Staphylococcus aureus screening and decolonization reduces the risk of surgical site infections in patients undergoing deep brain stimulation surgery.

In a controlled before-and-after study in a single centre, it was aimed to determine whether identification of Staphylococcus aureus nasal carriers followed by nasal mupirocin ointment and chlorhexidine soap reduced surgical site infections (SSIs) among 182 patients undergoing deep brain stimulation. In all, 119 patients were included in the control group and 63 in the screening group. There was a significant SSI decrease from 10.9% to 1.6% between the two groups (P<0.04; relative risk: 0.13; 95% confidence interval: 0.003-0.922). There were eight SSIs involving S. aureus in the control group, none in the screening group. No specific risk factors for SSI were identified.

Predictive factors for surgical site infection in head and neck cancer surgery: A case-control study.

Surgical Site Infection (SSI) after head and neck cancer surgery may be life threatening and induces increasing in healthcare cost. The objective of this present study was to identify predictive factors associated to surgical site infection in head and neck cancer surgery. Numerous predictive factors were analyzed with univariate case-control method, then with multivariate method. This retrospective study included 71 patients who have been hospitalized in our department during 2010 for a head and neck cancer surgery. The incidence of surgical site infection was 15.5%. The T3-T4 stages were identified as an independent predictive factor (p = 0.04). Our study does not find other predictive factor for a SSI. The NNIS index (National Nosocomial Infections Surveillance), used by the Center for disease control and prevention as predictive factor, was not valid in our study. A specific predictive index should include the tumor stage for Head and Neck Cancer surgery and should be taken into account for the management of a preventive antibiotic treatment.

Clostridium difficile O27 colitis: hospital-onset but community-acquired.

Large outbreaks of Clostridium difficile (CD) associated colitis in North America and Europe have been attributed to the emergence of the epidemic/toxin PCR Ribotype O27 CD strain (CD027). Due to the increased virulence of this epidemic strain and its propension for causing outbreaks, we performed a structured risk-assessment approach in order to determine the risks associated with the introduction of this strain within our university hospital. From February 2009 to January 2010, we identified 31 cases of CD027 associated colitis, whereby twenty one (67.7%) had symptoms onset more than 48 hours after admission and were classified as nosocomial. These patients had received wide-spectrum antimicrobials for other infections in the hospital before CD027 colitis diagnosis. The 31 patients with CD027 were admitted in 20 different units, managed by distinct health-care workers (HCWs), and no contact was identified between patients during their hospital stay. Furthermore, infection control audits showed 100% compliance with institutional guidelines for control of CD colitis. These findings suggest that CD027 is most frequently acquired in the community and emerges sporadically under antibiotic pressure during hospitalization.

Effect of higher minimum inhibitory concentrations of quaternary ammonium compounds in clinical E. coli isolates on antibiotic susceptibilities and clinical outcomes.

Quaternary ammonium compounds (QACs) are cationic surfactants used as preservatives and environmental disinfectants. Limited data are available regarding the effect of QACs in the clinical setting. We performed a prospective cohort study in 153 patients with Escherichia coli bacteraemia from February to September 2008 at University Hospital in Rennes. The minimum inhibitory concentrations (MICs) of antibiotics and QACs alkyldimethylbenzylammonium chloride (ADBAC) and didecyldimethylammonium chloride (DDAC) were determined by the agar dilution method. The capacity of biofilm production was assayed using the Crystal Violet method, and mutation frequencies by measuring the capacity of strains to generate resistance to rifampicin. Logistic regression analysis showed that one of the significant factors related to low MICs for ADBAC (≤16 mg/L) and DDAC (≤8 mg/L), was cotrimoxazole susceptibility (odds ratio: 3.72; 95% confidence interval: 1.22-11.24; P=0.02 and OR: 3.61; 95% CI: 1.56-7.56; P<0.01, respectively). Antibiotic susceptibility to cotrimoxazole was strongly associated with susceptibility to amoxicillin and nalidixic acid (P<0.01). Community-acquired or healthcare-associated bacteraemia, severity of bacteraemia, and patient outcome were independent of the MICs of ADBAC and DDAC. Our findings demonstrate an epidemiological relationship between higher MIC values of QACs in clinical E. coli isolates and antibiotic resistance.

Impact of surgical site infection surveillance in a neurosurgical unit.

This article describes a two-year surveillance of neurosurgical site infections and an outbreak of infections in deep brain stimulation (DBS) cases. From April to December 2008, six patients had a DBS surgical site infection (SSI). Audits of hygiene practices, infection control of the healthcare environment, and preoperative antimicrobial prophylaxis characteristics were carried out. The results of surgical audits showed that skin preparation and antimicrobial prophylaxis were not being performed adequately. In 2008, the general SSI rate was 1.8% (27 SSIs/1471 patients). Length of preoperative stay was significantly longer among infected patients (2.7 ± 2.9 months) compared with uninfected patients (2.2 ± 4.6 months) (P=0.01). Based on these results, skin preparation and antimicrobial prophylaxis were reviewed with the neurosurgery team. In 2009, the general SSI rate was reduced to 1.1% (16 SSI in 1410 patients), a reduction from 2008 (P=0.12). Although the overall incidence of SSI in 2008 (1.8%) was within the range of published data, this surveillance of SSIs permitted identification of site operative infected patients surgically treated for DBS. A set of actions was then taken to reduce SSI risk. This work demonstrates how an active surveillance programme can successfully change clinical care practice.

