A statistical method for estimating the proportion of cases resulting from cross-transmission of multi-resistant pathogens in an intensive care unit

Multi-resistant bacteria are an increasing challenge for infection control in hospitals and the proportion of patients newly colonized with multi-resistant bacteria during their hospital stay can be used to assess the effectiveness of infection control measures. Current laboratory methods for estimating this require expensive additional tests. We propose an alternative statistical method to estimate the proportion of cases resulting from transmission in a hospital from the distribution of time intervals between subsequent cases. A prerequisite for the application of this method is the existence of records from regular screening of the patients during their hospital stay, usually performed in intensive care units (ICUs). We describe the method and present an example of its application using records of two multi-resistant pathogens collected in an ICU over a three-year period. The estimated proportion of cases resulting from transmission was 0.73 (95% CI: 0.56-0.90) for meticillin-resistant Staphylococcus aureus and 0.45 (95% CI 0.15-0.75) for imipenem-resistant Pseudomonas aeruginosa. The method proposed here can be used for retrospective evaluation of clinical records in order to evaluate the effectiveness of infection control measures in low endemicity settings.     

医院医学工程科质量管理策略探讨

目的：从医学工程科职能和作用出发,探讨医学工程科设备管理存在的问题以及质量管理策略。方法：从组织构建,医疗设备和医用耗材的管理,以及医疗器械维护、维修等方面讨论医学工程科的质量管理策略。结果：通过开展医学工程质量管理,医疗设备使用效率明显提高,在组织建设、质量管理方面取得良好效果。结论：科学技术的进步和医院的快速发展,使医学工程科在医院的作用和职能不断深化和拓展,加强其质量管理,能更好地发挥医学工程科服务于临床、保障医疗工作的核心作用。     

套管针相关血流感染监控信息程序的建立与效果 FREE

目的探讨套管针相关血流感染监控信息程序的建立与效果,测试软件运行的稳定、有效与便利性。方法依托医院信息系统（HIS）,利用数据库oracle 10.0及编程工具powerbiuld 9.0,以套管针置入和项目为依据,探索开发医院感染目标性监测软件。将套管针置入性外周静脉血流感染纳入监测内容,整群提取2008年9-11月外周静脉留置套管针的2 318例患者为研究对象,了解其科室及疾病分布状况,并发症与留置时间、高渗液体与一般液体引起并发症的关系等。结果利用“HIS”,实现了数据共享,从整个数据库中获取留置套管针的相关数据,为感染监测提供了监测对象的基本资料。结果显示,套管针已广泛应用于不同科室、不同疾病的患者输液中;不同并发症与留置时间有关（P=0.000）,输入高渗液体与一般液体引起的并发症差异有高度显著性（P=0.000）;本组监测对象中,无一例发生相关血流感染。结论该程序可以快速全面地俘获外周静脉套管针的留置情况,为其相关感染判断提供基础资料,指导临床正确留置,加强防控,减少并发症的发生。     

A study of the efficacy and cost-effectiveness of MRSA screening and monitoring on surgical wards using a new,rapid molecular test (EMMS)

Background  

MRSA is a significant contributor to prolonged hospital stay, poor clinical outcome and increased healthcare costs amongst surgical patients. A PCR test has been developed for rapid detection of MRSA in nasal swabs. The aims of this study are (1) to estimate the effectiveness of screening using this rapid PCR tests vs culture in reducing MRSA cross-infection rates; (2) to compare the cost of each testing strategy, including subsequent health care costs; and (3) to model different policies for the early identification and control of MRSA infection in surgical patients.     

Infection control and human immunodeficiency virus: perceptions of risk among nurses and hospital domestic workers

Abstract: In December 1993 the first case of patient-to-patient transmission of human immunodeficiency virus (HIV), at a doctor's surgery in New South Wales, was documented. In an environment of heightened anxiety about HIV transmission and the adequacy of infection-control measures taken by health providers, it is important to explore perceptions of occupational risk of exposure to infection among hospital workers, reasons why hospital domestic workers sometimes depart from standard procedure in infection control, and how they regard the patients who have infectious diseases. In this study, at an infectious diseases hospital where there is an acute awareness of such issues, nurses had accurate knowledge about control of infection, including HIV, but had limited trust of that knowledge. They gave rationales for why they sometimes departed from infection-control procedures. They had low levels of fear of homosexuals and of acquired immune deficiency syndrome. The hospital domestic workers had lower levels of accurate knowledge about infection control, including HIV, and less trust of that knowledge and of protection by health provider from occupational exposure to infection. They had low levels of fear of homosexuals and HIV. Both groups sought regular, small-group, interactive education programs on infection control and HIV to allow them to discuss their concerns. Participatory education of workers should include eliciting concerns of participants, and should discuss concerns regarding administrators' and educators' interests in their safety and wellbeing.     

