Limited efficacy of alcohol-based hand gels.

Alcohol-based gels have been introduced recently in many hospitals worldwide for hand antisepsis. We investigated the antimicrobial efficacy of ten gels and four rinses according to European standards (EN 1500). No gel met the EN 1500 requirements within 30 s of application, whereas all hand rinses did.

Infective endocarditis: too ill to be operated?

Infective endocarditis remains a disease associated with high mortality in certain groups of patients, with death resulting primarily from central nervous system complications and congestive heart failure. Combined medical and surgical therapy reduces both early and late mortality in complicated cases, especially in patients with valvular dysfunction related to heart failure. In these patients, heart failure is the strongest indication for valve replacement.

Disinfectants that do.

Biocides are helpful in different healthcare settings to reduce or eradicate harmful pathogens on the skin, medical devices, and in the environment. This article reviews recent advances in hand hygiene, instrument sterilization, decolonization with mupirocin, and the challenges posed by environmental contamination, and prion disease. Do biocides induce resistance?

Resistance to amikacin and gentamicin among Gram-negative bloodstream isolates in a university hospital between 1989 and 1994.

OBJECTIVE: To characterize antimicrobial resistance patterns to amikacin (AN) and gentamicin (GM) among Gram-negative bloodstream isolates and to determine the possible relationship between use of AN and GM and the occurrence of antibiotic resistance during a 6-year period. METHODS: Standard media and techniques of isolation and identification were used. Antimicrobial susceptibility testing was performed with the disk diffusion method and API rapid ATB E strips.

Compliance with hand disinfection and its impact on hospital-acquired infections.

Hand hygiene prevents cross-infection in hospitals, but adherence to guidelines is poor among healthcare workers. Although some interventions to improve compliance have been successful, none had achieved lasting improvement until very recently. Reasons for non-compliance with recommendations occur at individual, group and institutional levels.

Infection control in the ICU.

Nosocomial infections (NIs) now concern 5 to 15% of hospitalized patients and can lead to complications in 25 to 33% of those patients admitted to ICUs. The most common causes are pneumonia related to mechanical ventilation, intra-abdominal infections following trauma or surgery, and bacteremia derived from intravascular devices. This overview is targeted at ICU physicians to convince them that the principles of infection control in the ICU are based on simple concepts and that the application of preventive strategies should not be viewed as an administrative or constraining control of their activity but, rather, as basic measures that are easy to implement at the bedside.

Nonantibibiotic measures for the prevention of Gram-positive infections.

While Gram-negative bacteria remain a leading cause of nosocomial infections such as ventilator-associated pneumonia and catheter-associated urinary tract infections, Gram-positive cocci are now responsible for a large majority of surgical site and bloodstream infections. A shift has occurred during the last decade and multidrug-resistant micro-organisms have become predominant in most referral centers. Severe infections with Gram-positive micro-organisms such as methicillin-resistant Staphylococcus aureus, coagulase-negative staphylococci, vancomycin-resistant enterococci, penicillin-resistant Streptococcus pneumoniae and, more recently, glycopeptide intermediate S.

Diagnostic value of procalcitonin, interleukin-6, and interleukin-8 in critically ill patients admitted with suspected sepsis.

To assess the diagnostic value of procalcitonin (PCT), interleukin (IL)-6, IL-8, and standard measurements in identifying critically ill patients with sepsis, we performed prospective measurements in 78 consecutive patients admitted with acute systemic inflammatory response syndrome (SIRS) and suspected infection. We estimated the relevance of the different parameters by using multivariable regression modeling, likelihood-ratio tests, and area under the receiver operating characteristic curves (AUC). The final diagnosis was SIRS in 18 patients, sepsis in 14, severe sepsis in 21, and septic shock in 25.

Arterial mycotic aneurysm rupture following kidney-pancreatic transplantation with exocrine pancreatic drainage into the bladder: an unusual observation.

In this case report, we describe two patients who received a kidney-pancreatic transplant through technique of exocrine pancreatic drainage into the bladder, and who subsequently developed arterial mycotic aneurysms at the site of the arterial anastomosis of the homograft.

[Candidiasis among non-neutropenic patients: from colonization to infection].

Invasive candidiasis is a dread complication in hospitalized patients, characterized by a mortality comparable to that of septic shock (40% to 60%). Its incidence in hospitalized patients is 0.5/1000 admissions, but it complicates about 10 per 1,000 admissions in critical care where it represents 10% to 15% of all nosocomial infections.

Variation in nosocomial infection prevalence according to patient care setting:a hospital-wide survey.

A study was performed to estimate the prevalence of nosocomial infections (NI) and assess differences between medical care settings in one hospital complex. A seven-day period-prevalence survey was conducted in May 1998 in a large primary and tertiary healthcare centre in Geneva, Switzerland, that included all patients in acute, sub-acute and chronic care settings. Variables included demography, exposure to invasive devices and antibiotics, surgical history, and patients' localization.