Influence of job seniority, hand hygiene education, and patient-to-nurse ratio on hand disinfection compliance.

Hand hygiene compliance was evaluated by direct observation in 2006 and 2007. In 2007, data on characteristics such as job seniority, hand hygiene education, and patient-to-nurse ratio during direct observations were collected. A hand hygiene promotional programme was performed between the two evaluations. Univariate and multivariate analysis identified factors associated with improved hand hygiene compliance. Between 2006 and 2007, from 761 hand hygiene opportunities, overall and partial compliance improved from 44.9% to 58% (P<0.001) and from 73.5% to 88.4% (P<0.001), respectively. In 2007, improvements in hand hygiene overall or partial compliance were seen when senior healthcare workers (HCWs) were present in the clinical area under investigation (P=0.04 or P=0.08, respectively). Partial hand hygiene compliance was significantly better in 2007 after a hand hygiene educational programme had been presented (P<0.015). Similar rates of compliance were observed whatever the patient-to-nurse ratio during the observation. Multivariate analysis identified job seniority as an independent predictor of hand hygiene compliance. Our results suggest that hand hygiene compliance is influenced by education on hand hygiene and that a senior HCW could act as a role model for other HCWs. These data should be considered when developing future hygiene interventions.

Outbreak of Serratia marcescens in a neonatal intensive care unit: contaminated unmedicated liquid soap and risk factors.

This study describes an outbreak of Serratia marcescens and its investigation and control in a neonatal intensive care unit (NICU). During a three-month period, five infants were colonised or infected by a single strain of S. marcescens. A case-control study, culture surveys and pulse-field gel electrophoresis analysis implicated a bottle soap dispenser as a reservoir of S. marcescens (P=0.032). Infants with S. marcescens colonisation or infection were also more likely to have been exposed to a central or percutaneous venous catheter (P=0.05) and had had longer exposure to endotracheal intubation (P=0.05). Soap dispensers are used in many hospitals and may be an unrecognised source of nosocomial infections. This potential source of infection could be reduced by using 'airless' dispensers which have no air intake for the distribution of soap. Prompt intervention and strict adherence to alcoholic hand disinfection were the key factors that led to the successful control of this outbreak.

Hand washing soap as a source of neonatal Serratia marcescens outbreak.

OBJECTIVE: To describe an outbreak of Serratia marcescens infections in a neonatal intensive care unit (NICU) and to report investigations and interventions having led to the cessation of the outbreak. DESIGN: Observational study of microbiological and epidemiological investigations realised during a S. marcescens outbreak between March and October 2006. METHODS: Nine cases were observed in a 5 months period. A Serratia outbreak was therefore identified, and all the strains were compared by pulsed-field gel electrophoresis (PFGE). Data from medical notes were gathered retrospectively. Environmental samples were gathered prospectively. RESULTS: Four infants were colonized and five infants were infected by S. marcescens. PFGE revealed that three different strains were present. Seven of the nine babies were infected by only one of these strains. This same strain was found in a nonantimicrobial soap bottle (NAS) that could be the source of contamination. CONCLUSION: It is the first time that S. marcescens is found in a NAS during a neonatal nosocomial outbreak. Molecular analysis is a method of choice to compare different strains. Identification and elimination of the nosocomial source and adherence to the infection control policies are essential to succeed in the containment of a nosocomial epidemic.

[Consumption of hand-hygiene products in health establishments in the west of France]. / La consommation de produits d'hygiène des mains dans les établissements de soins dans l'interrégion Ouest.

OBJECTIVES: The study had for aim to investigate hand hygiene product use in French hospitals between 2000 and 2003. DESIGN: A questionnaire was sent in 2002 and 2 more in 2003 and 2004 (for 2000 to 2003) requiring data on type of hospital, number of beds, staff members, admissions and patient-day, litres of mild soap, antiseptic soap and alcohol-based rub used and price per litre. Indices were calculated accordingly. RESULTS: 574 hospitals answered over the 4 year period (average 143 per year) representing an average of 50 000 beds/year, 80 000 full-time staff positions, 1.2 million admissions and 16 millions patient-days. The median consumption of mild soap was 3.8 l per bed, 2.7 l per staff member, 2.4 l per 100 admissions, and 10.6 ml per patient-day. The median consumption of antiseptic soap was 1 l per bed, 0.8 l per staff member, 4.8 l per 100 admissions, and 3.2 ml per patient-day. The median consumption of alcohol-based rub (HAS) was 0.3 l per bed, 0.3 l per staff-member, 1.5 l per admission, and 0.9 l per patient-day. Between 2000 and 2003, HAS use significantly increased from 69 to 88% (a relative increase of 31%) and the median consumption increased from 0.5 ml to 1.5 ml per patient-day. 370 fully completed grids gave a number of 7 opportunities per patient-day with less than 1 for HAS. CONCLUSION: The best indicator for an infection control practitioners is the quantity of alcohol-based solution in ml/patient-day and HAS per patient-day is the reference.