Liverpool Children's Hospital, N.H.S. Trust, Liverpool, United Kingdom.
| | | | | | | | | |
Collapse
|
25
|
Abstract
CONTEXT The stethoscope is a universal tool in the hospital that is in direct contact with many patients and can therefore be a vector in the dissemination of bacterial infections. OBJECTIVE To research the presence of bacteria, fungi and yeast on the stethoscope diaphragm and the resistance of bacteria to antimicrobial drugs. DESIGN Descriptive, prospective, non-controlled. SETTING A tertiary care hospital. SAMPLE Samples were taken randomly from 300 stethoscopes employed by medical staff (medical residents, medical students, nurses and nursing school students) and other sectors of the hospital. MAIN MEASUREMENTS Three hundred stethoscope diaphragms used in several sectors of the hospital facilities by medical doctors (63 samples), medical residents (54 samples), medical students (106 samples), nursing school students (33 samples) and specific sectors (36 samples) were analyzed. Material was collected randomly. It was collected with the aid of a sterile swab moistened in physiological solution, inoculated into Brain Heart Infusion media and incubated in an oven for 24 to 48 hours. After this period, the samples were inoculated into blood agar, MacConkey agar and Sabouraud media and identified by Gram staining and biochemical assays. An assay to test bacteria sensitivity to antibiotics was also carried out by the Kirby-Bauer method. RESULTS Eighty-seven percent of the analyzed stethoscopes were contaminated. Gram-positive cocci, yeasts, fungi and Gram-positive and negative bacilli were isolated. There was no significant association between the most predominant microorganisms and professional category. Staphylococcus aureus, Staphylococcus negative coagulase and Bacillus were significantly more frequent in relation to the presence of more than one microorganism on the stethoscope diaphragm. CONCLUSION Stethoscopes presented a high rate of contamination and their use without precautions can spread nosocomial infections.
Collapse
Affiliation(s)
- Maria Elisa Zuliani Maluf
- Department of Morphology and Pathology, Center for Medical and Biological Sciences, Pontifícia Universidade Católica, Praça Dr. José Ermirio de Moraes, 290 Sorocaba/SP, Brazil, CEP 18030-230.
| | | | | | | |
Collapse
|
26
|
Chandra PN, Milind K. Lapses in measures recommended for preventing hospital-acquired infection. J Hosp Infect 2001; 47:218-22. [PMID: 11247682 DOI: 10.1053/jhin.2000.0904] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This study was carried out in a rural tertiary care referral hospital in central India, to ascertain lapses made by people caring for neonates in measures recommended for preventing hospital-acquired infections. Unobtrusive observation of the healthcare personnel (doctors, nurses, mothers and hospital attendants) during care of the newborn was undertaken. Lapse in handwashing by healthcare personnel was observed around 41% of the time, although mothers practiced their instructions meticulously. Lapses in methods of hand drying were seen around 7-8% of the time, in those who did wash their hands. Gloves were not used around 21% of the time, when they should have been; and of those using gloves, they were unsterile in around 22% cases. At delivery babies were received unhygienically on approximately 67% of occasions observed. Lapses during cord care ranged from 14.2% to 28.6% and during resuscitation from 16.6% to 60% of occasions. An uncleaned stethoscope was used 75% of the time. The practice of putting a finger in the baby's mouth was observed on 18 occasions. Considerable lapses by all, in every measure recommended for the prevention of hospital-acquired infections were observed. It is concluded that nothing other than an individual's commitment is likely to be successful in preventing hospital-acquired infections.
Collapse
Affiliation(s)
- P N Chandra
- Neonatal Unit, Department of Paediatrics, Mahatma Gandhi Institute of Medical Sciences, Sevagram Wardha, 442 102, India
| | | |
Collapse
|
27
|
Dziekan G, Hahn A, Thüne K, Schwarzer G, Schäfer K, Daschner FD, Grundmann H. Methicillin-resistant Staphylococcus aureus in a teaching hospital: investigation of nosocomial transmission using a matched case-control study. J Hosp Infect 2000; 46:263-70. [PMID: 11170757 DOI: 10.1053/jhin.2000.0846] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In early 1996 a hospital-wide methicillin-resistant Staphylococcus aureus (MRSA) epidemic was recognized in a 900-bed university hospital. In order to investigate hospital-specific transmission routes, a case-control study was carried out. Cases and controls were matched for age (+/- 10 years), sex, admission date (+/- 10 days) and clinical department on admission. Data on potential risk factors, were retrieved by chart review. Between June 1996 and February 1997, 67 patients with hospital-acquired MRSA were identified. Molecular typing showed that 85% of the cases carried an indistinguishable strain. The average time at risk for cases and controls was 17.3 and 23.7 days, respectively (P= 0.01). Seventeen patients (25.4%) developed infection. Conditional multivariate regression analysis showed that intensity of care (P= 0.002), number of transfers (P= 0.019), and fluoroquinolone therapy (P= 0.025) were independently associated with acquisition of MRSA. Intensity of care can be considered as a surrogate marker for a number of manipulations which represent the main risk factors for MRSA transmission. Frequent transfers within the hospital hinder, not only the epidemiological analyses, but also efforts to bring an outbreak under control. Our findings give epidemiological support to recent molecular studies which suggest that fluoroquinolone use may increase the transmissibility of MRSA in hospitals.
