The Journal of hospital infection
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Transmission of Burkholderia (Pseudomonas) cepacia by close contact with colonized patients is well documented, and minimizing social contact between cystic fibrosis (CF) patients by segregation and cohorting of B. cepacia colonized patients has achieved some success in controlling the nosocomial and community spread of this organism. However, direct and indirect environmental transmission still occurs. There is evidence for transmission of B. cepacia to CF patients via pulmonary test equipment, nebulizers and other respiratory equipment used both in CF centres and for homecare, but little or no evidence of spread through aerosols, dental equipment, hands, contaminated disinfectants and water supplies. Infection control procedures for reducing the transmission of B. cepacia are discussed.
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In order to study the long-term distribution and population dynamics of Pseudomonas aeruginosa strains in a highly contaminated hospital environment, two 4-week epidemiological studies, with an interval of 4 years, were carried out in the cystic fibrosis (CF) ward of the Paediatric Clinic of the Medical School of Hannover. Out of the 1948 specimens taken, P. aeruginosa was mainly identified in those from moist, inanimate sources (200 isolates) and hospitalized CF patients (168 isolates). A correlation was established between the frequency with which P. aeruginosa-positive patients came into contact with hospital facilities and the rate of contamination of these facilities. ⋯ The most predominant clone was found in tap-water, sinks, wash-basins and creams with an incidence of 34 and 68% in the environmental isolates. The strains seemed to have spread into the adjacent control ward during the 4-year interval. Thus, the separation of colonized and non-colonized patients was undermined through the transfer of strains from a highly contaminated environment without additional hygiene precautions.
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A simple model of the costs and benefits of an infection control programme is presented. Liberal costs and conservative benefits were assumed. The concepts of crude and attributable mortality were applied to examine the cost per life year saved if a minority of infection-related deaths were prevented. An effective infection control programme is one of the most cost-beneficial medical interventions available in modern public health.
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Seventy-eight patients with culture-positive epidural catheters, were studied. Fifty-nine had symptoms of exit site infection and 11 patients had clinical meningitis, two of whom also had an epidural abscess. This corresponds to a local infection incidence of at least 4.3% and an incidence of central nervous system infection of at least 0.7% at Odense University Hospital. ⋯ The microorganisms isolated from the tips of the epidural catheters were coagulase-negative staphylococci (41%), Staphylococcus aureus (35%), Gram-negative bacilli (14%) and others (10%). The Gram-negative bacilli and S. aureus caused serious infections more frequently than the others. We discuss the symptoms and diagnosis of spinal epidural abscess and suggest a proposal for prophylactic and diagnostic guidelines for epidural catheter-related infections.