Association of Length of Stay With Contamination of Multidrug-Resistant Organisms in the Environment and Colonization in the Rectum of Intensive Care Unit Patients in China

Knowledge and practice of hand hygiene among hospitalised patients in a tertiary general hospital in China and their attitudes: a cross-sectional survey

OBJECTIVES

We aimed to gain a better understanding of patients' practice of hand hygiene (HH) and their knowledge and attitudes.

DESIGN

A cross-sectional survey.

SETTING

A 3500-bed university-affiliated medical hospital in China.

PARTICIPANTS

Inpatients and their family members or caregivers.

METHODS

An anonymous, self-reported questionnaire were used to collect data.

RESULTS

A total of 376 questionnaires were issued, and 310 respondents completed it. Of the 310 respondents, 47.4% had received HH education, and 13.5% had a completing understanding of HH. A majority of patients believed that handwashing was important for disease recovery, and that it could prevent infection development. A total of 62.3% of patients washed their hands <5 times a day and 49.0% spent <1 min every time. With regards to the seven steps of handwashing, 96.45% of the respondents adhered to the first step (washing the palms), but only 20.6% adhered to the fifth step (thumbs) and 17.7% to the sixth step (fingertips). Most respondents washed their hands only when visibly dirty. Few patients washed their hands before drinking fluids, and before and after interacting with visitors. HH compliance was lower among intensive care unit patients than medical patients.

CONCLUSIONS

In conclusion, this study demonstrated that patients had a positive attitude towards HH. However, their levels of knowledge and practice were unsatisfactory. A systematical education about patientHH is needed in future to correct this knowledge and behaviour.

High excess costs of infections caused by carbapenem-resistant Gram-negative bacilli in an endemic region

The financial burden of antibiotic resistance is a serious concern worldwide. The aim of this study was to describe the excess costs associated with pneumonia, bacteraemia, surgical site infections and intra-abdominal infections (IAIs) caused by carbapenem-resistant Gram-negative bacilli in Medellín, Colombia, an endemic region for carbapenem resistance. A cohort study was conducted in a third-level hospital from 2014-2015. All patients with carbapenem-resistant and carbapenem-susceptible Gram-negative bacterial infections were included. Pharmaceutical, medical and surgical direct costs were described from the health system perspective. Excess costs were estimated from generalised linear models with gamma distribution and adjusted for variables that could affect the cost difference. A total of 218 patients were enrolled, 48 (22.0%) of whom were infected with carbapenem-resistant bacteria. IAIs were the most frequent. The adjusted total excess cost was US$3966 [95% confidence interval (CI) US$1684-6249], with a significantly higher cost for antibiotics, followed by hospital stay, laboratory tests and interconsultation. The highest excess cost was attributed mainly to the use of broad-spectrum antibiotics (US$1827, 95% CI US$1005-2648), followed by length of hospital stay (US$1015, 95% CI US$163-1867). The results of this study highlight the importance of designing antimicrobial stewardship programmes and infection control strategies in endemic regions to reduce the financial threat of antimicrobial resistance to health systems.

Risk factors and medical costs for healthcare-associated carbapenem-resistant Escherichia coli infection among hospitalized patients in a Chinese teaching hospital

Background

The emergence and spread of Carbapenem-resistant Escherichia coli (CREC) is becoming a serious problem in Chinese hospitals, however, the data on this is scarce. Therefore, we investigate the risk factors for healthcare-associated CREC infection and study the incidence, antibiotic resistance and medical costs of CREC infections in our hospital.

Methods

We conducted a retrospective, matched case–control–control, parallel study in a tertiary teaching hospital. Patients admitted between January 2012 and December 2015 were included in this study. For patients with healthcare-associated CREC infection, two matched subject groups were created; one group with healthcare-associated CSEC infection and the other group without infection.

Results

Multivariate conditional logistic regression analysis demonstrated that prior hospital stay (<6 months) (OR:3.96; 95%CI:1.26–12.42), tracheostomy (OR:2.24; 95%CI: 1.14–4.38), central venous catheter insertion (OR: 8.15; 95%CI: 2.31–28.72), carbapenem exposure (OR: 12.02; 95%CI: 1.52–95.4), urinary system disease (OR: 16.69; 95%CI: 3.01–89.76), low hemoglobin (OR: 2.83; 95%CI: 1.46–5.50), and high blood glucose are associated (OR: 7.01; 95%CI: 1.89–26.02) with CREC infection. Total costs (p = 0.00), medical examination costs (p = 0.00), medical test costs (p = 0.00), total drug costs (p = 0.00) and ant-infective drug costs (p = 0.00) for the CREC group were significantly higher than those for the no infection group. Medical examination costs (p = 0.03), total drug costs (p = 0.03), and anti-infective drug costs (p = 0.01) for the CREC group were significantly higher than for the CSEC group. Mortality in CREC group was significantly higher than the CSEC group (p = 0.01) and no infection group (p = 0.01).

Conclusion

Many factors were discovered for acquisition of healthcare-associated CREC infection. CREC isolates were resistant to most antibiotics, and had some association with high financial burden and increased mortality.