scholarly journals Comparison of surveillance and clinical cultures to measure the impact of infection control interventions on the incidence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus in the hospital

2020 ◽  
pp. 1-5
Author(s):  
Surbhi Leekha ◽  
Lyndsay M. O’Hara ◽  
Alyssa Sbarra ◽  
Shanshan Li ◽  
Anthony D. Harris
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Control ◽  
The United States ◽  
Incidence Density ◽  
Surgical Intensive Care Unit ◽  
Care Hospital ◽  
Convenience Sample ◽  
Surveillance Cultures ◽  
The Impact

Abstract Objective: To evaluate whether clinical cultures are an appropriate surrogate for surveillance cultures to measure the effect of interventions on the incidence of MRSA and VRE in the hospital. Design: Cross-sectional and quasi-experimental, retrospective analysis Setting and population: Convenience sample of patients admitted between January 1, 2002, and June 31, 2011, to the medical intensive care unit (MICU) and surgical intensive care unit (SICU) of an acute-care hospital in the United States. Interventions: Asynchronously in the MICU and SICU, we introduced (1) universal glove and gown use, (2) bundled intervention to prevent central-line–associated bloodstream infection, and (3) daily chlorhexidine gluconate bathing. Results: We observed a statistically significant correlation between surveillance and clinical culture-based incidence rates of MRSA in the MICU (0.32; P < .001) and the SICU (0.37; P < .001) but not for VRE in either the MICU (0.16, P = .11) or the SICU (0.15; P = .12). For VRE, but not for MRSA, incidence density rates based on surveillance cultures were 2- to 4-fold higher than for clinical cultures. When evaluating the impacts of the interventions, different effect estimates were noted for universal glove and gown use on MRSA acquisition in MICU, and for VRE acquisition in both the MICU and the SICU based on surveillance versus clinical cultures. Conclusions: For multidrug-resistant organism acquisition, surveillance cultures should be used when feasible because clinical cultures may not be an appropriate surrogate. Clinical or surveillance-based end points for infection control interventions should reflect the conceptual model from colonization to infection and where an intervention might have an effect, rather than considering them interchangeable.

scholarly journals Nosocomial infections in a pediatric surgical intensive care unit: An unicentric cross-sectional study

2021 ◽  
Vol 74 (3-4) ◽  
pp. 112-116
Author(s):  
Marina Pandurov ◽  
Izabella Fabri-Galambos ◽  
Andjela Opancina ◽  
Anna Uram-Benka ◽  
Goran Rakic ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Nosocomial Infections ◽  
Hospital Length Of Stay ◽  
Surgical Intensive Care Unit ◽  
Negative Consequences ◽  
Surgical Intensive Care ◽  
Acinetobacter Baumanii ◽  
Cross Sectional ◽  
The Impact

Introduction. Nosocomial infections are a common complication in patients hospitalized in intensive care units. The aims of this research were to examine the incidence of nosocomial infections in patients admitted to the pediatric surgical intensive care unit, the impact of hospital length of stay and type of surgical disease on the incidence of nosocomial infections, the frequency of microorganisms causing nosocomial infections and their antibiotic susceptibility profile. Material and Methods. Data on 50 subjects were extracted from the database. The following data were taken from the medical histories of the examinees: age, sex, diagnosis, number of days at the hospital before admission to the intensive care unit, number of days in the intensive care unit, levels of C-reactive protein, applied antimicrobial drugs, isolated microorganisms and their susceptibility to antibiotics. Results. The incidence of nosocomial infections in the study period was 52%. Patients who developed nosocomial infection remained longer in the intensive care unit than those who did not develop it (p = 0.003). Patients with the diagnosis of acute abdomen had a statistically significantly higher incidence of nosocomial infections compared to other patients (p = 0.001). Gram-negative bacteria were the most commonly isolated pathogens (46.8%). Acinetobacter baumanii proved to be the most resistant species in this study, since 80% of the strains did not show sensitivity to any of the tested antibiotics. Conclusion. Nosocomial infections are present in slightly more than half of the patients treated at the pediatric surgical intensive care unit. Patients who developed nosocomial infections stayed longer in the pediatric surgical intensive care unit, which had negative consequences for their health and treatment costs.

scholarly journals Chlorhexidine Gluconate Bathing Program to Reduce Health Care–Associated Infections in Both Critically Ill and Non–Critically Ill Patients

2021 ◽  
Vol 41 (5) ◽  
pp. e1-e8
Author(s):  
Leigh Chapman ◽  
Lisa Hargett ◽  
Theresa Anderson ◽  
Jacqueline Galluzzo ◽  
Paul Zimand
Keyword(s):  
Health Care ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Critically Ill ◽  
Chlorhexidine Gluconate ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Telemetry Unit ◽  
Health Care Associated Infections ◽  
The Impact

