Risk factors for intensive care unit acquired nasal colonization of MRSA and its impact on MRSA infection.

OBJECTIVE: We aimed to determine the risk factors of methicillin-resistant Staphylococcus aureus (MRSA) colonization, and the impact of colonization on MRSA infection to evaluate the necessity of MRSA survey program in intensive care units (ICUs) in Turkey. METHODS: The patients hospitalized in medical and neurosurgical ICUs longer than 24 hr were included into the study. To determine anterior nares MRSA colonization, swabs were taken from each patient in the first 48 hr, and followed by once a week till discharge from ICUs. RESULTS: During the one-year follow-up period, the number of the hospitalized patients who spent more than 24 hr in ICUs was 195 of 372 and 85 of 619 in medical and neurosurgical ICUs, respectively. Totally, 23 out of 280 patients (14 from medical ICU, 9 from neurosurgical ICU) were colonized with MRSA, and 11 out of 23 colonized patients were accepted as ICU-acquired infection. The duration of ICU hospitalization in patients with ICU-acquired MRSA colonization was found to be longer than the noncolonized patients (18 days vs. 8 days, P value < 0.001). The presence of gastrostomy and femoral catheter were determined as risk factors for ICU-acquired MRSA colonization. The percentages of MRSA infection in patients with and without MRSA colonized were 8.6% and 1.1%, respectively (P value: 0.009). CONCLUSION: The presence of gastrostomy and femoral catheter, and the duration of ICU hospitalization were found to be related with ICU-acquired MRSA colonization. Also, MRSA nares colonization increased the rates of both MRSA infection and ICU hospitalization.

A model of complaint based for overcrowding emergency department: Five-Level Hacettepe Emergency Triage System.

BACKGROUND: To compare ESI Five-Level Triage System with 5-Level Hacettepe Emergency Triage System (HETS), which was developed for Overcrowded EDs in our country. METHODS: Over a period of six days, patients were assessed by a different ED staff everyday using HETS, then re-evaluated blindly by an emergency physician using HETS. Then patients were evaluated blindly for a third time by an independent, ESI-using emergency physician. RESULTS: Of the patients in the study, 133 were men, 175 were women and the average age was 44.41±18.033. Inter-rater agreement was 97.40% (Kappa=0.963) between HETS and HETS-Blind, 74.35% (Kappa=0.646) between HETS and ESI-Blind, 74.67% (Kappa=0.652) between HETS-Blind and ESI-Blind. Inter-observer agreement between the second emergency physician performing HETS-Blind and the first emergency physician, resident, or nurse was very good (Kappa=1.0). Intern doctor, non-medical secretary and paramedic were found to have almost very good agreement (Kappa=0.971; 0.935; 0.864, respectively). An overtriage of 7.25% and undertriage of 1.08% were found in HETS. CONCLUSION: Complaint-based HEST developed for overcrowded Eds is a triage system with a very good agreement between observations and observers. Low undertriage and overtriage ratios, and easy application by all staff from a non-medical secretary to the emergency physician.

Mechanical and infectious complications developing due to central venous catheterizations in the Emergency Department.

AIM: To investigate the rate of catheter-related bloodstream infections (CRBSI) and mechanical complications due to central venous catheter (CVC) insertion in the emergency department (ED) and the contributing factors. METHODS: A total of 236 patients who were admitted to our ED and underwent CVC insertion between July 2008 and July 2009 were included in this prospective study. The CVC indications, the urgency of the insertion (emergency or elective), catheter complications (mechanical or CRBSI) and the compliance of the emergency physician placing the catheter with infection control and prevention measures were investigated. RESULTS: The CVC had been inserted urgently in 103 (44%) of the cases and mechanical complication rates in these patients were higher than those receiving it electively (p less 0.05). Our total mechanical complication rate was 27 (11.4%) with the highest rate for femoral catheter (FC). The CRBSI rate was 5/1000 catheter days. None of the physicians inserting a catheter ensured hand hygiene before the procedure. CONCLUSION: The FC is used as the most common access route for a CVC in our ED but CRBSI rate and mechanical complication rate were lower than in the literature. We believe that increasing compliance with infection control and prevention measures, especially hand hygiene, can further decrease the CRBSI rate in the ED.