Healthcare infection最新文献

Background

Central line-associated bloodstream infections (CLABSI) are associated with significant morbidity, mortality and costs. Multimodal intervention programs are effective in bringing down the rates of CLABSI, but they are difficult to sustain. In an attempt to improve sustainability, we implemented two multimodal intervention programs focusing on high-yield measures and assessed their effect on monthly CLABSI rates over a period of 42 months.

Methods

The CLABSI rates were tracked on a monthly basis in a 300-bed Indian Corporate hospital and an analysis of the various contributing variables was done. The first intervention programin July 2009 put into practice the central line bundle. The second program went beyond the bundle and introduced high-yield measures like dedicated central line team and trolley, involved the senior management and promoted the ‘Scrub the Hub’ campaign while rectifying deficiencies observed in the first intervention program. The rates of CLABSI were statistically analysed in both the pre- and post-intervention periods.

Results

The CLABSI rates varied between 0 to 9.8 infections per 1000 catheter days in the 42 months period, the mean being 2.9. The difference in mean CLABSI rates before and after the first intervention program was not significant (5.2 versus 4.4 infections per 1000 catheter days (P > 0.05)). However, the next intervention programsaw a significant decrease in the mean rates of CLABSI in the subsequent 24 months (0.7 infections per 1000 catheter days (P < 0.05)). An overall 86.3% reduction in CLABSI rates in the entire study period was observed.

Conclusions

Repeated multimodal intervention programs with a focus on high-yield measures resulted in a sustained reduction in CLABSI rates (86.3%).

Introduction

Gastrointestinal endoscopes play an effective diagnostic role in modern medicine. The endoscopes become heavily contaminated with microorganisms during procedures and need careful reprocessing.

Methods

A prospective study was carried out at a gastroenterology hepatology unit to evaluate ATP bioluminescence, measured as relative light units (RLUs), to validate the decontamination processing of endoscopes. Flushes from endoscopes involved in 120 endoscopic procedures at four different stages: pre-patient (before the procedure), post-patient (after the procedure), post-cleaning (after manual cleaning) and post-disinfection were examined by ATP testing and microbiological culture. The hypothetical pass or fail limit of 100 RLUs was set according to previous studies in the literature. When the disinfection process failed, the above process was repeated.

Results

Average RLU readings were: pre-patient: 48; post-patient: 124 052; post-cleaning: 1423; and postdisinfection: 144. The corresponding culture results were: pre-patient: all negative; post-patient: all positive except for four; post-cleaning: positive except for 26; and post-disinfection: all negative. Although 21 (17%) of post-disinfection specimens showed failed ATPlevels of more than 100 RLUs, when the cleaning and disinfection process was repeated before they were used, all scopes then showed a pass level of less than 100 RLUs.

Conclusions

ATP bioluminescence has the potential to play an important role in the validation process. This process would allow a quick turnaround time following a simple check procedure to be classified as safe in a busy endoscopic unit.

Introduction

Regular audits of clinical waste (CW) disposal systems and examination of new technologies can lead to cost and waste reductions, and lowering of infection potential. Sydney Adventist hospital, a 360-bed acute-care private facility, noted that their 240 L, clinical waste (CW) bin system posed issues with infection risk, staff injury risk, aesthetics, logistics, space and cost and evaluated a new, linerless, reusable bin system.

Methods

A facility-wide audit was conducted of the current 240 L bin system before a three ward, 3-month staff evaluation of the new, 64 L, linerless, reusable bin system (Clinismart, SteriHealth Ltd, Melbourne, Vic., Australia). Clinical waste volume and mass were compared between systems over a 30-month period as were contractor costs, labour, space requirements and general waste (GW) mass. Staff opinion was sought via a 10-point questionnaire, and infection and injury risks audited.

