Successful Control of Widespread Methicillin-ResistantStaphylococcus aureusColonization and Infection in a Large Teaching Hospital in The Netherlands

2007 ◽  
Vol 28 (8) ◽  
pp. 970-975 ◽  
Author(s):  
M. J. C. A. van Trijp ◽  
D. C. Melles ◽  
W. D. H. Hendriks ◽  
G. A. Parlevliet ◽  
M. Gommans ◽  
...  
Keyword(s):  
The Netherlands ◽  
Medical Center ◽  
Hospital Staff ◽  
Dutch Hospital ◽  
Staff Members ◽  
Conventional Culture ◽  
Large Teaching Hospital ◽  
Low Prevalence ◽  
Mrsa Colonization ◽  
Search And Destroy

Objective.The low prevalence of infection and colonization with methicillin-resistantStaphylococcus aureus(MRSA) in The Netherlands is ascribed to a national “search-and-destroy” policy. We describe the measures that were implemented to control widespread MRSA colonization and infection in a Dutch hospital.Design.Descriptive intervention study.Setting.Teaching medical center with a capacity of 679 beds, including 16 intensive care beds.Interventions.MRSA colonization and infection were identified using conventional culture with a selective broth. Isolates were typed using pulsed-field gel electrophoresis. Measures to control the epidemic included screening of contacts (patients and hospital staff), screening of patients at readmission or discharge, strict isolation of MRSA-positive patients, decolonization of colonized staff and patients, the development of an electronic signal identifying MRSA-positive patients, and the development of a culture information-system for hospital personnel.Results.Awareness of uncontrolled dissemination of MRSA began in November 2001. Because the clone involved had a low minimum inhibitory concentration for oxacillin, at first it was not recognized as MRSA. In February 2002, when major screening efforts started, it appeared that MRSA had spread all over the hospital and that many staff members were colonized. By the end of December 2005, a total of 600 patients and 135 staff members were found to be newly colonized. The yearly incidence of cases of MRSA colonization and infection decreased from 351 in 2002 to 56 in 2005. Typing of the isolates showed that 3 MRSA clones were predominant. Outbreaks of colonization involving these clones did not occur after 2003.Conclusion.Our observations show that strict application of “search-and-destroy” measures can effectively control a huge epidemic of MRSA colonization and infection.

scholarly journals 5 Years of Experience Implementing a Methicillin-Resistant Staphylococcus aureus Search and Destroy Policy at the Largest University Medical Center in the Netherlands

2009 ◽  
Vol 30 (10) ◽  
pp. 977-984 ◽  
Author(s):  
Margreet C. Vos ◽  
Myra D. Behrendt ◽  
Damian C. Melles ◽  
Femke P. N. Mollema ◽  
Woutrinus de Groot ◽  
...  
Keyword(s):  
At Risk ◽  
Staphylococcus Aureus ◽  
The Netherlands ◽  
Transmission Rate ◽  
Medical Center ◽  
Tertiary Care ◽  
Reproduction Rate ◽  
Methicillin Resistant ◽  
Mrsa Colonization ◽  
Search And Destroy

Objective.TO evaluate the effectiveness of a rigorous search and destroy policy for controlling methicillin-resistant Staphylococcus aureus (MRSA) infection or colonization.Design.Hospital-based observational follow-up study.Setting.Erasmus University Medical Center Rotterdam, a 1,200-bed tertiary care center in Rotterdam, the Netherlands.Methods.Outbreak control was accomplished by the use of active surveillance cultures for persons at risk, by the preemptive isolation of patients at risk, and by the strict isolation of known MRSA carriers and the eradication of MRSA carriage. For unexpected cases of MRSA colonization or infection, patients placed in strict isolation or contact isolation and healthcare workers (HCWs) were screened. We collected data from 2000–2004.Results.During the 5-year study period, 51,907 MRSA screening cultures were performed for 21,598 persons at risk (8,403 patients and 13,195 HCWs). By screening, it was determined that 123 (1.5%) of 8,403 patients and 31 (0.2%) of 13,195 HCWs were MRSA carriers. From the performance of clinical cultures, it was determined that 54 additional patients were MRSA carriers, resulting in a total of 177 patients carrying MRSA. Of the 177 patients carrying MRSA, 144 (81%) were primary patients, and 33 (19%) secondary Patients. The average number of nosocomial transmissions was 6.7 per year. The cumulative incidence of MRSA colonization among this group of patients was 0.10 cases per 100 admissions. Of 156 cases of MRSA colonization, 44 (28%) were acquired in a foreign healthcare institution, and 45 (29%) were acquired in other Dutch hospitals, 22 (47%) of which were acquired in a single hospital in our region. There were 16 cases (10%) that occurred in a nursing home and another 16 cases (10%) that fulfilled our definition of community-acquired MRSA colonization; there were 4 cases (3%) categorized as “other” and 31 cases (20%) for which the source of MRSA acquisition remained unknown. The basic reproduction rate was 10-fold less for patients isolated on admission, compared with those who were not. During the 5-year study period, 5 episodes of MRSA bacteremia occurred in which 4 patients died, an incidence rate of 0.28 cases of infection per 100,000 patient-days per year.Conclusion.Our results show that, during a rigorous search and destroy policy, a low incidence of MRSA in our medical center was continuously observed and that this policy most likely contributed to a very low nosocomial transmission rate.

