An Outbreak Due to MultiresistantAcinetobacter baumanniiin a Burn Unit: Risk Factors for Acquisition and Management

2002 ◽  
Vol 23 (5) ◽  
pp. 261-267 ◽  
Author(s):  
Andrew E. Simor ◽  
Mark Lee ◽  
Mary Vearncombe ◽  
Linda Jones-Paul ◽  
Clare Barry ◽  
...  
Keyword(s):  
Risk Factors ◽  
Hand Hygiene ◽  
Tertiary Care ◽  
Healthcare Providers ◽  
Significant Risk ◽  
Hospital Environment ◽  
Resistant Bacteria ◽  
Environmental Cleaning ◽  
Burn Unit ◽  
Temporary Closure

Objectives:To describe the investigation and management of an outbreak due to multiresistantAcinetobacter baumanniiand to determine risk factors for acquisition of the organism.Setting:A 14-bed regional burn unit in a Canadian tertiary-care teaching hospital.Design:Case-control study with multivariate analysis of potential risk factors using logistic regression analysis. Surveillance cultures were obtained from the hospital environment, from noninfected patients, and from healthcare providers.Results:A total of 31 (13%) of 247 patients with acute burn injuries acquired multiresistantA. baumanniibetween December 1998 and March 2000; 18 (58%) of the patients were infected. The organism was recovered from the hospital environment and the hands of healthcare providers. Significant risk factors for acquisition of multiresistantA. baumanniiwere receipt of blood products (odds ratio [OR], 10.8; 95% confidence interval [CI95], 3.4 to 34.4;P< .001); procedures performed in the hydrotherapy room (OR, 4.1; CI95, 1.3 to 13.1;P= .02); and increased duration of mechanical ventilation (OR, 1.1 per day; CI95, 1.0 to 1.1;P=. 02).Interventions:Improved compliance with hand hygiene, strict patient isolation, meticulous environmental cleaning, and temporary closure of the unit to new admissions.Conclusions:Acquisition of multiresistantA. baumanniiwas likely multifactorial, related to environmental contamination and contact with transiently colonized healthcare providers. Control measures addressing these potential sources of multiresistantA. baumanniiwere successful in terminating the outbreak. Ongoing surveillance and continued attention to hand hygiene and adequate environmental cleaning are essential to prevent recurrent outbreaks due to antibiotic-resistant bacteria in burn units.

Reduction in Nosocomial Transmission of Drug-Resistant Bacteria After Introduction of an Alcohol-Based Handrub

2005 ◽  
Vol 26 (7) ◽  
pp. 650-653 ◽  
Author(s):  
Fred M. Gordin ◽  
Maureen E. Schultz ◽  
Ruth A Huber ◽  
Janet A. Gill
Keyword(s):  
Hand Hygiene ◽  
Inner City ◽  
Medical Center ◽  
Tertiary Care ◽  
Hospital Environment ◽  
Resistant Bacteria ◽  
Drug Resistant ◽  
Drug Resistant Bacteria ◽  
Tertiary Care Medical Center ◽  
Vancomycin Resistant

AbstractObjective:To assess quantitatively the clinical impact of using an alcohol-based handrub (ABHR) in the hospital environment, measuring impact as the incidence of new, nosocomial isolates of drug-resistant organisms.Design:An observational survey from 1998 to 2003 comparing the first 3 years of no ABHR use with the 3 years following, when an ABHR was provided for hand hygiene.Setting:An inner-city, tertiary-care medical center.Intervention:At baseline, an antimicrobial soap with 0.3% triclosan was provided for staff hand hygiene. The intervention was placement in all inpatient and all outpatient clinic rooms of wall-mounted dispensers of an ABHR with 62.5% ethyl alcohol. Data were collected on change in the incidence of three drug-resistant bacteria.Results:During the 6 years of the survey, all new, nosocomially acquired isolates of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Clostridium difficile-associated diarrhea were recorded. On comparison of the first 3 years with the final 3 years, there was a 21% decrease in new, nosocomially acquired MRSA (90 to 71 isolates per year; P = .01) and a 41% decrease in VRE (41 to 24 isolates per year; P < .001). The incidence of new isolates of C. difficile was essentially unchanged.Conclusion:In the 3 years following implementation of an ABHR, this hospital experienced the value of reductions in the incidence of nosocomially acquired drug-resistant bacteria. These reductions provide clinical validation of the recent CDC recommendation that ABHRs be the primary choice for hand decontamination. (Infect Control Hosp Epidemiol 2005;26:650-653)