Background Critical care nurses take care of patients with complicated, comorbid, and compromised conditions. These patients are at risk for health care–associated infections, which affect patients’ lives and health care systems in various ways. Objective To gauge the impact of routinely bathing patients with 4% chlorhexidine gluconate solution on the incidence of health care–associated infections in a medical-surgical intensive care unit and a postoperative telemetry unit; to outline the framework for a hospital-wide presurgical chlorhexidine gluconate bathing program and share the results. Methods A standard bathing protocol using a 4% chlorhexidine gluconate solution was developed. The protocol included time studies, training, monitoring, and surveillance of health care–associated infections. Results Consistent patient bathing with 4% chlorhexidine gluconate was associated with a 52% reduction in health care–associated infections in a medical-surgical intensive care unit. The same program in a postoperative telemetry unit yielded a 45% reduction in health care–associated infections. Conclusion A comprehensive daily 4% chlorhexidine gluconate bathing program can be implemented with standardized protocols and detailed instructions and can significantly reduce the incidence of health care–associated infections in intensive care unit and non–intensive care unit hospital settings.

Serratia marcescans Contamination of Antiseptic Soap Containing Triclosan: Implications for Nosocomial Infection

1984 ◽  
Vol 5 (9) ◽  
pp. 427-430 ◽  
Author(s):  
M. Anita Barry ◽  
Donald E. Craven ◽  
Theresa A. Goularte ◽  
Deborah A. Lichtenberg
Keyword(s):  
Intensive Care Unit ◽  
Pseudomonas Aeruginosa ◽  
Intensive Care ◽  
Nosocomial Infection ◽  
Surgical Intensive Care Unit ◽  
Minimal Bactericidal Concentration ◽  
Surgical Intensive Care ◽  
Time Kill ◽  
The Impact

Abstract During a recent investigation in our surgical intensive care unit, we found that several bottles of the antiseptic handwashing soap, OR Scrub®, were contaminated with Serratia marcescens. OR Scrub® contains 1% triclosan, lanolin, and detergents. The antimicrobial efficacy of OR Scrub® was examined in vitro using serial two-fold dilutions of soap inoculated with various concentrations of different nosocomial pathogens. The minimal bactericidal concentration (MBC) of OR Scrub® against Pseudomonas aeruginosa and several strains of S. marcescens was ≤1:2 By comparison, a non-antiseptic soap from the same manufacturer (Wash®) and 4% chlorhexidine (Hibiclens®) had MBCs for all strains tested of at least 1:64. Time-kill curves confirmed the findings of the initial experiments.This is the first report of extrinsic contamination of antiseptic soap containing triclosan. No infections could be attributed to the contaminated soap, but sporadic outbreaks of Serratia have occurred in the intensive care unit with no identifiable source. Although there have been few studies on the impact of antiseptic soap in reducing nosocomial infection, we question whether a soap with the limitations of OR Scrub® should be used in intensive care units or operating rooms.

scholarly journals Environmental contamination in a coronavirus disease 2019 (COVID-19) intensive care unit—What is the risk?

2020 ◽  
pp. 1-9
Author(s):  
Sean Wei Xiang Ong ◽  
Pei Hua Lee ◽  
Yian Kim Tan ◽  
Li Min Ling ◽  
Benjamin Choon Heng Ho ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Cell Culture ◽  
Intensive Care ◽  
Infection Control ◽  
Environmental Contamination ◽  
Transmission Risk ◽  
Common Area ◽  
The Common ◽  
General Wards ◽  
The Impact

Abstract Background: The risk of environmental contamination by severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in the intensive care unit (ICU) is unclear. We evaluated the extent of environmental contamination in the ICU and correlated this with patient and disease factors, including the impact of different ventilatory modalities. Methods: In this observational study, surface environmental samples collected from ICU patient rooms and common areas were tested for SARS-CoV-2 by polymerase chain reaction (PCR). Select samples from the common area were tested by cell culture. Clinical data were collected and correlated to the presence of environmental contamination. Results were compared to historical data from a previous study in general wards. Results: In total, 200 samples from 20 patient rooms and 75 samples from common areas and the staff pantry were tested. The results showed that 14 rooms had at least 1 site contaminated, with an overall contamination rate of 14% (28 of 200 samples). Environmental contamination was not associated with day of illness, ventilatory mode, aerosol-generating procedures, or viral load. The frequency of environmental contamination was lower in the ICU than in general ward rooms. Eight samples from the common area were positive, though all were negative on cell culture. Conclusion: Environmental contamination in the ICU was lower than in the general wards. The use of mechanical ventilation or high-flow nasal oxygen was not associated with greater surface contamination, supporting their use and safety from an infection control perspective. Transmission risk via environmental surfaces in the ICUs is likely to be low. Nonetheless, infection control practices should be strictly reinforced, and transmission risk via droplet or airborne spread remains.

scholarly journals A Diagnostic Stewardship Intervention To Improve Blood Culture Use among Adult Nonneutropenic Inpatients: the DISTRIBUTE Study

