RESUMEN
PURPOSE: The purpose of this study was to determine the effect of a silver-alloy hydrogel catheter on symptomatic catheter-associated urinary tract infections (CAUTIs). DESIGN: Multicenter before-after non-randomized cohort study. SUBJECTS AND SETTING: Seven acute care hospitals ranging in size from 124 to 607 beds participated in this study. The study population included adult patients with a positive urine culture 2 or more days after admission, who underwent Foley catheterization. METHODS: Catheter-associated urinary tract infection surveillance was conducted at each hospital for at least 3 months during the use of a standard catheter and 3 months during the use of the silver-alloy hydrogel catheter. Both the National Healthcare Safety Network (NHSN) surveillance and a clinical definition of CAUTI were used for rate calculation. RESULTS: A 47% relative reduction in the CAUTI rate was observed with the silver-alloy hydrogel catheter compared to the standard catheter when both infection definitions were used (0.945/1000 patient days vs 0.498/1000 patient days) (odds ratio = 0.53; P < .0001; 95% CI: 0.45-0.62). When only NHSN-defined CAUTIs were considered, a 58% relative reduction occurred in the silver-alloy hydrogel period (0.60/1000 patient days vs 0.25/1000 patient days) (odds ratio = 0.42; P < .0001; 95% CI: 0.34-0.53). Antimicrobial days for CAUTIs decreased from 1165 (standard catheter period) to 406 (silver-alloy hydrogel period). CONCLUSIONS: Use of a silver-alloy hydrogel urinary catheter reduced symptomatic CAUTI occurrences as defined by both NHSN and clinical criteria.
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Infecciones Relacionadas con Catéteres/prevención & control , Aleaciones de Oro/uso terapéutico , Hidrogel de Polietilenoglicol-Dimetacrilato/uso terapéutico , Plata/uso terapéutico , Cateterismo Urinario/métodos , Infecciones Urinarias/prevención & control , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Cateterismo Urinario/efectos adversos , Infecciones Urinarias/terapiaRESUMEN
OBJECTIVES: We report the results of the International Nosocomial Infection Control Consortium prospective surveillance study from January 2004 to December 2009 in 33 pediatric intensive care units of 16 countries and the impact of being in a private vs. public hospital and the income country level on device-associated health care-associated infection rates. Additionally, we aim to compare these findings with the results of the Centers for Disease Control and Prevention National Healthcare Safety Network annual report to show the differences between developed and developing countries regarding device-associated health care-associated infection rates. PATIENTS: A prospective cohort, active device-associated health care-associated infection surveillance study was conducted on 23,700 patients in International Nosocomial Infection Control Consortium pediatric intensive care units. METHODS: The protocol and methodology implemented were developed by International Nosocomial Infection Control Consortium. Data collection was performed in the participating intensive care units. Data uploading and analyses were conducted at International Nosocomial Infection Control Consortium headquarters on proprietary software. Device-associated health care-associated infection rates were recorded by applying Centers for Disease Control and Prevention National Healthcare Safety Network device-associated infection definitions, and the impact of being in a private vs. public hospital and the income country level on device-associated infection risk was evaluated. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Central line-associated bloodstream infection rates were similar in private, public, or academic hospitals (7.3 vs. 8.4 central line-associated bloodstream infection per 1,000 catheter-days [p < .35 vs. 8.2; p < .42]). Central line-associated bloodstream infection rates in lower middle-income countries were higher than low-income countries or upper middle-income countries (12.2 vs. 5.5 central line-associated bloodstream infections per 1,000 catheter-days [p < .02 vs. 7.0; p < .001]). Catheter-associated urinary tract infection rates were similar in academic, public and private hospitals: (4.2 vs. 5.2 catheter-associated urinary tract infection per 1,000 catheter-days [p = .41 vs. 3.0; p = .195]). Catheter-associated urinary tract infection rates were higher in lower middle-income countries than low-income countries or upper middle-income countries (5.9 vs. 0.6 catheter-associated urinary tract infection per 1,000 catheter-days [p < .004 vs. 3.7; p < .01]). Ventilator-associated pneumonia rates in academic hospitals were higher than private or public hospitals: (8.3 vs. 3.5 ventilator-associated pneumonias per 1,000 ventilator-days [p < .001 vs. 4.7; p < .001]). Lower middle-income countries had higher ventilator-associated pneumonia rates than low-income countries or upper middle-income countries: (9.0 vs. 0.5 per 1,000 ventilator-days [p < .001 vs. 5.4; p < .001]). Hand hygiene compliance rates were higher in public than academic or private hospitals (65.2% vs. 54.8% [p < .001 vs. 13.3%; p < .01]). CONCLUSIONS: Country socioeconomic level influence device-associated infection rates in developing countries and need to be considered when comparing device-associated infections from one country to another.
