Hospital epidemiologists' and infection preventionists' opinions regarding hospital-onset bacteremia and fungemia as a potential healthcare-associated infection metric.

OBJECTIVE: To ascertain opinions regarding etiology and preventability of hospital-onset bacteremia and fungemia (HOB) and perspectives on HOB as a potential outcome measure reflecting quality of infection prevention and hospital care. DESIGN: Cross-sectional survey. PARTICIPANTS: Hospital epidemiologists and infection preventionist members of the Society for Healthcare Epidemiology of America (SHEA) Research Network. METHODS: A web-based, multiple-choice survey was administered via the SHEA Research Network to 133 hospitals. RESULTS: A total of 89 surveys were completed (67% response rate). Overall, 60% of respondents defined HOB as a positive blood culture on or after hospital day 3. Central line-associated bloodstream infections and intra-abdominal infections were perceived as the most frequent etiologies. Moreover, 61% thought that most HOB events are preventable, and 54% viewed HOB as a measure reflecting a hospital's quality of care. Also, 29% of respondents' hospitals already collect HOB data for internal purposes. Given a choice to publicly report central-line-associated bloodstream infections (CLABSIs) and/or HOB, 57% favored reporting either HOB alone (22%) or in addition to CLABSI (35%) and 34% favored CLABSI alone. CONCLUSIONS: Among the majority of SHEA Research Network respondents, HOB is perceived as preventable, reflective of quality of care, and potentially acceptable as a publicly reported quality metric. Further studies on HOB are needed, including validation as a quality measure, assessment of risk adjustment, and formation of evidence-based bundles and toolkits to facilitate measurement and improvement of HOB rates.

Bacteria and vampirism in cinema.

A vampire is a non-dead and non-alive chimerical creature, which, according to various folklores and popular superstitions, feeds on blood of the living to draw vital force. Vampires do not reproduce by copulation, but by bite. Vampirism is thus similar to a contagious disease contracted by intravascular inoculation with a suspected microbial origin. In several vampire films, two real bacteria were staged, better integrated than others in popular imagination: Yersinia pestis and Treponema pallidum. Bacillus vampiris was created for science-fiction. These films are attempts to better define humans through one of their greatest fears: infectious disease.

Targeted versus universal decolonization to prevent ICU infection.

BACKGROUND: Both targeted decolonization and universal decolonization of patients in intensive care units (ICUs) are candidate strategies to prevent health care-associated infections, particularly those caused by methicillin-resistant Staphylococcus aureus (MRSA). METHODS: We conducted a pragmatic, cluster-randomized trial. Hospitals were randomly assigned to one of three strategies, with all adult ICUs in a given hospital assigned to the same strategy. Group 1 implemented MRSA screening and isolation; group 2, targeted decolonization (i.e., screening, isolation, and decolonization of MRSA carriers); and group 3, universal decolonization (i.e., no screening, and decolonization of all patients). Proportional-hazards models were used to assess differences in infection reductions across the study groups, with clustering according to hospital. RESULTS: A total of 43 hospitals (including 74 ICUs and 74,256 patients during the intervention period) underwent randomization. In the intervention period versus the baseline period, modeled hazard ratios for MRSA clinical isolates were 0.92 for screening and isolation (crude rate, 3.2 vs. 3.4 isolates per 1000 days), 0.75 for targeted decolonization (3.2 vs. 4.3 isolates per 1000 days), and 0.63 for universal decolonization (2.1 vs. 3.4 isolates per 1000 days) (P=0.01 for test of all groups being equal). In the intervention versus baseline periods, hazard ratios for bloodstream infection with any pathogen in the three groups were 0.99 (crude rate, 4.1 vs. 4.2 infections per 1000 days), 0.78 (3.7 vs. 4.8 infections per 1000 days), and 0.56 (3.6 vs. 6.1 infections per 1000 days), respectively (P<0.001 for test of all groups being equal). Universal decolonization resulted in a significantly greater reduction in the rate of all bloodstream infections than either targeted decolonization or screening and isolation. One bloodstream infection was prevented per 54 patients who underwent decolonization. The reductions in rates of MRSA bloodstream infection were similar to those of all bloodstream infections, but the difference was not significant. Adverse events, which occurred in 7 patients, were mild and related to chlorhexidine. CONCLUSIONS: In routine ICU practice, universal decolonization was more effective than targeted decolonization or screening and isolation in reducing rates of MRSA clinical isolates and bloodstream infection from any pathogen. (Funded by the Agency for Healthcare Research and the Centers for Disease Control and Prevention; REDUCE MRSA ClinicalTrials.gov number, NCT00980980).

