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Troeman DPR, Hazard D, van Werkhoven CHW, Timbermont L, Malhotra-Kumar S, Wolkewitz M, Ruzin A, Sifakis F, Harbarth S, Kluytmans JAJW. Association of Staphylococcus aureus Bacterial Load and Colonization Sites With the Risk of Postoperative S. aureus Infection. Open Forum Infect Dis 2024; 11:ofae414. [PMID: 39113829 PMCID: PMC11304588 DOI: 10.1093/ofid/ofae414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Accepted: 07/21/2024] [Indexed: 08/10/2024] Open
Abstract
Background The independent effects of extranasal-only carriage, carriage at multiple bodily sites, or the bacterial load of colonizing Staphylococcus aureus (SA) on the risk of developing SA surgical site infections and postoperative bloodstream infections (SA SSI/BSIs) are unclear. We aimed to quantify these effects in this large prospective cohort study. Methods Surgical patients aged 18 years or older were screened for SA carriage in the nose, throat, or perineum within 30 days before surgery. SA carriers and noncarriers were enrolled in a prospective cohort study in a 2:1 ratio. Weighted multivariable Cox proportional hazard models were used to assess the independent associations between different measures of SA carriage and occurrence of SA SSI/BSI within 90 days after surgery. Results We enrolled 5004 patients in the study cohort; 3369 (67.3%) were SA carriers. 100 SA SSI/BSI events occurred during follow-up, and 86 (86%) of these events occurred in SA carriers. The number of colonized bodily sites (adjusted hazard ratio [aHR], 3.5-8.5) and an increasing SA bacterial load in the nose (aHR, 1.8-3.4) were associated with increased SA SSI/BSI risk. However, extranasal-only carriage was not independently associated with SA SSI/BSI (aHR, 1.5; 95% CI, 0.9-2.5). Conclusions Nasal SA carriage was associated with an increased risk of SA SSI/BSI and accounted for the majority of SA infections. Higher bacterial load, as well as SA colonization at multiple bodily sites, further increased this risk.
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Affiliation(s)
- Darren P R Troeman
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Derek Hazard
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Cornelis H W van Werkhoven
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Leen Timbermont
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Surbhi Malhotra-Kumar
- Laboratory of Medical Microbiology, Vaccine and Infectious Disease Institute, University of Antwerp, Antwerp, Belgium
| | - Martin Wolkewitz
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg, Germany
| | - Alexey Ruzin
- Microbial Sciences, R&D BioPharmaceuticals, AstraZeneca, Gaithersburg, Maryland, USA
| | | | - Stephan Harbarth
- Infection Control Programme and WHO Collaborating Center, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Jan A J W Kluytmans
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
- Department of Medical Microbiology, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
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Singh S, Pandey H, Aggarwal HK, Pal S. Assessing the Impact of Training on Healthcare Providers' Adherence to Infection Control Measures in Hemodialysis Services. Cureus 2023; 15:e42978. [PMID: 37671230 PMCID: PMC10476009 DOI: 10.7759/cureus.42978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 08/04/2023] [Indexed: 09/07/2023] Open
Abstract
Background and objective Developing and implementing nursing interventions to educate nurses on infection control procedures in hemodialysis units is of utmost importance and offers significant benefits in enhancing the quality of care. This study aimed to assess the impact of training on nursing professionals' practices of hospital infection control measures in hemodialysis services. The research also intended to explore the potential association between these practices and various sociodemographic variables. Materials and methods This was a single-group, pre- and post-interventional study carried out in Haryana State, India. A pretested questionnaire consisting of 29 statements, the responses of which were measured on a 5-point Likert scale, was used as the study tool. Descriptive and statistical tests like paired-t-test were used to analyze the data. Results The practices section of the questionnaire comprised 29 statements, the responses to which were measured on a five-point Likert scale. The scoring ranged from 5 ("strongly agree", i.e., positive practice) to 1 ("strongly disagree", i.e., negative practice). The maximum achievable score was 145 and the minimum achievable score was 9. The pre-test group (i.e., before training intervention) had a mean practice score of 115.0945 [standard deviation (SD)=9.34, standard error of the mean (SE)=0.66]. However, the post-test group (i.e. after training intervention) had a mean score of 135.26 (SD=8.34, SE=0.59). The study found that structured training significantly increased the mean practice score (t=-33.70, p=0.001). In addition, the study also highlighted the significant association of mean practice scores with various demographic variables among the pre-test and post-test groups. The improvement in mean practice scores among the post-test group after the structured training program reveals that such interventions will ultimately lead to a decrease in central line-associated bloodstream infections (CLABSIs) among hemodialysis patients. Conclusions Our findings showed that the educational intervention led to significant improvements in the practices of the participants.