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Infecciones Relacionadas con Catéteres/epidemiología , Países en Desarrollo , Unidades de Cuidado Intensivo Pediátrico , Neumonía Asociada al Ventilador/epidemiología , Clase Social , Infección Hospitalaria/epidemiología , Infección Hospitalaria/etiología , Adhesión a Directriz , Desinfección de las Manos , Humanos , Estudios ProspectivosRESUMEN
Since 1946, Centers for Disease Control and Prevention (CDC) personnel have investigated outbreaks of infections and adverse events associated with delivery of health care. CDC Epidemic Intelligence Service officers have led onsite investigations of these outbreaks by systematically applying epidemiology, statistics, and laboratory science. During 1946-2005, CDC Epidemic Intelligence Service officers conducted 531 outbreak investigations in facilities across the United States and abroad. Initially, the majority of outbreaks involved gastrointestinal tract infections; however, in later years, bloodstream, respiratory tract, and surgical wound infections predominated. Among pathogens implicated in CDC outbreak investigations, Staphylococcus aureus, Enterococcus species, Enterobacteriaceae, nonfermentative Gram-negative bacteria, or yeasts predominated, but unusual organisms (e.g., the atypical mycobacteria) were often included. Outbreak types varied and often were linked to transfer of colonized patients or health care personnel between facilities (multihospital outbreaks), national distribution of contaminated products, use of invasive medical devices, or variances in practices and procedures in health care environments (e.g., intensive care units, water reservoirs, or hemodialysis units). Through partnerships with health care facilities and local and state health departments, outbreaks were terminated and lives saved. Data from investigations invariably contributed to CDC-generated guidelines for prevention and control of health care-associated infections.
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Centers for Disease Control and Prevention, U.S./historia , Brotes de Enfermedades/historia , Epidemiología/historia , Infecciones/historia , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Estados Unidos/epidemiologíaAsunto(s)
Portador Sano/diagnóstico , Infección Hospitalaria/prevención & control , Desinfección/métodos , Control de Infecciones/métodos , Unidades de Cuidados Intensivos , Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas/prevención & control , Femenino , Humanos , MasculinoRESUMEN
OBJECTIVES: Prolonged survival of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on environmental surfaces and personal protective equipment may lead to these surfaces transmitting this pathogen to others. We sought to determine the effectiveness of a pulsed-xenon ultraviolet (PX-UV) disinfection system in reducing the load of SARS-CoV-2 on hard surfaces and N95 respirators. METHODS: Chamber slides and N95 respirator material were directly inoculated with SARS-CoV-2 and were exposed to different durations of PX-UV. RESULTS: For hard surfaces, disinfection for 1, 2, and 5 minutes resulted in 3.53 log10, >4.54 log10, and >4.12 log10 reductions in viral load, respectively. For N95 respirators, disinfection for 5 minutes resulted in >4.79 log10 reduction in viral load. PX-UV significantly reduced SARS-CoV-2 on hard surfaces and N95 respirators. CONCLUSION: With the potential to rapidly disinfectant environmental surfaces and N95 respirators, PX-UV devices are a promising technology to reduce environmental and personal protective equipment bioburden and to enhance both healthcare worker and patient safety by reducing the risk of exposure to SARS-CoV-2.
