Nosocomial infection in neonates: inevitable or preventable?

In the neonatal intensive care unit population the nosocomial infection rate is highest in the lowest-birth-weight infants. It is this group of infants who require the most therapeutic interventions to support them leading to frequent invasive procedures and the longest exposure to the hospital environment. However, infection rates vary from one unit to another, suggesting that there are differences in either how infection rates are determined or the care provided in the various units. This article will describe nosocomial infections and rates in the neonatal intensive care unit and identify strategies of care to minimize the risks of nosocomial infection in low-birth-weight infants.     

极低出生体重儿院内感染状况及原因分析

目的探讨极低出生体重儿（verylowbirthweightinfant,VLBWI）院内感染特征,分析感染发生的可能危险因素,以便采取针对性的预防对策。方法回顾性调查2012年1～6月本院重症监护病房58例VLBWI感染发生情况、感染特征及感染发生的原因。结果58例WLBWI住院期间院内感染发生率为60．34％,感染病原菌主要为革兰氏阳性菌（占88．47％）,以肺部感染（占82．90％）为主;感染时间主要在出生后21d内。机械通气、经外周静脉置管术（peripherallvinsertedcentralcatheter,PICC）、阿氏评分≤7分、使用氟康唑及胎膜早破的VLBWI感染率较高（均P〈o．05）。结论VLBWI感染发生率较高,主要为肺部感染,发生时间主要集中在出生后21d内;机械通气、PICC、阿氏评分低、胎膜早破等是VLBWI感染的主要因素。应加强VLBWI出生后3W内的感染控制,尽量减少对患儿的侵入性操作,合理使用抗生素,同时加强围生期保健,降低早产发生率。     

Implications of Medicare reimbursement changes related to inpatient nursing care quality

Recent changes to the inpatient prospective payment system by the Centers for Medicare and Medicaid Services will negatively affect reimbursement to hospitals for patients who develop certain types of nursing-sensitive, hospital-acquired conditions such as pressure ulcers, falls with injuries, or nosocomial infections. The author examines the effects of the new payment policy on inpatient nursing care and addresses ways to improve quality and minimize financial impacts to hospitals.     

半开放管理模式下精神病患者医院感染情况调查分析

目的了解半开放式管理模式下精神病患者医院感染情况，提高对医院感染易感因素的认识，为进一步采取有效的预防控制措施提供依据。方法对2006年1—12月1046例精神病患者的医院感染发生情况进行调查，对于发生医院感染的患者，采用《医院感染病例调查登记表》调查并记录相关情况。结果1046例精神病患者中，出现医院感染62例共63例次，感染率为5．93％；感染部位中，呼吸道感染占首位（66．67％），其次为121腔感染（15．88％）；精神病患者住院2个月内医院感染发病率高于其他住院时间；不同种类精神病患者，其医院感染率差异无统计学意义。结论精神病患者医院感染多出现在疾病发作期，主要表现为呼吸道、口腔和胃肠道感染。加强卫生宣教，做好基础及生活护理，药物不良反应护理，对预防医院感染的发生至关重要。     

Iatrogenesis in the elderly. Nosocomial infections

The elderly are increasingly susceptible to nosocomial infection because of age-related changes and the presence of multiple chronic illness. Epidemics frequently occur in long-term care facilities with upper respiratory infections, diarrhea, conjunctivitis, and antibiotic-resistant bacteria the most common. Other common nosocomial infections are those of the respiratory tract, gastrointestinal tract, genitourinary system, and integumentary system. Infection control programs, systematic surveillance, regular inservice programs on infection control (especially handwashing), and employee and resident health programs can be instituted to decrease the incidence of nosocomial infections.     

Nosocomial infection rates as an indicator of quality

An interest in using nosocomial infection rates as an outcome measure to reflect quality of care in hospitals prompted us to consider factors in addition to quality that influence these rates. Approximately one third of nosocomial infections are potentially preventable, and changes in this "preventable" stratum of infections should reflect variations in quality. However, it will be necessary to identify those potentially preventable infections by calculating rates which are adjusted for intrinsic patient risk. Five other factors necessary for nosocomial infection rates to be a valid and reliable indicator of quality include identification of critical indicators (e.g., types of infection) and sampling schemes that most accurately reflect variations in quality; adoption of standardized, objective definitions of site-specific nosocomial infections; adoption of universal denominators across institutions; development of a monitoring system to assess compliance with surveillance and reporting procedures; and the adoption of more standardized training for infection control practitioners.     

Nosocomial infections: important acute care nursing-sensitive outcomes indicators

Clinical and cost burdens related to nosocomial infections continue to plague the US healthcare system. Vulnerable populations, such as the elderly and the immunocompromised are especially at risk. Current evidence suggests that because hospital stays are shorter, nosocomial infection rates per 1000 patients have actually increased. Nosocomial infections, specifically bacteremias, have been targeted by the American Nurses Association as outcomes that can be affected by nursing in acute care settings. Nursing staffing and practices recently have been linked to the incidence of nosocomial infections. Participation in national databases and benchmarking techniques can provide data-based evidence that nursing practice influences nosocomial infections. Advanced practice nurses are key to ensuring that evidence-based practice environments, in which data drive decision-making, can flourish so that nurses can identify and implement practices that can reduce the rates of nosocomial infections.     

