The Journal of hospital infection
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Review Meta Analysis
Skin antiseptics in venous puncture-site disinfection for prevention of blood culture contamination: systematic review with meta-analysis.
Blood cultures drawn by venous puncture are common clinical procedures for the detection of bacteraemia. Blood culture contamination (BCC) can lead to clinical misinterpretation and unnecessary expenses. We aimed to systematically review randomised controlled trials (RCTs) with skin antiseptics for prevention of contamination in venous-puncture drawn blood cultures. ⋯ Alcohol alone was not inferior to iodinated products for prevention of contamination in venous-puncture drawn blood cultures. The association of alcohol and povidone-iodine did not seem to be useful. Alcoholic chlorhexidine solutions reduced blood culture false positives compared with aqueous povidone-iodine.
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Increased numbers of healthcare-acquired infections, including those caused by antibiotic-resistant microbes, have created a need for improved infection control use of disinfection regimens. Commensurate with this has been an increasing number of reports on resistance to a wide variety of antimicrobials, including biocides. Cross-resistance between these biocides and other biocidal or antimicrobial agents has been well-documented. ⋯ In this review we propose definitions of adaptative processes and biocide resistance and survey the literature according to these definitions. We conclude that the current risks to healthcare delivery caused by resistance related to biocides are low, provided that biocides are used under appropriate conditions. The need for further research is addressed.
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The use of transmission precautions such as contact isolation in patients known to be colonised or infected with multidrug-resistant organisms is recommended in healthcare institutions. Although essential for infection control, contact isolation has recently been associated with adverse effects in patients. We undertook a systematic review to determine whether contact isolation leads to psychological or physical problems for patients. ⋯ Well-validated tools are necessary to investigate these results further. Large studies examining a number of safety indicators to assess the adverse effects of isolation are needed. Patient education may be an important step to mitigate the adverse psychological effects of isolation and is recommended.
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Review Meta Analysis Comparative Study
Effectiveness of different central venous catheters for catheter-related infections: a network meta-analysis.
We aimed to compare the effectiveness of various catheters for prevention of catheter-related infection and to evaluate whether specific catheters are superior to others for reducing catheter-related infections. We identified randomised, controlled trials that compared different types of central venous catheter (CVC), evaluating catheter-related infections in a systematic search of articles published from January 1996 to November 2009 via Medline, Embase, Web of Science, and the Cochrane Central Register of Controlled Trials. Network meta-analysis with a mixed treatment comparison method using Bayesian Markov Chain Monte Carlo simulation was used to combine direct within-trial, between-treatment comparisons with indirect trial evidence. ⋯ For prevention of CVC colonisation, adjusted silver iontophoretic catheters (odds ratio: 0.58; 95% confidence interval: 0.33-0.95), chlorhexidine and silver sulfadiazine catheters (0.49; 0.36-0.64), chlorhexidine and silver sulfadiazine blue plus catheters (0.37; 0.17-0.69), minocycline-rifampicin catheters (0.28; 0.17-0.43) and miconazole-rifampicin catheters (0.11; 0.02-0.33) were associated with a significantly lower rate of catheter colonisation compared with standard catheters. For prevention of CRBSI, adjusted heparin-bonded catheters (0.20; 0.06-0.44) and minocycline-rifampicin catheters (0.18; 0.08-0.34) were associated with a significantly lower rate of CRBSI with standard catheters. Rifampicin-based impregnated catheters seem to be better for prevention of catheter-related infection compared with the other catheters.
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Universal methicillin-resistant Staphylococcus aureus (MRSA) screening of adults admitted to hospital is being introduced in England. Routine obstetric patients are currently exempt from screening, but 'high risk' cases and women undergoing elective caesarean sections need to be included in the screening programme. ⋯ The epidemiology of MRSA in the USA, however, where community-associated MRSA strains are much more prevalent, is different from that in the UK. This article reviews current knowledge of MRSA screening in pregnancy and makes recommendations for current practice and future research.