Results

Inpatient workloads remained static over the study. Staff evaluations showed a strong preference for the new system which was rolled-out to all wards in the facility. Significant decreases were noted in CW mass (53.2% less), CW volume (65.2% less), CW disposal costs (30.9% less) and labour (69.2% less), and the new system was found to be more space-efficient and logistically superior. Waste segregation was markedly enhanced. Infection potential and injury risks noted with the 240 L system were eliminated.

Conclusion

The study found that the use of a smaller, 64 L, linerless, reusable, hospital wastebin system, through its design and operation, has the potential to reduce clinical waste volumes, increase labour efficiencies, decrease costs and minimise infection potential and sharps injury risk, all of which improve the quality of health care.

Zero-risk for CLABSI is achievable – but not without applying distinctively different strategies. Currently, the majority of ICU patients have a short dwell time, <9 days, and with aseptic insertion will remain infection-free for their entire ICU stay. But the minority of patients have a longer dwell time, contribute the majority of CLABSI and require more than aseptic insertion to reduce the risk of infection. Consequently, aggregating short and longer dwell times prevents us from evaluating care.

Background

We have perceived a deficit in both patients’ and health care workers’ (HCWs) knowledge and understanding of multi-resistant organisms (MROs) which may influence care and compliance with infection control precautions. We aimed to explore the knowledge and understanding of patients and HCWs about MROs.

Methods

Between September 2011 and April 2012, a purposive sample of 19 newly identified and existing patients withMROs were recruited. A15 to 20 min taped interview was conducted and analysed to identifycommon themes. In addition, 55 HCWs completed a questionnaire to assess knowledge regarding MROs.

Results

Almost half (47%) of the patients reported they ‘know very little’ or ‘do not know anything’ about terms including MRO, MRSA and VRE. Patients reported they were not provided with sufficient explanation regarding colonisation or infection.While seeing single-roomaccommodation as an advantage, some felt like an ‘alien’ and were ‘lonely’. Precautionary measures used by HCWs were noted by patients but they were unaware of the reasoning behind them. HCWs (76%) explained the terms MRO, MRSA and VRE adequately. Only 36% of them adequately explained colonisation and infection. Only half of the RN and Medical Officer respondents informed patients about their MRO status. Explanation about the type of MRO, its spread, risk factors and preventative measures were the topics HCWs perceived as important to discuss with patients.

Conclusion

Our findings suggest that patients’ knowledge of their MRO status is poor. Given the major role in educating patients, our study identified a deficit in HCWs’ knowledge regarding MROs. The information patients and HCWs perceived as important will assist in the development of future educational resources.

Background

Community-acquired urinary tract infection (UTI) is the most common bacterial infection encountered in hospitals. Effective empirical antibiotic therapy relies on updated epidemiological data.

Aim

We described the epidemiology of patients with urosepsis presenting to a community hospital in Taiwan in order to assess the appropriateness of empirical therapy.

Methods

Retrospective cohort study of hospitalised adult patients with UTI from 1 January to 31 December 2010. The clinical and microbiological characteristics were analysed using descriptive statistics. Logistic regression was performed to determine predictors of antibiotic resistance.

Results

A total of 420 consecutive patients with 599 isolates were identified. Most patients were ≥65 years old and women (75.4%), and 114 patients (27.1%) had bacteraemia. Escherichia coli (69%) was the most common organism. Cefazolin was effective against E. coli, K. pneumoniae, and P. mirabilis in greater than 80% of the cases. In male patients, urinary catheter and renal stone were independent predictors for cefazolin resistance; diabetes mellitus and malignancy were predictors among female patients.

Conclusion

Patients admitted with UTI should be screened to identify risk factors for bacteraemia and antimicrobial resistance. The treatment guideline in Taiwan needs to be revised in the current era of increasing antimicrobial resistance.

