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P Gastmeier

Publications and source records attributed to P Gastmeier.

At least 55 records · Page 3Linked to original sources
PubMed2004

Development of a surveillance system for nosocomial infections: the component for neonatal intensive care units in Germany.

Neonates are at high risk of nosocomial infections and surveillance has been shown to be valuable for the reduction of nosocomial infections. The National Nosocomial Infections Surveillance (NNIS) system established in the US has a special surveillance component for neonatal intensive care units (NICUs) with some fairly specific methods. However, there are no specific definitions of nosocomial infections in this patient group. When creating a surveillance component for NICUs in Germany we therefore decided not to adopt merely all Centers for Disease Control and Prevention definitions and NNIS methods, but also to develop our own surveillance methods for this patient group. For this process four steps became necessary: (1)development of modified definitions for nosocomial infections and their evaluation; (2)testing the NNIS method in three NICUs with infection control nurses; (3)a pilot project for a surveillance component within the national surveillance system in Germany; and (4)establishment of a surveillance component within our national surveillance system. The system is now established in 33 hospital departments and 66 NICUs participate in the surveillance system. We have an overview of 3357 neonates in three birthweight groups. This article explains the reasons for the various steps, and the advantages and disadvantages of modification of the original NNIS methods and definitions.

Clinical Protocols↗
PubMed2004

[Surveillance of nosocomial infections].

The field of hospital hygiene in Germany has undergone some changes in recent years. In addition to the traditional focus on hygiene, epidemiological activities in the field of nosocomial infections have become important for many hospitals. In order to measure these infections, a surveillance system has been established in Germany, which is known under the acronym KISS (Krankenhaus-Infektions-Surveillance-System, system for surveillance of hospital acquired infections). The system is based on the experiences and principles of the American NNIS-system (National Nosocomial Infections Surveillance), but takes into account the local circumstances and possibilities of participating hospitals in Germany. Meanwhile, hospitals can select among 6 KISS modules, which focus on the following topics or areas: intensive care units, neonatology intensive care unit, oncology, surgical patients, patients with venous or urinary catheters, as well as outpatients. KISS data may be used for quality management issues by individual hospitals and for benchmarking between hospitals. The time spent for surveillance in each hospital for one of the modules averages between two and three hours per week. The scientific literature on the subject of surveillance has convincingly shown that this kind of activity is cost-efficient. Cost-effectiveness is likely associated with surveillance activities within the KISS framework, as these activities will have a beneficial effect on nosocomial infection rates in participating hospitals.

Cross Infection↗
PubMed2004

[Legionella prevention in intensive care units].

From time to time hospitals are in the focus of the local and national media because of cases of nosocomial Legionnaires' disease. In particular intensive care patients are a risk group because of their high amount of immunocompromised patients with an increased risk of developing a Legionellosis. Therefore it is an important aim to maintain an effective prevention system. Nevertheless in some hospitals legionella can be identified. Particularly in these hospitals a high level of attention is required to recognize cases of legionellosis and to take adequately steps to avoid outbreaks of legionellosis. The following article explains the recently published recommendations of the American hospital hygiene experts.

Cross Infection↗
PubMed2004

[Microbiological isolates associated with nosocomial infections in intensive care units: data of 274 intensive care units participating in the German Nosocomial Infections Surveillance System (KISS)].

OBJECTIVE: To describe the frequency and distribution of microbiological isolates in association with nosocomial infections (NI) in intensive care units (ICUs) in Germany. METHODS: The hospital infection surveillance system (KISS = Krankenhaus-Infektions-Surveillance-System) started in Germany in January 1997 as a nationwide surveillance project for the voluntary registration of nosocomial infections. For ICUs reporting focuses on device-associated primary bloodstream infections, urinary tract infections, as well as on pneumonia and bronchitis. The data collected for each patient who acquires a nosocomial infection include the site of infection and patient demographics. Up to 4 pathogens can be recorded for each infection. RESULTS: From 1997 until 2002 274 ICUs were participating. The data of 590 695 patients with 18 073 device associated infections (ventilator-associated pneumonia and bronchitis, central line-associated bloodstream infection (BSI) and urinary catheter-associated urinary tract infection (UTI)) were analyzed. In the group of device-associated NI S. aureus was most frequently isolated (16.5/100NI) followed by Ps. aeruginosa (14.2/100NI), E. coli (13.9/100NI), enterococci (13.4/100NI) and C. albicans (11.2/100NI). Of all S. aureus isolates 20.0 % were MRSA. There was an increase of the MRSA rate from 8 % in 1997 to 26.9 % in 2002. The most frequent pathogen in BSI was coagulase-negative staphylococcus (31.0/100NI). In ventilator-associated pneumonia and bronchitis S. aureus was the most frequent pathogen (24.2 and 24.9/100NI). In more than half of all catheter-associated UTI E. coli (25.7/100NI) and enterococci (25.4/100NI) were found. After stratification for the type of ICU differences in the distribution of pathogens could be shown. CONCLUSIONS: The KISS data give an overview of the most important pathogens associated with nosocomial infections on ICUs in Germany.

