The Journal of hospital infection
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An outbreak of Acinetobacter baumannii colonization and infection occurred in 19 patients over a 14-month period during 1998-1999 on a neurosurgical intensive care unit. During efforts to control the outbreak a significant correlation was observed between the number of environmental isolates of A. baumannii obtained during each monthly screening and the number of patients with A. baumannii colonization/infection in the same calendar month (P < 0.004). ⋯ Failure to maintain low levels of environmental contamination with A. baumannii resulted in increases in patient colonization. This study showed that high standards of cleaning play an integral role in controlling outbreaks of A. baumannii in the intensive care unit setting.
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Iatrogenic meningitis (IM) is a rare complication of diagnostic and therapeutic lumbar puncture (LP). This study includes cases of IM managed in the Departments of Neurology, of two referral hospitals, in India between January 1984 and April 2002. The diagnosis of IM was made when symptoms of meningitis occurred 24 h to 21 days after LP. ⋯ This study shows high morbidity and mortality of IM after LP. Simple aseptic precautions under- taken before the procedure can prevent IM. The urgent need for increasing the awareness among medical personnel in peripheral hospitals of developing countries cannot be over emphasized.
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Comparative Study
Quality of local guidelines for surgical antimicrobial prophylaxis.
Surgical antimicrobial prophylaxis (AMP) is an effective measure to prevent surgical site infections. To determine the quality and availability of local guidelines for AMP, a survey was conducted in the public hospitals of a Northern Italian region. The guidelines for "Antimicrobial Prophylaxis in Surgery" by the Scottish Intercollegiate Guidelines Network (SIGN) were used as a standard by which the quality of the local guidelines was compared. ⋯ Only 8% of all procedure-specific guidelines (PSG) recommended an incorrect timing of AMP (not administering AMP at the induction of anaesthesia), while 41% recommended an incorrect duration (additional antimicrobial doses after completion of the surgical operation). This survey showed that having written protocols at local level does not necessarily mean they comply with available scientific evidence. Thus, the quality of local guidelines needs to be improved.
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Randomized Controlled Trial Clinical Trial
A prospective, randomized study in critically ill patients using the Oligon Vantex catheter.
Microbial colonization and the incidence of catheter-related bloodstream infections (CR-BSI) associated with Oligon Vantex silver central venous catheters (CVC) in critically ill patients were determined. A prospective, randomized, controlled 17-month trial was carried out in an intensive care unit (ICU). All patients requiring a triple-lumen CVC for four days or longer were enrolled. ⋯ CR-BSI occurred in five cases (four in CG). Rates of CR-BSI per 1000 catheter-days in the CG were 2.8 and in the SG, 0.8 (P<0.001). The Oligon Vantex silver catheter reduced the incidence of catheter-colonization and may decrease the risk of CR-BSI.
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Randomized Controlled Trial Comparative Study Clinical Trial
A needleless closed system device (CLAVE) protects from intravascular catheter tip and hub colonization: a prospective randomized study.
Hub colonization and subsequent intraluminal progression due to frequent opening and manipulation of intravenous systems is the cause of many catheter-related infections (CRI). A prospective, comparative, randomized study was performed to assess a new closed-needleless hub device (CLAVE) compared with conventional open systems (COS). End-points were hub and skin colonization, catheter tip colonization, catheter-related bloodstream infection (CRBSI) and number of accidental needlesticks. ⋯ There was one accidental needlestick and one catheter-related prosthetic endocarditis in the COS group. Multivariate analysis showed that CLAVE use was an independent protective factor for tip colonization. CLAVE offered significant protection from catheter-tip and hub colonization.