RESUMO
Urinary tract infection is the most common healthcare-associated infection in the intensive care unit and predominantly occurs in patients with indwelling urinary catheters. The predominant microorganisms causing catheter-associated urinary tract infection (CAUTI) in the intensive care unit are enteric Gram-negative bacilli, enterococci, Candida species, and Pseudomonas aeruginosa. Multidrug resistance is a significant problem in urinary pathogens. Duration of catheterization is the most important risk factor for development of CAUTI. Diagnosis, particularly in the intensive care unit setting, is very difficult, as asymptomatic bacteriuria may be difficult to differentiate from symptomatic CAUTI. In general, asymptomatic bacteriuria should not be treated, and treatment of CAUTI often requires removal of the catheter along with systemic antimicrobial therapy. General strategies for prevention of CAUTI apply to all healthcare-associated infections and include measures such as adherence to hand hygiene. Targeted strategies for prevention of CAUTI include limiting the use and duration of urinary catheterization, using aseptic technique for catheter insertion, and adhering to proper catheter care.
Assuntos
Infecções Relacionadas a Cateter/diagnóstico , Infecções Relacionadas a Cateter/prevenção & controle , Unidades de Terapia Intensiva , Infecções Urinárias/diagnóstico , Infecções Urinárias/prevenção & controle , Anti-Infecciosos/administração & dosagem , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/transmissão , Cateterismo , Cateteres de Demora/efeitos adversos , Desinfecção das Mãos , Humanos , Fatores de RiscoRESUMO
Stringent regulatory standards for reprocessing medical devices and equipment have proliferated in response to patient safety incidents in which improperly disinfected or contaminated endoscopes lead to large-scale disease transmission or outbreaks. This article details best practices in reprocessing reusable and single-use devices in otolaryngology, with particular attention to flexible fiberoptic endoscopes/nasophyarngoscopes, nasal speculums, and other clinic and operating room instruments. High-risk devices require sterilization, whereas lower risk devices may be reprocessed using various disinfection procedures. Reprocessing practices have implications for adequacy, efficiency, and cost. Nuanced understanding of procedures and their rationale ensures delivery of safe, ethical, and quality patient care.
Assuntos
Desinfecção/métodos , Segurança de Equipamentos/ética , Equipamentos e Provisões/classificação , Otolaringologia , Humanos , Otorrinolaringopatias/diagnóstico , Otorrinolaringopatias/terapia , Segurança do Paciente/normas , Melhoria de Qualidade/organização & administração , Estados Unidos , United States Food and Drug AdministrationRESUMO
Catheter-associated urinary tract infection remains one of the most prevalent, yet preventable, health care-associated infections. General prevention strategies include strict adherence to hand hygiene and antimicrobial stewardship. Duration of urinary catheterization is the most important modifiable risk factor. Targeted prevention strategies include limiting urinary catheter use; physician reminder systems, nurse-initiated discontinuation protocols, and automatic stop orders have successfully decreased catheter duration. Alternatives should be considered. If catheterization is necessary, proper aseptic practices for insertion and maintenance and closed catheter collection systems are essential for prevention. The use of bladder bundles and collaboratives aids in the effective implementation of prevention measures.