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COVID-19/prevención & control , Desinfección/métodos , SARS-CoV-2/efectos de la radiación , Rayos Ultravioleta , Animales , COVID-19/transmisión , COVID-19/virología , Chlorocebus aethiops , Desinfección/instrumentación , Equipo Reutilizado/normas , Humanos , Respiradores N95 , Equipo de Protección Personal , SARS-CoV-2/fisiología , Factores de Tiempo , Células Vero , XenónRESUMEN
BACKGROUND: Health care-associated, central venous catheter-related bloodstream infections (HA-BSIs) are a major cause of morbidity and mortality. Needleless connectors (NCs) are an important component of the intravenous system. NCs initially were introduced to reduce health care worker needlestick injuries, yet some of these NCs may increase HA-BSI risk. METHODS: We compared HA-BSI rates on wards or intensive care units (ICUs) at 5 hospitals that had converted from split septum (SS) connectors or needles to mechanical valve needleless connectors (MV-NCs). The hospitals (16 ICUs, 1 entire hospital, and 1 oncology unit; 3 hospitals were located in the United States, and 2 were located in Australia) had conducted HA-BSI surveillance using Centers for Disease Control and Prevention definitions during use of both NCs. HA-BSI rates and prevention practices were compared during the pre-MV period, MV period, and post-MV period. RESULTS: The HA-BSI rate increased in all ICUs and wards when SS-NCs were replaced by MV-NCs. In the 16 ICUs, the HA-BSI rate increased significantly when SS-NCs or needles were replaced by MV-NCs (6.15 vs 9.49 BSIs per 1000 central venous catheter [CVC]-days; relative risk, 1.54; 95% confidence interval, 1.37-1.74; P < .001). The 14 ICUs that switched back to SS-NCs had significant reductions in their BSI rates (9.49 vs 5.77 BSIs per 1000 CVC-days; relative risk, 1.65; 95% confidence interval, 1.38-1.96; p < .001). BSI infection prevention strategies were similar in the pre-MV and MV periods. CONCLUSIONS: We found strong evidence that MV-NCs were associated with increased HA-BSI rates, despite similar BSI surveillance, definitions, and prevention strategies. Hospital personnel should monitor their HA-BSI rates and, if they are elevated, examine the role of newer technologies, such as MV-NCs.
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Bacteriemia/epidemiología , Infecciones Relacionadas con Catéteres/epidemiología , Cateterismo Venoso Central/efectos adversos , Infección Hospitalaria/epidemiología , Bacteriemia/microbiología , Infecciones Relacionadas con Catéteres/microbiología , Cateterismo Venoso Central/instrumentación , HumanosAsunto(s)
Infección Hospitalaria/prevención & control , Transmisión de Enfermedad Infecciosa/prevención & control , Control de Infecciones/métodos , Staphylococcus aureus Resistente a Meticilina , Infecciones Estafilocócicas/prevención & control , Infección Hospitalaria/transmisión , Reacciones Falso Negativas , Humanos , Unidades de Cuidados Intensivos , Aislamiento de Pacientes , Proyectos de Investigación , Infecciones Estafilocócicas/transmisiónRESUMEN
STUDY OBJECTIVE: Many patients with pneumonia are admitted to respiratory isolation for possible tuberculosis (TB), but most do not have active TB. We created a decision instrument to predict which pneumonia patients do not need admission to a TB isolation bed. METHODS: The design was a prospective case series conducted in 11 university-affiliated, urban, US emergency departments (EDs) (EMERGEncy ID NET). Participants were patients admitted to the hospital through the ED with a diagnosis of pneumonia or suspected TB. The main outcome measure was derivation and validation of a sensitive decision instrument to identify patients not having TB (and not requiring isolation) according to clinical data and chest radiographs. RESULTS: Of 5,079 pneumonia patients, 224 (4.4%) had pulmonary TB according to sputum cultures or tissue staining. The instrument derived to predict which patients did not have pulmonary TB included no TB history or previous positive tuberculin skin test result, nonimmigrant, not homeless, not recently incarcerated, no recent weight loss, and no apical infiltrate or cavitary lesion on plain chest radiograph. When tested on the validation subgroup, the decision instrument exhibited a negative predictive value of 99.7% (95% confidence interval [CI] 99.1% to 99.9%), and a sensitivity of 96.4% (95% CI 91.1% to 99.0%). CONCLUSION: A decision instrument can accurately predict which patients with pneumonia do not require admission to TB isolation rooms.
