The Journal of hospital infection
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During a period of 10 years, 293 of 4270 admissions to the general intensive care unit (ICU) at Medway Maritime Hospital had 356 bacteraemias due to one of 14 microorganisms. Incidence of bacteraemia was least on the third day after admission, significantly greater on the fifth day and stable thereafter. From the fifth day the acquisition rate was 18.9 (16.5-21.3)/1000 bed-days, lower in those with an initial Acute Physiological Assessment and Chronic Health Evaluation II score (APII) <18, or admitted from the emergency room. ⋯ Hospital mortality in these patients was 45.6% (38.8-52.4), greater than in those with similar APII but sterile cultures [relative risk (RR): 1.30 (1.04-1.63) and matched controls, RR: 1.33 (1.09-1.63)]. Observed mortality was greater than predicted only in bacteraemic patients [RR: 1.31 (1.03-1.67)]. ICU-acquired bacteraemia was associated with an approximate additional absolute mortality of 11% contributing 0.5% to the 29.9% hospital mortality of all ICU admissions, 1.6% to the 34.6% of those staying >or=5 days, and 5.6% to the 35.9% of those remaining >24 days.
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Over a two-week period in November 2006, vancomycin-resistant Bacillus cereus was isolated from respiratory samples from six ventilated paediatric intensive care unit (PICU) patients. To investigate the possibility of a common source and extent of the dissemination, all procedures related to mechanical ventilation were monitored and surveillance cultures performed. B. cereus was isolated from reusable air-flow sensors, before and after on-site disinfection with 70% alcohol. ⋯ Intervening measures, including disinfection by autoclaving all reusable air-flow-guiding parts and the use of disposable non-autoclavable parts, resulted in rapid termination of the outbreak. B. cereus infections can cause significant morbidity, particularly in intensive care patients. Disinfection of all air-flow-guiding reusable parts for mechanical ventilation should be addressed with great care and should include effective autoclaving in order to eradicate spores.
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Healthcare-associated infection is a major cause of morbidity and mortality. Hand hygiene is regarded as the most effective method of prevention but is poorly performed by health workers. We report a systematic review identifying studies which investigated the effectiveness of interventions to increase hand hygiene compliance short and longer term and to determine their success in terms of hand hygiene compliance and subsequent effect on rates of healthcare-associated infection. ⋯ The review concludes that interrupted time-series studies may offer the most rigorous approach to assessing the impact of interventions to increase hand hygiene compliance. In such study designs the number of new cases of healthcare-associated infection should be taken as an outcome measure, with data collection points at least 12 months before intervention and afterwards to allow for seasonal trends. Contextual factors at national and at local level should be carefully documented to take into consideration the influence of secular trends.
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Controlled studies that address risk factors for, and clinical outcomes after, infection with extended-spectrum beta-lactamase (ESBL)-producing organisms are scant, particularly in the intensive care unit (ICU). Our objectives were to elucidate risk factors for the acquisition of ESBL-producing organisms in ICU; and to compare mortality in patients with ESBL- and non-ESBL bloodstream infections (BSIs) after controlling for disease severity and timeliness of appropriate antibiotic therapy. A retrospective cohort study was undertaken in the ICU from March 2004 to May 2006. ⋯ Although no statistically significant associations were demonstrated between individual risk factors and the acquisition of an ESBL-producing organism, appropriate therapy was delayed in cases (OR: 9.17; 95% CI: 2.00-42.20; P=0.0005) and survival estimates demonstrated a significantly increased early (<25 days after infection) mortality (OR for death 3.93; 95% CI: 1.05-14.63; P=0.03). Mortality in ICU, when adjusted for disease severity and appropriate antimicrobial therapy, though significant needs to be treated with caution due to the small number of cases (N=16 in 2 years). We believe that a high index of suspicion, early appropriate therapy and strict adherence to infection control are indicated in all patients at risk in ICU.