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Affiliation(s)
- Sukhbir Singh
- Hospital Administration, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Hemchandra Pandey
- Administration, Hemwati Nandan Bahuguna Medical Education University, Dehradun, IND
| | - Hari K Aggarwal
- General Medicine, Pandit Bhagwat Dayal Sharma Post Graduate Institute of Medical Sciences, Rohtak, IND
| | - Shekhar Pal
- Microbiology, Government Doon Medical College, Dehradun, IND
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Bharati J, Jha V. Global Dialysis Perspective: India. KIDNEY360 2020; 1:1143-1147. [PMID: 35368789 PMCID: PMC8815477 DOI: 10.34067/kid.0003982020] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 08/18/2020] [Indexed: 05/20/2023]
Affiliation(s)
- Joyita Bharati
- Department of Nephrology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vivekanand Jha
- The George Institute for Global Health, University of New South Wales, New Delhi, India
- Manipal Academy of Higher Education, Manipal, India
- School of Public Health, Imperial College, London, United Kingdom
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Loomba G, Dhandapani M, Kaur S, Ghai S, Biswal M, Ramachandran R, Gupta KL. The Effectiveness of Personal Hygiene Practices on Non-Cuffed Central Vein Catheter-Related Infection in Patients Undergoing Hemodialysis: A Randomized Controlled Trial. Indian J Nephrol 2019; 29:267-271. [PMID: 31423061 PMCID: PMC6668307 DOI: 10.4103/ijn.ijn_92_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Infection of the internal jugular vein (IJV) catheter continues to be a common cause of death in patients with end-stage renal disease undergoing hemodialysis (HD). The present study aimed to evaluate the effectiveness of personal hygiene on the incidence of IJV catheter-related bloodstream infection (CRBSI). A randomized, controlled, parallel, and non-inferiority trial was conducted on patients initiated on maintenance HD via right IJV catheter. Patients were randomly allocated to control and intervention group via computer-generated random table. Intervention package for the intervention group included hand washing (2–4 hourly and whenever visibly dirty), feet washing (12 hourly), and axillary shave (at any point during the study, no hair growth in axilla). Patients were provided with a pamphlet and reinforced to continue package till IJV catheter was in situ. Patients were followed up twice a week for one month from the date of catheter insertion for the incidence of CRBSI. The primary outcome of the study was percentage of patients free from CRBSI. On intention-to-treat analysis, the percentage of patients without CRBSI was 53.7% and 29.3% in the intervention and control arm, respectively [P = 0.04; 25.12% (1.43–45.28%)]. Positive blood cultures were higher in control (73.3%) as compared to the intervention group (28.6%) (P = 0.19). Personal hygiene interventions are an effective method to reduce the incidence of CRBSIs among population undergoing maintenance HD via non-cuffed IJV catheter.