Background

Urinary tract infections account for ~30% of healthcare-associated infections reported by hospitals. Virtually all healthcare-associated urinary tract infections (HAUTIs) are caused by instrumentation of the urinary tract, creating an opportunity to prevent a large proportion of HAUTIs, including catheter-associated urinary tract infections (CAUTIs). In Australia, there is no specific national strategy and surveillance system in place to address HAUTIs or CAUTIs. To determine the need for prospective surveillance of HAUTIs, we propose undertaking a national point prevalence study. This paper describes the methods that could be used to undertake such a study.

Methods

A cross-sectional point prevalence design is proposed. The population is all patients hospitalised overnight in Australian hospitals, with the sample to exclude outpatients and those in emergency departments. The proposed operational definition is that used by the Health Protection Agency. A standardised training package for data collectors is recommended with standardised data collection and analysis processes described. Individual patient consent should be waived.

Discussion

Explanation of aspects of the proposed methods are provided, primarily based on findings from a pilot study that informed the development of the proposed protocol. This included development and delivery of training for data collectors and use of the Health Protection Agency HAUTI surveillance definition, rather than the Centers for Disease Control definition.

Conclusion

Conducting a national point prevalence study on HAUTIs including CAUTIs will provide evidence that can be subsequently used to debate the cost effectiveness and value of prospective surveillance. By conducting a pilot study and critically evaluating that process, we have been able to propose a method that could be used for a single hospital or national study.

Introduction

Treatment of asymptomatic bacteriuria remains a common cause of inappropriate antibiotic use, particularly among patients with multiple comorbidities such as renal disease.

Methods

A pilot, retrospective, observational audit of 200 renal patients was conducted to evaluate significant differences in readmission and mortality rates between patients with asymptomatic bacteriuria (who were not given antibiotic treatment) and patients with symptomatic urinary tract infections.

Results

Nineteen (9.5%) patients had bacteriuria: 12 with symptomatic urinary tract infection and 7 with asymptomatic bacteriuria. None of the patients with asymptomatic bacteriuria were treated with effective antibiotics. There was no difference in readmission (42.9% v. 33.3%;P = 1.00) or mortality rates (0% v. 8.3%;P = 1.00) for patients with untreated asymptomatic bacteriuria when compared with patients with symptomatic urinary tract infections.

Conclusions

This pilot study suggests that it is safe not to treat asymptomatic bacteriuria in renal patients.

Background

Catheter-associated urinary tract infection (CAUTI) is the most common hospital-acquired infection. Key factors influencing the development of CAUTI are indwelling urinary catheter (IUC) insertion duration and nursing management for the prevention of this complication. There is very little evidence describing practice patterns associated with IUC management. The aim of this study was to determine the prevalence of IUC use within a major metropolitan tertiary-referral teaching hospital and to explore nurse-sensitive indicators for the prevention of CAUTI in this context.

Methods

We conducted a point prevalence survey of IUC use by reviewing every inpatient bed (n = 696) across two sites over a 2-day period in January 2013. Site 1 comprised (n = 520, 74.7%) acute inpatient beds and Site 2 (n = 176, 25.3%) aged care and rehabilitation beds within a single organisation.

Results

At the time of the survey 555 (79.7%) beds were occupied. Few patients (n = 69, 12.4%) had an IUC in situ and a standard Foley's catheter was used for the majority of patients (62, 92.5%). IUC insertion was more prevalent in women over 70 (20, 71.4%) when compared with men (18, 46.2%; χ² 4.24, P = 0.04). Fourteen nurse-sensitive indicators were assessed and although all indictors were not present for any single patient, drainage system management appeared to be in accordancewith recommended guidelines.Of the patients with an IUC12 (17.4%) had a urine sample sent in the 24 h preceding the survey and 5 (41.6%) of these samples were positive for bacterial colonisation.

Conclusion

The prevalence of IUC use in this tertiary teaching hospital was less than that in other centres despite a comparatively older inpatient population in the context of acute care needs. Nurses appear to be proficient in the management of IUC and associated drainage equipment and there is room for interdisciplinary improvement in documentation practices. Future research should test interventions to target appropriate insertion, ongoing need and timely removal of IUC.