Cross Infection↗
PubMed2004

[Isolation measurements for cystic fibrosis patients].

BACKGROUND: Respiratory tract infections significantly contribute to morbidity and mortality of cystic fibrosis patients. METHODS: We conducted a systematic literature review (Pubmed 01/1966 up to 09/2003) in order to present recommendations for the isolation of CF patients colonized with Burkholderia cepacia spp., Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Alcaligenes spp. Evidence and quality of 64 publications dealing with pathogen transmission or isolation measurements of colonized patients were evaluated. RESULTS: B. cepacia spp. was dealt most often with and 35 of 36 authors recommended the isolation of patients colonized with this pathogen. Isolation of patients colonized with P. aeruginosa was proposed by 21 of 25 authors. Only 5 studies concerned S. maltophilia or Alcaligenes spp. CONCLUSIONS: A) B. cepacia spp. colonized patients need to get a single room for their own. B) P. aeruginosa colonized CF patients should be separated from non-colonized CF patients. C) Patients harbouring even multi drug resistant P. aeruginosa, S. maltophilia or Alcaligenes spp. may not share their room with immunocompromised patients and should also be isolated when treated in intensive care units.

Cystic Fibrosis↗
PubMed2003

Design of a surveillance system of antibiotic use and bacterial resistance in German intensive care units (SARI).

BACKGROUND: Data on antibiotic consumption and bacterial resistance are important for benchmarking, ensuring quality of antibiotic treatment and helping to understand the relationship between the use of antibiotics and the emergence of resistance. METHODS: The SARI project is an ecological study that has established laboratory-based surveillance in German intensive care units (ICU). Resistance rates of 13 sentinel pathogens are reported and certain alert organisms are sent for genotyping and retesting of antimicrobial resistance. RESULTS: The project, initiated in February 2000, now includes 35 ICUs generating a total of 266,013 patient days, 354,356 defined daily doses (DDD) and providing susceptibility data on 21,354 isolates. Pooled antibiotic usage density (AD = DDD/1,000 patient days) was highest for penicillins with lactamase inhibitor (AD 338.3) followed by quinolones (AD 155.5) and second-generation cephalosporins (AD 124.6). Total AD was calculated as 1,337 DDD/1,000 patient days. Resistance rates (RR) for laboratories testing according to the German Industrial Standard (DIN) were 19.3% for methicillin-resistant Staphylococcus aureus (MRSA), 9.5% for ciprofloxacin-resistant Escherichia coli and 25.4% for imipenem-resistant Pseudomonas aeruginosa. 40% of the laboratories did not identify the extended spectrum beta lactamase production of a Klebsiella pneumoniae strain. CONCLUSION: Focusing on German ICUs, the SARI surveillance system provides a concept that produces a benchmark for the link between antibiotic resistance and consumption.

Anti-Bacterial Agents↗
PubMed2003

The preventable proportion of nosocomial infections: an overview of published reports.

The proportion of nosocomial infections potentially preventable under routine working conditions remains unclear. We performed a systematic review to describe multi-modal intervention studies, as well as studies assessing exogenous cross-infection published during the last decade, in order to give a crude estimate of the proportion of potentially preventable nosocomial infections. The evaluation of 30 reports suggests that great potential exists to decrease nosocomial infection rates, from a minimum reduction effect of 10% to a maximum effect of 70%, depending on the setting, study design, baseline infection rates and type of infection. The most important reduction effect was identified for catheter-related bacteraemia, whereas a smaller, but still substantial potential for prevention seems to exist for other types of infections. Based on these estimates, we consider at least 20% of all nosocomial infections as probably preventable, and hope that this overview will stimulate further research on feasible and cost-effective prevention of nosocomial infections for daily practice.

Bacteremia↗
PubMed2003

[Guidelines for the prevention of catheter-related infections].

The revised American guidelines of the Centers for Disease Control and Prevention (CDC) 'Guidelines for the prevention of catheter-related infections' were published on August 9, 2002. The goal of the guidelines is to promote patient safety and to decrease preventable infections by providing evidence-based recommendations for those healthcare providers who insert and maintain intravascular catheters. Since the guidelines were last issued in 1996, the science of prevention has yielded several important advances in new technology to prevent infection. In addition this update makes allowances for the fact that many new randomised controlled trials for the prevention of catheter-related infection were published in the last six years. Furthermore, several approaches, long known to be effective, need more emphasis by practitioners. The following publication summarizes the state of knowledge about the most important controversial prevention strategies and explains the recommendations.

Catheterization↗
PubMed2003

[Extended spectrum beta-lactamse (ESBL)-induced antibiotics resistance in gram-negative agents: what should be watched in intensive care medicine?].

Third-generation cephalosporins have an important part in the therapy of infections due to gram-negative bacteria. Extended spectrum beta-lactamases (ESBL) are able to hydrolize these antibiotics. As the number of ESBL-producing bacteria is increasing worldwide, detection of ESBL-producers is important for the both of prevention and therapy.

Critical Care↗
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↗
PubMed2002

Occurrence of methicillin-resistant Staphylococcus aureus infections in German intensive care units.