Risk Factors for Central Venous Catheter–Associated Bloodstream Infection in Pediatric Patients: A Cohort Study

2016 ◽  
Vol 37 (8) ◽  
pp. 939-945 ◽  
Author(s):  
Jillian Hansen Carter ◽  
Joanne Marie Langley ◽  
Stefan Kuhle ◽  
Susan Kirkland
Keyword(s):  
Risk Factors ◽  
Cohort Study ◽  
Hand Hygiene ◽  
Bloodstream Infection ◽  
Tertiary Care ◽  
Cox Proportional Hazards ◽  
Infection Prevention And Control ◽  
Temporal Association ◽  
Central Venous ◽  
Over Time

OBJECTIVETo examine the incidence of central-line–associated bloodstream infection (CLABSI) over time and to determine risk factors for CLABSI in hospitalized children.DESIGNProspective cohort study.SETTINGPediatric tertiary care referral center in Halifax, Nova Scotia, serving a population of 2.3 million.PARTICIPANTSPatients ages 0–18 years with central venous catheters (CVCs) inserted at this facility between 1995 and 2013.METHODSParticipants were followed from CVC insertion to CLABSI event or until CVC removal. Data were prospectively collected by clinicians, infection prevention and control staff, and nursing staff for the purposes of patient care, surveillance, and quality improvement. Cox proportional hazards regression was used to identify risk factors for CLABSI.RESULTSAmong 5,648 patients, 385 developed CLABSI (0.74 CLABSI per 1,000 line days; or 3.87 per 1,000 in-hospital line days). Most infections occurred within 60 days of insertion. CLABSI rates decreased from 4.87 per 1,000 in-hospital line days in 1995 to 0.78 per 1,000 in-hospital line days in 2013, corresponding to an 84% reduction. A temporal association of CLABSI reduction with a hand hygiene promotion campaign was identified. CVC type, number of lumens, dressing type, insertion vein, and being in the critical care unit were statistically significantly associated with CLABSI.CONCLUSIONSHospital-wide surveillance over an 18-year period identified children at highest risk for CLABSI and decreasing risk over time; this decrease was temporally associated with a hand hygiene campaign.Infect Control Hosp Epidemiol 2016;37:939–945

scholarly journals Vancomycin-resistance Enterococcal Colonization in Hospitalized Patients in Relation to Antibiotic Usage in a Tertiary Care Hospital of North India

2015 ◽  
Vol 7 (02) ◽  
pp. 108-111 ◽  
Author(s):  
Tuhina Banerjee ◽  
Shampa Anupurba ◽  
Joel Filgona ◽  
Dinesh K Singh
Keyword(s):  
Risk Factors ◽  
Multivariate Analysis ◽  
Tertiary Care ◽  
Significant Risk ◽  
Antibiotic Use ◽  
Antibiotic Usage ◽  
Hospitalized Patients ◽  
University Hospital ◽  
North India ◽  
Care Hospital

ABSTRACT Background: Alarming rise of vancomycin-resistant enterococci (VRE) is a global cause of concern. Several factors have been held responsible for such rise, of which antibiotic usage is a prominent one. Objectives: This study was undertaken to determine the intestinal VRE colonization rate amongst hospitalized patients in relation to use of various antibiotics in the Intensive Care Unit (ICU) of a tertiary care university hospital, India. Materials and Methods: Stool samples were collected weekly from all the patients in the adult ICU for a period of 6 months and processed for isolation and phenotypic and genotypic characterization of VRE isolates. Patient and treatment details were noted and cases (those with VRE in stool) and controls (those without VRE in stool) were compared statistically. Further, a multivariate analysis was done to identify those antibiotics as independent risk factors for VRE colonization. Results: VRE colonization was found in 34.56% (28/81) of the patients studied, with the majority 75% (21/28) carrying the vanA gene. The cases had significantly more (P < 0.05) duration of hospital stay and antibiotic exposure. Intake of metronidazole, vancomycin, and piperacillin-tazobactam were identified as significant risk factors both in univariate and multivariate analysis. Conclusion: A potential reservoir of VRE was thus revealed even in low VRE prevalence setting. Based on this high colonization status, restriction of empirical antibiotic use, reviewing of the ongoing antibiotic policy, and active VRE surveillance as an integral part of infection control strategy were suggested.

