Nasopharyngeal and Oropharyngeal Decontamination to Prevent Nosocomial Infection in Cardiac Surgery Patients

2018 ◽  
pp. 282-286
Author(s):  
Jose L. Diaz-Gomez ◽  
Sarah W. Robison
Keyword(s):  
Cardiac Surgery ◽  
Nosocomial Infection ◽  
Nosocomial Infections ◽  
Pathogenic Bacteria ◽  
Absolute Risk ◽  
Primary Source ◽  
Surgical Site Infections ◽  
Absolute Risk Reduction ◽  
Preventative Strategy ◽  
Duration Of Hospitalization

Preventing nosocomial infections is important to improve postoperative outcomes for cardiac surgery patients. The patient’s own flora is thought to be the primary source of potentially pathogenic bacteria. Therefore, decontamination is an appealing preventative strategy for reducing nosocomial infections. This study investigated the use of topical chlorhexidine gluconate for perioperative nasal and oropharyngeal decontamination in cardiac surgery patients. The intervention resulted in a significant reduction in lower respiratory tract infections, deep surgical site infections, use of nonprophylactic antibiotics, and duration of hospitalization. There was an absolute risk reduction in total nosocomial infection of 6.4%; 16 patients would have to be treated with the chlorhexidine decontamination strategy to prevent one nosocomial infection. Chlorhexidine is an advantageous antimicrobial because it has broad-spectrum coverage, is inexpensive, and is very well tolerated.

scholarly journals Potential of Therapeutic Bacteriophages in Nosocomial Infection Management

2021 ◽  
Vol 12 ◽  
Author(s):  
Nannan Wu ◽  
Tongyu Zhu
Keyword(s):  
Nosocomial Infection ◽  
Nosocomial Infections ◽  
Pathogenic Bacteria ◽  
Cost Effective ◽  
Good Manufacturing Practice ◽  
Modern Medicine ◽  
Patient Treatment ◽  
Phage Library ◽  
Infection Management ◽  
The Impact

Nosocomial infections (NIs) are hospital-acquired infections which pose a high healthcare burden worldwide. The impact of NIs is further aggravated by the global spread of antimicrobial resistance (AMR). Conventional treatment and disinfection agents are often insufficient to catch up with the increasing AMR and tolerance of the pathogenic bacteria. This has resulted in a need for alternative approaches and raised new interest in therapeutic bacteriophages (phages). In contrast to the limited clinical options available against AMR bacteria, the extreme abundance and biodiversity of phages in nature provides an opportunity to establish an ever-expanding phage library that collectively provides sustained broad-spectrum and poly microbial coverage. Given the specificity of phage-host interactions, phage susceptibility testing can serve as a rapid and cost-effective method for bacterial subtyping. The library can also provide a database for routine monitoring of nosocomial infections as a prelude to preparing ready-to-use phages for patient treatment and environmental sterilization. Despite the remaining obstacles for clinical application of phages, the establishment of phage libraries, pre-stocked phage vials prepared to good manufacturing practice (GMP) standards, and pre-optimized phage screening technology will facilitate efforts to make phages available as modern medicine. This may provide the breakthrough needed to demonstrate the great potential in nosocomial infection management.

Long-term Effects of Remote Ischemic Preconditioning on Kidney Function in High-risk Cardiac Surgery Patients

2017 ◽  
Vol 126 (5) ◽  
pp. 787-798 ◽  
Author(s):  
Alexander Zarbock ◽  
John A. Kellum ◽  
Hugo Van Aken ◽  
Christoph Schmidt ◽  
Mira Küllmar ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Cardiac Surgery ◽  
High Risk ◽  
Renal Dysfunction ◽  
Ischemic Preconditioning ◽  
Absolute Risk ◽  
Kidney Injury ◽  
Absolute Risk Reduction ◽  
Remote Ischemic Preconditioning ◽  
Major Adverse Kidney Events

