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Volume 21 - September 2000

Contents

Page 2 of 20

From the Risk and Prevention Conference

Reviews

  • How to Survey Nosocomial Infections

  • Petra Gastmeier, Dorit Sohr, Heinz-Michael Just, Alfred Nassauer, Franz Daschner, Henning Rüden
  • Published online by Cambridge University Press:
    02 January 2015, pp. 366-370

  • Many surveillance methods for nosocomial infections (NIs) have been put forward in the literature, and all have their advantages and disadvantages. Different surveillance methods are useful, depending on whether the objective of surveillance is only to increase sensitivity to infection control problems and to identify areas with possible infection control problems; to confirm a possible infection control problem through comparison with other units or departments; or to use surveillance data for identifying the sources of infections. Furthermore, time effectiveness is a major point in selecting the most appropriate method, particularly the method for case identification. In units or departments with a high level of NI, even highly time-consuming surveillance methods may be ultimately time-effective; in units or departments with a lower level of NI, the time-effectiveness depends on the time necessary for case identification. Close liaison with staff in the units is a sine qua non for the success of all surveillance activities

Letters to the Editor

  • Bacterial Contamination of Hospital Physicians' Stethoscopes

  • Undine A.R. Thofern
  • Published online by Cambridge University Press:
    02 January 2015, pp. 558-559
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  • Cost of Nosocomial Infections in Wuhan No. 4 Hospital, China

  • Lin Cao
  • Published online by Cambridge University Press:
    02 January 2015, pp. 4-5
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Medical News

  • Vancomycin-Intermediate S aureus in Korea

  • Gina Pugliese, Martin S. Favero
  • Published online by Cambridge University Press:
    02 January 2015, p. 756
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Letters to the Editor

  • Déjà Vu … All Over Again? The Importance of Instrument Drying

  • Lawrence F. Muscarella
  • Published online by Cambridge University Press:
    02 January 2015, pp. 628-629
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Books Received

Medical News

  • Reducing IV Device-Associated Infections

  • Gina Pugliese, Martin S. Favero
  • Published online by Cambridge University Press:
    02 January 2015, p. 448
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Letters to the Editor

Medical News

  • Triclosan and Antibiotic Resistance in S aureus

  • Gina Pugliese, Martin S. Favero
  • Published online by Cambridge University Press:
    02 January 2015, p. 629
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Editorial

  • Help Wanted

  • Published online by Cambridge University Press:
    02 January 2015, pp. 757-759
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  • editorial

  • Robert P. Gaynes
  • Published online by Cambridge University Press:
    02 January 2015, pp. 184-185
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Original Articles

  • Pharmacodynamic Modeling of Risk Factors for Ciprofloxacin Resistance in Pseudomonas aeruginosa

  • Judith M. Hyatt, Jerome J. Schentag
  • Published online by Cambridge University Press:
    02 January 2015, pp. S9-S11
  • Objective:

    To determine risk factors for ciprofloxacin resistance in Pseudomonas aeruginosa.

    Methods:

    Patients with cultures (any site) positive for P aeruginosa, susceptible to ciprofloxacin, between January 1993 and December 1996 were identified using a computerized database. Factors predictive of emergence of ciprofloxacin resistance in P aeruginosa strains isolated from the same cultured site, within 21 days of the initial culture, were determined. Factors considered included length of stay prior to initial P aeruginosa culture, isolation site, initial minimum inhibitory concentration (MIC), antibiotic area under the 24-hour concentration curve (AUC24), total area under the 24-hour inhibitory concentration curve ([AUIC24] AUC24/MIC summed for all active drugs), antibiotic(s) used as dichotomous variables (yes/no), and use of monotherapy or combination therapy.

    Results:

    Of 635 patients, 43 (7%) subsequently had ciprofloxacin-resistant P aeruginosa isolated. Four significantly differing patient groups were identified: group 1, P aeruginosa isolates from all sites other than the respiratory tract, treated with any drugs; group 2, respiratory tract isolates treated with drugs other than ciprofloxacin; group 3, respiratory tract isolates treated with ciprofloxacin at AUIC24 > 110 (μg·h/mL)/μg/mL; and group 4, respiratory tract isolates treated with ciprofloxacin at AUIC24 ≤110 (μg·h/mL)/μg/mL. The observed percentage resistant was a continuous function of prior length of stay in all four groups. Respiratory tract isolates had higher rates of ciprofloxacin resistance (12%) than isolates from other infection sites (4%). Respiratory tract isolates exposed to ciprofloxacin at AUIC24 ≤110 (μg·h/mL)/μg/mL had the highest resistance (17%). At AUIC24 >110 (μg·h/mL)/μg/mL, resistance was decreased to 11%, a rate similar to that seen in respiratory isolates not exposed to ciprofloxacin (7%).

