Infection control, hospital epidemiology, and patient safety

In situ forming hydrogel loaded with predatory bacteria treats drug-resistant corneal infection

The development of potent bactericidal antibiotic alternatives is important to address the current antibiotic crisis. A representative example is the topical delivery of predatory Bdellovibrio bacteriovorus bacteria to treat ocular bacterial infection. However, the direct topical use of B. bacteriovorus suspensions has the problem of easy loss and inactivation. Here, a B. bacteriovorus in situ forming hydrogel (BIG) was constructed for the ocular delivery of B. bacteriovorus. BIGs, as a fluid in their primitive state, were temperature- and cation- dually sensitive, which was rapidly transformed into immobile gels in the ocular environment. BIGs not only kept the activity of B. bacteriovorus but also retained on the ocular surface for a long time. The biosafety of BIGs was good without HCEC cell toxicity and hemolysis. More importantly, BIGs highly inhibited the growth of drug-resistant Pseudomonas aeruginosa whether in vitro or in the infected rat eyes. The ocular infection was completely controlled by BIGs with no corneal ulcers and inflammations. This living bacteria gel is a promising medication for the local treatment of drug-resistant bacteria-induced ocular infection.

Health professionals' knowledge about relative prevalence of hospital-acquired infections in Delta State of Nigeria

INTRODUCTION

Hospital-acquired infections (HAIs) constitute a serious global public health challenge, causing great suffering to many people across the globe at any given time. This study ascertains the knowledge of health professionals on the challenge and their compliance with infection control measures.

METHODS

Validated questionnaires were administered to 660 health professionals and supported with face-to-face interview. Data were analyzed using Statistical Package for Social Sciences (SPSS) version 16.0 (SPSS Inc, USA). Chi-square was used to test association between the independent and the outcome variables. Cut-off point for statistical significance was 5% (p value<0.05).

RESULTS

UTIs (61.4%) followed by Hospital-acquired Pneumonia (55.6%) were known to be the most prevalent HAIs in government hospitals while Staphylococcus aureus (54.4%) was reported the most microbial agent. In private health facilities, Hospital-acquired Pneumonia was known to be the most common (66.1%) while Pseudomonas aeruginosa was the most reported culprit. HAIs were reported to have occurred more in government hospitals and catheterization was the commonest modes of transmission in both health facilities.

CONCLUSION

The prevalence of HAIs in this state was reported to be high. Although health-care professionals have good knowledge of HAIs, active effort is not always made to identify and resolve them. Standardized surveillance of HAIs is urgently needed.

Guidelines for prevention of hospital acquired infections

These guidelines, written for clinicians, contains evidence-based recommendations for the prevention of hospital acquired infections Hospital acquired infections are a major cause of mortality and morbidity and provide challenge to clinicians. Measures of infection control include identifying patients at risk of nosocomial infections, observing hand hygiene, following standard precautions to reduce transmission and strategies to reduce VAP, CR-BSI, CAUTI. Environmental factors and architectural lay out also need to be emphasized upon. Infection prevention in special subsets of patients - burns patients, include identifying sources of organism, identification of organisms, isolation if required, antibiotic prophylaxis to be used selectively, early removal of necrotic tissue, prevention of tetanus, early nutrition and surveillance. Immunodeficient and Transplant recipients are at a higher risk of opportunistic infections. The post tranplant timetable is divided into three time periods for determining risk of infections. Room ventilation, cleaning and decontamination, protective clothing with care regarding food requires special consideration. Monitoring and Surveillance are prioritized depending upon the needs. Designated infection control teams should supervise the process and help in collection and compilation of data. Antibiotic Stewardship Recommendations include constituting a team, close coordination between teams, audit, formulary restriction, de-escalation, optimizing dosing, active use of information technology among other measure. The recommendations in these guidelines are intended to support, and not replace, good clinical judgment. The recommendations are rated by a letter that indicates the strength of the recommendation and a Roman numeral that indicates the quality of evidence supporting the recommendation, so that readers can ascertain how best to apply the recommendations in their practice environments.

