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F Daschner

Publications and source records attributed to F Daschner.

At least 37 records · Page 2Linked to original sources
PubMed2002

[Surveillance of postoperative wound infections: reference data of the Hospital Infection Surveillance System (KISS)].

BACKGROUND: Surgical site infections (SSI), the third-most-frequent nosocomial infection, are a problem in all fields of surgery. Assessing the level of one's own infection rates is often difficult, since there have been no suitable comparative data available in Germany in the past due to the lack of a uniform method of determining these rates. METHODS: Based on an American model, the Hospital Infection Surveillance System (KISS) has been carrying out a standard recording of SSI since 1997 in meanwhile 132 surgical departments of 89 hospitals. Specially trained hygiene personnel record SSI according to CDC definitions in selected indicator operations. RESULTS: Since January 1997, 1,549 SSI have been recorded in 71,038 operations using 13 different surgical techniques. The risk-ratified SSI rates for each of these surgical techniques are provided and can serve as orientational data for other departments. CONCLUSION: The KISS reference data can help in assessing one's own SSI rates. A prerequisite is surveillance according to the KISS protocol.

Confidence Intervals↗
PubMed2001

[Compliance with hand hygiene in intensive care units].

INTRODUCTION: Nosocomial infections are an important problem in modern hospitals. The prevalence in German intensive care units is 15.3%. Hand washing or hand disinfection is believed to be the most important means of preventing nosocomial infections. We wished to answer the following questions: 1. How good is the compliance of hand hygiene on intensive care units? 2. Is compliance associated with the patient/nurse-ratio? METHOD: In a study of 8 intensive care units the compliance of hand hygiene was observed on two occasions, once in May 1996 and again in November 1997. The prime necessity for hand disinfection occurred when handling ventilation devices, intravascular catheters, urinary catheters and dressings. In addition the patient/nurse-ratio was calculated. RESULTS: A total of 1,879 infection-relevant handlings were observed. The compliance of hand hygiene ranged from 25.7 to 83.2% (mean 55.2%). The most commonly observed handlings were the manipulation of venous catheters (52.7%), the highest compliance was observed with the manipulation of ventilation equipment (91.8%). With a better patient nurse ratio the compliance did not improve but remained the same or was even reduced. DISCUSSION: The compliance of hand disinfection is similar to other study results, but on some intensive care units there was considerable room for improvement. In this study the compliance of hand hygiene is more of a constant factor in individual intensive care units than associated with the patient/nurse-ratio.

Attitude of Health Personnel↗
PubMed2001

Surveillance of nosocomial infections in a neurology intensive care unit.

To identify overall and site-specific nosocomial infection (NI) rates in patients receiving neurological intensive care therapy, a prospective study was started in 1997 in the ten-bed neurological intensive-care unit (NICU) of the University Hospital of Freiburg, Germany. Case records and microbiology reports were reviewed twice a week, and ward staff were consulted. NI were defined according to the Center for Disease Control and Prevention (CDC) criteria and were categorised by specific infection site. Within 30 months, 505 patients with a total of 4,873 patient days were studied (mean length of stay: 9.6 days). 122 NI were identified in 96 patients (74 patients with one, 18 with two and 4 with three infections. An incidence of 24.2/100 patients and incidence density of 25.0/1,000 patient days of NI in the neurological ICU were documented. Site-specific incidence rates and incidence densities were: 1.4 bloodstream infections per 100 patients (1.9 central line-associated BSIs per 1,000 central line-days), 11.7 pneumonias per 100 patients (20.4 ventilator-associated pneumonias per 1,000 ventilator-days), 8.7 urinary tract infections per 100 patients (10.0 urinary catheter-associated urinary track infections (UTIs) per 1,000 urinary catheter-days). Additionally, 0.4 cases of meningitis, 0.8 ventriculitis, and 1.2 other infections (catheter-related local infection, diarrhea) were documented per 1,000 patient days. 15% of nosocomial pathogens were A. baumannii (due to a outbreak of an nosocomial pneumonia with A. baumannii), 13% S. aureus, 10% E. coli, 7% CNS,7% Bacteroides spp., 7% Enterobacter spp., 6,5% Klebsiella spp.,5.9% enterococci, 5.9% streptococci, and 4.7% Pseudomonas spp. In eight cases of NI no pathogen could be isolated. In future, data on NI in NICUs should be assessed in greater detail, both to improve the quality of care and serve as a basis for identification and implementation of the most effective measures by which to prevent these infections in patients receiving intensive neurological care.

