Bacterial contamination of multiple-dose vials: a prevalence study

BACKGROUND: Two patients died of a meningitis caused by Pseudomonas aeruginosa in a hospital in Germany in July 2001, their infections having been caused by a contaminated contrast media (iomeprol [Imeron]) used as a multiple-dose vial (MDV) over 8 days. Therefore, a prevalence study was performed to investigate the use and contamination of multiple-use vials in a tertiary hospital. METHODS: In a 1300-bed hospital on a specific day in November 2001, all used MDVs were collected by the infection control nurses. Information was recorded about the medication, labeling of vials, storing temperature, wards, and dates of opening. Each vial was also tested for sterility. RESULTS: Opened vials were to be found in all wards. Of the 227 vials available, 1 vial and 1 spike were contaminated with Staphylococcus epidermidis (contamination rate 0.9%; 95% CI, 0.3-2.1). The opening dates were marked on only 114 (50%) MDVs, 15 (13%) of which had already expired. Only 44 (19%) MDVs had been stored in the refrigerator, whereas 109 MDVs contained medications without any preserving agent. CONCLUSION: Results revealed somewhat risky handling of MDVs. In light of a possible high risk in this hospital of about 1 contaminated MDV per day, and in view of many reported outbreaks induced by contaminated MDVs, the following infection control measures were encouraged: alcohol hand hygiene, the disinfection of gums, observance of the manufacturer's recommendations, appropriate storing temperatures, marking the opening time, and avoiding the multiple use of medications not containing preserving agents.     

Microbial contamination of hospital bed handsets

BACKGROUND: Hospital bed handsets, including nurse call equipment and television controls, have been found to contain biologic material and may be contaminated with microbes. OBJECTIVE: The aim of this study was to assess the microbial contamination of hospital bed handsets. METHODS: Hospital bed handsets were removed from 115 randomly chosen rooms in a suburban hospital. The handsets were transported to the laboratory in a sterile fashion and opened using a sterile technique, and cultures were obtained from both the anterior and posterior surfaces of the units. RESULTS: The cultures of 12 units (10.4%) revealed no microorganisms. One hundred three units (89.6%) had cultures that grew microorganisms. Of the handsets that were found to contain microorganisms, 48 units (46.6%) had only 1 microorganism, and 55 units (53.4%) had multiple organisms, including 33 units (32.0%) with 2 microorganisms, 21 units (20.4%) with 3 microorganisms, and 1 unit (1.0%) with 4 microorganisms. The microorganisms identified included 90 isolates (87.4%) of coagulase-negative staphylococcus, 51 isolates (49.5%) of bacillus species, 13 isolates (12.6%) of fungal species, 8 isolates (7.8%) of nonhemolytic streptococcus species, 7 isolates (6.8%) of alpha-hemolytic streptococcus species, 1 isolate (1.0%) of Staphylococcus aureus, and 1 isolate (1.0%) of methicillin-resistant Staphylococcus aureus. CONCLUSION: Hospital bed handsets were found to have a high incidence of contamination with bacteria and fungus and were found to contain organisms that are known to be the etiologic agents in nosocomial infections. Because of the frequency and duration of contact between hospital patients and hospital bed handsets, existing infection control measures should be studied that could reduce the level of contamination of such handsets or that could isolate the handsets from the patient.     

Unsuspected pulmonary tuberculosis in a community teaching hospital

Tuberculosis remains a significant clinical and public health problem in the United States. To determine if a significant proportion of hospitalized patients diagnosed as having pulmonary tuberculosis were not suspected of the disease following initial patient assessment, we retrospectively reviewed the microbiology records of a 515-bed community teaching hospital and identified all patients with culture-proven Mycobacterium tuberculosis infection hospitalized between January 1983 and December 1987. Pulmonary tuberculosis was not suspected in 13 (42%) of 31 patients with active disease. These patients were elderly (92% aged 65 years or older vs 8% aged less than 65 years), had a delay in respiratory isolation (6 vs 1 days) and diagnosis (8 vs 3 days), in addition to a longer hospitalization (16 vs 11 days) with increased mortality (46% vs 11%). Inadequate diagnosis may contribute to the persistence of morbidity and mortality from tuberculosis in this country.     

Undetected Bacillus pseudo-outbreak after renovation work in a teaching hospital

A 602-bed capacity hospital underwent complete renovation from 1999 to 2004. In April 2005, the Infection Control Team was informed of the occurrence of three consecutive cases of Bacillus cereus bacteremia in a ward for patients with hematologic malignancies. A retrospective analysis of patients with Bacillus isolates was initiated. We found more Bacillus cereus isolates from blood samples in 2004 compare to the preceding years. Swab samples were collected in the particular ward from the surface of a working desk, filter unit of the air-conditioners, entrance of air inlet ducts, exit of the air outlet ducts and three-way valves of the particular ward under the consideration of iatrogenic contamination. Towels and gowns used in the ward were examined. Dens dust was noted in the filter of the air-conditioner and inlets/outlets of the air-ventilation system of the ward. Bacillus cereus was isolated from the dust, and from cleaned towels and gowns. PFGE fingerprinting differed among four patients' sample. We considered the present case as an undetected Bacillus cereus pseudo-outbreak that lasted for about one year after the renovation work of the hospital. We also considered that filters of the HVAC-system and towels and gowns were probable sources of the outbreak.     

