Suspicion of viral gastroenteritis does improve compliance with hand hygiene.

PURPOSE: Viral gastroenteritis is common on pediatric wards, increasing the need for adherence with hand hygiene recommendations in order to prevent cross-transmission. Therefore, we investigated hand hygiene reflecting complete work-day activities on pediatric wards and focused on the influence of viral gastroenteritis. There are, so far, no studies representing complete working days on pediatric wards or addressing the influence of viral gastroenteritis. METHODS: This was a prospective, observational study (144 h in each group) on hand hygiene behavior in the care for children with and without suspected or proven viral gastroenteritis. RESULTS: We documented 40 and 30 hand hygiene opportunities per patient-day for ward-associated healthcare workers for children with and without viral gastroenteritis, respectively (P = 0.316). Healthcare workers' compliance with hand hygiene recommendations was significantly higher in children with viral gastroenteritis compared to those without, i.e., 72 versus 67% (P = 0.033), especially among physicians, being 92 versus 50% (P = 0.032). Compliance tended to be higher after patient contact than before, especially in the children with gastroenteritis (78 vs. 62%; P = 0.083). CONCLUSIONS: We conclude that viral gastroenteritis seemed to increase the number of daily opportunities for hand hygiene and did significantly increase compliance. In particular, this effect was seen after patient contact. Further research might address the awareness of undiagnosed transmissible diseases in order to prevent cross-transmissions.

External ventricular and lumbar drainage-associated meningoventriculitis: prospective analysis of time-dependent infection rates and risk factor analysis.

BACKGROUND: Data on time-dependency of external ventricular drainage (EVD)- and lumbar drainage (LD)-associated meningoventriculitis (MV) are scarce and discussions on the subject are controversial; no data exist for infection rates (IR) relative to drainage-days. For this reason, we conducted an observational study to determine time-dependent IRs and to perform a risk factor analysis. PATIENTS AND METHODS: All patients (n = 210) requiring an EVD or LD during an 18-month period in 2007 and 2008 were enrolled and characterized. Data on type and duration of drainage, ICP measurement, number of drainage manipulations, hospital stay and time point of MV were analysed statistically. RESULTS: A total of 34 MV cases were reported with 17 for each kind of drainage accounting for an IR of 7.5 and 24.7 MV/1000 EVD- and LD-days, respectively. Of these, 28/34 MV (82%) occurred within the first 12 days, and IRs were highest between days 4 and 9. Longer drainage duration (>5 and >9 days, respectively) was correlated with a significant lower risk of MV (p = 0.03; p < 0.001). In this study, significant risk factors for MV were LD [vs. EVD, OR: 2.3 (1.1-4.7); p = 0.01], a previous MV [OR: 7.0 (2.1-23.3); p = 0.002], and neoplasm [OR: 11.6 (3.4-39); p = 0.001]. Simultaneous drainage, ICP and a previous drainage showed no influence on infection. CONCLUSION: To the best of our knowledge, this study is the first to provide data on time dependency of EVD- and LD-associated MV-IR based on drainage-days. However, because of the limited scale of our study, it would be desirable to confirm these results in a more powerful larger study. In conclusion, we recommend that future efforts should be made to better identify preventable risk factors as well as to define time periods of higher risk for the difficult-to-diagnose MV infection as a first step in profiling high risk patients.

Healthcare worker-related MRSA cluster in a German neonatology level III ICU: a true European story.

Here we investigated a cluster of eight newly Methicillin-resistant Staphylococcus aureus (MRSA)-colonized neonates at an ICU, and present data on molecular strain characterization as well as the source identification process in which we analyze the impact of MRSA-colonized HCWs. Molecular strain characterization revealed a unique pattern which was identified as spa-type t 127--an extremely rare strain type in Germany. Environmental sampling and screening of parents of colonized neonates proved negative. However, staff screening identified one healthcare worker (HCW; 1/134) belonging to a group of recently employed Romanian HCWs who was colonized with the spa 127 strain. Subsequent screening also detected MRSA in 9/51 Romanian HCWs (18%) and 7/9 (14% of all) isolates showed the same molecular pattern as the index case (spa/PFGE type). All carriers were successfully decolonized, after which no new patient cases occurred. As a result, we have now implemented a universal screening programme of all new employees as part of our infection control management strategy. MRSA-colonized HCWs can act as a source for in hospital transmission. Since HCWs from high endemic countries are particular prone to being colonized, they may pose a risk to patients.

Periodic surveillance of nosocomial infections in a neurosurgery intensive care unit.

BACKGROUND: We assessed data on the epidemiology of nosocomial infections (NIs) in a 14-bed neurosurgical intensive care unit (NSICU) and used surveillance data for the promotion of quality improvement activities. PATIENTS AND METHODS: Prospective periodic surveillance was performed over five 3-month periods between July 1998 and October 2002 on all patients admitted with a length of stay > 24 hours. RESULTS: 763 patients with a total of 4,512 patient days and a mean length of stay of 5.9 days were enrolled within the 15-month study period. A total of 93 NIs were identified in 82 patients. Urinary tract infections (24.7%), pneumonia (23.6%), and bloodstream infections (17.2%) were the most frequent NIs recorded. Device-associated incidence rates were 6.0 (3.8-9.0, CI(95%)) for urinary tract infection, 4.4 (2.4-7.4, CI(95%)) for bloodstream infection, and 10.3 (6.3-15.9, CI(95%)) for pneumonia per 1,000 days at risk. For improvement of infection control-related processes, evidence-based infection control guidelines were established and an NSICU nurse was designated to be responsible for infection control issues on the ward. In addition, several infection control problems arose during the observation periods and were rapidly responded to by introducing specific intervention strategies. CONCLUSION: Periodic surveillance is a valuable tool for assessing the epidemiology of NIs in the NSICU setting as well as for promoting the initiation of quality improvement activities.

[Periodic surveillance of nosocomial infections in two neurology intensive care units. A valuable tool for quality management in intensive care]. / Periodische Surveillance nosokomialer Infektionen auf zwei neurologischen Intensivstationen. Ein wertvolles Instrument für das intensivmedizinische Qualitätsmanagement.

BACKGROUND AND OBJECTIVE: Nosocomial infections are a common problem in intensive care therapy and have relevant influence on morbidity, mortality and associated costs. The aim of this study was to assess data on the epidemiology of nosocomial infections and related risk factors in neurological intensive care patients and to use them for internal quality management. METHODS: Prospective periodic surveillance was performed in the first quarter of the years 1999 and 2000 in two neurology intensive care units. RESULTS: Within the surveillance period, 340 patients with 2443 patient days and a mean length of stay 7,6 days were enrolled. A total of 63 nosocomial infections were identified in 51 patients. In comparison with national reference data, device utilisation rates as well as device-associated nosocomial infection rates were on a higher level. By timely and interpretative feedback of the surveillance data, for the first time the unit-specific nosocomial infection situation was made clear for the ward staff. As a result, different quality management activities like establishment of evidence-based infection control guidelines, continuous surveillance for pneumonia and optimisation of empirical antibiotic therapy were initiated in both units. CONCLUSION: The establishment of periodic surveillance proved to be a valuable tool for the promotion of quality management activities in both intensive care units.