Assuntos
Infecções Bacterianas/etiologia , Infecções Relacionadas a Cateter/etiologia , Cateteres Urinários/efeitos adversos , Infecções Urinárias/etiologia , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/prevenção & controle , Infecções Relacionadas a Cateter/epidemiologia , Infecções Relacionadas a Cateter/prevenção & controle , Humanos , Estados Unidos , Infecções Urinárias/epidemiologia , Infecções Urinárias/prevenção & controleRESUMO
OBJECTIVE: To determine whether increases in contact isolation precautions are associated with decreased adherence to isolation practices among healthcare workers (HCWs). DESIGN: Prospective cohort study from February 2009 to October 2009. SETTING: Eleven teaching hospitals. PARTICIPANTS: HCWs. METHODS: One thousand thirteen observations conducted on HCWs. Additional data included the number of persons in isolation, types of HCWs, and hospital-specific contact precaution practices. Main outcome measures included compliance with individual components of contact isolation precautions (hand hygiene before and after patient encounter, donning of gown and glove upon entering a patient room, and doffing upon exiting) and overall compliance (all 5 measures together) during varying burdens of isolation. RESULTS: Compliance with hand hygiene was as follows: prior to donning gowns/gloves, 37.2%; gowning, 74.3%; gloving, 80.1%; doffing of gowns/gloves, 80.1%; after gown/glove removal, 61%. Compliance with all components was 28.9%. As the burden of isolation increased (20% or less to greater than 60%), a decrease in compliance with hand hygiene (43.6%-4.9%) and with all 5 components (31.5%-6.5%) was observed. In multivariable analysis, there was an increase in noncompliance with all 5 components of the contact isolation precautions bundle (odds ratio [OR], 6.6 [95% confidence interval (CI), 1.15-37.44]; P = .03) and in noncompliance with hand hygiene prior to donning gowns and gloves (OR, 10.1 [95% CI, 1.84-55.54]; P = .008) associated with increasing burden of isolation. CONCLUSIONS: As the proportion of patients in contact isolation increases, compliance with contact isolation precautions decreases. Placing 40% of patients under contact precautions represents a tipping point for noncompliance with contact isolation precautions measures.
Assuntos
Infecção Hospitalar/prevenção & controle , Luvas Protetoras/estatística & dados numéricos , Fidelidade a Diretrizes , Higiene das Mãos/estatística & dados numéricos , Hospitais de Ensino , Humanos , Isolamento de Pacientes , Recursos Humanos em Hospital/estatística & dados numéricos , Estudos Prospectivos , Roupa de Proteção/estatística & dados numéricosRESUMO
OBJECTIVE: Peripherally inserted central catheter (PICC) tip malposition is potentially associated with complications, and postplacement adjustment of PICCs is widely performed. We sought to characterize the association between central line-associated bloodstream infection (CLABSI) or venous thrombus (VT) and PICC adjustment. DESIGN: Retrospective cohort study. SETTING: University of Michigan Health System, a large referral hospital. PATIENTS: Patients who had PICCs placed between February 2007 and August 2007. METHODS: The primary outcomes were development of CLABSI within 14 days or VT within 60 days of postplacement PICC adjustment, identified by review of patient electronic medical records. RESULTS: There were 57 CLABSIs (2.69/1,000 PICC-days) and 47 VTs (1.23/1,000 PICC-days); 609 individuals had 1, 134 had 2, and 33 had 3 or more adjustments. One adjustment was protective against CLABSI (P=.04), whereas 2 or 3 or more adjustments had no association with CLABSI (P=.58 and .47, respectively). One, 2, and 3 or more adjustments had no association with VT formation (P=.59, .85, and .78, respectively). Immunosuppression (P<.01), power-injectable PICCs (P=.05), and 3 PICC lumens compared with 1 lumen (P=.02) were associated with CLABSI. Power-injectable PICCs were also associated with increased VT formation (P=.03). CONCLUSIONS: Immunosuppression and 3 PICC lumens were associated with increased risk of CLABSI. Power-injectable PICCs were associated with increased risk of CLABSI and VT formation. Postplacement adjustment of PICCs was not associated with increased risk of CLABSI or VT.
Assuntos
Bacteriemia/epidemiologia , Infecções Relacionadas a Cateter/epidemiologia , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Infecção Hospitalar/epidemiologia , Trombose Venosa/epidemiologia , Bacteriemia/microbiologia , Infecções Relacionadas a Cateter/microbiologia , Cateterismo Venoso Central/métodos , Cateterismo Periférico/métodos , Infecção Hospitalar/microbiologia , Feminino , Fungemia/epidemiologia , Fungemia/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Trombose Venosa/etiologiaRESUMO
In cases of central nervous system infection, it is crucial for the neuroradiologist to provide an accurate differential diagnosis of the possible pathogens involved so that treating physicians can be aided in the choice of empiric therapy. This approach requires the radiologist to be aware of local epidemiology and have knowledge of infectious agents that are endemic to their area of practice. This article reviews and discusses the changing epidemiology of pathogens most often observed in meningitis, brain abscess, epidural abscess, postoperative infections, and human immunodeficiency virus infection.
