Nosocomial bloodstream infections in patients with implantable left ventricular assist devices.

Background: Implantable left ventricular assist devices (LVAD) are used as a bridge to transplantation but are associated with a high risk of infection including nosocomial bloodstream infections (BSI).

Methods: We retrospectively reviewed the medical records of all patients with implantable LVAD at the Cleveland Clinic with 72 hours or longer of LVAD support from January 1992 through June 2000, to determine the attack rate, incidence, and impact of nosocomial BSI in patients with LVAD. A nosocomial BSI was defined using Centers for Disease Control and Prevention definition.

Handwashing compliance: what works?

Unlabelled: Health care personnel--particularly physicians--do a poor job of complying with national handwashing guidelines, yet handwashing is the cornerstone of infection control. New products designed to increase compliance are available, such as automated handwashing machines, but their clinical benefits have not been fully studied. The best solution for now may be to continue awareness campaigns and education programs, ensure access to sinks and appropriate antiseptic products, and promote the use of alcohol disinfectants when handwashing is not possible.

Early onset prosthetic valve endocarditis: the Cleveland Clinic experience 1992-1997.

Background: We reviewed all cases of early onset prosthetic valve endocarditis (EO-PVE) occurring less than 12 months after valve operation among 7,043 patients undergoing heart valve replacements or repairs at The Cleveland Clinic between 1992 and 1997.

Methods: Cases were defined by the Duke criteria and identified through prospective surveillance.

Results: Seventy-seven cases of EO-PVE were identified (1 per 100 procedures), and during the study period the incidence of EO-PVE decreased from 1.

Rule-makers who establish infection control standards.

Standards of care and regulations of employment have been instituted to guard the safety of patients, employees, and employers. The evolution of many rules is mystifying because the sources and the enforcers are diverse. This article identifies authoritative agents that influence or create rules that guide infection control practice.

Secular trends in nosocomial bloodstream infections in a 55-bed cardiothoracic intensive care unit.

Background: Although bloodstream infections (BSIs) occur more frequently in intensive care unit patients than in ward patients, most studies of nosocomial BSIs in critically ill patients have not distinguished between intensive care unit populations beyond surgical, medical, and pediatric patients.

Methods: The primary objective of this study was to characterize the secular trends in rates of nosocomial BSIs for all pathogens among patients admitted to a busy cardiothoracic intensive care unit in a single tertiary care institution between January 1986 and December 1995. Patients with nosocomial BSIs were identified through continual prospective surveillance.