    Conclusions:

    Application of pharmacokinetic and pharmacodynamic principles to dosing of ciprofloxacin may reduce the risk of ciprofloxacin resistance to the level seen in isolates exposed to other agents.

Letters to the Editor

Medical News

  • Management of Ventilator-Associated Pneumonia

  • Gina Pugliese, Martin S. Favero
  • Published online by Cambridge University Press:
    02 January 2015, p. 370
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Original Articles

  • Increasing Pneumococcal Vaccination Rates Among Residents of Long-Term–Care Facilities: Provider-Based Improvement Strategies Implemented by Peer-Review Organizations in Four Western States

  • Kurt B. Stevenson, John W. McMahon, Sr, Jan Harris, J. Richard Hillman, Steven D. Helgerson
  • Published online by Cambridge University Press:
    02 January 2015, pp. 705-710
  • Objective:

    To evaluate collaborative efforts and intervention strategies by peer-review organizations (PROs) and long-term-care facilities (LTCFs) for improving pneumococcal vaccination rates among residents of LTCFs.

    Design:

    Prospective, before-after quality improvement project.

    Setting:

    133 LTCFs in Alaska, Idaho, Montana, and Wyoming.

    Patients:

    All residents of participating LTCFs.

    Methods:

    Baseline pneumococcal vaccination rates were determined by medical-record review, self-reporting by patient or family members, and review of Medicare claims information. Remeasurement of vaccination rates was accomplished from documentation of vaccination of eligible residents by each LTCF.

    Results:

    133 LTCFs with 7,623 residents from Alaska, Idaho, Montana, and Wyoming participated in this quality-improvement project. This accounted for 41% (133/321) of the potential nursing homes and resident population in the participating states. Baseline overall vaccination rates were 40% (3,050/7,589). The overall vaccination rate improved to 75% (5,720/7,623, P<.001). The number of facilities meeting the Healthy People 2000 vaccination goal of 80% improved from 18% (24/133) to 62% (83/133, P<.001). Initial use of chart stickers and implementation of standing orders led to similar increases in vaccination rates, but the standing-order strategy required commitment of fewer PRO resources at a statewide level. Remeasurement of vaccination rates in a subset of participating Idaho LTCFs 1 year after initial vaccination efforts demonstrated a sustained vaccination rate of 70% in facilities enforcing a standing-order policy.

    Conclusions:

    Simple and straightforward vaccination strategies implemented in LTCFs over a short period of time can have a significant impact on vaccination rates. Collaborative efforts between state PROs and LTCFs enhance implementation of these strategies and can result in the achievement of national vaccination objectives. Standing orders appear to be one intervention effective in sustaining successful vaccination efforts. Regardless of the specific interventions employed, PROs played a significant role in facilitating vaccination program development and intervention implementation.

Letters to the Editor

Centers for Disease Control and Prevention

  • 4th Decennial International Conference on Nosocomial and Healthcare-Associated Infections

  • Published online by Cambridge University Press:
    02 January 2015, pp. 86-165
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From the Risk and Prevention Conference

Reviews

  • Scheduled Replacement of Central Venous Catheters Is Not Necessary

  • Jean-François Timsit
  • Published online by Cambridge University Press:
    02 January 2015, pp. 371-374

  • Although half of intensivists routinely replace their central venous catheters (CVCs), this practice is not supported by data from randomized control studies or by pathophysiology of CVC infection. The daily risk of CVC infection is considered to be a constant; the risk of catheter infection is directly related to the duration of catheter insertion. Consequently, the routine change of the catheter is able to decrease the number of infections per catheter but not to modify the number of infections per day of catheter insertion. This assertion is supported by evidence-based medicine: scheduled replacement every 3 or 7 days has not been shown to alter the infectious risks of CVCs in randomized studies or a meta-analysis.

    Moreover, routine replacement at a new site exposes the patient to an increased risk of mechanical complications. The overall rate of mechanical complications per catheter inserted is approximately 3%. Guidewire exchange of the catheters may reduce the risk of mechanical complications, but unfortunately is associated with a higher rate of catheter colonization and catheter-related bacteremia. Routine replacement of CVCs is not necessary.

Page 2 of 20