Unit based procedures: impact on the incidence of nosocomial infections in the newborn intensive care unit

Nosocomial infections are one of the major causes of morbidity in the Newborn Intensive Care Unit (NICU). Known risk factors include birth weight, gestational age, severity of illness and its related length of stay, and instrumentation. Infections result in prolonged hospital stays and, consequently, increased hospital costs. As advances in medical technology improve mortality in the tiniest of infants, it is imperative that health care providers identify effective interventions to minimize the risks of nosocomial infections in the NICU. This article examines the effects of common procedures on the incidence of nosocomial infections. Unit-based procedures discussed include visitation, hand washing and nail care, skin and cord care, maintenance of hubs in peripheral and central lines, gowning and isolation procedures, use and misuse of antibiotics, and unit design and staffing. Investigation of these procedures in individual units may reveal areas to improve patient outcomes.     

Multiresistant coagulase-negative staphylococci disseminate frequently between intubated patients in a multidisciplinary intensive care unit

Introduction  

The intensive care unit is burdened with a high frequency of nosocomial infections often caused by multiresistant nosocomial pathogens. Coagulase-negative staphylococci (CoNS) are reported to be the third causative agent of nosocomial infections and the most frequent cause of nosocomial bloodstream infections. CoNS are a part of the normal microflora of skin but can also colonize the nasal mucosa, the lower airways and invasive devices. The main aim of the present study was to investigate colonization and the rate of cross-transmissions of CoNS between intubated patients in a multidisciplinary intensive care unit.     

Infection control and prevention strategies in the ICU

Although only 5–10% of all hospitalized patients are treated in ICUs, they account for approximately 25% of all nosocomial infections, and the incidence of nosocomial infections in ICUs is 5–10 times higher than that observed in general hospital wards. Systemic and respiratory infections are far more common than in general wards, and most epidemics originate, in ICUs. Nosocomial infections are the primary focus of most infection control programmes because they are the cause of high mortality rates in ICUs. Effective programmes are usually based on the cooperation of the intensive care physician, the infectious disease specialist, the microbiologist and the clinical epidemiologist. The infectious disease specialist develops specific guidelines for the antimicrobial therapy of typical infections which minimize the selective pressure for microorganisms within the ICU. The microbiologist provides rapid and accurate diagnosis of the pathogens involved. The clinical epidemiologist identifies epidemics at early stages, using epidemiological tools and molecular typing methods, as well as summarizing trends of antimicrobial susceptibility patterns and setting standards for isolation practices. A simple and inexpensive way to reduce nosocomial infections in ICUs is to ensure that staff disinfect their hands after dealing with a patient. Intravascular devices, mechanical ventilation and urinary catheterization are major risk factors for nosocomial infections, and their use should be evaluated daily and discontinued as soon as clinically possible. Selective decontamination of the digestive tract and the use of standard immunoglobulin for prophylaxis are still controversial and need further investigation. The use of monoclonal antibodies, such as anti-endotoxin antibodies, has failed to improve the prognosis in the critically ill septic patient. Today, the major infectious threat to ICU patients is the increase in multiply-resistant microor-ganisms: methicillin-resistantStaphylococcus aureus, enterococci andCandida spp. in particular.     

Prevention of nosocomial infections in the medical office

Nosocomial infections are usually considered to be a problem of hospitals. However, outpatient care is also not without risks to the patient or to the healthcare workers. Cases of iatrogenic infections following invasive acts such as intramuscular injections in medical offices have occurred repeatedly and have resulted in malpractice charges against the physicians involved. This illustrates a need for physicians in private practice to establish a concept for the prevention of nosocomial infections in their office. This concept should include patients as well as healthcare workers and must be adapted to the particular setting of the practice. After implementation of such a concept, it will be possible to provide care to all patients--the routine patient, the routine patient undergoing an invasive procedure, the patient who is colonized with a resistant microorganism, as well as the patient who presents himself with an infectious disease--under conditions that minimize the risk of nosocomial infection to the patient as well as to the healthcare workers. The essential elements of such a concept include written guidelines for disinfection, sterilization and personnel protection. Depending on the type of practice, additional guidelines, i.e. guidelines for reprocessing of endoscopes in a gastroenterology practice, will be needed.     

Nationwide surveillance of nosocomial infections in Switzerland--methods and results of the Swiss Nosocomial Infection Prevalence Studies (SNIP) in 1999 and 2002

The first multi-center prevalence study of nosocomial infections in Switzerland took place in 1996. Since then, the number of participating hospitals has steadily increased. Today, 72 hospitals of various sizes are part of the Swiss-NOSO surveillance network and represent 30% of all Swiss acute care hospitals, which include approximately 10,000 acute care beds. This article describes the methodology of the national prevalence studies and the results of the 1999 and 2002 surveys. The proportion of infected patients was 10.1% and 8.1% in 1999 and 2002, respectively. The highest prevalence occurred in intensive care units. The most prevalent nosocomial infections were surgical site infections, urinary tract infections, pneumonia, and bloodstream infections. Increasingly, crude rates of nosocomial infections serve as a quality indicator and are used for interhospital comparison and benchmarking. This may be misleading due to differences in case-mix between hospitals as shown in the 1999 study. Using a coordinated approach within a national network, surveillance of nosocomial infections has established itself as an indispensible part of infection control and prevention in Swiss hospitals.     