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Técnicas de Apoyo para la Decisión , Aislamiento de Pacientes , Neumonía/complicaciones , Tuberculosis Pulmonar/complicaciones , Tuberculosis Pulmonar/transmisión , Adulto , Distribución de Chi-Cuadrado , Femenino , Hospitales Urbanos , Humanos , Masculino , Persona de Mediana Edad , Neumonía/diagnóstico por imagen , Valor Predictivo de las Pruebas , Estudios Prospectivos , Radiografía , Sensibilidad y Especificidad , Tuberculosis Pulmonar/diagnóstico por imagen , Estados UnidosAsunto(s)
Antiinfecciosos/uso terapéutico , Profilaxis Antibiótica , Portador Sano/diagnóstico , Control de Infecciones/métodos , Infecciones Estafilocócicas/prevención & control , Infección de la Herida Quirúrgica/prevención & control , Portador Sano/tratamiento farmacológico , Clorhexidina/uso terapéutico , Humanos , Mupirocina/uso terapéutico , Aislamiento de Pacientes , Infecciones Estafilocócicas/diagnósticoRESUMEN
BACKGROUND: Allografts are commonly used in orthopedic reconstructive surgery. In 2001, approximately 875,000 musculoskeletal allografts were distributed by U.S. tissue banks. After the death from Clostridium sordellii sepsis of a 23-year-old man who had received a contaminated allograft from a tissue bank (Tissue Bank A), the Centers for Disease Control and Prevention initiated an investigation, including enhanced case finding, of the methods used for the recovery, processing, and testing of tissue. METHODS: A case of allograft-associated clostridium infection was defined as a culture-proven infection of a surgical site within one year after allograft implantation, from January 1998 to March 2002. We traced tissues to tissue banks that recovered and processed these tissues. We also estimated the rates of and risk ratios for clostridium infections for tissues processed by the implicated tissue bank and reviewed processing and testing methods used by various tissue banks. RESULTS: Fourteen patients were identified, all of whom had received allografts processed by Tissue Bank A. The rates of clostridium infection were 0.12 percent among patients who received sports-medicine tissues (i.e., tendons, femoral condyles, menisci) from Tissue Bank A and 0.36 percent among those who received femoral condyles in particular. The risk-ratio estimates for clostridium infections from tissues processed by Tissue Bank A, as compared with those from other tissue banks, were infinite (P<0.001) for musculoskeletal allografts, sports-medicine tissues, or tendons. Because Tissue Bank A cultured tissues only after treating them with a nonsporicidal antimicrobial solution, some test results were probably false negatives. Tissues from implicated donors were released despite the isolation of clostridium or bowel flora from other anatomical sites or reports of infections in other recipients. CONCLUSIONS: Clostridium infections were traced to allograft implantation. We provide interim recommendations to enhance tissue-transplantation safety. Tissue banks should validate processes and culture methods. Sterilization methods that do not adversely affect the functioning of transplanted tissue are needed to prevent allograft-related infections.