Psychometric Properties and Measurement Invariance of Short-Form Life Attitude Inventory for Hospital Staff

2021 ◽  
Author(s):  
Kang-Ju Chou ◽  
Ying-Yao Cheng ◽  
Hua-Chang Fang ◽  
Fu-Zong Wu ◽  
Pei-Chin Lin ◽  
...  
Keyword(s):  
Health Care ◽  
Root Mean Square ◽  
Internal Consistency ◽  
Short Form ◽  
Medical Center ◽  
Hospital Staff ◽  
Mean Square ◽  
Order Model ◽  
Staff Members ◽  
Attitude Inventory

Abstract Background: The life attitude of health care workers can deeply influence the quality of care. Examining the performance of the Short-Form Life Attitude Inventory (SF-LAI), this study analyzes the factorial structure, reliability, and invariance of the revised SF-LAI across genders and professions among the staff of a teaching medical center.Methods: The SF-LAI was developed for university students in Taiwan. From January to February 2019, we administered a cross-sectional survey of life attitudes by distributing the SF-LAI to all staff members of a medical center in Taiwan. The construct validity was evaluated using a confirmatory factor analysis (CFA). Model fit was assessed in terms of the comparative fit index (CFI), Tucker–Lewis index (TFI), standardized root mean square residual (SRMR), and root mean square of error of approximation (RMSEA). Internal consistency was calculated using Cronbach’s alpha. We also performed the CFA invariance analysis for the SF-LAI-R across genders and professions (physician, nurse and other hospital staff). Results: Of 884 (24.62%) responses, 835 were valid. The participants had a mean age of 47.8 years, and 20.12% were male. In a comparison of multiple CFAs, a second-order model with six factors outperformed other models. The goodness of fit indices revealed the CFI was 0.955, TFI was 0.952, RMSEA was 0.071, and SRMR was 0.038. The Cronbach’s alphas for composite reliability and internal consistency were all greater than 0.8. The first and second-order model had metric and scalar invariance across genders and professions.Conclusions: As health care demands evolve, humanities are becoming more important in medical education. Life attitude of hospital care worker is a crucial indicator of whether one embodies the ideals of a humanistic education. The revised SF-LAI has acceptable structural validity, internal consistency, and invariance across genders and professions among staff members of a teaching medical center.

Hospital Experience with Varicella-Zoster Virus

1986 ◽  
Vol 7 (6) ◽  
pp. 312-316 ◽  
Author(s):  
Keith Krasinski ◽  
Robert S. Holzman ◽  
Rita LaCouture ◽  
Alfred Florman
Keyword(s):  
Infection Control ◽  
Varicella Zoster Virus ◽  
Hospital Staff ◽  
Control Measures ◽  
Varicella Zoster ◽  
Staff Members ◽  
Infection Control Measures ◽  
Serologic Testing ◽  
Care Workers ◽  
History Of

AbstractVaricella-zoster virus (VZV), one of the most common highly communicable agents of disease, stimulates aggressive infection control measures. In a 1-year period, at one hospital, at least 93 inpatients (82 adult patients, 11 pediatric patients) and 2 hospital staff with active varicella-zoster infections served as potential sources of nosocomial infection. Six incidents of exposure to the virus that occurred without the protection of standard infection control precautions were investigated by the infection control surveillance team. One hundred fifty-six patients and 353 hospital staff were exposed. Fifty-one patients had no history of varicella-zoster infection, but only five were susceptible by serologic testing. One hundred one staff members had no history of varicella-zoster, but only 11 were susceptible by serologic testing. These exposures resulted in three secondary varicella-zoster infections, six courses of varicella-zoster immune globulin prophylaxis and furlough of 13 staff members. Epidemiologic investigation consumed approximately 356 hours of staff time, and management of exposed persons cost approximately $41,500. Prospective knowledge of the immune status of health care workers would vastly decrease the time and effort required to control hospital VZV exposures.

Update and external validation of a multivariable prediction model for tube feeding dependency for at least four weeks during chemoradiotherapy for head and neck cancer.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 6040-6040
Author(s):  
Anna C. H. Willemsen ◽  
Annemieke Kok ◽  
Laura W.J. Baijens ◽  
J. P. De Boer ◽  
Remco de Bree ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Radiation Dose ◽  
The Netherlands ◽  
Prediction Model ◽  
Head And Neck ◽  
Neck Cancer ◽  
Predictive Value ◽  
Medical Center ◽  
External Validation ◽  
Tube Feeding

