The Value of Targeted Nursing in Preventing Nosocomial Infection in Neurology Department

Abstract Rapid determination of an infective aetiology causing neurological inflammation in the cerebrospinal fluid can be challenging in clinical practice. Post-surgical nosocomial infection is difficult to diagnose accurately, as it occurs on a background of altered cerebrospinal fluid composition due to the underlying pathologies and surgical procedures involved. There is additional diagnostic difficulty after external ventricular drain or ventriculoperitoneal shunt surgery, as infection is often caused by pathogens growing as biofilms, which may fail to elicit a significant inflammatory response and are challenging to identify by microbiological culture. Despite much research effort, a single sensitive and specific cerebrospinal fluid biomarker has yet to be defined which reliably distinguishes infective from non-infective inflammation. As a result, many patients with suspected infection are treated empirically with broad-spectrum antibiotics in the absence of definitive diagnostic criteria. To begin to address these issues, we examined cerebrospinal fluid taken at the point of clinical equipoise to diagnose cerebrospinal fluid infection in 14 consecutive neurosurgical patients showing signs of inflammatory complications. Using the guidelines of the Infectious Diseases Society of America, six cases were subsequently characterized as infected and eight as sterile inflammation. Twenty-four contemporaneous patients with idiopathic intracranial hypertension or normal pressure hydrocephalus were included as non-inflamed controls. We measured 182 immune and neurological biomarkers in each sample and used pathway analysis to elucidate the biological underpinnings of any biomarker changes. Increased levels of the inflammatory cytokine interleukin-6 and interleukin-6-related mediators such as oncostatin M were excellent indicators of inflammation. However, interleukin-6 levels alone could not distinguish between bacterially infected and uninfected patients. Within the patient cohort with neurological inflammation, a pattern of raised interleukin-17, interleukin-12p40/p70 and interleukin-23 levels delineated nosocomial bacteriological infection from background neuroinflammation. Pathway analysis showed that the observed immune signatures could be explained through a common generic inflammatory response marked by interleukin-6 in both nosocomial and non-infectious inflammation, overlaid with a toll-like receptor-associated and bacterial peptidoglycan-triggered interleukin-17 pathway response that occurred exclusively during infection. This is the first demonstration of a pathway dependent cerebrospinal fluid biomarker differentiation distinguishing nosocomial infection from background neuroinflammation. It is especially relevant to the commonly encountered pathologies in clinical practice, such as subarachnoid haemorrhage and post-cranial neurosurgery. While requiring confirmation in a larger cohort, the current data indicate the potential utility of cerebrospinal fluid biomarker strategies to identify differential initiation of a common downstream interleukin-6 pathway to diagnose nosocomial infection in this challenging clinical cohort.

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An analysis of infection control of varicella-zoster virus infections in Addenbrooke's Hospital Cambridge over a 5-year period, 1987–92

Epidemiology and Infection ◽

10.1017/s0950268800001278 ◽

1996 ◽

Vol 117 (1) ◽

pp. 165-171 ◽

Cited By ~ 16

Author(s):

T. G. Wreghitt ◽

J. Whipp ◽

C. Redpath ◽

W. Hollingworth

Keyword(s):

Nosocomial Infection ◽

Infection Control ◽

Prospective Study ◽

Varicella Zoster Virus ◽

Virus Infections ◽

Patient Case ◽

Varicella Zoster ◽

Staff Members ◽

Spread Of Infection ◽

The Cost

SummaryThis prospective study analyses infections with varicella-zoster virus (VZV) in Addenbrooke's Hospital, Cambridge during 1987–92 and examines the spread of infection. In total, 93 patients and staff experienced VZV infection. Twenty-one patients had varicella and 49 experienced zoster. None of 101 patients and 1 of 625 staff members in contact with varicella cases acquired infection. By contrast, 2 of 227 patients, and 5 of 1039 staff in contact with zoster cases acquired varicella. One out of 28 (3·6%) VZV antibody-negative patients and staff in contact with varicella acquired infection, compared with 5 out of 29 (17·2%) VZV antibody-negative patients and staff in contact with zoster. Thus, zoster was found to be a more frequent cause of nosocomial infection than varicella. Fourteen members of staff had VZV infection during the study period. One of 99 patients and none of 389 staff members in contact with these cases developed varicella. The cost of dealing with infection control for VZV infections in our hospital is estimated to be £714 per patient case and a total of £13204 per year.

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Nosocomial Infection and Multidrug-Resistant Bacteria Surveillance in Intensive Care Units: A Survey in France

Infection Control and Hospital Epidemiology ◽

10.1086/502482 ◽

2005 ◽

Vol 26 (1) ◽

pp. 13-20 ◽

Cited By ~ 21

Author(s):

François L'Hériteau ◽

Corinne Alberti ◽

Yves Cohen ◽

Gilles Troché ◽

Pierre Moine ◽

...