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Infecciones por Clostridium/transmisión , Clostridium/aislamiento & purificación , Transmisión de Enfermedad Infecciosa , Fémur/trasplante , Tendones/trasplante , Adolescente , Adulto , Infecciones por Clostridium/epidemiología , Desinfección , Femenino , Fémur/microbiología , Humanos , Masculino , Persona de Mediana Edad , New York , Riesgo , Tendones/microbiología , Bancos de Tejidos/normas , Trasplante de Tejidos/efectos adversos , Trasplante Homólogo/efectos adversos , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: From June 30, 1998, through March 21, 1999, several patients in the surgical intensive care unit of a hospital acquired Serratia marcescens bacteremia. We investigated this outbreak. METHODS: A case was defined as the occurrence of S. marcescens bacteremia in any patient in the surgical intensive care unit during the period of the epidemic. To identify risk factors, we compared patients with S. marcescens bacteremia with randomly selected controls. Isolates from patients and from medications were evaluated by pulsed-field gel electrophoresis. The hair of one employee was tested for fentanyl. RESULTS: Twenty-six patients with S. marcescens bacteremia were identified; eight (31 percent) had polymicrobial bacteremia, and seven of these had Enterobacter cloacae and S. marcescens in the same culture. According to univariate analysis, patients with S. marcescens bacteremia stayed in the surgical intensive care unit longer than controls (13.5 vs. 4.0 days, P<0.001), were more likely to have received fentanyl in the surgical intensive care unit (odds ratio, 31; P<0.001), and were more likely to have been exposed to two particular respiratory therapists (odds ratios, 13.1 and 5.1; P<0.001 for both comparisons). In a multivariate analysis, receipt of fentanyl and exposure to the two respiratory therapists (adjusted odds ratio for one therapist, 6.7; P=0.002; adjusted odds ratio for the other therapist, 9.5; P=0.02) remained significant. One respiratory therapist had been reported for tampering with fentanyl; his hair sample tested positive for fentanyl. Cultures of fentanyl infusions from two case patients yielded S. marcescens and E. cloacae. The isolates from the case patients and from the fentanyl infusions had similar patterns on pulsed-field gel electrophoresis. After removal of the implicated respiratory therapist, no further cases occurred. CONCLUSIONS: An outbreak of S. marcescens and E. cloacae bacteremia in a surgical intensive care unit was traced to extrinsic contamination of the parenteral narcotic fentanyl by a health care worker. Our findings underscore the risk of complications in patients that is associated with illicit narcotic use by health care workers.
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Bacteriemia/epidemiología , Brotes de Enfermedades , Transmisión de Enfermedad Infecciosa de Profesional a Paciente , Terapia Respiratoria , Infecciones por Serratia/epidemiología , Infecciones por Serratia/transmisión , Serratia marcescens/aislamiento & purificación , Técnicos Medios en Salud , Bacteriemia/microbiología , Enterobacter cloacae/aislamiento & purificación , Contaminación de Equipos , Fentanilo/administración & dosificación , Fentanilo/análisis , Cabello/química , Humanos , Infusiones Parenterales/instrumentación , Unidades de Cuidados Intensivos , Masculino , Análisis Multivariante , Narcóticos/administración & dosificación , Narcóticos/análisis , Trastornos Relacionados con Opioides , Factores de Riesgo , Infecciones por Serratia/microbiología , Serratia marcescens/genéticaRESUMEN
OBJECTIVE: We conducted an intervention study to assess the impact of the use of an alcohol-chlorhexidine-based hand sanitizer on surgical site infection (SSI) rates among neurosurgical patients in Ho Chi Minh City, Vietnam. DESIGN: A quasi-experimental study with an untreated control group and assessment of neurosurgical patients admitted to 2 neurosurgical wards at Cho Ray Hospital between July 11 and August 15, 2000 (before the intervention), and July 14 and August 18, 2001 (after the intervention). A hand sanitizer with 70% isopropyl alcohol and 0.5% chlorhexidine gluconate was introduced, and healthcare workers were trained in its use on ward A in September 2000. No intervention was made in ward B. Centers for Disease Control and Prevention definitions of SSI were used. Patient SSI data were collected on standardized forms and were analyzed using Stata software (Stata). RESULTS: A total of 786 patients were enrolled: 377 in the period before intervention (156 in ward A and 221 in ward B) and 409 in the period after intervention (159 in ward A and 250 in ward B). On ward A after the intervention, the SSI rate was reduced by 54% (from 8.3% to 3.8%; P=.09), and more than half of superficial SSIs were eliminated (7 of 13 vs 0 of 6 in ward B; P=.007). On ward B, the SSI rate increased by 22% (from 7.2% to 9.2%; P=.8). In patients without SSI, the median postoperative length of stay and the duration of antimicrobial use were reduced on ward A (both from 8 to 6 days; P<.001) but not on ward B. CONCLUSIONS: Our study demonstrates that introduction of a hand sanitizer can both reduce SSI rates in neurosurgical patients, with particular impact on superficial SSIs, and reduce the overall postoperative length of stay and the duration of antimicrobial use. Hand hygiene programs in developing countries are likely to reduce SSI rates and improve patient outcomes.
