Evaluation of separate vs pooled swab cultures, different media, broth enrichment and anatomical sites of screening for the detection of methicillin-resistant Staphylococcus aureus from clinical specimens.

Early identification of methicillin-resistant Staphylococcus aureus (MRSA) carriers is a major component of an MRSA control programme. The cost and laboratory workload could be markedly reduced by processing multiple swabs from one person in one culture broth (specimen pooling). We evaluated the sensitivity for MRSA detection and the growth rate of pooled swabs compared with individual processing. In total, 1254 swabs from 423 subjects (two to five swabs per subject) were submitted for detection of MRSA. Swabs were suspended in 2-mL volumes of sterile Todd-Hewitt Broth and divided into two 1-mL aliquots. One aliquot of the suspension was processed as a single specimen, and the other aliquot was mixed (pooled) with other suspensions in which swabs from the same patient were suspended. Forty-four (10%) pooled samples were positive for MRSA. Specimens from seven additional patients that were negative when pooled were positive when processed separately. There was no case where the pooled specimen was positive but the separate specimens were negative. The diagnostic sensitivity of pooled surveillance cultures compared with single cultures, when only subjects colonized by MRSA were considered, was 86% and the false-negative rate was 14%. Eighty percent of the pooled positive cultures were detected by the third day and all were detected by the fourth day. Fifty-four percent of the specimens processed separately were detected by the second day and all were detected by the fourth day. Pooling of specimens decreases the sensitivity of MRSA detection compared with processing each swab separately, particularly in swabs with a low number of colony-forming units. In all subjects whose pooled samples were negative but whose swabs examined separately were positive, the swabs examined separately were negative on primary plates and positive only after culturing in enrichment broth.

From legacy systems towards modern health information systems.

This article describes an approach of transferring legacy hospital information system to a modern HIS, which would support requirements of modern information age. There are several reasons, which force us to perform such a migration: from the weakness of design of legacy system to the need of covering new technologies (such as Inter/intranet) and new business conditions. The transition should be gradual, therefore a multilevel approach to the data is suggested, enabling us the transition, as well as including of the new, upcoming standards. The process of transition was started by the system covering the doctor's work. Responses to this part were very positive; therefore, we estimate that we are on the right way. We, however, know that the transitions will be neither fast nor cheap and this is the reason we shall have to find some more solutions.

Doctor friendly electronic patient record.

In this paper we would like to show importance of using modern information technology in implementation and development of health information systems. Our main focus is on doctor's work. Doctors will use computer only if they will see clear advantages. Traditional data gathering and display are not sufficient, so modern software should provide speech interfacing and computer graphics in various applications and enable the use of electronic mail, hand held computers, electronic data interchange, etc. among other features. This paper tries to show the needs for applications of those features. They are already implemented as part of our hospital information systems.

Implementation problems of decision support system for nosocomial infection.

Decision support system for nosocomial infection therapy Ptah can reduce antibiotic misuse with data about bacteria resistance and antibiotic ineffectiveness. Resistance vectors in time series show epidemiological problems with resistant bacterias, named house-bacteria. Most important implementation factors are integrated hospital information system and doctors, nurses and managers interested in problems of nosocomial infection.