The Journal of hospital infection
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Randomized Controlled Trial
Arterial catheter-related bloodstream infection: incidence, pathogenesis, risk factors and prevention.
Arterial catheters are essential in critical care for haemodynamic and blood gas monitoring. The risk of infection remains ill defined. ⋯ In patients in intensive care with cryptogenic sepsis or bacteraemia, arterial catheter-related BSI must also be suspected and excluded. The most common route of infection is extraluminal; as such, novel technologies shown to prevent bloodstream infection with CVCs, such as chlorhexidine for cutaneous antisepsis and chlorhexidine-impregnated dressings, may also be of benefit with arterial catheters.
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Bloodstream infections in patients with kidney disease: risk factors for poor outcome and mortality.
Information regarding bloodstream infections (BSIs) in patients with kidney diseases is scarce and mainly derived from selected groups of patients. ⋯ Nephrology patients have a high incidence of BSI, particularly patients undergoing haemodialysis. The predominant micro-organisms causing BSI episodes were Gram-negative bacilli. Patients with kidney disease have high BSI-related morbidity and mortality. Risk factors for mortality were high Charlson comorbidity index and persistent BSI. The presence of fever during the BSI episodes was found to be a protective factor.
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Elizabethkingia meningoseptica is a nosocomial-adapted Gram-negative bacillus intrinsically resistant to antibiotics commonly used in the intensive care setting. An outbreak investigation commenced when five patients developed E. meningoseptica infection in two intensive care units (ICUs). ⋯ Introduction of non-sanctioned practices due to suboptimal unit design may have unintentional consequences for ICU patients. Room design and staff workflows must be optimized for patient safety as lapses in procedure can inadvertently put patients at risk.
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Meticillin-resistant Staphylococcus aureus (MRSA) has been entrenched in Singapore hospitals since the 1980s, with an excess of 600 non-duplicate cases of infections (120 bacteraemia episodes) each year in our 995-bed university hospital. Approximately 5% of our hospital beds are used as isolation facilities. ⋯ Successful staged implementation of an MRSA bundle in a hyper-endemic setting is sustainable and represents a model that may be adapted for similar settings.
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Comparative Study
Targeted versus universal screening and decolonization to reduce healthcare-associated meticillin-resistant Staphylococcus aureus infection.
The benefits of universal meticillin-resistant Staphylococcus aureus (MRSA) admission screening, compared with screening targeted patient groups and the additional impact of discharge screening, are uncertain. ⋯ Compared with universal screening, targeted screening substantially reduced the amount of screening and decolonization required to achieve only 12% lower reduction in infection. Targeted screening and decolonization could lower the risk of resistance emerging as well as offer a more efficient use of resources.