Healthcare-associated infection and the patient experience: a qualitative study using patient interviews.

There is an increasing emphasis on the need for further patient involvement within healthcare to ensure that the voice of the patient is heard. This exploratory study utilised in-depth face-to-face interviews with patients to explore narratives from their experiences around healthcare-associated infection (HCAI). Interviews were undertaken with patients who had been diagnosed with a Staphylococcus aureus bloodstream infection and patients who had been in the same hospital but had not been diagnosed with a bloodstream infection. The lack of both verbal and written communications was a major concern for most patients regardless of their infection status. Some patients also stated that they were not comfortable about asking questions, and only a small number of patients and relatives stated that they would challenge staff about their practice. Although some patients retained confidence in the National Health Service (NHS), the majority had very little or no confidence in the NHS in relation to HCAI and would have serious concerns about this if they were to return to hospital. The results suggest that there are a number of issues that must be addressed in order to enhance the quality of care, safety of patients and the patient experience in relation to infection prevention and control. In addition, policy-makers, managers and all healthcare workers must ensure that patients are involved in the design and evaluation of systems change and information.

Rehabilitation of a child with meningococcal septicemia and quadrilateral limb loss: a case report.

Acquired quadrilateral limb loss is a rare occurrence in children. One cause of this condition is severe meningococcal septicemia. We present the case of a boy who, at 14 months of age, required extensive amputation after an episode of meningococcal septicemia. We review his medical recovery and rehabilitation, including upper- and lower-limb prosthetic prescription and training, and adaptation to his altered body. A multidisciplinary approach led to effective management of his complex clinical and psychologic needs. This case illustrates the need to address a range of medical, prosthetic, and family issues central to successful clinical outcome.

Povidone-iodine's effects and role in the management of periodontal diseases: a review.

This review article addresses the effects of povidone-iodine (PVP-I) and its utility in the treatment of periodontal diseases. There are data to support the following statements: PVP-I is a potent antiseptic and, when used as a component in a rinse with H202, the rinse can decrease the level of gingivitis. With regards to patients with adult periodontitis, there is some evidence to indicate that PVP-I delivered via an ultrasonic device achieves better results in deep pockets than ultrasonic debridement when water is the irrigant. The benefits of PVP-I in the treatment of refractory periodontitis are unclear. Subgingival irrigation with PVP-I may reduce the incidence of bacteremia if it is employed as a pre-procedural intrasulcular irrigant; however, this technique is not recommended for high-risk patients. PVP-I is a safe antiseptic and does not appear to impede wound healing or induce resistant bacteria. It is an approved drug whose intraoral use is an unlabeled indication. In conclusion, the literature suggests that utilization of PVP-I is potentially beneficial in the management of some periodontal diseases. However, additional clinical trials are needed to verify this assessment, since it is based upon a limited number of studies.

[Münchhausen syndrome in otorhinolaryngology]. / Das Münchhausen-Syndrom in der Hals-Nasen-Ohren-Heilkunde.

The case of a 22-year-old nurse with Münchausen syndrome is described. Faked symptoms included sudden hearing loss and fever. In addition to the definition and classification, clues for diagnosis of faked disease are given. Early diagnosis avoids unnecessary diagnostic and therapeutic procedures. The prognosis of Münchhausen's syndrome depends on the ability to establish an effective doctor-patient relationship, even though the nature of disease renders any treatment difficult.