Preventing healthcare-associated infection: risks, healthcare systems and behaviour.

Author(s):Ferguson JK

Source:Internal Medicine Journal [Intern Med J] 2009 Sep; Vol. 39 (9), pp. 574-81.

Abstract:More than 177 000 potentially preventable healthcare-associated infections (HAIs) occur per annum in Australia with sizable attributable mortality. Organizational systems to protect against HAI in hospitals in Australia are relatively poorly developed. Awareness and practice of infection control by medical and other healthcare staff are often poor. These lapses in practice create significant risk for patients and staff from HAI. Excessive patient exposure to antimicrobials is another key factor in the emergence of antibiotic-resistant bacteria and Clostridium difficile infection. Physicians must ensure that their interactions with patients are safe from the infection prevention standpoint. The critical preventative practice is hand hygiene in accord with the World Health Organization 5 moments model. Improving the use of antimicrobials, asepsis and immunization also has great importance. Hospitals should measure and feed back HAI rates to clinical teams. Physicians as leaders, role models and educators play an important part in promoting adherence to safe practices by other staff and students. They are also potentially effective system engineers who can embed safer practices in all elements of patient care and promote essential structural and organizational change. Patients and the public in general are becoming increasingly aware of the risk of infection when entering a hospital and expect their carers to adhere to safe practice. Poor infection control practice will be regarded in a negative light by patients and their families, regardless of any other manifest skills of the practitioner.

Educational interventions for prevention of healthcare-associated infection: a systematic review.

Author(s):Safdar N; Abad C

Source:Critical Care Medicine [Crit Care Med] 2008 Mar; Vol. 36 (3), pp. 933-40.

Abstract:BACKGROUND: Healthcare-associated infections (HCAIs) are associated with considerable morbidity and mortality. Education of healthcare providers is a fundamental measure to prevent HCAI. OBJECTIVE: To perform a systematic review to determine the effect of educational strategies of healthcare providers for reducing HCAI. DATA SOURCE: Multiple computerized databases for the years 1966 to November 1, 2006, supplemented by manual searches for relevant articles. STUDY SELECTION: English-language controlled studies and randomized trials that included an educational intervention and provided data on the incidence of one or more kinds of HCAIs were included. DATA EXTRACTION: Data were extracted on study design, patient population, type of intensive care unit, details of the educational intervention, target group for intervention, incidence of HCAI, duration of follow-up, and costs of intervention. Both investigators abstracted data using a standard data abstraction form; study quality was also assessed. DATA SYNTHESIS: A total of 26 studies used a number of different educational programs targeting varied study populations of healthcare providers to determine their effect on HCAI rates. Most were pre-post intervention studies and were implemented in the intensive care setting. There was a statistically significant decrease in infection rates after intervention in 21 studies, with risk ratios ranging from 0 to 0.79. The beneficial effect of education was apparent in teaching and nonteaching institutions and in lesser-developed countries and developed nations. LIMITATIONS: Only English language studies were included. Because of the study designs and limitations of the individual studies, a causal association between educational interventions and reduced HCAI rates cannot be made. CONCLUSIONS: The implementation of educational interventions may reduce HCAI considerably. Cluster randomized trials using validated educational interventions and costing methods are recommended to determine the independent effect of education on reducing HCAI and the cost-savings that may be realized with this approach.

Streptococcus pneumoniae bacteraemia in children

Author(s):Myers C; Gervaix A

Source:International Journal Of Antimicrobial Agents [Int J Antimicrob Agents] 2007 Nov; Vol. 30 Suppl 1, pp. S24-8. Date of Electronic Publication: 2007 Aug 20.

Abstract:Occult bacteraemia is the most frequent invasive disease caused by Streptococcus pneumoniae in children less than 3 years of age. Despite the relative frequency of this infection, its management is still a challenging task for paediatricians because fever is often the only symptom and a considerable overlap exists in the clinical presentation of children with fever without a focus due to viral illness and children with occult bacteraemia. Management protocols take into account the age of the patient, the clinical score for severity and the results of laboratory tests such as the white blood cell count, the C-reactive protein and the blood procalcitonin level in order to define accurately who will benefit from an antibiotic treatment. Despite appropriate healthcare facilities and access to care the case fatality rate in developed countries is around 9% in children aged less than 1 year. Prevention with the 7-valent conjugate vaccine against S. pneumoniae will decrease morbidity and mortality associated with invasive disease due to these bacteria. However, replacement by non-vaccine serotypes has been noted in countries where the vaccine is widely used and this concern needs to be monitored carefully over the next few years.

Risk factors for hospital-acquired infections in the neonatal intensive care unit

Author(s):Saiman L Source:Seminars In Perinatology [Semin Perinatol] 2002 Oct; Vol. 26 (5), pp. 315-21.