Nosocomial infections in intensive care wards: A multicenter prospective study

In a three-year prospective investigation, a total of 6,952 patients were investigated prospectively in nine intensive care wards and their rate of nosocomial infections was analysed. The frequency of the nosocomial infections varied between 3% and 27%. The most frequent nosocomial infections were urinary tract infections, sepsis, infections of the skin and of the subcutaneous tissue, pneumonia and wound infections. The most frequent causes of sepsis were ventilation pneumonia, venous catheters, wound infections and urinary tract infections. The pathogen spectrum was analysed. By specific control of infection with employment of an infection control nurse, the frequency of nosocomial infections on intensive care wards was lowered from 17.2% to 14.3% within one year in one of the hospitals.     

新生儿重症监护室医院感染危险因素研究

目的研究新生儿住院期间医院感染的发生情况,探讨其危险因素,实施干预措施。方法通过回顾性调查方法,对山东省立医院新生儿重症监护室住院的3075例新生儿患者进行了调查分析。结果2006～2008年,本医院新生儿重症监护室3075例新生儿住院患者中共51例发生55例次医院感染,感染发病率为1.66%,例次感染发病率为1.79%。新生儿发生医院感染的危险因素为出生体重≤1500g、胎龄≤32周、窒息、侵入性操作、肠外营养等。感染部位以下呼吸道为首位,占68.62%。结论通过调查分析,掌握了新生儿发生医院感染的危险因素,加强对侵入性治疗的管理和护理、缩短有创操作及治疗,将有助于减少新生儿医院感染的发生。     

Nosocomial infections and immunity: lesson from brain-injured patients

Of brain-injured patients admitted to intensive care units, a significant number acquires nosocomial infections. Increased susceptibility to infectious agents could, at least partly, be due to transient immunodepression triggered by brain damage. Immune deficiency in patients with severe brain injury primarily involves T cell dysfunction. However, humoral and phagocytic deficiencies are also detectable. Activation of the hypothalamo–pituitary–adrenal axis and the sympathetic nervous system plays a crucial role in brain-mediated immunodepression. In this review we discuss the role of immunodepression in the development of nosocomial infections and clinical trials on immunomodulation in brain-injured patients with hospital-acquired infections.     

神经外科重症监护病房医院感染调查及护理对策

目的:了解神经外科重症监护病房患者医院感染发生情况及危险因素,提出医院感染护理预防措施。方法:回顾性分析神经外科重症监护病房1511例住院患者临床资料。结果:医院感染发生率为19.1%(289/1511),60岁以上患者感染率最高,达30.3%。总感染例次为917次,其中肺部感染例次构成比最高50.7%(465/917),>28d置管患者的感染率为100%。结论:神经外科重症监护病房医院感染发生率高,应加强护理预防,包括护理管理、规范洗手、以及对呼吸,泌尿系统等护理干预才能降低医院感染率。     

Colonization and infection in surgical intensive care patients —a prospective study

Nosocomial infections are a major problem in intensive care patients. Thirty-nine patients, requiring intensive care for 5 days or more (mean 15.8 days) were prospectively investigated, to determine the relation between colonisation and nosocomial infection. Thrice weekly, cultures from the oropharynx, respiratory and digestive tract were obtained. Colonization with aerobic gram-negative microorganisms of the oropharynx, respiratory and digestive tract significantly increased during the stay in the Intensive Care Unit. In 29 patients (74%) 78 nosocomial infections were diagnosed. The most frequent nosocomial infections were pneumonia (26 patients, 66.6%), catheterrelated bacteraemia (11 patients, 28.2%), and wound infections (7 patients, 17.9%). In 59 instances (75.6%), colonization with the same potential pathogenic microorganism preceeded the nosocomial infection. The overall mortality was 25.6% (10 patients), bacteraemia with aerobic gram-negative microorganisms being the cause of death in 7 patients.     

Are plants vectors for transmission of infection in acute care?

This article reviews relevant research that sheds light on the role of plants and flowers in hospital-acquired infections. After a review of a survey of acute care hospital policies, evidence-based practice recommendations intended to reduce nosocomial infections in acute and critical care are provided.     

317例住院精神病患者医院感染调查分析

目的:调查317例住院精神病患者院内感染发生率及其特点,为控制院内感染,提高医疗质量提供有效措施。方法:对317例住院精神病患者发生的院内感染进行回顾性调查,并进行相关项目的统计、比较。结果:院内感染发生率为2%,呼吸道感染占首位,同时显示院内感染的发生与所患精神疾病及精神科药物副作用有一定关系。结论:做好消毒隔离,加强症状观察和精神科药物副作用的护理,能减少院内感染的发生。