Assuntos
Infecções Bacterianas/epidemiologia , Infecções Parasitárias do Sistema Nervoso Central/epidemiologia , Meningites Bacterianas/epidemiologia , Meningite Fúngica/epidemiologia , Meningite Viral/epidemiologia , Meningite/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Infecções Oportunistas Relacionadas com a AIDS/prevenção & controle , Infecções Oportunistas Relacionadas com a AIDS/transmissão , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/prevenção & controle , Infecções Bacterianas/transmissão , Abscesso Encefálico/diagnóstico , Abscesso Encefálico/epidemiologia , Abscesso Encefálico/prevenção & controle , Infecções Parasitárias do Sistema Nervoso Central/diagnóstico , Infecções Parasitárias do Sistema Nervoso Central/prevenção & controle , Infecções Parasitárias do Sistema Nervoso Central/transmissão , Estudos Transversais , Países em Desenvolvimento , Diagnóstico Diferencial , Humanos , Meningite/diagnóstico , Meningite/prevenção & controle , Meningites Bacterianas/diagnóstico , Meningites Bacterianas/prevenção & controle , Meningites Bacterianas/transmissão , Meningite Fúngica/diagnóstico , Meningite Fúngica/prevenção & controle , Meningite Fúngica/transmissão , Meningite Viral/diagnóstico , Meningite Viral/prevenção & controle , Meningite Viral/transmissão , Prognóstico , Fatores de Risco , Infecção da Ferida Cirúrgica/diagnóstico , Infecção da Ferida Cirúrgica/epidemiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Viagem , VacinaçãoRESUMO
Reuse of both single-use and multiuse medical devices is a common practice and can result in transmission of infection when appropriate sterilization or reprocessing does not occur. Reuse of single-use devices can be problematic because there are no clear standards for reprocessing, although data regarding adverse outcomes are limited. Single-use devices are commonly reused, appropriately or inappropriately, in resource-limited settings because of cost constraints. Reuse of medical devices raises important legal and ethical questions.
Assuntos
Descontaminação/métodos , Reutilização de Equipamento , Controle de Infecções/métodos , Infecção Hospitalar/prevenção & controle , Equipamentos Descartáveis/economia , Contaminação de Equipamentos/prevenção & controle , Reutilização de Equipamento/economia , Reutilização de Equipamento/normas , Ética Médica , Humanos , Controle de Infecções/normas , Guias de Prática Clínica como Assunto , Estados UnidosRESUMO
Prosthetic joint infection (PJI) is a serious complication of total joint arthroplasty (TJA) that can negatively affect functional status and quality of life. This article examines the epidemiology of PJI and reviews current diagnostic, treatment, and management strategies. Diagnosis can be challenging because presenting symptoms are often nonspecific and there is no simple gold standard diagnostic test. Successful treatment of PJI requires a combination of medical and surgical strategies. Given the devastating nature of PJI and the increasing numbers of TJAs performed, prevention efforts remain critical.