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Antiinfecciosos Locales/administración & dosificación , Clorhexidina/administración & dosificación , Infección Hospitalaria/prevención & control , Etanol/administración & dosificación , Desinfección de las Manos , Higiene/educación , Infección de la Herida Quirúrgica/prevención & control , Adolescente , Adulto , Infección Hospitalaria/epidemiología , Equipos y Suministros de Hospitales/provisión & distribución , Femenino , Unidades Hospitalarias , Hospitales Universitarios , Hospitales Urbanos , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Neuroquirúrgicos/efectos adversos , Educación del Paciente como Asunto , Habitaciones de Pacientes , Personal de Hospital/educación , Infección de la Herida Quirúrgica/epidemiología , Vietnam/epidemiologíaRESUMEN
Approximately 2,000,000 healthcare-associated infections (HAIs) annually occur in US healthcare facilities and lead to approximately 60,000 90,000 deaths and cost $17 29 billion dollars. Such HAIs are an equal, if not more common problem, worldwide. Many evidence-based HAI prevention guidelines exist. However, despite knowing what to do, the challenge remains of getting clinicians to comply with these recommendations. In the USA, a variety of forces, including the public and legislators, are demanding HAI prevention. This is illustrated by the Consumers Union's effort to get legislation in every state for public HAI rate reporting. In addition, a number of profit-making and non-profit-making organizations have initiated major HAI prevention interventions. At least three common themes for these interventions exist. First, no single intervention prevents any HAI; rather a "bundle" approach, using a package of multiple interventions based on evidence provided by the infection control community and implemented by a multidisciplinary team is the model for successful HAI prevention. Second, benchmarking is inadequate and a culture of zero tolerance is required. Third, a culture of accountability and administrative support is required. Such interventions have illustrated that much greater levels of HAI prevention can be accomplished than ever estimated in the past. Implementation of evidence-based HAI prevention interventions should be a high priority for all healthcare facilities to reduce preventable HAIs to the greatest extent possible.
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Benchmarking/tendencias , Infección Hospitalaria/prevención & control , Control de Infecciones/estadística & datos numéricos , Guías de Práctica Clínica como Asunto/normas , Cateterismo Venoso Central/efectos adversos , Farmacorresistencia Bacteriana , Desinfección de las Manos , Humanos , Control de Infecciones/métodos , Control de Infecciones/tendencias , Estados UnidosRESUMEN
A 19-item survey instrument was designed and mailed by the Infectious Diseases Society of America to its membership to determine the media preferred by infectious diseases physicians for continuing medical education on general topics and on antimicrobial resistance. The objective of the survey was to offer the developers of educational programs knowledge on which to base more-effective ways to deliver educational materials to physicians in this specialty.