Abstract:Infants in the neonatal intensive care unit (NICU) have many risk factors for infection. Compared with older children and adults, infants, particularly premature infants, are relatively immunocompromised. Patients in the NICU have intrinsic risk factors for infections due to immunological “deficiencies” or inadequate development of mechanical barriers such as skin and gastrointestinal tract mucosa. Like other ICU populations, NICU patients have extrinsic risk factors for infection such as prolonged hospitalization, invasive procedures, instrumentation, medical treatments and concomitant medical conditions. Compared with healthy full-term infants, patients in the NICU develop abnormal flora, which is generally acquired in the NICU from patient-to-patient transmission via hand carriage of healthcare workers. This flora is frequently multidrug-resistant as it has developed under the selective pressure of antibiotics and can cause invasive disease. An understanding of the risk factors that are associated with hospital-acquired infections is essential to design preventive strategies.

The safe use of children’s toys within the healthcare setting.

Author(s):Little K; Cutcliffe S Source:Nursing Times [Nurs Times] 2006 Sep 19-25; Vol. 102 (38), pp. 34-7.

Abstract:Toys are classed as a potential source of infection because they can become contaminated with microorganisms from unwashed hands, body fluids or from children putting them in their mouths. Environmental audits by infection control teams have shown that toys kept in healthcare settings are often dirty and not subject to the recommended cleaning protocols.

Nosocomial HIV infection: epidemiology and prevention–a global perspective.

Author(s):Ganczak M; Barss P

Source:AIDS Reviews [AIDS Rev] 2008 Jan-Mar; Vol. 10 (1), pp. 47-61.

Abstract:Because, globally, HIV is transmitted mainly by sexual practices and intravenous drug use and because of a long asymptomatic period, healthcare-associated HIV transmission receives little attention even though an estimated 5.4% of global HIV infections result from contaminated injections alone. It is an important personal issue for healthcare workers, especially those who work with unsafe equipment or have insufficient training. They may acquire HIV occupationally or find themselves before courts, facing severe penalties for causing HIV infections. Prevention of blood-borne nosocomial infections such as HIV differs from traditional infection control measures such as hand washing and isolation and requires a multidisciplinary approach. Since there has not been a review of healthcare-associated HIV contrasting circumstances in poor and rich regions of the world, the aim of this article is to review and compare the epidemiology of HIV in healthcare facilities in such settings, followed by a consideration of general approaches to prevention, specific countermeasures, and a synthesis of approaches used in infection control, injury prevention, and occupational safety. These actions concentrated on identifying research on specific modes of healthcare-associated HIV transmission and on methods of prevention. Searches included studies in English and Russian cited in PubMed and citations in Google Scholar in any language. MeSH keywords such as nosocomial, hospital-acquired, iatrogenic, healthcare associated, occupationally acquired infection and HIV were used together with mode of transmission, such as “HIV and hemodialysis”. References of relevant articles were also reviewed. The evidence indicates that while occasional incidents of healthcare-related HIV infection in high-income countries continue to be reported, the situation in many low-income countries is alarming, with transmission ranging from frequent to endemic. Viral transmission in health facilities occurs by unexpected and unusual as well as more frequent modes. HIV can be transmitted to patients and to donors of blood products by specific vehicles and vectors during blood transfusion, plasma donation, and artificial insemination, by improperly sterilized sharps, by medical equipment during activities such as dialysis and organ transplantation, and by healthcare workers infected by occupational exposure to hazards such as blood-contaminated sharps. Personal, equipment, and environmental factors predispose to acquisition of nosocomial HIV and all are pertinent for prevention. For infection and injury control, poverty is often an underlying determinant. While sophisticated new tests offer improved HIV detection, increasingly higher marginal costs limit their feasibility in many settings. Modest investment in safer equipment and appropriate integrated training in infection control, injury prevention, and occupational safety should provide greater benefit.

Healthcare-associated atypical pneumonia

Author(s):Forgie S; Marrie TJ

Source:Seminars In Respiratory And Critical Care Medicine [Semin Respir Crit Care Med] 2009 Feb; Vol. 30 (1), pp. 67-85. Date of Electronic Publication: 2009 Feb 06.

Abstract:Atypical pneumonia was first described in 1938, and over time, Mycoplasma, Legionella, and Chlamydophila were the agents commonly linked with community-associated atypical pneumonia. However, as technology has improved, so has our understanding of this clinical entity. It is now known that there are many agents linked with atypical pneumonia in the community, and many of these agents are also major causes of healthcare-associated pneumonia. This article discusses the history, epidemiology, and pathogenesis of infection; control of infection; clinical findings; diagnosis; and, where applicable, treatment of the agents of healthcare-associated atypical pneumonia. Bacterial agents include Legionella species, Mycoplasma pneumoniae, Chlamydophila species, and Coxiella burnetii. Although there are over 100 viruses that can cause respiratory tract infections, only a fraction of those have been defined in the context of healthcare-associated atypical pneumonia: adenovirus and human bocavirus (HBoV); rhinovirus; human coronaviruses (HCoV), including HCoV 229E, HCoV OC43, HCoV NL63, HCoV HKU1; members of the paramyxoviridae (parainfluenza viruses, human metapneumovirus, and respiratory syncytial virus); hantavirus; influenza; and severe acute respiratory syndrome (SARS) Co-V. Our knowledge about healthcare-associated atypical pneumonia will continue to evolve as newer pathogens are identified and as newer diagnostic modalities such as multiplex polymerase chain reaction are introduced.