Collapse
Affiliation(s)
- G Dziekan
- Institutes of Environmental Medicine and Hospital Epidemiology, University Hospital Freiburg, Hugstetterstr. 55, D-79106 Freiburg, Germany.
| | | | | | | | | | | | | |
Collapse
|
28
|
|
29
|
Bernard L, Kereveur A, Durand D, Gonot J, Goldstein F, Mainardi JL, Acar J, Carlet J. Bacterial contamination of hospital physicians' stethoscopes. Infect Control Hosp Epidemiol 1999; 20:626-8. [PMID: 10501265 DOI: 10.1086/501686] [Citation(s) in RCA: 89] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Because stethoscopes might be potential vectors of nosocomial infections, this study, conducted in a 450-bed general hospital, was devised to evaluate the bacterial contamination of stethoscopes; bacterial survival on stethoscope membranes; the kinetics of the bacterial load on stethoscope membranes during clinical use; and the efficacy of 70% alcohol or liquid soap for membrane disinfection. Among the 355 stethoscopes tested, 234 carried > or =2 different bacterial species; 31 carried potentially pathogenic bacteria. Although some bacteria deposited onto membranes could survive 6 to 18 hours, none survived after disinfection.
Collapse
|
30
|
Nick JM. Organic buildup and residual blood on infant stethoscopes in maternal-infant areas. J Obstet Gynecol Neonatal Nurs 1999; 28:143-50. [PMID: 10102541 DOI: 10.1111/j.1552-6909.1999.tb01978.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To identify the presence of residual blood and organic matter on "clean" stethoscopes in maternal-infant units. DESIGN In this retrospective, nonexperimental study, stethoscopes were tested using qualitative measurements. SETTING Using a nonprobability sampling technique, 11 acute care hospitals in a three-state area of the southwestern United States were studied. PARTICIPANTS All stethoscopes found on the maternal-infant units were included, for a total sample size of 97. INSTRUMENTS A hand-held 10-power lens was used to visually rank the amount of organic buildup, and the phenolphthalein test was used to detect residual blood on the stethoscope. RESULTS Of 97 clean infant stethoscopes, 80% of labor and delivery and 72% of nursery stethoscopes had organic buildup on the diaphragm. Both areas had similar rates of organic buildup, chi2 (1, N = 97) = 1.00, p = ns. Nursery areas did have significantly lower rates of residual blood than stethoscopes from labor and delivery, phi2 (1, N = 97) = 9.89, p = .002. Seventy-six percent of labor and delivery stethoscopes were positive for blood, as compared to 46% of nursery stethoscopes. CONCLUSIONS Traditional methods for cleaning stethoscopes used in labor and delivery and nursery areas are ineffective in removing blood and other body fluids from the stethoscope.
Collapse
Affiliation(s)
- J M Nick
- School of Nursing at Loma Linda University, CA 92350, USA
| |
Collapse
|
31
|
Assadian O, Assadian A, Aspöck C, Koller W, Brook I. The Stethoscope as a Potential Source of Transmission of Bacteria. Infect Control Hosp Epidemiol 1998. [DOI: 10.2307/30141363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
|
32
|
Leprat R, Minary P, Devaux V, de Wazière B, Dupond JL, Talon D. Why, when and how to clean stethoscopes. J Hosp Infect 1998; 39:80-2. [PMID: 9617692 DOI: 10.1016/s0195-6701(98)90250-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
33
|
Abstract
External otitis caused by Staphylococcus aureus was observed in a nurse after extensive use of a stethoscope. The infection recurred and a similar organism was isolated from the stethoscope's earpiece. The infection did not recur after the earpiece was cleansed after each use. In a prospective study, the bacterial flora of 35 earpieces was evaluated. Fifty-three isolates, 36 aerobic or facultative and 17 anaerobic, were recovered. The number of organisms per earpiece ranged from 14 to 204 (average 92 +/- 17). The predominant isolates were Staphylococcus epidermidis (16 isolates), Propionibacterium acnes (12), and Saureus (7). The study demonstrates the colonization of the stethoscope's earpiece with microorganisms that possess the potential for causing nosocomial infection.
Collapse
Affiliation(s)
- I Brook
- Department of Pediatrics, Georgetown University School of Medicine, Washington, DC, USA
| |
Collapse
|