Everybody hands-on to avoid ESKAPE: effect of sustained hand hygiene compliance on healthcare-associated infections and multidrug resistance in a paediatric hospital.

PURPOSE: Hand hygiene is the most important strategy for preventing healthcare-associated infections (HCAIs); however, the impact of hand hygiene in middle-income countries has been poorly described. In this work, we describe the impact of the programme 'Let's Go for 100' on hand hygiene adherence, HCAIs rates and multidrug-resistant (MDR) bacteria, including the molecular typing of methicillin-resistant Staphylococcus aureus (MRSA) strains. METHODOLOGY: A multimodal, hospital-wide hand hygiene programme was implemented from 2013. 'Let's Go for 100' involved all healthcare workers and encompassed education, awareness, visual reminders, feedback and innovative strategies. Monthly hand hygiene monitoring and active HCAI surveillance were performed in every ward. Molecular typing of MRSA was analysed by pulsed-field gel electrophoresis (PFGE).Results/Key findings. Hand hygiene adherence increased from 34.9 % during the baseline period to 80.6 % in the last 3 months of this study. The HCAI rate decreased from 7.54 to 6.46/1000 patient-days (P=0.004). The central line-associated bloodstream infection (CLABSIs) rate fell from 4.84 to 3.66/1000 central line-days (P=0.05). Negative correlations between hand hygiene and HCAIs rates were identified. The attack rate of MDR-ESKAPE group bloodstream infections decreased from 0.54 to 0.20/100 discharges (P=0.024). MRSA pulsotypes that were prevalent during the baseline period were no longer detected after the 5th quarter, although new strains were identified. CONCLUSIONS: A multimodal hand hygiene programme in a paediatric hospital in a middle-income country was effective in improving adherence and reducing HCAIs, CLABSIs and MDR-ESKAPE bloodstream infections. Sustaining hand hygiene adherence at a level of >60 % for one year limited MRSA clonal transmission.

Efectividad terapéutica de inmunoglobulina intravenosa pH 4.25 en sepsis neonatal experimental por Klebsiella pneumoniae / Therapeutic effectwith of an intravenous immunoglobulin ph 4.25 in experimental Klebsiella pneumoniae new-born sepsis

En este estudio evaluamos la actividad opsonizante in vitro y el efecto in vivo de una preparación de inmunoglobulina para uso intravenoso (IGIV) con pH 4.24 contra Klebsiella pneumoniae. Se utilizaron ensayos de opsonofagocitosis en microplacas y se midieron los índices de muerte bacteriana a 60 y 150 minutos e incubación con leucocitos polimorfonucleares (PMNs) de adultos sanos. Para el estudio in vivo, se infectaron a 44 ratas Wistar recién nacidas (RN) con una dosis letal 75% de Klebsiella pneumoniae K-8 y 90 minutos después se administró IGIV pH 4.25 a dosis de 500 mg/Kg a 24 animales y a los otros 20 una solución balanceada de fosfatos como placebo. La sobrevida se observó durante 10 días. Los índices de muerte bacteriana fueron mejores cuando se opsonizó a la bacteria con IGIV pH 4.25, contrastando con otras fuentes de opsoninas, tanto a los 60 minutos (76%) p < 0.001, como a los 150 minutos (69%) p < 0.0001, de incubación con los PMNs. La sobrevida fue mejor en el grupo tratado con IGIV pH 4.25 (17/24) que en el grupo testigo (5/20), con diferencia significativa (p = 0.0029). Estos resultados sugieren que la IGIV pH 4.25 puede ser de utilidad para su empleo clínico en neonatos con sepsis por Klebsiella pneumoniae. Inmunoglobulina intravenosa; infección experimental; recién nacido; sepsis neonatal; Klebsiella pneumoniae