Adolescent↗
PubMed2001

[Prevention of postoperative wound infections. Evidence-based recommendations].

Among all hospitalized patients, surgical site infections (SSI) are the third most frequently hospital-acquired-infection. SSIs remain a substantial cause of morbidity and mortality among surgical patients. This may be partially explained by the emergence of antimicrobial-resistant pathogens and the increased numbers of patients who are elderly and/or have a wide variety of chronic, debilitating, or immunocompromising underlying diseases. This is why it is essential to implement SSI prevention measures. In April 1999 the Centers for Disease Control and Prevention (CDC) presented the "Guideline for Prevention of Surgical Site Infection". The recommendations represent the consensus of the Hospital Infection Control Practices Advisory Committee (HICPAC) regarding strategies for the prevention of SSIs. Whenever possible, the recommendations are based on data from well-designed scientific studies. This guideline is a major step forward and is also essential to optimize the management of surgical patients in Germany.

Age Factors↗
PubMed2001

[Reduction of nosocomial infections by a public health quality management concept in surgical patients. 1: Significant reduction of a high initial rate].

A successful introduction of surveillance of NI and quality circles for prevention of infection was achieved in hospital A. The major requirements therefore are according to our experiences determination of the topics of the quality circles by the participants themselves, interest and engagement for the work of the quality circles and the realization of ideas, support by the hospitals' management, acceptance of this work by the wards, continuous evaluation of the work of the quality circle. Often the most important problem was not identification of weaknesses and creating of possible solutions, but putting the ideas into practice on the wards. This was the case for problems in the field of care as well as in the responsibility of physicians. Altogether a significant 42% reduction of nosocomial infections was achieved.

Cross Infection↗
PubMed2001

[Reduction of nosocomial infections by public health quality management in surgical patients. 2: No reduction in low initial infection rate].

In the framework of a prospective controlled study in surgical and intensive care units of four study and four control hospitals it was tried to set up an infection control quality management concept for reduction of nosocomial infections in hospital D. With an incidence density of 5.4 nosocomial infections per 1,000 patient days the most favorable situation among the four study hospitals was found initially in this hospital. However, after a small decrease of infection rate during the first study year, no benefit of intervention was achieved in this hospital at the end of the study (6.4 nosocomial infections per 1,000 patient days). Possible explanations may be a very small potential for reduction at the beginning, a change of patient mix due to a new head of the department and the phenomenon of the "regression to the mean". Distinct improvements of the situation were achieved on the level of process quality. Meanwhile surveillance of nosocomial infections became an integral part of quality management in this hospital. The quality circle method was not well accepted for the longterm. But the concept of link nurses was introduced successfully.

Cross Infection↗
PubMed2001

Converting incidence and prevalence data of nosocomial infections: results from eight hospitals.

OBJECTIVE: To investigate the use of the formula of Rhame and Sudderth for the interconversion of prevalence and incidence data on the frequency of nosocomial infections. DESIGN: Comparison of observed and calculated incidence data and prevalence data. SETTING: One 8-week incidence investigation in the surgical and intensive care units of eight medium-sized hospitals; three separate point-prevalence studies in the same units. RESULTS: The overall prevalence observed after the three prevalence studies in 2,169 patients was 6.8% (95% confidence interval [CI95], 5.7-8.0). In 2,882 discharged patients observed during the incidence study, the mean hospitalization was 9.8 days; patients with one or more nosocomial infection had a mean hospitalization time of 22.3 days and a mean interval of 8.2 days from admission to the first day of infection. Based on these data, the overall calculated incidence was 4.7%, whereas the observed incidence was 4.3% (CI95, 3.6-5.2). Vice versa, an overall prevalence of 6.2% was found when calculated from the observed incidence data. The incidence data calculated from prevalence data also were within the confidence interval of the incidences observed for urinary tract infections and surgical-site infections. (However, it was not possible to convert the data for two of the eight hospitals.) CONCLUSION: The approximate mathematical relationship between the prevalence and incidence data of nosocomial infection is confirmed by this study. However, although it is theoretically possible, we would not recommend the conversion of prevalence into incidence data or vice versa.