洁净手术部的医院感染管理

目的 探讨提高洁净手术部医院感染管理工作水平的方法.方法 从洁净手术部的建设标准入手,运用空气和物体表面微生物的理论,论述了洁净手术部医院感染管理的艰巨性、复杂性、专业性和法规性.结果 严格规范洁净手术部的建设标准,是做好医院感染管理工作的坚实基础;坚持介入洁净手术部的工程质量验收,是做好医院感染管理工作不可缺少的重要环节;全面开展洁净手术部的日常监控,是做好医院感染管理工作的有效手段;努力创新洁净手术部现代管理模式是做好医院感染管理工作的精髓.结论 洁净手术部的医院感染管理,必须要强调全方位控制细菌的综合措施,要规范净化空调保障体系,实施全过程监控.     

An outbreak of Serratia marcescens infection in a special-care baby unit of a community hospital in United Arab Emirates: the importance of the air conditioner duct as a nosocomial reservoir

We report an outbreak of Serratia marcescens infection in a special-care baby unit (SCBU) of a university-affiliated community hospital in the United Arab Emirates. The outbreak involved 36 infants and lasted for 20 weeks. Seven of the colonized infants developed invasive illnesses in the form of bacteraemia (four cases), bacteraemic meningitis (two) and clinical sepsis (one). Three other term infants had purulent conjunctivitis. There were five deaths with an overall mortality of 14%. S. marcescens was cultured from airflow samples from the air conditioning (AC) which was the reservoir of infection in this outbreak. Elimination of the nosocomial source and outbreak containment were eventually achieved by specialized robotic cleaning of the entire AC duct system of the SCBU. Strict adherence to the infection control policies was reinforced to prevent transmission of cross-infection.     

Human papillomavirus and cervical neoplasia: epidemiological considerations

Recent clinical research using new diagnostic and laboratory techniques indicates that human papillomavirus (HPV) infection may play a key role in the development of cervical neoplasia. Cervical HPV infection is found in 1-3% of routine Papanicolaou smears, and preliminary data suggest that women with cervical HPV infection have about a tenfold greater risk of developing cervical intraepithelial neoplasia (CIN) compared with those with no HPV infection. This paper discusses how epidemiological studies can reduce misclassification of cervical HPV infection and CIN through selective use of research advances in cytologic, histologic and colposcopic techniques. These studies can also assess whether certain potential cocarcinogens interact synergistically with HPV. Since an estimated 2-10% of women with cervical HPV lesions develop associated CIN within a year, it appears feasible to conduct prospective studies of the risk of malignant transformation of cervical HPV lesions.     

Developing an infection control for anaesthetic equipment

Hospital risk management demands the development of broad and inclusive infection control policies. This is particularly true for anaesthetic equipment where appropriate recommendations on decontamination measures remains a difficult subject for infection control teams since there are no national guidelines. It is a topic which has perhaps been neglected in hospital infection control policies despite the widespread use of anaesthetic equipment in many clinical areas outside the theatre complex. This article offers practical guidance when preparing an infection control policy for anaesthetic equipment. The cost effectiveness of single patient use items versus reprocessing equipment is discussed. The importance of a multi-disciplinary approach, especially where the evidence base is weak, is highlighted.     

Developing an infection control policy for anaesthetic equipment

Hospital risk management demands the development of broad and inclusive infection control policies. This is particularly true for anaesthetic equipment where appropriate recommendations on decontamination measures remains a difficult subject for infection control teams since there are no national guidelines. It is a topic which has perhaps been neglected in hospital infection control policies despite the widespread use of anaesthetic equipment in many clinical areas outside the theatre complex. This article offers practical guidance when preparing an infection control policy for anaesthetic equipment. The cost effectiveness of single patient use items versus reprocessing equipment is discussed. The importance of a multi-disciplinary approach, especially where the evidence base is weak, is highlighted.     

