Rapid monitoring of vancomycin-resistant Enterococcus faecium in hospital departments by repetitive element palindromic polymerase chain reaction.

BACKGROUND: The current increase in nosocomial infections caused by vancomycin-resistant enterococci (VRE) warrants improvement of detection methods and hygiene measures. Knowledge of the local epidemiology is important for monitoring compliance of medical personnel with hygiene measures. AIM: To evaluate semi-automated repetitive element palindromic polymerase chain reaction (rep-PCR) for rapid molecular typing of VRE. METHODS: Primary VRE isolates were collected during an observation period of one year and retrospectively typed by rep-PCR. Molecular typing was performed on isolates from two departments with elevated VRE rates and patients with increased risk for systemic VRE infections. Typing results were correlated with temporal and spatial information on patient moves, VRE laboratory results and multi-locus sequence typing (MLST). FINDINGS: Approximately 70% of VRE isolates within a department could be assigned to similarity clusters. Spread of VRE was limited to the individual departments. There was no evidence for spread of endemic VRE strains within the geographical catchment area of the hospital. Our results demonstrate the utility of rep-PCR typing on a department level. However, a Diversilab® threshold of ≥98% had to be applied to claim similarity, and suspected transmissions needed to be confirmed by vanA/B genotyping and compiled information on spatial and temporal patient contact. MLST verified the findings. CONCLUSION: Spread of predominantly detected vancomycin-resistant Enterococcus faecium was limited to the department level with no evidence for wider dissemination within the hospital. Well-standardized and validated (semi-)automated rep-PCR systems are useful for rapid detection of possible VRE transmission. However, suspected transmissions need to be confirmed by clinical and microbiological parameters.

The prevalence of perioperative nurse clinical judgments.

A clinical judgement about a patient situation precedes the selection of appropriate nursing actions and the identification of patient outcomes. The North American Nursing Diagnosis Association nomenclature (i.e., nursing diagnoses) is the accepted language for naming nurse's clinical judgements. Two hundred thirty-nine members of the Association of Operating Room Nurses, Inc, rated the frequency and treatment priority of 60 nursing diagnoses. They rated two diagnostic labels (i.e., risk for perioperative positioning injury, risk for infections occurring in more than 50% of the clinical judgments they make about perioperative patient situations that require immediate nursing action. These data reinforce perioperative nurses' primary role in protecting surgical patients from harm.

Cardiac arrest in ambulatory surgery. The management perspective.

Preventing cardiac arrests requires constant vigilance on the part of the entire perioperative team. In the preoperative phase, physicians must make careful patient selections based on the patients' risk factors, and cancel the cases or admit the patients if problems are found. In the intraoperative phase, the anesthesia personnel must carefully monitor vital signs, observe tissue perfusion, replace fluids, position the patient to maximize vital functions, and carefully select the anesthetic agents. In the postoperative phase, nurses must carefully observe and monitor the patient, especially high-risk patients, and take any necessary precautions. They must also explain instructions to the patient regarding complications after discharge. Although a manager may establish careful patient selection criteria, the day may come when the staff members must respond to a cardiac arrest in the ambulatory surgery unit. When it does, management of the patient must be the first priority. The staff members must correctly diagnose the problem, send for assistance, perform CPR, mobilize equipment, oxygen, and medications, control traffic, document interventions, and record patient responses. In an ambulatory setting, there is a high probability that family members or friends will be with the patient. A nurse should be delegated to take them to a quiet area away from the immediate crisis, and provide information and emotional support. Frequent reports will help them cope with the crisis. Public awareness and knowledge about CPR has greatly increased since it was first used in 1960. By 1977, some 12 million Americans had been CPR-trained and some 53 million more were awaiting training.(ABSTRACT TRUNCATED AT 250 WORDS)