Improving adherence to hand hygiene practice: a multidisciplinary approach.

Hand hygiene prevents cross-infection in hospitals, but health-care workers' adherence to guidelines is poor. Easy, timely access to both hand hygiene and skin protection is necessary for satisfactory hand hygiene behavior. Alcohol- based hand rubs may be better than traditional handwashing as they require less time, act faster, are less irritating, and contribute to sustained improvement in compliance associated with decreased infection rates.

Clinical implications of stenotrophomonas maltophilia resistant to trimethoprim-sulfamethoxazole: a study of 69 patients at 2 university hospitals.

We conducted a retrospective case study at 2 tertiary care centers to determine the clinical implications of trimethoprim-sulfamethoxazole resistant Stenotrophomonas maltophilia (TSRSM). Of 69 reviewed cases (mean age, 57 y; male gender, 70%), 40 (58%) were classified as infections associated with TSRSM (respiratory tract, 14; soft tissue, 11; bloodstream, 8; other sites, 7). Severe underlying comorbidities (86%) and previous antibiotic exposure (99%) were common.

Hand hygiene-beliefs or science?

Over a century has passed since Ignaz P. Semmelweis demonstrated the association between hand hygiene and nosocomial infections, but this simple procedure is still not recognized by many healthcare workers as one of the most important measures to prevent cross-transmission of microorganisms. A relatively large amount of research has been done, in particular to try to understand why compliance remains so low, in order to implement successful promotion campaigns.

Screening for methicillin-resistant Staphylococcus aureus in the endemic hospital: what have we learned?

Control of methicillin-resistant Staphylococcus aureus (MRSA) still generates controversy among infection control practitioners. Opponents claim that once MRSA becomes endemic in an institution, control efforts are no longer justified. This review examines the usefulness, feasibility and cost-effectiveness of control programmes in acute-care hospitals where eradication of MRSA has either failed or has never been attempted; hence, the pathogen has become endemic.

Risk factors for persistent carriage of methicillin-resistant Staphylococcus aureus.

We determined risk factors associated with persistent carriage of methicillin-resistant Staphylococcus aureus (MRSA) among 102 patients enrolled in a double-blind, placebo-controlled trial of nasally administered mupirocin ointment. MRSA decolonization was unsuccessful in 77 (79%) of 98 patients who met the criteria for evaluation. By univariate analysis, 4 variables were found to be associated with persistent MRSA colonization (P < .

Hand Hygiene Revisited: Lessons from the Past and Present.

Hand hygiene is the most effective measure to prevent cross-transmission of microorganisms. Adequate hand hygiene can be achieved by standard handwashing--with water alone or with soap--or by the use of an alcohol-based hand-rub solution. Despite considerable efforts, compliance with this simple infection-control measure remains low.

[Invasive candidiasis in critically ill patients].

Invasive candidiasis is rare in the general population (about 8 episodes/100,000/year), but has a higher incidence in hospitalised patients (0.5/1000 admissions). It complicates about 10 per 1000 admissions in critical care, where it represents 10-15% of all nosocomial infections.

Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme.

Background: Hand hygiene prevents cross infection in hospitals, but compliance with recommended instructions is commonly poor. We attempted to promote hand hygiene by implementing a hospital-wide programme, with special emphasis on bedside, alcohol-based hand disinfection. We measured nosocomial infections in parallel.

Problems and solutions in hospital-acquired bacteraemia.

Despite infection control efforts, bacteraemia remains one of the most frequent and challenging hospital-acquired infections and is associated with high attributable morbidity and mortality and additional use of healthcare resources. Prevention and control of hospital-acquired blood-stream infection requires improved detection methods, better definition of patient populations at risk, more refined guidelines for the interpretation of positive blood cultures and a better discrimination between sporadic contaminants and true bacteraemia. These issues are addressed in the current review together with those related to the diagnosis, management and recent advances in the prevention of cathether-related bacteraemia, the leading cause of hospital-acquired blood-stream infection.

Effect of delayed infection control measures on a hospital outbreak of methicillin-resistant Staphylococcus aureus.

All patients positive for methicillin-resistant Staphylococcus aureus (MRSA) at the University Hospitals of Geneva, Switzerland, between 1989 and 1997 (N = 1771) were included in a cohort study to evaluate the consequences of delayed containment of a hospital-wide outbreak occurring during a 4-year absence of MRSA control measures. The effects of efforts to control both the MRSA reservoir and the number of bacteraemic patients were assessed. Intensive infection control measures were initiated in 1993 and included patient screening, on-site surveillance, contact isolation, a computerized alert system, and hospital-wide promotion of hand hygiene.

Improving compliance with hand hygiene in hospitals.

Hand hygiene prevents cross-infection in hospitals, but compliance with recommended instructions often is poor among healthcare workers. Although some previous interventions to improve compliance have been successful, none has achieved lasting improvement. This article reviews reported barriers to appropriate hand hygiene and factors associated with poor compliance.