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Affiliation(s)
| | | | - Sukhpal Kaur
- National Institute of Nursing Education, Chandigarh, India
| | - Sandhya Ghai
- National Institute of Nursing Education, Chandigarh, India
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Ghavghani FR, Rahbarnia L, Naghili B, Dehnad A, Bazmani A, Varshochi M, Ghaffari Agdam MH. Nasal and extra nasal MRSA colonization in hemodialysis patients of north-west of Iran. BMC Res Notes 2019; 12:260. [PMID: 31077228 PMCID: PMC6509970 DOI: 10.1186/s13104-019-4298-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/03/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES Methicillin resistant Staphylococcus (S.) aureus colonization is one of the main causes of serious infections in hemodialysis patients. This cross-sectional study was performed to examine prevalence of MRSA colonization and evaluation of risk factors in hemodialysis patients. A total of 560 swab samples from nasal, the skin around catheter and throat were collected from 231 hemodialysis patients in Tabriz. The standard biochemical tests were used for identification of S. aureus isolates. Antimicrobial susceptibility profile was determined against 11 antibiotics by the disk diffusion method. Phenotypic test of S. aureus was performed using novobiocin 30 μg/disc, and methicillin sensitivity test was performed by cefoxitin 30 μg/disc. RESULTS Overall, 50.65% (118/231) hemodialysis patients were positive for S. aureus which 34.93% (80/231) of patients were MRSA carriage. The MRSA colonization in patients with a catheter (44.06%) was more than individuals utilizing a fistula (24.57%, p = 0.030). Among sampling sites, the highest MRSA was related to nasal samples (30.70%, p < 0.00001). Extra nasal colonization of S. aureus was observed in 12.71% patients. The highest rates of resistance were observed against ampicillin (93.98%) and the highest sensitivity was against linezolid antibiotic (5.42%). These findings highlight the necessity of prophylaxis against S. aureus in individuals under dialysis.
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Affiliation(s)
- Fatemeh Ravanbakhsh Ghavghani
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, P.O.Box; 5163639888, Tabriz, Iran
| | - Leila Rahbarnia
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, P.O.Box; 5163639888, Tabriz, Iran. .,Higher Education Institute of Rab-Rashid, Tabriz, Iran, Tabriz, Iran.
| | - Behrooz Naghili
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, P.O.Box; 5163639888, Tabriz, Iran
| | - Alireza Dehnad
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, P.O.Box; 5163639888, Tabriz, Iran.,Higher Education Institute of Rab-Rashid, Tabriz, Iran, Tabriz, Iran.,Biotechnology Department, East Azerbaijan Research and Education Canter Agricultural and Natural Resources, AREEO, Tabriz, Iran
| | - Ahad Bazmani
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, P.O.Box; 5163639888, Tabriz, Iran
| | - Mojtaba Varshochi
- Infectious and Tropical Diseases Research Center, Tabriz University of Medical Sciences, P.O.Box; 5163639888, Tabriz, Iran
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Sethi J, Bagai S, Ramachandran R, Kumar V, Rathi M, Kohli HS, Gupta KL. Time to Revisit the Use of Nontunneled Dialysis Vascular Catheters Even in Cost-Limited Setting. Indian J Nephrol 2018; 28:406-407. [PMID: 30271008 PMCID: PMC6146739 DOI: 10.4103/ijn.ijn_443_17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- J Sethi
- Department of Nephrology, PGIMER, Chandigarh, India
| | - S Bagai
- Department of Nephrology, PGIMER, Chandigarh, India
| | | | - V Kumar
- Department of Nephrology, PGIMER, Chandigarh, India
| | - M Rathi
- Department of Nephrology, PGIMER, Chandigarh, India
| | - H S Kohli
- Department of Nephrology, PGIMER, Chandigarh, India
| | - K L Gupta
- Department of Nephrology, PGIMER, Chandigarh, India
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Sherman RA. Briefly Noted. Semin Dial 2017. [DOI: 10.1111/sdi.12604] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Sherman RA. Briefly Noted. Semin Dial 2017. [DOI: 10.1111/sdi.12560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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