The Journal of hospital infection
-
The advent of interferon-gamma release assays (IGRAs) provides new options for detection of latent tuberculosis infection (LTBI). This is particularly relevant to healthcare workers (HCWs), who are at higher risk of infection, but who have often also been vaccinated. In this article, we discuss the role of IGRAs for the diagnosis of LTBI in various healthcare settings. ⋯ TB assay has not been adequately assessed in HCWs; the few studies available showed enhanced specificity of T-SPOT. TB when compared to TST. This review confirms the utility of IGRAs as important tools in the prevention and control of tuberculosis in healthcare settings.
-
Randomized Controlled Trial
Evaluation of add-on devices for the prevention of phlebitis and other complications associated with the use of peripheral catheters in hospitalised adults: a randomised controlled study.
The aim of this study was to assess the role of add-on devices for the prevention of phlebitis and other complications associated with the use of peripheral catheters. Patients admitted to an infectious diseases ward and requiring the insertion of a peripheral catheter for at least 24h were randomly allocated to be managed with or without add-on devices. Incidence of phlebitis and all complications were the primary outcomes. ⋯ The beneficial effect on mechanical or all complications was noticeable after six days of catheterisation. Add-on devices do not reduce the incidence of phlebitis but may prevent mechanical complications. However, the impact of add-on devices on the incidence of all complications is at most small and only apparent after the sixth day of catheter use.
-
During a nine-year study period, 96 episodes of nosocomial bloodstream infection (BSI) due to Acinetobacter baumannii were identified in the adult intensive care units (ICUs) of Shin Kong Wu Ho-Su Memorial Hospital. Seventy-seven (80.2%) of these were available for matching in terms of age, sex, primary diagnosis of ICU admission, ICU ward, and disease severity. Univariate analysis showed that central venous catheter use, ventilator use, prior A. baumannii colonisation, and respiratory and cardiovascular organ failure were significantly associated with acquiring A. baumannii BSI in the ICU. ⋯ However, the mean length of ICU and hospital stay and mean hospital cost of patients with A. baumannii BSI significantly increased, with an estimated 8.7 days excess length of ICU stay, 19.1 days excess hospital stay, and US $8480 extra hospital costs. Imipenem and meropenem remained the most active antimicrobial agents, both with 95.5% susceptibility (MIC50=0.25 and 0.5, respectively). Improving hand hygiene of healthcare workers and aseptic care of vascular catheters and endotracheal tubes are important measures to prevent A. baumannii colonisation and decrease the incidence of BSI.
-
The cost of catheter-related bloodstream infection (CRBSI) is substantial in terms of morbidity, mortality and financial resources. Total parenteral nutrition (TPN) is a recognised risk factor for CRBSI. In 1997, an intravenous nutrition nurse was promoted to TPN surveillance clinical nurse manager (CNM) and quarterly infection audit meetings were introduced to monitor trends in CRBSI. ⋯ The savings made by preventing 9.8 infections per year were calculated from data on bed-days obtained from the hospital finance office. The cost in hospital days saved per annum was euro135,000. Introduction of a TPN surveillance CNM saved the hospital at least euro78,300 per annum and led to a significant decrease in CRBSIs in TPN patients.