scholarly journals MALNUTRITION, SEPSIS AND TUMOR LYSIS SYNDROME ARE ASSOCIATED WITH INCREASED RATE OF ACUTE MORTALITY IN MATURE B CELL NON-HODGKIN LYMPHOMA IN PEDIATRIC POPULATION- STUDY FROM TERTIARY CARE HOSPITAL IN PAKISTAN

2019 ◽  
Vol 11 (1) ◽  
pp. 02019043
Author(s):  
Raheela Mansoor
Keyword(s):  
Risk Factors ◽  
Fungal Infection ◽  
B Cell ◽  
Pediatric Population ◽  
Tertiary Care ◽  
Tumor Lysis Syndrome ◽  
Significant Risk ◽  
Early Death ◽  
Care Hospital ◽  
Tumor Lysis

Background:            Outcomes of pediatric mature B cell NHL in resource challenged countries are negatively affected by increased rate of early and toxic deaths. Aim of this study is to assess rate of acute mortality and define significant risk factors present in children with mature B Cell NHL. Methods: A retrospective analysis was done of patients with B cell NHL from January 2012 till December 2016. Risk factors studied for acute mortality were malnutrition, stage, prior surgery with open laparotomy, LDH levels, tumor lysis syndrome, sepsis and fungal infection Results: Total 233 patients were enrolled in the study. Eighty five (36.4%) were below 15th percentile.  Treatment was started in 226 patients. Eighty eight percent children showed 20% response after COP pre-phase. Tumor lysis syndrome was developed in 20.6 % (n = 48) children and 42.9% (n = 100) patients had sepsis, 71/100 patients had culture proven sepsis. 19.7% (n = 46) patients developed fungal infection. There was 19.7% (n = 46) acute mortality.  Most common cause of death was sepsis (n = 22, 47.8%) followed by acute renal failure secondary to tumor lysis syndrome. On multivariate analysis, three independent variables found significant for early death are malnutrition, sepsis and tumor lysis syndrome. Conclusion: Rate of acute mortality in B cell NHL is high in our set up and significant risk factors are tumor lysis syndrome, sepsis and malnourishment at time of presentation.

Challenging the Current Treatment Paradigm for Methicillin-Resistant Staphylococcus Epidermidis Peritonitis in Peritoneal Dialysis Patients

2002 ◽  
Vol 22 (3) ◽  
pp. 335-338 ◽  
Author(s):  
Robert E. Ariano ◽  
Christine Franczuk ◽  
Adrian Fine ◽  
Godfrey K.M. Harding ◽  
Sheryl A. Zelenitsky
Keyword(s):  
Risk Factors ◽  
Peritoneal Dialysis ◽  
Staphylococcus Epidermidis ◽  
Methicillin Resistance ◽  
Tertiary Care ◽  
Significant Risk ◽  
Response Rates ◽  
Care Hospital ◽  
Clinical Failure ◽  
Empiric Treatment

Objectives To analyze clinical outcomes of Staphylococcus epidermidis peritoneal dialysis peritonitis before and after an interventional switch from a vancomycin/tobramycin to a cefazolin/tobramycin regimen for empiric treatment. To examine risk factors associated with clinical failure. Design A retrospective study. Setting A peritoneal dialysis program within a university-affiliated tertiary-care hospital. Patients 93 episodes of S. epidermidis peritonitis over a 6-year period. Interventions Clinical responses were compared between treatments using chi-square or Fisher's exact test. Univariate and multivariate analyses were used to identify significant risk factors for clinical failure. Measurements and Main Results There was no difference in the overall response rates observed with vancomycin (40/49; 81.6%) and cefazolin (23/29; 79.3%) regimens for episodes of S. epidermidis peritonitis. Furthermore, the presence of methicillin resistance in 63 of 93 cases (67.7%) had no influence on clinical outcome, with response rates of 83.9% (26/31) and 82.4% (14/17) for empiric vancomycin and cefazolin regimens, respectively. Tobramycin therapy of less than 2 days was an independent risk factor for clinical failure in multivariate logistic regression analysis (odds ratio 4.44, 95% confidence interval 1.28 – 15.48; p = 0.02). Conclusions Empiric treatment with intraperitoneal cefazolin was as effective as vancomycin for S. epidermidis peritonitis despite a high prevalence of methicillin resistance. Tobramycin therapy of less than 2 days was strongly associated with treatment failure.