Keyword(s):

Nosocomial Infection ◽

Infection Control ◽

Multiple Correspondence Analysis ◽

Venous Catheter ◽

Multidrug Resistant ◽

Resistant Bacteria ◽

Central Venous ◽

Venous Catheterization ◽

Structural Variables ◽

Tract Infections

AbstractObjectives:To evaluate nosocomial infection (NI) surveillance strategies in French ICUs and to identify similar patterns defining subsets within which comparisons can be made.Design:A questionnaire was sent to all French ICUs, and a random sample of nonresponders was interviewed.Participants:Three hundred ninety-five responder ICUs (69%) in France.Results:In 282 ICUs (71%), a dedicated ICU staff member was responsible for infection control activities. The microbiology laboratory was usually in the hospital (90%) and computerized (94%) but issued regular hospital microbiology records in only 48% of cases. Patients receiving mechanical ventilation, central venous catheterization, and urinary catheterization were 90%, 79%, and 60%, respectively. Patients were screened for carriage of mul-tidrug-resistant bacteria on admission and during the stay in 70% and 60% of ICUs, respectively, most often targeting MRSA. Quantitative cultures were used to diagnose ventilator-associated pneumonia (VAP) in 90% of ICUs, including distal specimens in 80% and bronchoscopy specimens in 60%. Quantitative central venous catheter (CVC)-segment cultures were used in 70% of ICUs. All CVCs were cultured routinely in 53% of the ICUs. Despite wide variations in infection control and surveillance strategies, multiple correspondence analysis identified 13 key points (4 structural variables and 9 variables concerning the diagnosis of VAP, the surveillance and diagnosis of catheter-related and urinary tract infections, and the mode of screening of MRSA carriers) that categorize the variability of French ICUs' approaches to NIs.Conclusion:This study revealed profound differences in N1 surveillance strategies across ICUs, indicating a need for caution when using N1 surveillance data for comparisons and benchmarking.

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N-CDAD in Canada: Results of the Canadian Nosocomial Infection Surveillance Program 1997 N-CDAD Prevalence Surveillance Project

Canadian Journal of Infectious Diseases ◽

10.1155/2001/304098 ◽

2001 ◽

Vol 12 (2) ◽

pp. 81-88 ◽

Cited By ~ 9

Author(s):

Meaghen Hyland ◽

Marianna Ofner-Agostini ◽

Mark Miller ◽

Shirley Paton ◽

Marie Gourdeau ◽

...

Keyword(s):

Health Care ◽

Nosocomial Infection ◽

Toxin Production ◽

Health Care Facilities ◽

Surveillance Program ◽

Prevention Measures ◽

Case Definitions ◽

Infection Surveillance ◽

Positive Stool ◽

The Impact

BACKGROUND:A 1996 preproject survey among Canadian Hospital Epidemiology Committee (CHEC) sites revealed variations in the prevention, detection, management and surveillance ofClostridium difficile-associated diarrhea (CDAD). Facilities wanted to establish national rates of nosocomially acquired CDAD (N-CDAD) to understand the impact of control or prevention measures, and the burden of N-CDAD on health care resources. The CHEC, in collaboration with the Laboratory Centre for Disease Control (Health Canada) and under the Canadian Nosocomial Infection Surveillance Program, undertook a prevalence surveillance project among selected hospitals throughout Canada.OBJECTIVE:To establish national prevalence rates of N-CDAD.METHODS:For six weeks in 1997, selected CHEC sites tested all diarrheal stools from inpatients for eitherC difficiletoxin orC difficilebacteria with evidence of toxin production. Questionnaires were completed for patients with positive stool assays who met the case definitions.RESULTS:Nineteen health care facilities in eight provinces participated in the project. The overall prevalence of N-CDAD was 13.0% (95% CI 9.5% to 16.5%). The mean number of N-CDAD cases were 66.3 cases/100,000 patient days (95% CI

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Contamination of Propofol Infusions in the Intensive Care Unit: Incidence and Clinical Significance

Anaesthesia and Intensive Care ◽

10.1177/0310057x9802600205 ◽

1998 ◽

Vol 26 (2) ◽

pp. 162-164 ◽

Cited By ~ 27

Author(s):

S. A. R. Webb ◽

B. Roberts ◽

F. X. Breheny ◽

C. L. Golledge ◽

P. D. Cameron ◽

...

Keyword(s):

Intensive Care Unit ◽

Intensive Care ◽

Observational Study ◽

Nosocomial Infection ◽

Wound Infection ◽

Clinical Significance ◽

Low Grade ◽

Clinical Infection ◽

Icu Patients

Epidemics of bacteraemia and wound infection have been associated with the infusion of bacterially contaminated propofol administered during anaesthesia. We conducted an observational study to determine the incidence and clinical significance of administration of potentially contaminated propofol to patients in an ICU setting. One hundred patients received a total of 302 infusions of propofol. Eighteen episodes of possible contamination of propofol syringes were identified, but in all cases contamination was by a low-grade virulence pathogen. There were no episodes of clinical infection or colonization which could be attributed to the administration of contaminated propofol. During the routine use of propofol to provide sedation in ICU patients the risk of nosocomial infection secondary to contamination of propofol is extremely low.

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A microbiological survey of stethoscopes in Australian teaching hospitals: potential for nosocomial infection?

Australian Infection Control ◽

10.1071/hi05079 ◽

2005 ◽

Vol 10 (3) ◽

pp. 79-86

Author(s):

Justin T Denholm ◽

Anthony Levine ◽

Ian H Kerridge ◽

Chris Ashhurst-Smith ◽

John Ferguson ◽

...

Keyword(s):

Nosocomial Infection ◽

Teaching Hospitals

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