American journal of infection control
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Am J Infect Control · Jun 2001
Multicenter StudyNosocomial infection rates in US children's hospitals' neonatal and pediatric intensive care units.
Few data are available on nosocomial infections (NIs) in US children's hospitals' neonatal or pediatric intensive care units. The Pediatric Prevention Network (PPN) was established to improve characterization of NIs in pediatric patients and to develop and test interventions to decrease NI. ⋯ The number of months that NICU or PICU NI surveillance was conducted varied among hospitals. Reported NICU and PICU NI rates varied by hospital; some reported overall NI rates, and others focused on one or more particular sites of infection (eg, BSI or pneumonia). Many did not provide NICU device-associated rates stratified by birth-weight group. Denominators used to calculate device-associated infection rates also varied, with hospitals reporting either patient-days or device-days. These findings suggest the need to determine reasons for variations and to identify optimal NI surveillance methods at children's hospitals so that valid interhospital NI rate comparisons can be made.
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Am J Infect Control · Apr 2001
Unique epidemiology of nosocomial urinary tract infection in children.
Nosocomial urinary tract infection (NUTI) occurs with varying frequency in children and is thought to be associated with urethral instrumentation. In response to changing infection control resources at our facility, we reviewed NUTI to determine whether the frequency of NUTI, associated complications, or presence of a remediable risk factor (instrumentation) justified ongoing routine infection control surveillance. ⋯ NUTI poses a less significant burden of illness (incidence, associated morbidity) than other nosocomial infection in children. If resources do not permit hospital-wide surveillance, high-risk children with urethral instrumentation and newborns and infants could be targeted. Although E coli remains the most common cause of pediatric NUTI, fungi have become the second most common pathogen in this tertiary care population. Risk factors for NUTI in noncatheterized children remain to be delineated.
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Am J Infect Control · Feb 2001
Comparative StudyCommunity-acquired bacteremia at a teaching versus a nonteaching hospital: impact of acute severity of illness on 30-day mortality.
Few studies have focused recently on the epidemiology of community-acquired bacteremia (CAB) and there have been few comparisons of CAB in teaching versus nonteaching hospitals. ⋯ Among patients with CAB, acute severity of illness on admission was the most important predictor of 30-day mortality at both hospitals. Even though patients with CAB were, on average, more severely ill at the time of admission to the teaching hospital, 30-day mortality rates were not significantly different between the two hospitals because deaths correlated with high APS APACHE III scores at both facilities. The APS APACHE III score on admission provides important prognostic information among patients with CAB.
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Am J Infect Control · Feb 2001
Comparative StudyChanging concepts in long-term central venous access: catheter selection and cost savings.
Long-term central venous access is becoming an increasingly important component of health care today. Long-term central venous access is important therapeutically for a multitude of reasons, including the administration of chemotherapy, antibiotics, and total parenteral nutrition. Central venous access can be established in a variety of ways varying from catheters inserted at the bedside to surgically placed ports. Furthermore, in an effort to control costs, many traditionally inpatient therapies have moved to an outpatient setting. This raises many questions regarding catheter selection. Which catheter will result in the best outcome at the least cost? It has become apparent in our hospital that traditionally placed surgical catheters (ie, Hickmans and central venous ports) may no longer be the only options. The objective of this study was to explore the various modalities for establishing central venous access comparing indications, costs, and complications to guide the clinician in choosing the appropriate catheter with the best outcome at the least cost. ⋯ Traditional surgically placed central catheters are increasingly being replaced by peripherally inserted central venous access devices. Significant cost savings and fewer severe complications can be realized by preferential use of peripherally inserted central catheters when clinically indicated. Cost savings may not be as significant when comparing radiologically placed versus surgically placed catheters. However, significant cost savings and fewer severe complications are associated with peripheral central venous access versus the surgical or radiologic approach.
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Am J Infect Control · Dec 2000
Computer keyboards and faucet handles as reservoirs of nosocomial pathogens in the intensive care unit.
We postulate that computer keyboards and faucet handles are significant reservoirs of nosocomial pathogens in the intensive care unit (ICU) setting. ⋯ The colonization rate for keyboards and faucet handles, novel and unrecognized fomites, is greater than that of other well-studied ICU surfaces in rooms with patients positive for MRSA. Our findings suggest an associated pattern of environmental contamination and patient infection, not limited to the patient's room. Pulsed-field gel electrophoresis results have documented an indistinguishable strain of MRSA present as an environmental contaminant on these two fomites and in two patients with clinical infections patients during the same period. We believe these findings add evidence to support the hypothesis that these particular surfaces may serve as reservoirs of nosocomial pathogens and vectors for cross-transmission in the ICU setting. New infection control policies and engineering plans were initiated on the basis of our results.