The risks and benefits of chemical fumigation in the health care environment

Fumigation of hospital rooms with high concentrations of toxic chemicals has been proposed to reduce microbial agents on hospital surfaces and to control infections. Chemical fumigation has been used effectively in other areas, such as building decontamination after bioterrorism events, in agriculture, and in residential structures. However, even in these situations, there have been incidents where fumigants have escaped, causing illness and death to exposed workers and the public. Before expanding the use of a potentially hazardous technology in areas where there are vulnerable individuals, it is important to fully weigh benefits and risks. This article reviews the effectiveness of fumigation as a method of inactivating microbes on environmental surfaces and in reducing patient infection rates against the potential risks. Peer-reviewed literature, consensus documents, and government reports were selected for review. Studies have demonstrated that fumigation can be effective in inactivating microbes on environmental surfaces. However, the current consensus of the infection control community is that the most important source of patient infection is direct contact with health care workers or when patients auto-infect themselves. Only one peer-reviewed, before-after study, at one hospital reported a significant reduction in infection rates following chemical fumigation. The limitations of this study were such that the authors acknowledged that they could not attribute the rate reduction to the fumigation intervention. A serious concern in the peer-reviewed literature is a lack of evidence of environmental monitoring of either occupational or non-occupational exposures during fumigation. Currently, there are neither consensus documents on safe fumigation exposure levels for vulnerable bedridden patients nor sampling methods with an acceptable limit of detection for this population. Until additional peer-reviewed studies are published, demonstrating significant reductions in patient infection rates following chemical fumigation and consensus guidance on the safe exposure levels and monitoring methods, chemical fumigation in health care should be conducted only in the most stringently controlled research settings.     

Airborne infection in a fully air-conditioned hospital. I. Air transfer between rooms.

Measurements have been made of the extent of air exchange between patient rooms in a fully air-conditioned hospital using a tracer-gas method. When the rooms were ventilated at about six air changes per hour, had an excess airflow through the doorway of about 0.1 m.3/sec. and the temperature difference between rooms and corridor was less than 0.5 degrees C., concentrations of the tracer in rooms close to that in which it was being liberated were 1000-fold less than that in the source room. This ratio fell to about 200-fold in the absence of any excess airflow through the doorways. Considerable dilution took place along the corridors so that the concentration fell by around 10-fold for every 10 m. of corridor.     

普通病房护理人员医院感染控制的细节管理

目的提高普通病房护理人员的医院感染管理成效。方法分析普通病房护理人员在医院感染控制中存在的问题。措施通过培训提高护理人员和病人的医院感染意识,建立护患相互督导机制;加强院科两级督查并与绩效挂钩;病区成立“医院感染质控小组”;提供手卫生方便快捷的物资保障：赠送护手霜给予护士人文关怀。结果护理人员医院感染意识增强,行为逐渐规范。洗手液用量：干预前每病人每天6mL,干预后每病人每天13mL。结论健全制度,加强培训及考核并与绩效挂钩,给予人文关怀,是医院感染控制的关键。     

支气管灌洗术对支气管扩张合并肺部感染的疗效观察

目的探讨支气管肺泡灌洗术(BAL)对支气管扩张(BE)合并肺部感染的临床效果。方法选择我院2009年5月至2011年12月确诊为支气管扩张并肺部感染患者共50例,上述患者随机分为观察组和对照组。对照组患者常规给予抗生素、治疗合并症等对症支持治疗。观察组在上述治疗基础上实施支气管肺泡灌洗术。观察两组患者治疗期间发热、咳痰、痰液性质、X线胸片等改善情况,记录两组住院时间。结果观察组住院时间平均为10.2±4.9天;对照组平均住院时间为21.1±3.1天;观察组住院时间时间显著低于对照组,差异有统计学意义(P<0.05);观察组总有效率和对照组总有效率比较,前者高于后者,差异有统计学意义(P<0.05)。结论支气管灌洗术治疗支气管扩张肺部感染临床效果显著,促进患者康复,值得借鉴。     

临床实验室医院感染危险因素与对策

目的探讨临床实验室医院感染的危险因素与对策。方法提出临床实验室可能存在的医院感染危险因素,设立了8个方面相应的措施和对策。结果采取相应的对策和措施,有效预防控制实验室医院感染的发生。结论临床实验室完全可以通过制定健全的制度、严格的操作规程和相应的控制措施,有效预防控制实验室医院感染的发生。     

