The Journal of hospital infection
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Most published studies of the activity of biocides against methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) have been based on suspension tests. This study was undertaken to provide information on the effect of chlorhexidine and povidone iodine on bacteria dried on to surfaces, a situation in which biocide activity is known to be reduced. ⋯ Povidone iodine was equally active against resistant and sensitive strains of both species with microbicidal effects (ME), i.e. the log(10)concentration of micro-organisms compared with controls treated with distilled water, after 1.5 min of 3.14 and 3.49 for VRE and VSE respectively, and 3.47 and 3.78 for MRSA and MSSA. Chlorhexidine was equally active against VRE and VSE (ME 3.37 vs. 3. 56 after 7 min, respectively), but was significantly less active against MRSA as opposed to MSSA (ME 3.07 vs. 3.83 after 10 min, P= 0. 017).
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Selective decontamination of the digestive tract (SDD), a strategy designed to prevent or minimize the impact of infection by potentially pathogenic micro-organisms in critically ill patients requiring long-term mechanical ventilation, comprises four component protocols, aiming to control the three types of infection occurring in such cases: (i) a parenteral antibiotic, cefotaxime, administered for a few days to prevent primary endogenous infections typically occurring 'early'; (ii) the topical antimicrobials polymyxin E, tobramycin and amphotericin B employed throughout the stay in the intensive care unit to prevent secondary endogenous infections tending to develop 'late'; (iii) a high standard of hygiene to prevent exogenous infections that may occur throughout the stay in the intensive care unit; (iv) surveillance samples of throat and rectum to distinguish between these three types of infection, to monitor the compliance and the efficacy of the treatment, and to detect the emergence of resistance at an early stage. A recent, rigorous, meta-analysis examining 33 randomized SDD trials involving 5727 patients demonstrated a significant reduction in overall mortality (20%) and in the incidence of respiratory tract infections (65%); conclusive evidence that SDD saves the lives of critically ill patients and confirmation that SDD is now an evidence based medicine manoeuvre. This same meta-analysis found no instance of the emergence of resistance or of associated superinfections and/or outbreaks in any of the 33 studies during a period extending upwards of 10 years. By the criterion of cost-per-survivor, four recent randomized trials showed that patient survival is improved more cheaply by employing SDD than by the traditional approaches.
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Clinical Trial Controlled Clinical Trial
A prospective clinical study to investigate the microbial contamination ofa needleless connector.
Needleless connectors, which allow direct access to intravascular catheters, are widely used in clinical practice. The benefits of these devices to healthcare workers are well documented; however, the potential risk of microbial contamination and associated infection is unclear. This clinical study evaluated microbial contamination rates for a needleless connector, Connecta Clave(R) (CC(R)), as compared to a conventional three-way tap, which was connected to the hubs of central venous catheters (CVC) immediately following insertion. ⋯ The external surface of 33% (27/82) of the CC(R) silicone seals were contaminated after clinical use. Micro-organisms were also isolated from 9% (8/91) of the silicone seals after disinfection. The use of this needleless connector, compared to standard caps therefore does not appear to increase the risk of infection via the internal lumen of three-way taps.
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Surveillance is an essential element of hospital infection control programs. Previous studies have shown that interhospital comparison of intensive care unit (ICU) nosocomial infections (NI) may be best made by comparing ICU-type-specific, device-associated infection rates and that these adjusted rates vary by ICU type. The aim of this study was to evaluate whether significant structural improvements introduced in an adult general ICU were associated with changes in the NI rates in this unit. ⋯ Structural changes and reduction in device utilization ratios were not followed by change in NI rates in this unit. VAP and BSI rates were comparable to those reported for neurosurgical and burn ICUs, respectively, in the NNIS System, despite a much higher device utilization ratios. The present study provides specific surveillance data for further interhospital comparison with similar types of ICUs.