Nosocomial Gram-positive antimicrobial susceptibility pattern at a referral teaching hospital in Tehran, Iran

Aims: The aim of the study was to evaluate epidemiology and susceptibility patterns of nosocomial Gram-positive infections in a referral teaching hospital. Methods: Over a 1 year period, Gram-positive microorganisms isolated from specimens of hospitalized patients with documented nosocomial infection underwent antimicrobial susceptibility testing using the disk diffusion test. In addition, possible risk factors for developing multidrug-resistant bacteria were evaluated. Results: During the study period, a total of 137 nosocomial infections were detected. Staphylococcus aureus was the most frequently isolated microorganism (56.2%), followed by Enterococcus spp. (21.9%) and Staphylococcus epidermidis (15.3%). All S. aureus strains were sensitive to vancomycin, teicoplanin, linezolid and chloramphenicol. More than 50% of enterococci strains were resistant to vancomycin and teicoplanin. Possible risk factors for multidrug resistance among isolated pathogens were history of antibiotic use and intubation of patient for mechanical ventilation. Conclusion: This study showed high rates of antimicrobial resistance among nosocomial Gram-positive pathogens, complicating antibiotic therapy and its outcomes.

Original submitted 26 March 2012; Revised submitted 27 April 2012

[Isolation precautions in a tertiary paediatric hospital]

INTRODUCTION

Isolation is one of the measures to prevent the spread of nosocomial infections. However, in children's hospitals, given the type of patients and infections, and the architectural features of hospital wards, isolation precautions are sometimes difficult to implement and enforce.

MATERIAL AND METHODS

An observational, descriptive study was conducted on the isolation precautions taken at the Children's Hospital Vall d'Hebron in Barcelona, from January to December, 2007. The isolation precautions applied were those of the Centers for Disease Control and Prevention from the USA, and those of the Department of Health of the Generalitat de Cataluña.

RESULTS

Of the patients admitted during the study period, 5.4% needed isolation. The General Paediatrics ward generated the highest number of isolations (10.7%). The most frequently microorganisms needing isolation precautions were respiratory syncytial virus and rotavirus. Contact precautions was the type of isolation most applied (90% of isolations). The Neonatal Intensive Care Unit and the Paediatric Oncology and Haematology Service were the areas with a greater number of patients isolated due to infection or colonization by multiresistant bacteria (48% and 67% of the isolations, respectively).

CONCLUSIONS

The implementation of a surveillance and infection control program is essential to reduce the rate of hospital-acquired infections. Knowledge of the frequency of isolated patients at each centre and the availability of resources for the correct application of isolation precautions are fundamental for these goals to be achieved.

Health Care–Associated Infection in the Pediatric Intensive Care Unit

•Handwashing is the most important means of preventing nosocomial infection. Each pediatric intensive care unit should develop programs to increase compliance with hand hygiene. •Nonessential invasive devices should be removed. Establish routines that require individual patient evaluation of device use daily. •Antimicrobial stewardship aims to minimize overexposure and unnecessary use of broad-spectrum antibiotics. Antibiotic-resistant bacteria are an increasing concern as a cause of hospital-acquired infection, requiring a multipronged approach to control that includes adherence to isolation procedures, appropriate use of antibiotics, educational interventions, prescribing guidelines, and restriction of the use of some antibiotics. •A comprehensive infection prevention and control program allied with organizational quality and patient safety programs is an essential strategy for minimizing hospital-acquired infections. Critical care teams should establish strong collaborative partnerships with the infection prevention and control service. •Parents and visitors should be made partners of the infection control team to help prevent infection in their children.

Outbreaks of Serratia marcescens in neonatal and pediatric intensive care units: clinical aspects, risk factors and management

The following recommendations are derived from a systematic analysis of 34 Serratia marcescens outbreaks described in 27 publications from neonatal and pediatric intensive care units (NICU, PICU), in which genotyping methods were used to confirm or exclude clonality. The clinical observation of two or more temporally related cases of nosocomial S. marcescens infection should raise the suspicion of an outbreak, particularly in the NICU or PICU setting. Since colonized or infected patients represent the most important reservoir for cross transmission, hygienic barrier precautions (contact isolation/cohortation, the use of gloves and gowns in addition to strictly performed hand disinfection, enhanced environmental disinfection) should immediately be implemented and staff education given. Well-planned sampling of potential environmental sources should only be performed when these supervised barrier precautions do not result in containment of the outbreak. The current strategy of empiric antibiotic treatment should be reevaluated by a medical microbiologist or an infectious disease specialist. Empiric treatment of colonized children should use combination therapy informed by in vitro susceptibility data; in this context the high propensity of S. marcescens to cause meningitis and intracerebral abscess formation should be considered. In vitro susceptibility patterns do not reliably prove or exclude the clonality of the outbreak isolate. Genotyping of the isolates by pulse-field gel electrophoresis or PCR-based methods should be performed, but any interventions to interrupt further nosocomial spread should be carried out without waiting for the results.