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Actitud del Personal de Salud , Farmacorresistencia Microbiana , Educación Médica Continua/métodos , Epidemiología/educación , Médicos/psicología , Humanos , Médicos/estadística & datos numéricos , Sociedades Médicas , Encuestas y CuestionariosRESUMEN
OBJECTIVE: To compare the cumulative incidence of infections acquired in the pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU). DESIGN: Estimation of the cumulative incidence of infections with data obtained from the Pediatric Prevention Network (PPN) point-prevalence survey and observed rates from the National Nosocomial Infections Surveillance (NNIS) system. SETTING: Ten hospitals participated in both the PPN survey and NNIS system. PARTICIPANTS: All patients present on the PPN survey dates (August 4, 1999, or February 1, 2000) in the NICUs or PICUs of the PPN hospitals were included in the survey. Point prevalences for PICU-acquired and for NICU-acquired infections at these hospitals were calculated from the survey data. The cumulative incidence rates were estimated from the point prevalence rates using a standard formula and a standard method for calculating the time to recovery (ie, on the basis of the assumption that discontinuance of antimicrobial therapy indicates recovery from infection); alternate methods to judge the time to recovery from infection were also explored. RESULTS: The average cumulative incidence of intensive care unit-acquired infection for NICUs and PICUs combined (all units), as measured by NNIS, was 14.1 cases per 100 patients; in comparison, the prevalence was 14.06 cases for 100 patients (median difference, -0.95 cases per 100 patients; 95% confidence interval, -4.6 to 5.0 cases per 100 patients), and the estimated cumulative incidence using the standard method of calculating the time to recovery was 13.8 cases per 100 patients (median difference, -1.5 cases per 100 patients; 95% confidence interval, -9.1 to 2.9 cases per 100 patients). Estimates of cumulative incidence using alternate methods for calculation of time to recovery did not perform as well (range, 4.9-100.9 cases per 100 patients). The average incidence density for all units, as measured by the NNIS system, was 6.8 cases per 1,000 patient-days, and the estimate of incidence density using the standard method of calculating the time to recovery was 3.6 cases per 1,000 patient-days (median difference, 4.3 cases per 1,000 patient-days; 95% confidence interval, 0.9 to 9.2 cases per 1,000 patient-days). Estimated incidence densities using alternate methods for determining recovery time correlated closely with observed incidence densities. CONCLUSIONS: In this patient population, the simple point prevalence provided the best estimate of cumulative incidence, followed by use of a standard formula and a standard method of calculating the time to recovery. Estimation of incidence density using alternate methods performed well. The standard formula and method may provide an even better estimate of cumulative incidence than does simple prevalence in general populations.
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Infección Hospitalaria/epidemiología , Unidades de Cuidado Intensivo Neonatal/estadística & datos numéricos , Unidades de Cuidado Intensivo Pediátrico/estadística & datos numéricos , Preescolar , Hospitales/estadística & datos numéricos , Humanos , Incidencia , Lactante , Recién Nacido , Modelos Estadísticos , Vigilancia de la Población , Prevalencia , Estados Unidos/epidemiologíaRESUMEN
Of 33,111 patients admitted to a large hospital in Vietnam from November 2000 through July 2001, a total of 303 were undergoing hemodialysis and had pyrogenic reactions (ie, fever and/or rigors). Ten case patients (3.3%) had documented bacteremia; pathogens were largely waterborne microorganisms. Pyrogenic reactions in case patients might have occurred because of suboptimal water quality or inadequate dialyzer reprocessing procedures.