Abstract Background In a multicenter, randomized trial, the authors enrolled patients at high-risk for acute kidney injury as identified by a Cleveland Clinic Foundation score of 6 or more. The authors enrolled 240 patients at four hospitals and randomized them to remote ischemic preconditioning or control. The authors found that remote ischemic preconditioning reduced acute kidney injury in high-risk patients undergoing cardiac surgery. The authors now report on the effects of remote ischemic preconditioning on 90-day outcomes. Methods In this follow-up study of the RenalRIP trial, the authors examined the effect of remote ischemic preconditioning on the composite endpoint major adverse kidney events consisting of mortality, need for renal replacement therapy, and persistent renal dysfunction at 90 days. Secondary outcomes were persistent renal dysfunction and dialysis dependence in patients with acute kidney injury. Results Remote ischemic preconditioning significantly reduced the occurrence of major adverse kidney events at 90 days (17 of 120 [14.2%]) versus control (30 of 120 [25.0%]; absolute risk reduction, 10.8%; 95% CI, 0.9 to 20.8%; P = 0.034). In those patients who developed acute kidney injury after cardiac surgery, 2 of 38 subjects in the remote ischemic preconditioning group (5.3%) and 13 of 56 subjects in the control group (23.2%) failed to recover renal function at 90 days (absolute risk reduction, 17.9%; 95% CI, 4.8 to 31.1%; P = 0.020). Acute kidney injury biomarkers were also increased in patients reaching the major adverse kidney event endpoint compared to patients who did not. Conclusions Remote ischemic preconditioning significantly reduced the 3-month incidence of a composite endpoint major adverse kidney events consisting of mortality, need for renal replacement therapy, and persistent renal dysfunction in high-risk patients undergoing cardiac surgery. Furthermore, remote ischemic preconditioning enhanced renal recovery in patients with acute kidney injury.

scholarly journals Post-cardiac surgery bacterial contamination

2021 ◽  
Vol 64 (4) ◽  
pp. 5-9
Author(s):  
Aliona Nastas ◽  
Keyword(s):  
Cardiac Surgery ◽  
Nosocomial Infections ◽  
Heart Defects ◽  
Surgical Site Infections ◽  
Cross Sectional Study ◽  
Microsoft Excel ◽  
Cross Sectional ◽  
High Incidence ◽  
Tract Infections ◽  
And Control

Background: Septic purulent nosocomial infections (SPNI) are one of the most significant healthcare challenges of post-surgical procedures. SPNI are associated with increased morbidity, mortality and admission costs. It is a priority to determine the level of nosocomial infections (NI). This study aims to evaluate the bacterial contaminations after cardiac surgery within the Department of Acquired Heart Defects (DAHD). Material and methods: A cross-sectional study was designed and the medical records of 1189 patients who underwent cardiac surgery within the DAHD of a multiprofile hospital were retrospectively analyzed. The data were collected and stored in a Microsoft Excel spreadsheet. Results: The incidence rate of SPNI following cardiac surgery was 317.57‰ compared to 15.02‰ officially reported (p <0.001). Of the most common infections among the total of 418 cases of SPNI studied, 32.06% were surgical site infections, 23.18% were associations of infections, 19.14% – respiratory tract infections. A patient with SPNI has an average of 22.25 days/bed spent in hospital, compared with the average for a patient without SPNI of 12.27 days/bed. The etiological structure includes 28 species of microorganisms including gram-positive (61.92%) and gram-negative (38.08%). Conclusions: Given the relatively high incidence of the SPNI and its impact, it is imperative to take more serious measures to prevent and control these infections

scholarly journals Nosocomial infections in the departments of orthopedics and traumatology

2005 ◽  
Vol 62 (7-8) ◽  
pp. 507-511
Author(s):  
Jadranka Maksimovic ◽  
Ljiljana Markovic-Denic ◽  
Marko Bumbasirevic ◽  
Jelena Marinkovic
Keyword(s):  
Orthopedic Surgery ◽  
Nosocomial Infections ◽  
Surgical Site Infections ◽  
Surgical Patients ◽  
Epidemiological Surveillance ◽  
Laboratory Findings ◽  
Duration Of Hospitalization ◽  
Definition Of ◽  
Tract Infections ◽  
Hospital Days

Aim. To determine the incidence and the localization of nosocomial infections (NI) in the departments of orthopedics and traumatology. Methods. A prospective cohort study carried out between February 1 and July 31, 2002 included all of the surgical patients who were hospitalized longer than 48 hours, as well as 30 days after the discharge. The patients were examined and their diagnoses made according to the definition of NI, that was based on the clinical and/or laboratory findings. Results. Out of 277 hospitalized patients, 78 had a total of 91 NIs. Sixty seven (85.8%) of the patients had 1 registered NI each, 9 (11.6%) of the patient had 2 NIs each, while only the 2 (2.6%) were with 3 NIs. The incidence of the patients with HAI was 28.2% (95% IP = 22.9-33.5), while the incidence of HAI was 32.8%. The patients who developed a NI were hospitalized almost twice as long as the patients who did not (t test = 6.0, DF = 275, p < 0.001). In regard to the duration of hospitalization, the incidence of NI was 12.3 per 1000 patient-hospital days. The patients operated on most frequently had the surgical-site infections (69.2%). Of 63 infections of the surgical site, 3 patients (4.8%) were diagnosed as having the NI at that localization following the discharge, and then the urinary tract infections, 25.3% (23/91), and sepsis, 5.5% (5/91). Conclusion. Epidemiological surveillance was the first step towards the prevention and the eradication of NI. The results of this study could be of use in planning of the adequate measures for the prevention of NI in the departments of orthopedic surgery.

