Methicillin-resistant Staphylococcus aureus (MRSA) in Europe: which infection control measures are taken?

BACKGROUND: The prevalence of hospital-acquired Methicillin-resistant Staphylococcus aureus (MRSA) infections shows a huge variety across Europe. Some countries reported a reduction in MRSA frequency, while in others countries increasing MRSA rates have been observed. To reduce the spread of MRSA in the healthcare setting, a sufficient MRSA management is essential. In order to reflect the MRSA management across Europe, MRSA prevention policies were surveyed in ten countries. MATERIALS AND METHODS: The survey was performed by questionnaires in European intensive care units (ICUs) and surgical departments (SDs) in 2004. Questionnaires asked for availability of bedside alcohol hand-disinfection, isolation precautions, decolonization and screening methods. The study was embedded in the Hospital in Europe Link for Infection Control through Surveillance (HELICS) Project, a European collaboration of national surveillance networks. HELICS was initiated in order to harmonize the national surveillance activities in the individual countries. Therefore, HELICS participants developed surveillance modules for nosocomial infections in ICUs and for surgical site infections (SSI). The coordination of this surveillance has now been transferred to the European Centre for Disease Prevention and Control (ECDC). RESULTS: A total of 526 ICUs and 223 SDs from ten countries sent data on organisational characteristics and policies, demonstrating wide variations in care. Substantial variation existed in availability of bedside alcohol hand-disinfection, which was much higher in participating ICUs rather than in SDs (86 vs. 59%). Surveillance cultures of contact patients were obtained in approximately three-fourths of all SDs (72%) and ICUs (75%). Countries with decreasing MRSA proportions showed especially strict implementation of various prevention measures. CONCLUSION: The data obtained regarding MRSA prevention measures should stimulate infection control professionals to pursue further initiatives. Particularly, the vigorous MRSA management in countries with decreasing MRSA proportions should encourage hospitals to implement preventive measures in order to reduce the spread of MRSA.

National influences on catheter-associated bloodstream infection rates: practices among national surveillance networks participating in the European HELICS project.

This study was performed to evaluate associations between organisational characteristics, routine practices and the incidence densities of central venous catheter-associated bloodstream infections (CVC-BSI rates) in European intensive care units (ICUs) as part of the HELICS project (Hospitals in Europe Link for Infection Control through Surveillance). Questionnaires were sent to ICUs participating in the national nosocomial infection surveillance networks in 2004. The national networks were asked for the CVC-BSI rates of the ICUs participating for the time period 2003--2004. Univariate and multivariate risk factor analyses were performed to identify which practices had the greatest impact on CVC-BSI rates. A total of 526 ICUs from 10 countries sent data on organisational characteristics and practices, demonstrating wide variation in care. CVC-BSI rates were also provided for 288 ICUs from five countries. This made it possible to include 1383444 patient days, 969897 CVC days and 1935 CVC-BSI cases in the analysis. Adjusted logistic regression analysis showed that the categorical variables of country [odds ratio (OR) varying per country from OR: 2.3; 95% confidence interval (CI): 0.5-10.2; to OR: 12.8; 95% CI: 4.4-37.5; in reference to the country with the lowest CVC-BSI rates] and type of hospital 'university' (OR: 2.08; 95% CI: 1.02-4.25) were independent risk factors for high CVC-BSI rates. Substantial variation existed in CVC-BSI prevention activities, surveillance methods and estimated CVC-BSI rates among the European countries. Differences in cultural, social and legal perspectives as well as differences between healthcare systems are crucial in explaining these differences.

Epidemiology of nosocomial bloodstream infections in Belgium, 1992-1996.

The main results of the bloodstream infection (BSI) component of the Belgian National Programme for the Surveillance of Hospital Infections (NSIH project) are reported. From October 1992 to September 1996, 117 hospitals (59.1% of Belgian acute-care institutions) reported 13678 nosocomial BSIs. The incidence was 7.05 BSI episodes per 10000 patient-days. The incidence of BSI increased with hospital size and over time. Bloodstream infections were secondary to an infectious body site in 40.3% of the episodes, catheter-related in 23.5%, and of unknown origin in 36.2%. The associated in-hospital mortality was 31.4% and was highest in BSIs secondary to a respiratory tract infection (49.3%). In intensive care units, the incidence of BSI was 38.5 per 10000 patient-days. Coagulase-negative staphylococci were the most prevalent microorganisms (22%), followed by Staphylococcus aureus (14.1%) and Escherichia coli (13.5%). In catheter-related BSIs, these proportions were 41.9%, 18.8%, and 2.3%, respectively. The proportion of polymicrobial episodes was 9.9%. Methicillin resistance in Staphylococcus aureus was 22.3%. With its high participation rate, the NSIH project has characterized the epidemiology of nosocomial BSIs in Belgium during the period studied.

Why do men with urethritis in Cameroon prefer to seek care in the informal health sector?

OBJECTIVE: To study the impact of cost of treatment for sexually transmitted diseases (STDs) on the preference of men with urethritis to seek care in the informal sector. SUBJECTS AND METHODS: A random sample of young men from the general population of Yaoundé and Douala, Cameroon, and of employees of a Yaoundé factory underwent a structured interview on the occurrence of STD-related complaints and health seeking behaviour. Men who consulted in the formal sector were compared with men consulting in the informal sector, with regards to cost of medication and level of education. RESULTS: Sixteen percent of men in the general population and 20% of factory employees reported a history of urethritis in the 12 months preceding the interview. Of the men in the general population 53% had sought care in the formal sector; among the factory employees this proportion was 56%. Men who did not consult in the formal sector spent significantly less on drugs than men who did consult in the formal sector: median cost $14.4 versus $24.0 (p = 0.02) for drugs purchased in pharmacies; median cost $8 versus $32 for drugs purchased in small stores or from acquaintances. Preference for formal health services was associated with higher educational attainment. CONCLUSION: In large towns in Cameroon the utilisation of formal health services for STD related complaints is low and the high cost of treatment in the formal sector may play an important role in the choice of care option.