Impact of a multidimensional infection control strategy on catheter-associated urinary tract infection rates in the adult intensive care units of 15 developing countries: findings of the International Nosocomial Infection Control Consortium (INICC).

PURPOSE: We aimed to evaluate the impact of a multidimensional infection control strategy for the reduction of the incidence of catheter-associated urinary tract infection (CAUTI) in patients hospitalized in adult intensive care units (AICUs) of hospitals which are members of the International Nosocomial Infection Control Consortium (INICC), from 40 cities of 15 developing countries: Argentina, Brazil, China, Colombia, Costa Rica, Cuba, India, Lebanon, Macedonia, Mexico, Morocco, Panama, Peru, Philippines, and Turkey. METHODS: We conducted a prospective before-after surveillance study of CAUTI rates on 56,429 patients hospitalized in 57 AICUs, during 360,667 bed-days. The study was divided into the baseline period (Phase 1) and the intervention period (Phase 2). In Phase 1, active surveillance was performed. In Phase 2, we implemented a multidimensional infection control approach that included: (1) a bundle of preventive measures, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of CAUTI rates, and (6) feedback of performance. The rates of CAUTI obtained in Phase 1 were compared with the rates obtained in Phase 2, after interventions were implemented. RESULTS: We recorded 253,122 urinary catheter (UC)-days: 30,390 in Phase 1 and 222,732 in Phase 2. In Phase 1, before the intervention, the CAUTI rate was 7.86 per 1,000 UC-days, and in Phase 2, after intervention, the rate of CAUTI decreased to 4.95 per 1,000 UC-days [relative risk (RR) 0.63 (95% confidence interval [CI] 0.55-0.72)], showing a 37% rate reduction. CONCLUSIONS: Our study showed that the implementation of a multidimensional infection control strategy is associated with a significant reduction in the CAUTI rate in AICUs from developing countries.

Tuberculosis in stem cell transplant patients.

Tuberculosis (TB) is an increasing health problem, and patients undergoing stem cell transplantation (SCT) are at high risk of acquiring TB. Following a review of the medical literature, this article reports the current situation of TB in SCT patients. A PubMed search was undertaken using the keywords 'tuberculosis', 'stem cell transplantation' and 'bone marrow transplantation', and cases with meaningful data for analysis were included. The medical literature contains relatively few data on TB and SCT. Although there is a risk of TB in allogeneic SCT patients, this is less than in solid organ transplant patients, and the risk in autologous SCT patients is similar to the risk in the general population. The incidence of TB in SCT patients is proportional to the incidence of TB in the general population. Evidence favouring TB prophylaxis is not well established. While allogeneic transplantation carries a risk of TB, this is not true for autologous transplantation. Prophylaxis can only be an option for selected patients or countries with high rates of TB.

[Colony-stimulating factors]. / Koloni stimüle edici faktörler.

The colony-stimulating factors are glycoprotein hormones that regulate the proliferation and differentiation of hematopoietic progenitor cells and the function of mature blood cells. They are claimed to be used in the therapy of some hematologic disorders as well as infectious diseases in recent years.

[Laboratory infections]. / Laboratuvar enfeksiyonlari.

Infection constitutes an important professional hazard for health care workers. Since the past decades infections acquired during laboratory work have caused morbidity and even mortality among laboratory employees. In this article the importance of laboratory acquired infections and some guidelines for protection are stated.

[Staphylococcal biotyping and the use of computers]. / Stafilokoklarin biyokimyasal tiplendirilmesi ve bilgisayar kullanimi.

Ninety coagulase negative staphylococci isolated from various clinical specimens in Clinical Microbiology laboratory of Hacettepe University Faculty of Medicine, were biotyped using a special computer program. Types of 30 strains isolated from pus were found to be S. epidermidis (36.7%), S. haemolyticus (20%), S. simulans (13.3%) and S. hominis (10%) respectively. Among the strains isolated from blood S. epidermidis was again the predominant microorganism (40%), followed by S. haemolyticus (20%) and S. simulans (10%).

Campylobacter and enterohaemorrhagic Escherichia coli (EHEC) associated gastroenteritis in Turkish children.

From May 1989 to April 1990, stool specimens of 677 children less than 15-years old who were admitted to the Hacettepe University outpatient department of Pediatrics with acute enteritis were collected to search for four common enteric pathogens: Salmonella, Shigella, Campylobacter, and enterohaemorrhagic Escherichia coli (EHEC). At least one of the three bacteria was detected in 107 (15.8%) of the patients. Campylobacter was found in 72 (10.6%) of the samples. Shigella and Salmonella spp. were isolated in 26 (3.8%) and 11 (1.6%) children respectively. EHEC was not isolated from any of the stool samples. None of the 100 healthy children examined as a control group yielded any of the four pathogens in their stools. Campylobacter should be considered as an important aetiological agent of diarrhoeal diseases in Turkey, where EHEC is not a common pathogen.