Generalized and Prolonged Use of Gentamicin-Lock Therapy Reduces Hemodialysis Catheter-Related Infections Due to Gram Negatives.

INTRODUCTION: The incidence of catheter-related bloodstream infections (CRBSI) ranges from 2.2 to 5.5 episodes per 1,000 catheter-days. Our aim was to evaluate the utility of a generalized and prolonged gentamicin-lock therapy in patients undergoing hemodialysis (HD) in a third-level hospital for the reduction in CRBSI. METHODS: A prospective cohort analyzed before and after intervention. During intervention periods after each HD-session, the catheter lumens were locked with gentamicin/heparin for all patients compared to nonintervention periods were the same procedure was performed without gentamicin. Active surveillance was performed for HD CRBSI. Microbiologic assessment and epidemiological data were gathered. Continuous hand hygiene and water quality monitoring were performed. RESULTS: The rates of CRBSI were reduced from 1.28 to 0.2 cases per 1,000 catheter-days when the lock therapy was employed (p = 0.001) The greatest reduction was for CRBSI caused by Pseudomonas aeruginosa were no cases were recorded during the intervention periods (p = 0.001). There was a significant reduction in the total number of isolates; Gram-negative bacterial species (-97.2%) and Gram-positive bacterial species (-61.5%) although only the former reached statistical significance (p = 0.0001). The difference in the absolute risk reduction was 20.56% (95% CI 14.46-26.66%), the calculated Number Needed to Treat was 5 (95% CI 3.8-6.9). No adverse effects were noted. CONCLUSION: In the current study, gentamicin-lock therapy was associated with a significant reduction in CRBSI specially with P. aeruginosa and other Gram-negative bacteria. It proved to be safe and effective intervention when applied to the entire population of HD patients.

Enhancement of hand hygiene compliance among health care workers from a hemodialysis unit using video-monitoring feedback.

BACKGROUND: The importance of hand hygiene in the prevention of health care-associated infection is well known. Experience with hand hygiene compliance (HHC) evaluation in hemodialysis units is scarce. METHODS: This study was a 3-phase, prospective longitudinal intervention study during a 5-month period in a 13-bed hemodialysis unit at a university hospital in Northern Mexico. The unit performs an average of 1,150 hemodialysis procedures per month. Compliance was evaluated by a direct observer and a video assisted observer. Feedback was given to health care workers in the form of educational sessions and confidential reports and video analysis of compliance and noncompliance. RESULTS: A total of 5,402 hand hygiene opportunities were registered; 5,201 during 7,820 minutes of video footage and 201 by direct observation during 1,180 minutes. Lower compliance during the baseline evaluation was observed by video monitoring compared with direct observation (P <0.05). Discrepancy between both methods was 29.2% (0.4%-59.8%); the average improvement in compliance during the study was 30.6% (range, 7.3%-75.5%). Global and Individual results for each subject revealed a statistically significant Improvement in the majority. Noncompliance according to WHO's 5 Moments for HH was greater for moment 5 (30.1%). We estimated that a health care worker in a hemodialysis unit could take 22-44.3% of working hours for proper hand hygiene compliance. CONCLUSIONS: Video-assisted monitoring of hand hygiene is an excellent method for the evaluation of HHC in a hemodialysis unit; enhanced HHC can be achieved through a feedback program to the hemodialysis staff that includes video examples and confidential reports.

Association between early influenza vaccination and the reduction of influenza-like syndromes in health care providers.

A comparison of 2 different influenza seasons (2013-2014 and 2014-2015) where early vaccination among health care providers (HCPs) in the latter was the difference. Differences in leave of absence because of influenza-like illness (ILI) (52 vs 15 [total number of leave of absence issued], P < .001) and total days of lost work (218 vs 68, P < .001) were found for the 2013-2014 and 2014-2015 seasons, respectively. An association between earlier influenza vaccination among HCPs and a reduction in ILI, leave of absence, and days of lost work was found.

Impact of daily chlorhexidine baths and hand hygiene compliance on nosocomial infection rates in critically ill patients.

BACKGROUND: Up to 25% of all nosocomial infections (NIs) develop in critically ill patients. Our objective was to evaluate chlorhexidine (CHX) bathing and hand hygiene (HH) compliance in the reduction of NIs in the intensive care unit. METHODS: The study comprised three 6-month periods: preintervention (PIP; soap/water bathing), intervention (IP; bathing with CHX-impregnated wipes), and postintervention (PoIP; soap/water bathing). An HH program was implemented during the IP and PoIP. Primary outcomes were global and specific NI rates. RESULTS: A total of 1007 patients were included. Infection rates per 100 discharges were higher in the PIP compared with the IP and also higher in the PoIP compared with the IP (P = .0004 and .0109, respectively). Global infection rates per 1000 hospital-days were higher in the PIP than in the IP (P = .0268). The rates of ventilator-associated pneumonia (VAP) and catheter-associated urinary tract infection (CAUTI) were higher in the PIP than in the IP (P = .036 and .0001, respectively). Isolation of Acinetobacter baumannii from VAP specimens (P = .0204) and isolation of Candida spp from CAUTI specimens (P = .0005) decreased as well. CONCLUSION: The combined intervention reduced global and specific infection rates, including rates of VAP associated with A baumannii and CAUTI associated with Candida spp.

A 5-year surveillance of occupational exposure to bloodborne pathogens in a university teaching hospital in Monterrey, Mexico.

BACKGROUND: Occupational exposure to bloodborne pathogens (OEBPs) is a serious health and safety concern for health care providers. Lack of experience of medical personal in training could make them more susceptible for acquiring infections by these infectious agents. METHODS: We conducted a 5-year retrospective review of all reported occupational exposures. Characteristics, risk factors, and management of the accidents were obtained from OEBP database. RESULTS: A total of 951 events were analyzed, and 94.3% occurred in medical personnel in training; of those, 87.4% were percutaneous injuries. The emergency room was the hospital ward with more events recorded (34.1%), followed by the internal medicine and surgical wards. A hollow needle was used in 59.1% of the events, a suture needle in 10.7%, and a lancet in 8.8%. Most of events were recorded in the morning shift (38.3%). The months with fewer reports of events were January, July, and December, and the months with the highest reports were the combined months of October 2006 through 2011. CONCLUSION: A high incidence of OEBP in medical personnel in training was detected; this high frequency correlates with the dynamics of the student population during the year and the hands on practice that the nursing and medical students receive.