6040 Background: Patients who receive chemoradiation or bioradiation (CRT/BRT) for locally advanced head and neck squamous cell carcinoma (LAHNSCC) often experience high toxicity rates, which may interfere with oral intake, leading to (temporary) tube feeding (TF) dependency. International guidelines recommend gastrostomy insertion when the expected use of TF exceeds four weeks. In this study we aimed to update and externally validate a prediction model to identify patients in need for TF for at least four weeks, meeting the international criteria for prophylactic gastrostomy insertion. Methods: This retrospective multicenter cohort study was performed in four tertiary referral head and neck cancer centers in the Netherlands. The prediction model was developed using data from the University Medical Center Utrecht and the Netherlands Cancer Institute. The model was externally validated in patients from the Maastricht University Medical Center and Radboud University Medical Center. The primary endpoint was TF, initiated during or within 30 days after completion of CRT/BRT, and administered for at least four weeks. Potential predictors were retrieved from patient medical records and radiotherapy dose-volume parameters were calculated. Results: The developmental and validation cohort included 409 and 334 patients respectively. Multivariable analysis showed significant predictive value (p < 0.05) for adjusted diet at start of CRT/BRT, percentage weight change prior to treatment initiation, WHO performance status, tumor-site, nodal stage, mean radiation dose to the contralateral parotid gland, and mean radiation dose to the oral cavity. The area under the receiver operating characteristics curve for the updated model was 0.73 and after external validation 0.64. Positive and negative predictive value at 90% cut off were 80.0% and 48.2% respectively. Conclusions: This externally validated prediction model to estimate TF-dependency for at least four weeks in LAHNSCC patients performs well. This model, which will be presented, can be used in clinical practice to guide personalized decision making on prophylactic gastrostomy insertion.

scholarly journals Fathering Agency Staff Members’ Perspectives on Domestic Violence Perpetration

2010 ◽  
Vol 5 (1) ◽  
pp. 47-56
Author(s):  
Peter F. Cronholm ◽  
Willie Ellison ◽  
Silvana Mazzella ◽  
Marcy Witherspoon ◽  
Joy Bowman Lim ◽  
...  
Keyword(s):  
Domestic Violence ◽  
Odds Ratio ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Agency Staff ◽  
Staff Members ◽  
Training Interventions ◽  
Violence Perpetration ◽  
Low Prevalence ◽  
Routine Inquiry

Purpose: To describe the perspectives of fathering staff regarding domestic violence (DV) perpetration. Materials and methods: A cross-sectional survey of 85 fathering staff members was conducted to identify behaviors and barriers regarding inquiry about DV perpetration. Results: Almost half (47.1%) of the surveyed staff reported never having identified DV perpetration. Routine inquiry was less likely if staff perceived low prevalence rates among their clients (odds ratio [OR] = 0.11, p = .001), did not have standard ways of asking (OR = 0.11, p < .001), or if they had never identified family violence before (OR = 0.07, p < .001). Increased years as a provider (OR = 6.62, p = .001) and DV training (OR = 7.29, p = .003) increased rates of DV perpetration inquiry. Conclusions: Staff of fathering agencies do not routinely screen for DV perpetration likely due to the interplay between individual and agency-level barriers. Appropriate training interventions can address identified barriers.

scholarly journals The Lifelines COVID-19 Cohort: a questionnaire-based study to investigate COVID-19 infection and its health and societal impacts in a Dutch population-based cohort

2020 ◽  
Author(s):  
Kate Mc Intyre ◽  
Pauline Lanting ◽  
Patrick Deelen ◽  
Henry Wiersma ◽  
Judith M. Vonk ◽  
...  
Keyword(s):  
Risk Factors ◽  
Informed Consent ◽  
The Netherlands ◽  
Disease Susceptibility ◽  
Medical Center ◽  
Dutch Population ◽  
Physical And Mental Health ◽  
Weekly Basis ◽  
Wide Range ◽  
Societal Impacts

AbstractThe COVID-19 pandemic has affected billions of people around the world not only through the infection itself but also through its wider impact on public health and daily life. To assess the effects of the pandemic, a team of researchers across a wide range of disciplines developed and implemented the Lifelines COVID-19 questionnaire, leading to the development of the Lifelines COVID-19 cohort. This cohort is recruited from participants of the Lifelines prospective population cohort and the Lifelines NEXT birth cohort, and participants were asked to fill out detailed questionnaires about their physical and mental health and experiences on a weekly basis starting in late March of 2020 and on a bi-weekly basis staring in June 2020. The Lifelines region covers the three Northern provinces of the Netherlands— Drenthe, Groningen and Friesland—which together account for ∼10% of the Dutch population. To date, >70,000 people have responded to the questionnaires at least once, and the questionnaire program is still ongoing. Data collected by the questionnaires will be used to address four aspects of the outbreak: (1) how the COVID-19 pandemic developed in the three northern provinces of the Netherlands, (2) which environmental risk factors predict disease susceptibility and severity, (3) which genetic risk factors predict disease susceptibility and severity and (4) what are the psychological and societal impacts of the crisis.Informed consentAll Lifelines and Lifelines NEXT participants have provided informed consent that provide the opportunity for add-on research.Research involving human participantsBoth the Lifelines and the Lifelines NEXT studies were approved by the ethics committee of the University Medical Center Groningen.

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