Assuntos
Infecções Bacterianas/terapia , Prótese Articular , Infecções Relacionadas à Prótese/terapia , Anti-Infecciosos/uso terapêutico , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/prevenção & controle , Remoção de Dispositivo , Gerenciamento Clínico , Contaminação de Equipamentos/prevenção & controle , Humanos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/prevenção & controle , Fatores de RiscoRESUMO
OBJECTIVES/HYPOTHESIS: Surgical site infections (SSIs) are an important cause of morbidity and mortality after head and neck surgery. Our primary objective was to determine the efficacy of preoperative topical antimicrobial decolonization before head and neck surgery. STUDY DESIGN: Prospective, randomized controlled trial. METHODS: This study was conducted among 84 patients presenting for head and neck surgery requiring admission to an academic medical center. Preoperative cultures were performed to identify Staphylococcus aureus carriers. Patients were randomized to preoperative topical antimicrobial decolonization with a 5-day regimen of chlorhexidine skin rinses and intranasal mupirocin coupled with standard perioperative systemic antimicrobial prophylaxis, versus standard prophylaxis alone. The main outcome was the incidence of SSIs. RESULTS: Despite a trend suggesting a decrease in SSIs with perioperative topical antimicrobial decolonization (24% vs. 10%), there was no significant difference (odds ratio, 0.34; 95% confidence interval, 0.10-1.18; P = .079). Patients with a higher American Society of Anesthesiologists score (3 vs. 1; P = .02), with more operative blood loss (P = .05), and who required operative takeback (P = .04) had a higher rate of SSIs; there was a trend suggesting a higher rate of SSIs among patients undergoing clean-contaminated surgery compared to clean cases (P = .08) and among those having received prior radiation (P = .07) or chemotherapy (P = .06). CONCLUSIONS: Preoperative antimicrobial decolonization did not significantly decrease the incidence of SSIs after head and neck surgery, but might be considered for high-risk groups despite the lack of conclusive evidence confirming efficacy. Risk factors for SSIs after head and neck surgery are identified for the first time in a prospective study.
Assuntos
Antibacterianos/administração & dosagem , Anti-Infecciosos Locais/administração & dosagem , Antibioticoprofilaxia/métodos , Clorexidina/administração & dosagem , Neoplasias de Cabeça e Pescoço/cirurgia , Mupirocina/administração & dosagem , Infecção da Ferida Cirúrgica/microbiologia , Infecção da Ferida Cirúrgica/prevenção & controle , Administração Intranasal , Administração Tópica , Distribuição de Qui-Quadrado , Feminino , Humanos , Incidência , Masculino , Michigan/epidemiologia , Pessoa de Meia-Idade , Estudos Prospectivos , Fatores de Risco , Infecções Estafilocócicas/epidemiologia , Infecções Estafilocócicas/microbiologia , Infecções Estafilocócicas/prevenção & controle , Infecção da Ferida Cirúrgica/epidemiologia , Resultado do TratamentoRESUMO
Total joint arthroplasty (TJA) is commonly performed on older adults. Prosthetic joint infection (PJI) is a serious complication of TJA that can significantly impact quality of life and physical function. In this review, we discuss the epidemiology and risk factors for PJIs among older adults. We also offer an overview of current diagnostic, treatment and management strategies for PJI. Given the serious nature of PJI, prevention efforts remain essential. Several approaches to infection prevention exist, including antimicrobial prophylaxis and decolonization. Although there are standardized recommendations for antimicrobial prophylaxis, the specific regimens must be individualized based on the patient's drug allergies, potential for drug interactions, renal function and bodyweight. The best approach to pre-operative screening and decolonization programmes remains unclear. Each of these issues is reviewed in detail with a focus on adverse effects and current debates regarding best practice. Given the increased numbers of TJAs performed, additional research on prevention and management is critical.
Assuntos
Antibioticoprofilaxia/métodos , Artroplastia de Substituição/efeitos adversos , Infecções Relacionadas à Prótese/prevenção & controle , Idoso , Antibioticoprofilaxia/efeitos adversos , Artroplastia de Substituição/métodos , Humanos , Assistência Perioperatória/métodos , Cuidados Pré-Operatórios/métodos , Infecções Relacionadas à Prótese/diagnóstico , Infecções Relacionadas à Prótese/terapia , Fatores de RiscoRESUMO
Central line-associated bloodstream infections (CLABSIs) have been reduced in number but not eliminated in our intensive care units with use of central line bundles. We performed an analysis of remaining CLABSIs. Many bloodstream infections that met the definition of CLABSI had sources other than central lines or represented contaminated blood samples.