Dexmedetomidine versus Propofol Sedation Reduces Delirium after Cardiac Surgery

2016 ◽  
Vol 124 (2) ◽  
pp. 362-368 ◽  
Author(s):  
George Djaiani ◽  
Natalie Silverton ◽  
Ludwik Fedorko ◽  
Jo Carroll ◽  
Rima Styra ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Absolute Risk ◽  
Controlled Trial ◽  
Absolute Risk Reduction ◽  
Confusion Assessment Method ◽  
Assessment Method ◽  
Number Needed To Treat ◽  
Confusion Assessment ◽  
Institutional Ethics ◽  
Randomization Code

Abstract Background Postoperative delirium (POD) is a serious complication after cardiac surgery. Use of dexmedetomidine to prevent delirium is controversial. The authors hypothesized that dexmedetomidine sedation after cardiac surgery would reduce the incidence of POD. Methods After institutional ethics review board approval, and informed consent, a single-blinded, prospective, randomized controlled trial was conducted in patients 60 yr or older undergoing cardiac surgery. Patients with a history of serious mental illness, delirium, and severe dementia were excluded. Upon admission to intensive care unit (ICU), patients received either dexmedetomidine (0.4 μg/kg bolus followed by 0.2 to 0.7 μg kg−1 h−1 infusion) or propofol (25 to 50 μg kg−1 min−1 infusion) according to a computer-generated randomization code in blocks of four. Assessment of delirium was performed with confusion assessment method for ICU or confusion assessment method after discharge from ICU at 12-h intervals during the 5 postoperative days. Primary outcome was the incidence of POD. Results POD was present in 16 of 91 (17.5%) and 29 of 92 (31.5%) patients in dexmedetomidine and propofol groups, respectively (odds ratio, 0.46; 95% CI, 0.23 to 0.92; P = 0.028). Median onset of POD was on postoperative day 2 (1 to 4 days) versus 1 (1 to 4 days), P = 0.027, and duration of POD 2 days (1 to 4 days) versus 3 days (1 to 5 days), P = 0.04, in dexmedetomidine and propofol groups, respectively. Conclusions When compared with propofol, dexmedetomidine sedation reduced incidence, delayed onset, and shortened duration of POD in elderly patients after cardiac surgery. The absolute risk reduction for POD was 14%, with a number needed to treat of 7.1.

Converting Incidence and Prevalence Data of Nosocomial Infections Results From Eight Hospitals

2001 ◽  
Vol 22 (1) ◽  
pp. 31-34 ◽  
Author(s):  
Petra Gastmeier ◽  
Helga Bräuer ◽  
Dorit Sohr ◽  
Christine Geffers ◽  
Dietmar H. Forster ◽  
...  
Keyword(s):  
Confidence Interval ◽  
Nosocomial Infection ◽  
Nosocomial Infections ◽  
Surgical Site Infections ◽  
Prevalence Data ◽  
Prevalence Studies ◽  
Incidence Data ◽  
Discharged Patients ◽  
Separate Point ◽  
Tract Infections

AbstractObjective:To investigate the use of the formula of Rhame and Sudderth for the interconversion of prevalence and incidence data on the frequency of nosocomial infections.Design:Comparison of observed and calculated incidence data and prevalence data.Setting:One 8-week incidence investigation in the surgical and intensive care units of eight medium-sized hospitals; three separate point-prevalence studies in the same units.Results:The overall prevalence observed after the three prevalence studies in 2,169 patients was 6.8% (95% confidence interval [CI95], 5.7-8.0). In 2,882 discharged patients observed during the incidence study, the mean hospitalization was 9.8 days; patients with one or more nosocomial infection had a mean hospitalization time of 22.3 days and a mean interval of 8.2 days from admission to the first day of infection. Based on these data, the overall calculated incidence was 4.7%, whereas the observed incidence was 4.3% (CI95, 3.6-5.2). Vice versa, an overall prevalence of 6.2% was found when calculated from the observed incidence data.The incidence data calculated from prevalence data also were within the confidence interval of the incidences observed for urinary tract infections and surgical-site infections. (However, it was not possible to convert the data for two of the eight hospitals.)Conclusion:The approximate mathematical relationship between the prevalence and incidence data of nosocomial infection is confirmed by this study. However, although it is theoretically possible, we would not recommend the conversion of prevalence into incidence data or vice versa.

