The Journal of hospital infection
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The hospital environment can sometimes harbour methicillin-resistant Staphylococcus aureus (MRSA) but is not generally regarded as a major source of MRSA infection. We conducted a prospective study in surgical wards of a London teaching hospital affected by MRSA, and compared the effectiveness of standard cleaning with a new method of hydrogen peroxide vapour decontamination. MRSA contamination, measured by surface swabbing was compared before and after terminal cleaning that complied with UK national standards, or hydrogen peroxide vapour decontamination. ⋯ The hospital environment can become extensively contaminated with MRSA that is not eliminated by standard cleaning methods. In contrast, hydrogen peroxide vapour decontamination is a highly effective method of eradicating MRSA from rooms, furniture and equipment. Further work is needed to determine the importance of environmental contamination with MRSA and the effect on hospital infection rates of effective decontamination.
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Prospective surveillance programmes to monitor the incidence of surgical-site infection (SSI) in patients who have had orthopaedic implant surgery can be difficult to implement due to limited human and technical resources. In addition, prolonged patient follow-up, up to one year, may be required. Traditional methods of surveillance can be enhanced by using administrative databases to assist in case finding and facilitate overall surveillance activities. ⋯ Patients aged over 80 years experienced a significantly higher rate of infection after THR compared with patients aged 80 or less (z-test, z = 2.56, P = 0.015), but not for TKR. No patients with an SSI died during follow-up. The WA Data Linkage System provided a unique opportunity to review the incidence of SSIs in patients undergoing THR or TKR surgery in WA hospitals.
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Comparative Study
Test models to determine cleaning efficacy with different types of bioburden and its clinical correlation.
The importance of cleaning as a first crucial step in reprocessing instruments and endoscopes is recognized worldwide. However, no standards to determine the efficacy of cleaning have been established. We have therefore investigated Bodedex forte, a new cleaner, in various test models derived from critical types of bioburden on flexible endoscopes. ⋯ The difference between the three cleaners was significant (P < 0.001) chi-squared test). The superiority of the cleaning capacity of the new cleaner was demonstrated in various test models, which were designed according to the clinical relevance of different bioburdens. Implementation of accepted and reproducible standards for testing the cleaning efficacy will remain a goal for the next years.
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Invasive aspergillosis is a rare disease in intensive care unit (ICU) patients and carries a poor prognosis. The aim of the present study was to determine the attributable mortality due to invasive aspergillosis in critically ill patients. In a retrospective, matched cohort study (July 1997-December 1999), 37 ICU patients with invasive aspergillosis were identified together with 74 control patients. ⋯ A multivariate survival analysis showed invasive aspergillosis [hazard ratio (HR): 1.9, 95% CI: 1.2-3.0; P = 0.004] and acute respiratory failure (HR: 6.5, 95%: 1.4-29.3; P < 0.016) to be independently associated with in-hospital mortality. In conclusion, it was found that invasive aspergillosis in ICU patients carries a significant attributable mortality of 18.9%. In a multivariate analysis, adjusting for other co-morbidity factors, invasive aspergillosis was recognized as an independent predictor of mortality.
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We studied the extent to which hospitals can expect to receive reimbursement for costs relating to nosocomial infections (NI) under the diagnosis-related groups (DRG) system of clinical claims and calculated the loss of reimbursement due to missed or incorrect registration of infective complications on hospital discharge records (HDR). We calculated clinical claim reimbursement in three scenarios: the good, in which all NI are recorded on HDR; the bad, in which a proportion of NI recorded on HDR observed at the 41 participating hospitals; the ugly, in which none of the NI are recorded on HDR. We analysed in which patients the recording of infective complications changed the DRG clinical claim and the economic consequences on reimbursements. ⋯ The difference between the bad and the good scenarios shows an average loss of 215 for every case. Our calculated good scenario could cover only 3.8% of direct costs per case attributable to NI. Real, tangible benefits in health, both social and economic, will only accrue from the monitoring and control of NI in hospitals.