2020 ◽  
Vol 58 (10) ◽  
Author(s):  
Valeria Fabre ◽  
Eili Klein ◽  
Alejandra B. Salinas ◽  
George Jones ◽  
Karen C. Carroll ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Blood Culture ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Control Units ◽  
Stewardship Program ◽  
Academic Center ◽  
Before And After ◽  
The Impact

ABSTRACT Interventions to optimize blood culture (BCx) practices in adult inpatients are limited. We conducted a before-after study evaluating the impact of a diagnostic stewardship program that aimed to optimize BCx use in a medical intensive care unit (MICU) and five medicine units at a large academic center. The program included implementation of an evidence-based algorithm detailing indications for BCx use and education and feedback to providers about BCx rates and indication inappropriateness. Neutropenic patients were excluded. BCx rates from contemporary control units were obtained for comparison. The primary outcome was the change in BCxs ordered with the intervention. Secondary outcomes included proportion of inappropriate BCx, solitary BCx, and positive BCx. Balancing metrics included compliance with the Centers for Medicare and Medicaid Services (CMS) SEP-1 BCx component, 30-day readmission, and all-cause in-hospital and 30-day mortality. After the intervention, BCx rates decreased from 27.7 to 22.8 BCx/100 patient-days (PDs) in the MICU (P = 0.001) and from 10.9 to 7.7 BCx/100 PD for the 5 medicine units combined (P < 0.001). BCx rates in the control units did not decrease significantly (surgical intensive care unit [ICU], P = 0.06; surgical units, P = 0.15). The proportion of inappropriate BCxs did not significantly change with the intervention (30% in the MICU and 50% in medicine units). BCx positivity increased in the MICU (from 8% to 11%, P < 0.001). Solitary BCxs decreased by 21% in the medicine units (P < 0.001). Balancing metrics were similar before and after the intervention. BCx use can be optimized with clinician education and practice guidance without affecting sepsis quality metrics or mortality.

Epidemiologic, Clinical, and Economic Evaluation of an Outbreak of Clonal Multidrug-ResistantAcinetobacter baumanniiInfection in a Surgical Intensive Care Unit

2007 ◽  
Vol 28 (11) ◽  
pp. 1247-1254 ◽  
Author(s):  
Lisa S. Young ◽  
Allison L. Sabel ◽  
Connie S. Price
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Intensive Care ◽  
Infection Control ◽  
Significant Risk ◽  
Surgical Intensive Care Unit ◽  
Surgical Intensive Care ◽  
Duration Of Hospitalization ◽  
Tract Infections ◽  
Pulsatile Lavage

Objectives.To determine risk factors for acquisition of multidrug-resistant (MDR)Acinetobacter baumanniiinfection during an outbreak, to describe the clinical manifestations of infection, and to ascertain the cost of infection.Design.Case-control study.Setting.Surgical intensive care unit in a 400-bed urban teaching hospital and level 1 trauma center.Patients.Case patients received a diagnosis of infection due toA. baumanniiisolates with a unique pattern of drug resistance (ie, susceptible to imipenem, variably susceptible to aminoglycosides, and resistant to all other antibiotics) between December 1, 2004, and August 31, 2005. Case patients were matched 1 : 1 with concurrently hospitalized control patients. Isolates' genetic relatedness was established by pulsed-field gel electrophoresis.Results.Sixty-seven patients met the inclusion criteria. Case and control patients were similar with respect to age, duration of hospitalization, and Charlson comorbidity score. MDRA. baumanniiinfections included ventilator-associated pneumonia (in 56.7% of patients), bacteremia (in 25.4%), postoperative wound infections (in 25.4%), central venous catheter-associated infections (in 20.9%), and urinary tract infections (in 10.4%). Conditional multiple logistic regression was used to determine statistically significant risk factors on the basis of results from the bivariate analyses. The duration of hospitalization and healthcare charges were modeled by multiple linear regression. Significant risk factors included higher Acute Physiology and Chronic Health Evaluation II score (odds ratio [OR], 1.1 per point increase;P= .06), duration of intubation (OR, 1.4 per day intubated;P<.01), exposure to bronchoscopy (OR, 22.7;P= .03), presence of chronic pulmonary disease (OR, 77.7;P= .02), receipt of fluconazole (OR, 73.3;P<.01), and receipt of levofloxacin (OR, 11.5;P= .02). Case patients had a mean of $60,913 in attributable excess patient charges and a mean of 13 excess hospital days.Interventions.Infection control measures included the following: limitations on the performance of pulsatile lavage wound debridement, the removal of items with upholstered surfaces, and the implementation of contact isolation for patients with suspected MDRA. baumanniiinfection.Conclusions.This large outbreak of infection due to clonal MDRA. baumanniicaused significant morbidity and expense. Aerosolization of MDRA. baumanniiduring pulsatile lavage debridement of infected wounds and during the management of respiratory secretions from colonized and infected patients may promote widespread environmental contamination. Multifaceted infection control interventions were associated with a decrease in the number of MDRA. baumanniiisolates recovered from patients.

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