The Journal of hospital infection
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Multicenter Study
Epidemiology of nosocomial bloodstream infections in Estonia.
A prospective multicentre hospital-wide surveillance study was performed to investigate nosocomial bloodstream infections (BSIs) and to promote BSI surveillance in Estonia in 2004-2005. All patients from the acute care departments of two referral centres and one central hospital were included. A total of 549 episodes of BSI occurred in 507 patients (0.6 cases per 1000 patient-days). ⋯ The incidence of BSI did not differ significantly from other reported studies. With the exception of relatively high antimicrobial resistance among pseudomonas, the overall resistance patterns of Estonian nosocomial bloodstream pathogens were similar to those seen in Nordic countries and lower than in Central and Southern Europe. This study contributes to the development and implementation of surveillance in Estonian hospitals.
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Colonisation with meticillin-resistant Staphylococcus aureus (MRSA) has previously been described as a risk factor for subsequent infection. MRSA colonisation reached endemic proportions in most healthcare institutions in the UK during the 1990s. Bacteraemia due to MRSA is associated with increased mortality and morbidity compared with meticillin-susceptible S. aureus and national targets have been set for reduction. ⋯ There was a statistically significant reduction in the proportion of patients colonised from 14.6% to 7.0% (P<0.001) and the total number of bacteraemia cases from 42 to 22 (P=0.012) in the initial 24 months of surveillance compared to the most recent 24 months. Regular surveillance of MRSA carriage is useful for monitoring the effects of control measures on MRSA carriage among inpatients. Interventions to reduce carriage are able to reduce the pool of MRSA carriers, thereby reducing cases of bacteraemia.
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This study investigated the potential factors linked to healthcare-associated infection (HCAI) rates in acute National Health Service hospitals, analysing mandatory surveillance data with existing data available to the Healthcare Commission, and supplemented by a bespoke questionnaire. A questionnaire was developed to cover important elements related to the management and control of HCAI. Additional data were collated from other sources. ⋯ These findings for MRSA and CDAD are supported by evidence from the infection control literature. We have found relationships between interventions and higher infection rates that are counterintuitive and that may represent examples of what we call 'reactive practice' to higher rates of infection. Whilst it is interesting to hypothesise that these interventions may be swift and simple to introduce and may not be sustained compared to more strategic and planned interventions linked to lower infection rates, they most probably simply represent the beginning of a culture change and embedding of infection control practice.