Healthcare-associated infections in pediatric cancer patients: results of a prospective surveillance study from university hospitals in Germany and Switzerland

Background

Pediatric cancer patients face an increased risk of healthcare-associated infection (HAI). To date, no prospective multicenter studies have been published on this topic.

Methods

Prospective multicenter surveillance for HAI and nosocomial fever of unknown origin (nFUO) with specific case definitions and standardized surveillance methods.

Results

7 pediatric oncology centers (university facilities) participated from April 01, 2001 to August 31, 2005. During 54,824 days of inpatient surveillance, 727 HAIs and nFUOs were registered in 411 patients. Of these, 263 (36%) were HAIs in 181 patients, for an incidence density (ID) (number of events per 1,000 inpatient days) of 4.8 (95% CI 4.2 to 5.4; range 2.4 to 11.7; P < 0.001), and 464 (64%) were nFUO in 230 patients. Neutropenia at diagnosis correlated significantly with clinical severity of HAI. Of the 263 HAIs, 153 (58%) were bloodstream infections (BSI). Of the 138 laboratory-confirmed BSIs, 123 (89%) were associated with use of a long-term central venous catheter (CVAD), resulting in an overall ID of 2.8 per 1,000 utilization days (95% CI 2.3 to 3.3). The ID was significantly lower in Port-type than in Hickman-type CVADs. The death of 8 children was related to HAI, including six cases of aspergillosis. The attributable mortality was 3.0% without a significant association to neutropenia at time of NI diagnosis.

Conclusion

Our study confirmed that pediatric cancer patients are at an increased risk for specific HAIs. The prospective surveillance of HAI and comparison with cumulative multicenter results are indispensable for targeted prevention of these adverse events of anticancer treatment.

Eliminating nosocomial infections at Ascension Health

BACKGROUND

Eliminating nosocomial infections was identified as one of eight priorities for action for Ascension Health. St. John Hospital and Medical Center (SJHMC), and St. Vincent's Hospital (STV), designated alpha sites, developed best practices for the prevention of catheter-related blood stream infections (CR-BSIs) and ventilator-associated pneumonia (VAP), respectively.

METHODS

Both hospitals used the Institute for Healthcare Improvement model of "bundles" to achieve the goal of reducing nosocomial infections and also implemented multidisciplinary rounds and the use of daily goal sheets in the intensive care unit (ICU).

RESULTS

Through the use of ventilator bundle, central line (CL) bundle, MDRs, and daily goal sheets, both facilities reduced CR-BSIs and VAPs by more than 50%.

DISCUSSION

SJHMC saw the benefit of having the physical presence of the ICPs in the ICUs, providing the staff with on-the-spot reinforcement of the initiative. STV found by starting the change process through the use of a flexible MDR team, the hospital was able to successfully implement positive changes in its ICU culture. On the basis of the success in the ICU, the concept of MDR teams eventually was adapted and spread to all units. Open communication among all patient caregivers was extended and served to provide improved patient care throughout the hospital.

Critical care issues in the early management of severe trauma

Violent trauma and road traffic injuries kill more than 2.5 million people in the world every year, for a combined mortality of 48 deaths per 100,000 population per year. Most trauma deaths occur at the scene or in the first hour after trauma, with a proportion from 34% to 50% occurring in hospitals. Preventability of trauma deaths has been reported as high as 76% and as low as 1% in mature trauma systems. Critical care errors may occur in a half of hospital trauma deaths, in most of the cases contributing to the death. The most common critical care errors are related to airway and respiratory management, fluid resuscitation, neurotrauma diagnosis and support, and delayed diagnosis of critical lesions. A systematic approach to the trauma patient in the critical care unit would avoid errors and preventable deaths.