What is healthcare-associated pneumonia and how is it managed?

Author(s):Carratal? J; Garcia-Vidal C

Source:Current Opinion In Infectious Diseases [Curr Opin Infect Dis] 2008 Apr; Vol. 21 (2), pp. 168-73.

Abstract:PURPOSE OF REVIEW: Pneumonia developing before hospital admission in patients in close contact with the health system was recently termed ‘healthcare-associated pneumonia’ and proposed as a new category of respiratory infection. We focus on the recent literature concerning the epidemiology, causative organisms, antibiotic susceptibilities, and outcomes of and empirical antibiotic therapy for this condition. RECENT FINDINGS: The reported incidence of healthcare-associated pneumonia among patients requiring hospitalization for pneumonia ranges from 17% to 67%. Hospitalization within 90 days before pneumonia, attending a dialysis clinic and residing in a nursing home were the most common criteria for healthcare-associated pneumonia. Compared with patients with community-acquired pneumonia, those with healthcare-associated pneumonia are older, have greater co-morbidity, and are more likely to have aspiration pneumonia and pneumonia caused by antibiotic-resistant pathogens. Patients with healthcare-associated pneumonia also more frequently initially receive an inappropriate antibiotic therapy, have higher case fatality rates and have longer hospital stay. SUMMARY: Many patients hospitalized with pneumonia via the emergency department have healthcare-associated pneumonia. There are significant differences in the spectrum of causative organisms and antibiotic susceptibilities between healthcare-associated and community-acquired pneumonia. Physicians should differentiate patients with healthcare-associated pneumonia from those with community-acquired pneumonia to promote a targeted approach when selecting initial antibiotic therapy.

Toys–friend or foe? A study of infection risk in a paediatric intensive care unit.

Author(s):Fleming K; Randle J

Source:Paediatric Nursing [Paediatr Nurs] 2006 May; Vol. 18 (4), pp. 14-8.

Abstract:Toys are an established part of the hospital experience for the child and family. They are seen as a source of comfort and security and form part of the child-friendly environment. However, they can also act as a source of healthcare associated infection which can be harmful to children, especially those who are in intensive care environments. This small-scale study was conducted in a paediatric intensive care unit at a large teaching hospital and involved swabbing those toys that had been brought in by families and those that were provided by the hospital. Findings show that 85 per cent of the toys harboured viable bacteria, which could be damaging to the child’s health. Recommendations for practice are identified to ensure that toys remain a component of the child’s hospitalisation yet are safe in relation to the transmission of infections not just in PICU but in all paediatric settings.

Healthcare-associated infection in acute hospitals: which interventions are effective?

Author(s):Mears A; White A; Cookson B; Devine M; Sedgwick J; Phillips E; Jenkinson H; Bardsley M

Source:The Journal Of Hospital Infection [J Hosp Infect] 2009 Apr; Vol. 71 (4), pp. 307-13. Date of Electronic Publication: 2009 Feb 06.

Abstract:This study investigated the potential factors linked to healthcare-associated infection (HCAI) rates in acute National Health Service hospitals, analysing mandatory surveillance data with existing data available to the Healthcare Commission, and supplemented by a bespoke questionnaire. A questionnaire was developed to cover important elements related to the management and control of HCAI. Additional data were collated from other sources. Infection outcomes comprised the mandatory surveillance data, for both meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia and Clostridium difficile-associated diarrhoea (CDAD). The response rate was 90%. A lower MRSA rate was linked to hand hygiene and isolation and a lower rate of CDAD to cleanliness, good antimicrobial prescribing practices and surveillance of infections. Lower rates of both organisms were related to strategic planned interventions, such as the inclusion of infection control in the staff development programme. However, certain interventions, for example increased levels of training, were related to a higher infection rate. These findings for MRSA and CDAD are supported by evidence from the infection control literature. We have found relationships between interventions and higher infection rates that are counterintuitive and that may represent examples of what we call ‘reactive practice’ to higher rates of infection. Whilst it is interesting to hypothesise that these interventions may be swift and simple to introduce and may not be sustained compared to more strategic and planned interventions linked to lower infection rates, they most probably simply represent the beginning of a culture change and embedding of infection control practice.