Estimated incidence of acute pulmonary embolism in a community/teaching general hospital

PURPOSE: This study attempts to determine the incidence of established acute pulmonary embolism (PE) in a community/teaching general hospital. BACKGROUND: The reported incidence of objectively diagnosed acute PE among hospitalized adults in a large urban hospital or major university hospital ranges from 0.27 to 0.40%. Whether the incidence of PE in other categories of hospitals fits within this narrow range is unknown. METHODS: Patients with acute PE diagnosed by ventilation/perfusion lung scan, pulmonary angiography, compression ultrasound in a patient with suspected PE, autopsy, or (by coincidence) lung biopsy were identified among patients hospitalized during a 2-year period from 1998 to 2000. The incidence of PE was also determined according to age, sex, and race. RESULTS: Among adult patients (> or = 20 years old), the incidence of established acute PE was 95 of 34,567 patients (0.27%; 95% confidence interval [CI], 0.22 to 0.34%). No PE was diagnosed in patients < 20 years old. The incidence of PE in men was 36 of 13,722 patients (0.26%; 95% CI, 0.18 to 0.36%); in women, it was 59 of 20,845 patients (0.2%; 95% CI, 0.22 to 0.36%; not significant [NS]). The incidence in African-Americans adults was 10 of 4,344 patients (0.23%; 95% CI, 0.11 to 0.42%); in white adults, it was 84 of 28,615 patients (0.29%; 95% CI, 0.23 to 0.36%; NS). CONCLUSION: The incidence of PE in a community/teaching general hospital was comparable to the incidence in a large urban-care center and in a major university hospital.     

Microbial contamination of enteral feed administration sets in a pediatric institution

BACKGROUND: Enteral feeding tubes have been associated with outbreaks of antimicrobial-resistant organisms, but the pathogenesis of this association has not been investigated. We hypothesized that the enteral feed administration sets become colonized externally by microbes grown from the enteral tube hub, and therefore serve as a reservoir of organisms that can be crosstransmitted. METHODS: We conducted a prospective observational cohort pilot study, obtaining bacterial cultures from the external enteral feed administration set and from the hub of nasogastric, gastric, or gastrojejunal tubes in children receiving enteral feeding while hospitalized in a tertiary care pediatric hospital. RESULTS: Thirty-six of 37 hubs cultured had bacterial growth. Twenty-nine of 36 administration sets (78%) sampled had at least 1 microbe isolated that was also cultured from the hub. No significant risk factors for colonization were identified. CONCLUSIONS: Enteral feed administration sets are frequently colonized by organisms in the enteral tube hub. These sets can serve as a reservoir of organisms that can be crosstransmitted between patients. Adherence to Standard Precautions is critical when handling enteral feeding apparatuses.     

Estimating the patient care costs of teaching in a teaching hospital

PURPOSE: Because leaders at medical schools and teaching hospitals need current data to estimate the clinical costs of graduate medical education, the authors developed a new methodology to estimate the hospital costs associated with the presence of teaching physicians for the year 2002. METHOD: A hospital accounting system was used to determine the case mix-adjusted direct variable costs for 41,522 inpatient admissions associated with or without a teaching physician. RESULTS: Prior to adjustment, teaching cases had greater median costs than non-teaching cases. After severity adjustment, teaching cases in aggregate were associated with an additional 4.4% of the total direct variable cost of inpatient admissions, or US 3.6 million dollars. The size of the teaching effect varied by service, ranging from -5.7% for medical services to 13 percent for behavioral services. The effect of teaching on cost centers such as laboratory, pharmacy, and radiology varied by specialty service. Teaching was associated with a negligible 0.7% relative difference in length of stay. CONCLUSION: The incremental effects of teaching on hospital patient care costs are modest. These analyses can be repeated annually to detect changes in teaching costs and to target areas of excessive cost for interventions that improve efficiency. Our results and methods for identifying hospital costs associated with teaching services may prove useful in negotiations between academic health centers and affiliated teaching hospitals.     

Bed rest in a sydney teaching hospital

This paper looks at two surveys of bed rest, conducted in a general hospital. The first survey, conducted early one afternoon, assessed the prevalence of bed rest within the hospital. It was found that most of the patients (67%) were in bed, and nearly half of those (42%) were in bed for reasons other than being too sick or unsafe to be up, or because bed rest was part of their treatment. A second survey, in which a sample of general hospital patients was repeatedly observed throughout the day, found that patients with no requirements for bed rest spent 63% (95% confidence limits: 51-75%) of the active part of the day in bed. It may be that because of the nature of hospital design, many patients are unnecessarily confined to bed because there is simply nowhere else to go. Inappropriate use of bed rest has implications for patient health and the utilization of scarce hospital resources.     

Management of diabetic ketoacidosis in a teaching hospital

Abstract The aim of our study was to evaluate clinical management of diabetic ketoacidosis (DKA) in a teaching hospital. We followed all the patients hospitalised for DKA over six years (1995–2000), and we recorded clinical data, laboratory finding at entrance and clinical management. We compared the data to the standards set in guidelines. Our study showed an important delay of initiation of intravenous fluid (70% of cases), an under-replacement with intravenous fluid (69% of cases) and with potassium therapy (80% of cases), and an excessive use of alkali therapy. In conclusion, suboptimal management of DKA occurred in a large percentage of patients.