American journal of infection control
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Am J Infect Control · Dec 2008
Comparative StudyPreventing central venous catheter-associated bloodstream infections: development of an antiseptic barrier cap for needleless connectors.
Reports of outbreaks associated with the use of needle-free valve connectors suggest 2 common risk factors: (1) poor adherence to disinfection practices before use and (2) a design that allows contamination when not in use. Swabbing a membranous septum with 70% isopropyl alcohol may not eliminate septal surface contamination. Frequent access through and handling of needle-free connectors also puts patients at increased risk of central venous catheter-related bloodstream infections (CR-BSIs). A novel antiseptic barrier cap has been designed to maintain health care worker safety and eliminate the vulnerabilities of existing systems to contamination and CR-BSIs for patients at risk. ⋯ An antiseptic barrier cap was highly effective in sterilizing the septum of a needle-free valve connector and preventing entry of any microorganisms, even with heavy contamination of the septum. This new technology should now be evaluated in a clinical trial with CR-BSI as the primary outcome measure.
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Am J Infect Control · Dec 2008
Provision and use of personal protective equipment and safety devices in the National Study to Prevent Blood Exposure in Paramedics.
Paramedics are at risk for human immunodeficiency virus, hepatitis B virus, and hepatitis C virus infection from occupational blood exposure. This study examined how often paramedics are provided with personal protective equipment (PPE), sharps containers, and selected safety devices by their employers; the frequency with which paramedics use sharps containers and these safety devices; and paramedics' attitudes regarding this equipment. ⋯ Lack of access to safety devices is the major barrier to their use, and the higher rates of provision and use in California may be the result of the state's early safety needle legislation. Increased provision, training, and improvement of safety equipment are needed to better protect paramedics from blood exposure.
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Am J Infect Control · Dec 2008
Epidemiology of bloodstream infection associated with parenteral nutrition.
Catheter-related bloodstream infections (CR-BSIs) occur in 1.3% to 26.2% of patients with central venous catheters used to administer parenteral nutrition (PN). Because of their nutritional components, PN solutions can support microbial growth. Contamination during preparation and handling is rare in hospitals and home-infusion pharmacies but may be difficult to control in a home setting. The risk of infection is increased in hospitalized patients because of malnutrition-associated immunosuppression, hyperglycemia exacerbated by dextrose infusion, microbial colonization/contamination of catheter hubs and the skin surrounding insertion site, and poor nursing care. During long-term catheter use for PN, an intraluminal biofilm, catheter-tip fibrin sheath or tail, or central venous thrombosis creates sites for microbial seeding and infection. Chronic conditions and psychosocial issues also increase the risk of infection. In hospitalized patients with BSIs, the most common organisms are coagulase-negative staphylococcus, Staphylococcus aureus, Enterococcus, Candida spp, Klebsiella pneumoniae, and Pseudomonas aeruginosa. In the long-term PN population, approximately 60% of CR-BSIs are caused by coagulase-negative Staphylococcus. ⋯ The best plan of care for a suspected or known infected catheter in a hospitalized patient is to reinsert a new central line after 48 hours of antibiotic treatment and negative blood cultures. In patients who receive long-term PN, hospitalization increases the risk of a nosocomial infection because the catheter can be contaminated by staff. A patient with fungemia must always be admitted and catheter removed. With gram-positive and gram-negative organisms, the catheter may not need to be removed. In most patients receiving PN at home, removing a long-term venous-access device is challenging. Peripheral vein access or peripherally inserted central catheters are needed until a new permanent device can be inserted after negative blood cultures are obtained. Evaluation of remote site infection also is necessary. Strategies to reduce or prevent infection include catheter lock therapy, daily evaluation of continued need for PN, enteral rather than PN support, and avoiding overfeeding. More studies are needed to demonstrate conclusively the benefits of immunonutrition, such as the use of omega-3 or glutamine supplements to reduce CR-BSIs in patients receiving PN.
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Am J Infect Control · Dec 2008
Randomized Controlled TrialInvestigation of a nosocomial outbreak by alginate-producing pan-antibiotic-resistant Pseudomonas aeruginosa.
The nosocomial spread of pan-antibiotic-resistant nonfermentative bacteria is an increasing concern. This study investigated the microbiologic and epidemiologic characteristics of a hospital outbreak due to alginate-producing, pan-antibiotic-resistant Pseudomonas aeruginosa (PAR-Pa). ⋯ This study illustrates the ability of pan-antibiotic-resistant P. aeruginosa to cause an outbreak with significant mortality and stresses the need for precautions to prevent the spread of such highly resistant strains.
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Am J Infect Control · Dec 2008
Personal protective equipment in health care: can online infection control courses transfer knowledge and improve proper selection and use?
We used observational evaluation to assess the ability of an online learning course to effectively transfer knowledge on personal protective equipment (PPE) selection and removal. During orientations for new hospital staff, 117 participants applied either airborne, droplet, or contact precautions in mock scenarios. Postcourse, all 3 scenarios demonstrated improvement in PPE sequence scores (P = .001); moreover, hand hygiene also was more frequent during both donning and doffing of PPE (P < .001).