scholarly journals Risk factors for infection with multidrug-resistant bacteria in non-ventilated patients with hospital-acquired pneumonia

2013 ◽  
Vol 39 (3) ◽  
pp. 339-348 ◽  
Author(s):  
Renato Seligman ◽  
Luis Francisco Ramos-Lima ◽  
Vivian do Amaral Oliveira ◽  
Carina Sanvicente ◽  
Juliana Sartori ◽  
...  
Keyword(s):  
Risk Factors ◽  
Independent Predictor ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Multidrug Resistant ◽  
Categorical Variables ◽  
Resistant Bacteria ◽  
Hospital Acquired Pneumonia ◽  
Hospital Acquired ◽  
Ventilated Patients

OBJECTIVE: To identify risk factors for the development of hospital-acquired pneumonia (HAP) caused by multidrug-resistant (MDR) bacteria in non-ventilated patients. METHODS: This was a retrospective observational cohort study conducted over a three-year period at a tertiary-care teaching hospital. We included only non-ventilated patients diagnosed with HAP and presenting with positive bacterial cultures. Categorical variables were compared with chi-square test. Logistic regression analysis was used to determine risk factors for HAP caused by MDR bacteria. RESULTS: Of the 140 patients diagnosed with HAP, 59 (42.1%) were infected with MDR strains. Among the patients infected with methicillin-resistant Staphylococcus aureus and those infected with methicillin-susceptible S. aureus, mortality was 45.9% and 50.0%, respectively (p = 0.763). Among the patients infected with MDR and those infected with non-MDR gram-negative bacilli, mortality was 45.8% and 38.3%, respectively (p = 0.527). Univariate analysis identified the following risk factors for infection with MDR bacteria: COPD; congestive heart failure; chronic renal failure; dialysis; urinary catheterization; extrapulmonary infection; and use of antimicrobial therapy within the last 10 days before the diagnosis of HAP. Multivariate analysis showed that the use of antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria (OR = 3.45; 95% CI: 1.56-7.61; p = 0.002). CONCLUSIONS: In this single-center study, the use of broad-spectrum antibiotics within the last 10 days before the diagnosis of HAP was the only independent predictor of infection with MDR bacteria in non-ventilated patients with HAP.

scholarly journals Effectiveness of Hand Hygiene Video cum Demonstration on Knowledge and Practice, among Mothers of Neonates Admitted in NICU

2021 ◽  
Vol 10 (33) ◽  
pp. 2799-2802
Author(s):  
Sangithaa Varsha G. ◽  
Geetha D ◽  
Anita David
Keyword(s):  
Intensive Care ◽  
Hand Hygiene ◽  
Neonatal Intensive Care ◽  
Tertiary Care ◽  
Hospital Environment ◽  
Control Group ◽  
Study Group ◽  
Care Hospital ◽  
Post Test ◽  
Knowledge And Practice

BACKGROUND Proper hand hygiene is the single most important, simplest, and least expensive means of reducing the prevalence of health care association infection (HAIs) and nosocomial infection. Several studies have demonstrated that hand washing virtually eradicates the carriage of infections in intensive care units (ICUs). For more than 150 years, hand hygiene has been researched in the hospital environment as a way of preventing transmission of bacteria, infection and death. The purpose of this study was to import the significance of the hand hygiene and to improve the skills in performing hand hygiene among mothers of neonates admitted in neonatal intensive care unit (NICU) at tertiary care hospital. METHODS A self structured knowledge questionnaire (KQ), practice questionnaire (PQ) and practice checklist (PC) was administered. The one to one method video on hand hygiene was played by using a laptop for about 15 minutes as an intervention with demonstration done by investigator and return demonstration was done by mothers, post test was conducted on 3rd day and 5th day followed by the intervention. RESULTS The mean scores of knowledge showed improvement in post test than the pre test in both the groups, but there was an increase in practice mean score between the groups which showed an improvement in the study group, it was higher than the control group which was statistically significant at P < 0.001. Overall, there were minimal positive correlations between the level of knowledge and practice for the study group in post-test and post-test II. Minimum positive correlation was evident but there was no significance. CONCLUSIONS This study concludes that it enhanced the knowledge on hand hygiene among mothers of neonates and it helped mothers to understand the importance of hand hygiene, when to do, how to do, why to do. Thus, it expected directly or indirectly to reduce the infection rate among neonates admitted in NICU. Further, the nurses have a great responsibility in ensuring parents adherence to hand hygiene. KEY WORDS Mothers of Neonate in NICU, Hand Hygiene, Video cum Demonstration, Mothers KPC.

