Infectious disease clinics of North America
-
The toll of health care-associated infections on patients and the seeming ease of the procedure thought best able to prevent them have focused a spotlight onto hand hygiene performance. Poor performance of hand hygiene by health care workers inspires outrage in the general public. ⋯ Guidelines encouraging use of alcohol-based hand hygiene agents have facilitated hand hygiene improvement efforts. These efforts and evidence that improved hand hygiene performance is associated with a reduction in health care-associated infections should encourage those in the hand hygiene campaigns.
-
Health care-associated viral respiratory infections, common among hospitalized children, also occur among adults and institutionalized persons and result in increased patient morbidity, mortality, and health care costs. Approximately 20% of patients with healthcare-associated pneumonia have viral respiratory infections, with 70% of these infections caused by adenovirus, influenza virus, parainfluenza virus, and respiratory syncytial virus (RSV). These infections typically reflect the level of viral activity within the community. This article focuses on the epidemiology, transmission, and control of health care-associated RSV and influenza virus.
-
Infect. Dis. Clin. North Am. · Mar 2011
ReviewCentral line-associated bloodstream infections: prevention and management.
Approximately 80,000 central venous line-associated bloodstream infections (CLA-BSI) occur in the United States each year. CLA-BSI is most commonly caused by coagulase-negative staphylococci, Staphylococcus aureus, Candida spp, and aerobic gram-negative bacilli. ⋯ Use of strict aseptic technique for insertion is the key method for the prevention of CLA-BSI. Various methods can be used to reduce unacceptably high rates of CLA-BSI, including use of an antiseptic- or antibiotic-impregnated catheter, daily chlorhexidine baths/washes, and placement of a chlorhexidine-impregnated sponge over the insertion site.
-
Catheter-associated urinary tract infections (CAUTIs) account for approximately 40% of all health care-associated infections. Despite studies showing benefit of interventions for prevention of CAUTI, adoption of these practices has not occurred in many healthcare facilities in the United States. As urinary catheters account for the majority of healthcare-associated UTIs, the most important interventions are directed at avoiding placement of urinary catheters and promoting early removal when appropriate. ⋯ If indwelling catheterization is appropriate, proper aseptic practices for catheter insertion and maintenance and use of a closed catheter collection system are essential for preventing CAUTI. The use of antimicrobial catheters also may be considered when the rates of CAUTI remain persistently high despite adherence to other evidence-based practices, or in patients deemed to be at high risk for CAUTI or its complications. Attention toward prevention of CAUTI will likely increase as Center for Medicare and Medicaid Services and other third-party payers no longer reimburse for hospital-acquired UTI.
-
Infect. Dis. Clin. North Am. · Mar 2011
ReviewCommon approaches to the control of multidrug-resistant organisms other than methicillin-resistant Staphylococcus aureus (MRSA).
Curbing antibiotic resistance is a challenge in health care today. Infections caused by multidrug-resistant organisms are estimated to cause 12,000 deaths and cost 3.5 billion dollars in excess health care costs in the United States annually. ⋯ Common control strategies targeting these pathogens are reviewed and opportunities for research and more effective deployment of existing tools are highlighted. When there is less extensive evidence available from the published literature, the experience with methicillin-resistant Staphylococcus aureus is discussed as it might apply to other pathogens.