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Infección Hospitalaria/etiología , Fiebre/microbiología , Unidades de Hemodiálisis en Hospital , Diálisis Renal/efectos adversos , Adolescente , Adulto , Anciano , Bacteriemia/epidemiología , Bacteriemia/etiología , Cateterismo Periférico/efectos adversos , Cateterismo Periférico/instrumentación , Infección Hospitalaria/epidemiología , Infección Hospitalaria/microbiología , Desinfección , Contaminación de Equipos , Equipo Reutilizado , Femenino , Fiebre/epidemiología , Fiebre/etiología , Humanos , Masculino , Persona de Mediana Edad , Diálisis Renal/instrumentación , Vietnam/epidemiología , Microbiología del AguaRESUMEN
OBJECTIVE: To characterize red eye reactions occurring within 24 hours after receipt of units of leukocyte-reduced red blood cells, determine their etiology, and investigate their potential link to transfusion. METHODS: We conducted a survey of transfusion facilities nationwide to determine the scope and magnitude of the reactions; performed case-control and cohort studies among transfused patients at the facility where most reactions occurred; and performed animal experiments, using cellulose acetate derivatives extracted from leukocyte-reduction filters and filter precursors, to reproduce reactions. RESULTS: From January 1, 1997, through January 15, 1998, we identified 159 reactions in 117 patients from 17 states. Reactions were characterized by conjunctival erythema or hemorrhage (in 100% of patients), eye pain (in 62%), photophobia (in 46%), and decreased visual acuity (in 32%). Symptom onset occurred 1-24 hours after initiation of transfusion and resolved within a median of 5 days. Reactions were associated with transfusion sessions that included units of red blood cells filtered with a specific brand of filter, the LeukoNet filter (HemaSure) (odds ratio, 100.4; P<.001). There was a dose-response relationship between the number of LeukoNet-filtered units transfused and the attack rate for reactions, ranging from 0.8% among sessions in which 1 unit was transfused to 27.3% among sessions in which 3 or more units were transfused (P<.001). A similar ocular syndrome was elicited in rabbits injected with cellulose acetate derivatives extracted from unused LeukoNet filters or filter precursors. No reactions were reported after LeukoNet filters were withdrawn from the market. CONCLUSIONS: This transfusion-associated red eye syndrome was linked to a specific brand of leukocyte-reduction filter and likely resulted from cellulose acetate derivatives leached from the filter membrane.
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Conjuntiva/patología , Eritema/patología , Transfusión de Eritrocitos/efectos adversos , Oftalmopatías/etiología , Procedimientos de Reducción del Leucocitos , Animales , Brotes de Enfermedades , Oftalmopatías/epidemiología , Oftalmopatías/patología , Filtración , Hemorragia/patología , Humanos , Michigan/epidemiología , Oregon/epidemiología , Dolor , Fotofobia , Conejos , Síndrome , Agudeza Visual , Washingtón/epidemiologíaRESUMEN
OBJECTIVE: The aim of this study was to determine the efficacy of a multimodal hand hygiene intervention program in reducing health care insurance claims for hygiene preventable infections (eg, cold and influenza), absenteeism, and subjective impact on employees. METHODS: A 13.5-month prospective, randomized cluster controlled trial was executed with alcohol-based hand sanitizer in strategic workplace locations and personal use (intervention group) and brief hand hygiene education (both groups). Four years of retrospective data were collected for all participants. RESULTS: Hygiene-preventable health care claims were significantly reduced in the intervention group by over 20% (Pâ<â0.05). Absenteeism was positively impacted overall for the intervention group. Employee survey data showed significant improvements in hand hygiene behavior and perception of company concern for employee well-being. CONCLUSION: Providing a comprehensive, targeted, yet simple to execute hand hygiene program significantly reduced the incidence of health care claims and increased employee workplace satisfaction.
Asunto(s)
Absentismo , Higiene de las Manos/normas , Costos de la Atención en Salud , Lugar de Trabajo , Femenino , Desinfectantes para las Manos/administración & dosificación , Conocimientos, Actitudes y Práctica en Salud , Promoción de la Salud , Humanos , Masculino , Persona de Mediana Edad , Salud Laboral , Servicios de Salud del Trabajador , Estudios Prospectivos , Estudios RetrospectivosRESUMEN
The Centers for Medicare and Medicaid Services (CMS) Hospital Compare central line-associated bloodstream infection (CLABSI) data and private databases containing new-generation intravenous needleless connector (study NC) use at the hospital level were linked. The relative risk (RR) of CLABSI associated with the study NCs was estimated, adjusting for hospital characteristics. Among 3074 eligible hospitals in the 2013 CMS database, 758 (25%) hospitals used the study NCs. The study NC hospitals had a lower unadjusted CLABSI rate (1.03 vs 1.13 CLABSIs per 1000 central line days, P < .0001) compared with comparator hospitals. The adjusted RR for CLABSI was 0.94 (95% confidence interval: 0.86, 1.02; P = .11).