Carbapenem-resistant Klebsiella pneumoniae associated with a long-term--care facility --- West Virginia, 2009-2011

On January 27, 2011, a West Virginia county health department was notified of a cluster of carbapenem-resistant Klebsiella pneumoniae (CRKP) cases detected by a local hospital (hospital A). CRKP infections frequently are resistant to a majority of antimicrobial agents and have an increased risk for morbidity and mortality. The West Virginia Bureau for Public Health (WVBPH) conducted field investigations to identify all cases, characterize risk factors for infection, and abstract data for a matched case-control study. Nineteen case-patients and 38 control patients were identified. Infection with CRKP was associated with admission from or prior stay at a local long-term--care facility (LTCF A). Pulsed-field gel electrophoresis (PFGE) analysis indicated that all five hospital A clinical specimens and all 11 point prevalence survey isolates from LTCF A were closely related. This is the first outbreak of CRKP identified in West Virginia. Recommendations to LTCF A included the following: 1) initiate surveillance for multidrug resistant organisms; 2) revise and improve infection prevention and control activities within the facility; 3) educate residents and their families, physicians, and staff members about CRKP; and 4) identify qualified personnel to coordinate infection control functions within the facility. Although LTCF A has made significant improvements, the outbreak investigation is ongoing. Additional site visits have been conducted, and additional colonized residents have been identified; the last clinical case was detected in July. These findings demonstrate the interconnectedness of the health-care system and factors potentially contributing to transmission of infection. Interventions targeting all levels of care are needed to prevent further CRKP transmission.     

临床工程师在院内感染控制中的作用与自身安全防护

目的:调查研究医学装备存在的院内感染风险,研究临床工程师职责内的可行性防控办法.方法:采用自制调查问卷,对医院在用医学装备表面微生物情况和消毒现状、临床工程师手消毒情况进行调查,分析院内感染风险存在的原因,通过擦拭消毒方式对微生物杀灭能力试验,评估擦拭消毒可靠性.结果:医学装备表面存在多种有害微生物,但送达临床工程部门...     

Infection control practices to reduce airborne bacteria during total knee replacement: a hospital survey in four states.

OBJECTIVE: To describe the use of laminar airflow, body exhaust, and ultraviolet lights during total knee replacement (TKR) in four U.S. states. DESIGN: Survey of healthcare facilities. SETTING: Hospitals in Illinois, North Carolina, Ohio, and Tennessee that performed TKR during 2000 as identified by Medicare claims data. PARTICIPANTS: Hospitals responding to a mailed questionnaire. RESULTS: Two hundred ninety-five (73%) of 405 eligible hospitals that performed 18,374 primary and revision TKR procedures responded to the questionnaire. Among responding hospitals, 30% reported regular use (for > 75% of procedures) of laminar airflow, 42% reported regular use of body exhaust, and 5% reported regular use of ultraviolet lights. Among hospitals providing complete data, 150 (58%) performing 66% of procedures reported regular use of at least one of these techniques. On regression analyses, laminar airflow was used more often by hospitals with a TKR volume greater than 25 procedures per year (odds ratio [OR], 2.0; 95% confidence interval [CI95], 1.1-3.7) and orthopedic residency programs (OR, 2.8; CI95, 1.3-6.3), but its use was not significantly related to hospital setting or ownership status. CONCLUSIONS: Although these clean air practices are not recommended by any U.S. governmental or professional organization, they are used in nearly two-thirds of TKR procedures. Better information about their impact on current practice and more explicit guidelines may aid decisions about the use of these resource-intensive infection control practices.     

血液透析室医院感染的管理现状及控制措施

目的 分析血液透析室医院感染的管理现状及危险因素,探讨有效的预防控制措施.方法 制定细化、执行力强的感染控制制度;转变管理观念,将感染管理的重心转移到临床;改善透析环境,合理布局;加强医院感染知识培训,提高医务人员感染控制的意识;规范各种操作流程;加大对血液透析室的监督检查力度,坚持医院感染质量管理的持续改进.结果 通过有效的管理与控制,血液透析环境明显改善,医务人员操作符合规范,降低了医院感染发生率,提高了医疗质量.结论 分析血液透析室当前存在的问题,控制感染的危险因素,可以有效控制医院感染的发生.