BACKGROUND: This study aims to describe the occurrence of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infections and the relation between endemic and epidemic nosocomial MRSA infections in intensive care units (ICUs) in Germany. METHODS: The ICU component within the German national nosocomial infections surveillance system (KISS) was established in January 1997. The number of participating ICUs increased from 25 in 1997 to 178 (June 2000). In every case of nosocomial infection (NI), the pathogens identified were referred to the surveillance system. To identify clusters and outbreaks and distinguish them from mere single events, the following simple definitions were applied: a "cluster" was two nosocomial MRSA infections within 3 months; an "outbreak" was three or more nosocomial MRSA infections within 3 months; all other MRSA infections were classed as "single events." RESULTS: A total of 10,261 NIs were identified during the observation period in the 139 ICUs which had been participating for at least 6 months. Among the 1,535 nosocomial S. aureus infections, 219 MRSA infections were identified (14.3%). Only 51 (36.7%) of the 139 KISS ICUs identified nosocomial MRSA infections. In 12 ICUs (8.6%) however, more than 50% of all nosocomial S. aureus infections were caused by MRSA. The mean incidence density was 0.31 nosocomial MRSA infections/1,000 patient days (range 0-3.6). Outbreaks were registered in 13 ICUs, clusters in 12 further ICUs and only single events in the remaining 26. 64.0% of all MRSA infections were registered during outbreaks and 12.8% in cluster situations. Thus, only 23.2% of MRSA infections were single events. CONCLUSION: These definitions of clusters and outbreaks can only provide an estimate of the real number of cases. However, through the targeted identification of ICUs with endemic and epidemic MRSA problems and subsequent strict measures to prevent the spread of MRSA within these ICUs, it may be possible to retain, or even reduce, the present level of MRSA infections in Germany.

Cross Infection↗
PubMed2002

The practice of perioperative antibiotic prophylaxis in eight German hospitals.

BACKGROUND: Although there is consensus in the international literature on the benefits of using perioperative antibiotic prophylaxis (PAP), there is still considerable scope for improving its use in many hospitals. MATERIALS AND METHODS: In this study, data on the practice of PAP were recorded in eight German hospitals within the framework of a prospective controlled interventional study for the surveillance and prevention of nosocomial infections. RESULTS: A total of 627 surgical procedures (appendectomies, other colorectal procedures, total prosthetic hip replacement) were assessed; 397 with PAP and 224 without PAP; six procedures could not be evaluated. Of the 397 PAP recorded, only 180 (45.3%) were performed correctly in accordance with international standards as a preoperative single dose (19/59 PAP in appendectomies, 72/188 PAP in other colorectal procedures, 89/150 PAP in total prosthetic hip replacement). CONCLUSION: There is still great uncertainty regarding the point in time at which PAP should be administered and its duration. Additional efforts are necessary to improve PAP in accordance with published evidence-based guidelines.

Anti-Bacterial Agents↗
PubMed2002

Comparison of hospital-acquired infection rates in paediatric burn patients.

The objective of the present study was to determine risk factors for development of the most common hospital-acquired infections in paediatric burn patients in order to give recommendations for surveillance. The prospective cohort study in a paediatric burn centre was conducted over a period of two years using uni- and multivariate analysis for risk factor identification. In a group of 41 children with an mean total burn surface area (TBSA) of 18.9% 42 hospital-acquired infections were observed. The overall infection rate was 59.7 nosocomial infections per 1000 patient days, the device-associated nosocomial infection rates per 1000 device days were 55.2 for pneumonia, 8.9 for primary bloodstream infections and 41.7 for urinary tract infections. The incidence density of burn wound infections was 18.5 per 1000 patient days. The percentage of TBSA was a significant risk factor for burn wound infections, but percentage of TBSA was not a risk factor for the device-associated infections. Duration of urinary catheter use and ventilation were identified as risk factors for the corresponding hospital-acquired infection. Surveillance of hospital-acquired infections in burn intensive care units should be performed in the same way as other intensive care unit types, as recommended by the National Nosocomial Infections Surveillance system, without consideration of the percentage of TBSA. In addition, burn wound infections should be recorded using the percentage of TBSA for stratification of burn wound infection rates.

Analysis of Variance↗
PubMed2001

[Respiratory filters and pneumonia: many unresolved questions].

BACKGROUND AND OBJECTIVE: The use of heat and moisture exchanging filters (HMEF) instead of conventional heated humidifiers is a cost-effective method in intensive care medicine. It was the objective of this paper to investigate the evidence for HMEF from the viewpoint of prevention of pneumonia and to investigate the appropriate changing intervals as well as filter materials. METHOD: Randomised controlled trials published in recent years and focusing on prevention of pneumonia as well as other prospective controlled studies were reviewed systematically. RESULTS: The studies demonstrate neither a clear advantage nor disadvantage of HMEF. No final statement is possible concerning changing intervals and the most appropriate filter materials. However, the data give some evidence for a possible extension of changing intervals to 72 hours without harm to the patients and probably show very little influence of filter materials. CONCLUSION: Because of the economic advantages of HMEF instead of an active humidification, the use of filters--with the exception of contraindications for individual patients--should be preferred.

Filtration↗
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↗