scholarly journals AN OBSERVATIONAL STUDY OF CESAREAN TRENDS AT A TEACHING HOSPITAL IN PUNJAB

2021 ◽  
pp. 109-113
Author(s):  
SUPARNA GROVER ◽  
SUNITA MEENA ◽  
AJAY CHHABRA
Keyword(s):  
Risk Factors ◽  
Observational Study ◽  
Caesarean Delivery ◽  
Prospective Observational Study ◽  
Tertiary Care ◽  
Significant Risk ◽  
Medical College ◽  
Government Hospitals ◽  
Patient Groups ◽  
Group 5

Objectives: The objective of the study was to study the indications and risk factors for caesarean section (CS) and to study the caesarean rates in various patient groups as per Robson’s classification. Methods: This prospective observational study was conducted at Government Medical College Amritsar over a period of six months. All the patients admitted for delivery beyond 22 weeks were allotted to Robson groups on admission and the indications of all CS were recorded. The data collected were tabulated and analyzed statistically. Results: There were 553 deliveries in the study period, of which there were 241 CS amounting to a caesarean rate of 43.6%. Nulliparity, previous caesarean delivery and malpresentation were significant risk factors for CS but induction of labor was not associated with increased probability of caesarean delivery. Previous caesarean delivery was the most common indication of CS followed by foetal distress. Among Robson groups, group 10 had the biggest group size and biggest contribution to cesarean rates followed by group 5. Conclusion: Tertiary care government hospitals have a higher cesarean rates due to referral of high-risk pregnancies. Increasing the rates of trial of labour after caesarean is one of the interventions that may serve to decrease the caesarean rates in such institutions.

scholarly journals Risk factors for post-partum hemorrhage in patients who underwent operative vaginal delivery in a tertiary care center

2021 ◽  
Author(s):  
Gayatri Devi Sivasambu ◽  
Sujani B. Kempaiah ◽  
Urvashi Thukral
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Vaginal Delivery ◽  
Post Partum ◽  
Tertiary Care ◽  
Significant Risk ◽  
Post Partum Hemorrhage ◽  
Second Stage ◽  
Operative Vaginal Delivery ◽  
Vaginal Deliveries

Background: Operative vaginal delivery is a timely intervention to cut short second stage labor when imminent delivery is in the interests of mother, fetus, or both. It reduces second stage cesarean section morbidity and uterine scar and its influence on future obstetric career. The possible structural neonatal adverse outcomes due to operative vaginal delivery are well quantified. However, its effects on maternal outcome need to be understood better. In this paper, we study the effect of operative vaginal delivery on maternal post-partum hemorrhage (PPH) and the associated risk factors.Methods: It was a retrospective study carried out for the period July 2016 to July 2020 at Ramaiah Medical College, Bengaluru. Total number of vaginal deliveries in this period were 6318. Out of these, 1020 patients underwent assisted vaginal delivery using vacuum/ forceps/ sequential use of instrument. Blood loss greater than 500 ml is considered PPH for the purpose of this study. 15% of the study population was noted to have PPH. We employ a multivariate logistic regression to identify statistically significant risk factors for PPH in women undergoing operative vaginal delivery.Results: The logistic regression model identifies multiparity, maternal age, neonatal birth weight more than 3.5 kg, application of forceps in women with hypertensive disorders, III-degree tear, cervical tear to significantly increase the risk of PPH in our study population.Conclusions: Certain factors seem to increase the risk of PPH in operative vaginal delivery. The risks and benefits must be weighed properly before use of instruments.

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