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Volume 26 - September 2005

Contents

Page 1 of 10

Announcement

Editorial

  • Double, Double, Toil and Trouble Infections Still Spreading in Long-Term–Care Facilities

  • Suzanne F. Bradley
  • Published online by Cambridge University Press:
    21 June 2016, pp. 227-230
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Letters to the Editor

Editorial

  • Air, Hair, Knees, Nose

  • James T. Lee
  • Published online by Cambridge University Press:
    21 June 2016, pp. 900-902
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  • The Next Battleground for Patient Safety: Influenza Immunization of Healthcare Workers

  • Christopher J. Hoffmann, Trish M. Perl
  • Published online by Cambridge University Press:
    21 June 2016, pp. 850-851
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Letters to the Editor

  • Contamination of Guidewires During Insertion of Central Venous Catheters in an Intensive Care Setting

  • Susanah Palmer, Thomas Solano
  • Published online by Cambridge University Press:
    21 June 2016, pp. 506-507
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Editorial

  • Clostridium difficile: Responding to a New Threat From an Old Enemy

  • L. Clifford McDonald
  • Published online by Cambridge University Press:
    21 June 2016, pp. 672-675
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Other

Editorial

  • Healthcare Behaviors and Risky Business First, Do No Harm

  • David K. Henderson
  • Published online by Cambridge University Press:
    21 June 2016, pp. 739-744
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Letters to the Editor

Editorial

  • Of Models and Methods: Our Analytic Armamentarium Applied to Methicillin-Resistant Staphylococcus aureus

  • Published online by Cambridge University Press:
    21 June 2016, pp. 594-597
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Letters to the Editor

Original Articles

  • Standardized Infection Surveillance in Long-Term Care Interfacility Comparisons From a Regional Cohort of Facilities

  • Kurt B. Stevenson, James Moore, Holly Colwell, Barbara Sleeper
  • Published online by Cambridge University Press:
    21 June 2016, pp. 231-238
  • Objectives:

    To measure infection rates in a regional cohort of long-term-care facilities (LTCFs) using standard surveillance methods and to analyze different methods for interfacility comparisons.

    Setting:

    Seventeen LTCFs in Idaho.

    Design:

    Prospective, active surveillance for LTCF-acquired infections using standard definitions and case-finding methods was conducted from July 2001 to June 2002. All surveillance data were combined and individual facility performance was compared with the aggregate employing a variety of statistical and graphic methods.

    Results:

    The surveillance data set consisted of 472,019 resident-days of care with 1,717 total infections for a pooled mean rate of 3.64 infections per 1,000 resident-days. Specific infections included respiratory (828; rate, 1.75), skin and soft tissue (520; rate, 1.10), urinary tract (282; rate, 0.60), gastrointestinal (77; rate, 0.16), unexplained febrile illnesses (6; rate, 0.01), and bloodstream (4; rate, 0.01). Initially, methods adopted from the National Nosocomial Infections Surveillance System were used comparing individual rates with pooled means and percentiles of distribution. A more sensitive method appeared to be detecting statistically significant deviations (based on chi-square analysis) of the individual facility rates from the aggregate of all other facilities. One promising method employed statistical process control charts (U charts) adjusted to compare individual rates with aggregate monthly rates, providing simultaneous visual and statistical comparisons. Small multiples graphs were useful in providing images valid for rapid concurrent comparison of all facilities.

    Conclusion:

    Interfacility comparisons have been demonstrated to be valuable for hospital infection control programs, but have not been studied extensively in LTCFs.

Letter to the Editor

  • Caution Should Be Exercised When Using the Standardized Infection Ratio

  • Miguel Delgado-Rodríguez, Javier Llorca
  • Published online by Cambridge University Press:
    21 June 2016, pp. 8-9
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Original Articles

  • Use of Stochastic Epidemic Modeling to Quantify Transmission Rates of Colonization With Methicillin-Resistant Staphylococcus Aureus in an Intensive Care Unit

  • Marie Forrester, Anthony N. Pettitt
  • Published online by Cambridge University Press:
    21 June 2016, pp. 598-606
  • Objective:

    To consider statistical methods for estimating transmission rates for colonization of patients with methicillin-resistant Staphylococcus aureus (MRSA) in an intensive care unit (ICU) from three different sources: background contamination, non-isolated patients, and isolated patients.

    Methods:

    We developed statistical methods that allowed for the analysis of interval-censored, routine surveillance data and extended the general epidemic model for the flow of patients through the ICU.

    Results:

    Within this ICU, the rate of transmission to susceptible patients from a background source of MRSA (0.0092 case per day; 95% confidence interval [CI95], 0.0062–0.0126) is approximately double the rate of transmission from a non-isolated patient (0.0052 case per day; CI95, 0.0013–0.0096) and six times the rate of transmission from an isolated patient (0.0015 case per day; CI95, 0.0001–0.0043). We used the methodology to investigate whether transmission rates vary with workload.

    Conclusion:

    Our methodology has general application to infection by and transmission of pathogens in a hospital setting and is appropriate for quantifying the effect of infection control interventions. (Infect Control Hosp Epidemiol 2005;26:598-606)

Letters to the Editor

Editorial

  • Infections in Long-Term-Care Facilities: Screen or Clean?

  • Chesley L. Richards, Jr.
  • Published online by Cambridge University Press:
    21 June 2016, pp. 800-801
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Orginal Article

  • Preoperative Low Molecular Weight Heparin as Venous Thromboembolism Prophylaxis in Patients at Risk for Prosthetic Infection After Knee Arthroplasty

  • Angel Asensio, Antonio Ramos, Elena Múñez, José L. Vilanova, Pedro Torrijos, Fernando J. Garcia
  • Published online by Cambridge University Press:
    21 June 2016, pp. 903-909
  • Objective:

    To investigate the effect of preoperative initiation of low molecular weight heparin as prophylaxis for deep venous thrombosis in patients at risk of developing surgical-site infections after knee arthroplasty.

    Design:

    Case–control study nested in a cohort. The incidence of surgical-site infection in the cohort was calculated. With the use of data extracted from medical histories and after adjustment for other risk factors, the effect of preoperative heparinization on the risk of incisional and prosthetic infection among case-patients and control-patients (1:3 ratio) was assessed.

    Setting:

    Orthopedic department in a tertiary-care referral hospital.

    Patients:

    A cohort of 160 consecutive patients who had received prosthetic knee implants between October 1, 2001, and November 30, 2003.

    Results:

    Eighteen patients with surgical-site infections were identified, yielding an incidence of incisional and prosthetic infection of 6.9 (95% confidence interval [CI95], 3.5 to 12.0) and 4.4 (CI95,1.8 to 8.8) cases per 100 patients undergoing surgery, respectively. Surgical-site infection was associated with preoperative use of low molecular weight heparin (odds ratio [OR], 6.2 after adjustment for medical and surgical factors; CI95, 1.5 to 23). Prosthetic infection was strongly associated with preoperative use of prophylaxis (OR, undetermined [100% exposure in case-patients vs 35% exposure in control-patients]; P = .002), but incisional surgical-site infection was not.

    Conclusion:

    The use of low molecular weight heparins immediately before knee arthroplasty as prophylaxis for deep venous thrombosis should be questioned because of probable increased risk of prosthetic infection.

Letters to the Editor

Page 1 of 10