Nosocomial Infections in Spain: Results of Five Nationwide Serial Prevalence Surveys (EPINE Project, 1990–1994)

1996 ◽  
Vol 17 (5) ◽  
pp. 293-297
Author(s):  
Josep Vaqué ◽  
José Rosselló ◽  
Antoni Trilla ◽  
Vicente Monge ◽  
Juan García-Caballero ◽  
...  
Keyword(s):  
Nosocomial Infection ◽  
Acute Care ◽  
Nosocomial Infections ◽  
Prevalence Rate ◽  
Respiratory Tract Infections ◽  
Surgical Site Infections ◽  
Core Sample ◽  
Convenience Sample ◽  
Prevalence Studies ◽  
Tract Infections

AbstractObjective: To determine trends in rates of nosocomial infections in Spanish hospitals.Design: Prospective prevalence studies, performed yearly from 1990 through 1994.Setting: A convenience sample of acute-care Spanish hospitals.Participants and Patients: The number of hospitals and patients included were as follows: 1990, 125 hospitals and 38,489 patients; 1991, 136 and 42,185; 1992, 163 and 44,343; 1993, 171 and 46,983; 1994, 186 and 49,689. A core sample of 74 hospitals, which participated in all five surveys and included a mean of 23,871 patients per year, was analyzed separately.Results: The overall prevalence rate of patients with nosocomial infections in the five studies was as follows: 1990, 8.5%; 1991, 7.8%; 1992, 7.3%; 1993, 7.1%; and 1994, 7.2%. The prevalence rate of patients with nosocomial infection in the core sample of 74 hospitals was 8.9%, 8.0%, 7.4%, 7.6%, and 7.6%, respectively (test for trend, P=.0001). Patients admitted to intensive care units had a 22.8% prevalence rate of nosocomial infection in 1994. The most common nosocomial infections by primary site were urinary tract infection and surgical site infections, followed by respiratory tract infections and bacteremia. More than 60% of all infections were supported by a microbiological diagnosis.Conclusions: The EPINE project provides a uniform tool for performing limited surveillance of nosocomial infections in most Spanish acute-care hospitals. Its use helps to spread an accepted set of definitions and methods for nosocomial infection control in the Spanish healthcare system. The surveys indicate that the prevalence of nosocomial infections has been reduced over the last 5 years in a core sample of Spanish hospitals.

scholarly journals Hospital Stay in Nosocomial Infections

2019 ◽  
Vol 33 (7-8) ◽  
pp. 142-9
Author(s):  
Herry Garna
Keyword(s):  
Child Health ◽  
Length Of Stay ◽  
Nosocomial Infection ◽  
Medical School ◽  
Prospective Study ◽  
Hospital Stay ◽  
Nosocomial Infections ◽  
Duration Of Hospitalization

A 9 month prospective study on nosocomial infections was held from August 1988 till April 1989 at the Department of Child Health, Medical School, Padjadjaran University, Hasan Sadikin Hospital Bandung. The purpose of the study was to compare the duration of hospitalization in patients with and without nosocomial infections. The Department of Child Health has 4 main wards, A2 (for low sosioeconomic families), A3 (for middle and high socioeconomic families), R-17 (for neonates) anda NICU. There were 4328 hospitalized pediatrica patients observed consisting of 293 children (29 9%) in A2, 485 (11.2%) in A3, 2487 (57.5%) in R-17, and 41 episodes in NICU, showing rates of 9.9% in A2, 4.5% in A3, 8.8% in R-17 and 65.1% in NICU. The means hospital stay of patients with nosocomial infecitons were 26.77 and 22.44 days in A2 and NICU, while in A3 and R-17 17.61 and 6.75 days. The means hospital stay of patients without nosocomial infecitons were 13.11 and 9.24 days in A2 and NICU, and 1 0.48 and 3.10 days In A3 and R-1 7. Length of stay specific nosocomial infeciton rate rose with the duration of hospitalization, with 3 2% of patients staying upt to 6 days, 16.7% of patients staying 7-13 days, 19.7% of patients staying 14 to 20 days, and 48,8% of patients staying 35 days or more. It can be concluded that the longer the length of stay, the higher the number of nosocomial infections. The overall mean hospital stay of patients with nosocomial infection was 2.4 times higher than that without nosocomial infection.

Sign in / Sign up

Export Citation Format

Share Document