The Journal of hospital infection
-
Comparative Study
Use of pulsed-field gel electrophoresis to investigate an outbreak of Serratia marcescens infection in a neonatal intensive care unit.
Serratia marcescens is a well-recognized hospital-acquired pathogen, which has been associated with a number of specific outbreaks, particularly in critically ill neonates. We used pulsed-field gel electrophoresis (PEGE) typing to analyse an outbreak in a neonatal intensive care unit (NICU). We included samples from nine patients, three handwashes and ten environmental isolates from an outbreak (February to August 1999) in addition to four patient isolates from different wards of our hospital during the same time period. ⋯ We concluded that cross-transmission via transient contamination of hands was the major route for this outbreak. Strict handwashing practices, the cohorting and isolation of colonized and infected patients, and the regular dis-infection of incubators are crucial steps for preventing the transmission of S. marcescens in an NICU. This PFGE method is highly discriminatory for the thorough epidemiological investigation of an outbreak of S. marcescens.
-
A survey of two acute district general hospitals (A and B) was undertaken to investigate the extent of methicillin-resistant Staphylococcus aureus (MRSA) contamination of ward-based computer terminals. Of 25 terminals examined, MRSA was identified in six (24%). Environmental contamination was of a low level. ⋯ MRSA containment and handwashing policies were similar at both hospitals, though only hospital B actively audited handwashing compliance and had a 44% higher rate of paper towel usage per hospital bed. Ward-based computer terminals pose a low risk of MRSA cross-infection. This risk can be further reduced if all staff wash their hands before and after patient contact.
-
A prospective cohort study was performed to evaluate the influence of catheter manipulations on catheter associated bloodstream infection (CABSI) in neonates. Neonates admitted between 1 November 1993 and 31 October 1994 at the neonatal intensive care unit of a university hospital were included in the study. ⋯ Catheter manipulations independently associated with CABSI were disinfection of the catheter hub (OR = 1.2, 95% CI = 1.1-1.3), blood sampling (OR = 1.4, 95% CI = 1.1-1.8), heparinization (OR = 0.9, 95% CI = 0.8-1.0) and antisepsis of exit site (OR = 0.9, 95% CI = 0.8-1.0). This study indicates that certain manipulations (e.g. blood sampling through the central line) and disconnection of the central venous catheter, which necessitates disinfection of the catheter hub, increase the risk of CABSI, while other procedures (e.g. heparinization and exit site antisepsis), protect against CABSI in neonates.
-
Cases of ventilator-associated pneumonia (VAP) were investigated in a cardiothoracic surgery postoperative intensive care unit between 1 January 1999 and 31 December 1999. A total of 1716 patients who had undergone cardiothoracic operations and admitted to the intensive care unit (ICU) were included in the study. Patient- and laboratory-based prospective surveillance of VAP was done along with other hospital-acquired infections. ⋯ No causative micro-organism was identified in 2% of cases. The same bacteria were isolated in both blood and endotracheal aspirate cultures in 10 of 46 pneumonia cases (22%). The crude mortality rate of VAP was calculated as 30%
-
The effect of different head coverings on air-borne transmission of bacteria and particles in the surgical area was studied during 30 strictly standardized sham operations performed in a horizontal laminar air flow (LAF) unit. The operating team members wore disposable gowns plus either a non-sterile head covering consisting of a squire type disposable hood and triple laminar face mask, a sterilized helmet aspirator system or no head cover at all. In the wound area both types of head cover resulted in low and comparable air (means of 8 and 4cfu/m(3)) and surface contamination (means of 69 and 126cfu/m(2)/h) rates. ⋯ No correlation between air and surface contamination rates or between air contamination and air particle counts was found. We conclude that, from a bacteriological point of view, disposable hoods of squire type and face masks are equally as efficient as a helmet aspirator system and both will efficiently contain the substantial emission of bacteria-carrying droplets from the respiratory tract occurring when head cover is omitted. Finally, the use of bacterial air counts to assess surgical site surface contamination in horizontal LAF units must be seriously questioned.