Cross Infection↗
PubMed2001

Surveillance of nosocomial infections in ICUs: is postdischarge surveillance indispensable?

OBJECTIVE: To determine how many infections are missed if the postdischarge surveillance (PDS) follow-up of intensive care unit (ICU) patients that is required by the National Nosocomial Infection Surveillance System method is not done. DESIGN: ICU patients were followed up and surveillance results with PDS (gold standard) and without PDS were compared. SETTING: Surgical or interdisciplinary ICUs in eight German acute-care hospitals. PATIENTS: All 1,857 patients within a 6-month period in the participating ICUs (a total of 9,129 ICU-patient-days). RESULTS: Without PDS, 45 urinary tract infections (UTIs) were diagnosed, compared with 53 with PDS; thus, 15% of the UTIs were missed if no postdischarge follow-up was performed. Three nosocomial pneumonias (4%) and one bloodstream infection (8%) also were missed if surveillance was carried out without PDS. A total of 198 nosocomial infections (NIs) were recorded with PDS, compared to 175 NIs without PDS. Approximately 12% of all ICU-associated NIs were missed if no follow-up was done. CONCLUSIONS: Since it is very time-consuming to follow patients after their transfer from the ICU, we do not perform a postdischarge follow-up of patients in the course of routine surveillance.

Cross Infection↗
PubMed2001

Cost efficacy of tazobactam/piperacillin versus imipenem/cilastatin in the treatment of intra-abdominal infection.

OBJECTIVE: To compare the cost, efficacy and cost efficacy of tazobactam/piperacillin and imipenem/cilastatin in the treatment of intra-abdominal infection. DESIGN: The analysis was retrospective and based on a decision tree. Effectiveness data were obtained from 19 published clinical trials. Direct costs were quantified per patient from the time the decision was made to administer the antibacterial to the end of the first course of treatment or the end of a subsequent course of treatment, if required. The primary end-point was the cost per successfully treated patient. The cost per life saved was also analysed. Various follow-up times were taken into account. PERSPECTIVE: German National Health Insurance funds. STUDY POPULATION: 1744 patients with intra-abdominal infection. INTERVENTIONS: Tazobactam/piperacillin (total daily dosage of 13.5 g/day) and imipenem/cilastatin (total daily dosage of 1.5 to 4 g/day). The mean duration of treatment varied from 5.5 to 8.2 days for tazobactam/piperacillin and 5 to 9.4 days for imipenem/cilastatin. MAIN OUTCOME MEASURE AND RESULTS: Compared with imipenem/cilastatin, treatment with tazobactam/piperacillin was more effective and the overall treatment costs were lower. In the base-case analysis, the cost-efficacy ratio (cost per successfully treated patient) was 7881 German deutschmarks (DM) for tazobactam/piperacillin and DM11,390 for imipenem/cilastatin. The incremental cost-efficacy ratio (per life saved) varied between -DM72,567 and -DM350,738 for tazobactam/piperacillin. Sensitivity analyses revealed that the results were robust against various assumptions on cost parameters, clinical outcomes and length of treatment. All costs reflect 1998 values; $US1 = DM1.85. CONCLUSIONS: This study suggests that compared with imipenem/cilastatin, tazobactam/piperacillin is more cost efficacious in the treatment of intra-abdominal infections and that it offers a cost advantage through fewer relapses and lower daily therapeutic costs.

Abdomen↗
PubMed2001

[The methicillin-resistant Staphylococcus aureus problem: public health--rituals].

Measures employed to control MRSA infections are frequently not proven scientifically and therefore constitute mere rituals. The German-speaking Working Group for Hospital Infection Control recommends that surgery on MRSA patients be performed in one surgical unit only at the very end of the operation program, even if this means postponing surgery to the evening or night hours. From a hygiene point of view this is unnecessary. Data presented here describe the most common modes and routes of S. aureus transmission during surgery. Other rituals during preoperative preparation, washing and disinfecting the hands or procedure after so called septic interventions, visiting the lavatory etc. are described.

Cross Infection↗