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P Gastmeier

Publications and source records attributed to P Gastmeier.

At least 91 records · Page 5Linked to original sources
PubMed1999

Catheter-associated primary bloodstream infections: epidemiology and preventive methods.

The incidence of catheter-associated primary bloodstream infections (BSIs) in Germany as defined by the CDC (Centers for Disease Control) has been determined on the basis of (a) a national prevalence study in a representative sample of 72 hospitals (NIDEP), and (b) an incidence study in which data about the use and duration of insertion of central venous catheters (CVC) and of catheter-associated BSI were collected from 25 intensive-care units (ICUs) participating in the hospital infection surveillance system (KISS+) and analyzed. The first study showed primary bloodstream infection to be the fourth most frequent nosocomial infection at 8.3% of all nosocomial infections. With an ICU prevalence of 2.1%, primary BSI comprises 12.8% of all nosocomial infections observed in ICU patients. The second study showed a 60.4% prevalence of CVC use in German ICUs. An analysis of 55,400 CVC days in 14,988 ICU patients in the KISS hospitals yielded 2.2 CVC-associated BSIs per 1,000 CVC days (CI95 1.8-2.6). The rates of CVC-associated BSI on individual hospital wards were very variable and indicates a reduction potential. A reduction in the number of infections of about one-third would prevent 1,000-1,400 deaths due to CVC-associated BSI annually as well as about 40,000 to 60,000 extra days of hospital stay and the associated costs.

Catheterization, Central Venous↗
PubMed1999

Neonatal nosocomial infection surveillance: incidences by site and a cluster of necrotizing enterocolitis.

Nosocomial infection (NI) was prospectively studied in hospitalized neonates during a 10-month period. The Centers for Disease Control (CDC) criteria (some specified for neonates) were used for surveillance. Forty-nine of 677 infants experienced 73 episodes of NI. The overall incidence was 10.8 NI/100 patients and 6.5 NI/1,000 patient days. The average monthly NI number did not correlate with patient load. Very low birth weight (VLBW) infants showed a higher NI incidence (81.8 NI/100 patients and 11.1 NI/1,000 patient days), also elevated if adjusted for their inherently longer neonatal intensive care unit (NICU) stay. The most common NI sites in the VLBW stratum were sepsis and necrotizing enterocolitis (NEC), the latter occurring in a seasonal cluster. It can be concluded that surveillance for NIs should focus on VLBW infants and include the evaluation of NEC, as it behaves like a nosocomial disease.

Anti-Bacterial Agents↗
PubMed1999

Guidelines for infection prevention and control in Germany: evidence- or expert-based?

Nosocomial infections (NI) are a major problem, and numerous measures are being recommended for preventing NIs in Germany. However, the evidence for the efficacy of many currently recommended measures is incomplete or has been established for certain sub-groups of patients or specific conditions only. In view of this situation, it is necessary to improve the established measures for preventing NIs. Since many procedures and components of infection control involve additional expenditure, their deployment can only be justified if their efficiency has been demonstrated or is highly likely on the basis of rational considerations.

Cross Infection↗
PubMed1999

How many nosocomial infections are missed if identification is restricted to patients with either microbiology reports or antibiotic administration?

OBJECTIVE: To investigate how many nosocomial infections would be missed if surveillance activities were restricted to patients having either microbiology reports or antibiotic administration. DESIGN: Analysis of data from a large prevalence study on nosocomial infections (Nosocomial Infections in Germany-Surveillance and Prevention). SETTING: A total of 14,966 patients were investigated in medical, surgical, obstetric-gynecologic, and intensive-care units of 72 German hospitals representatively selected according to size. Five hundred eighteen patients (3.5%) had at least one nosocomial infection. Microbiology reports were available for 56.6% of these patients on the prevalence day, and 86.3% received antibiotics. RESULTS: Only 31 nosocomially infected patients (6%) would have been missed by using either microbiology reports or antibiotic treatment as an indicator. These indicators of nosocomial infections had a high diagnostic sensitivity for nosocomial pneumonia (98.8%), urinary tract infections (96.3%), and primary bloodstream infections (95.3%), but a lower sensitivity for wound infections (85.4%). Thus, 97.4% of all nosocomial infections were found with this method in intensive-care units and 96.1% in medicine units, but only 89.7% in surgical departments. In 9 (12.5%) of 72 hospitals, the overall sensitivity would have been <80% using a combination of the two indicators. For this reason, the situation in one's own hospital should be checked before using this method. CONCLUSIONS: After checking the situation in one's own hospital, the "either-or" approach using the two indicators "microbiology report" and "antibiotic administration" can be recommended as a time-saving measure to diagnose pneumonia, urinary tract, and primary bloodstream infections. For wound infections, additional information obtained by changing dressings or participating in ward rounds is necessary to achieve satisfactory sensitivity in the surveillance of nosocomial infections. Of course, it is necessary that the surveillance staff discard all false positives to ensure a satisfactory specificity.

Anti-Bacterial Agents↗
PubMed1998

Prevalence of nosocomial infections in representative German hospitals.

The nosocomial infection (NI) rate in German hospitals was studied in order to create reference data for comparison in hospitals where ongoing surveillance is impossible. The study was designed as a one-day prevalence study. Patients in 72 selected hospitals (inclusion criteria: acute care hospitals with departments for general medicine, surgery, obstetrics/gynaecology) were examined by four external investigators (physicians trained and validated in the diagnosis of NI). A total of 14,996 patients were studied. The overall prevalence rate was 3.5% (CI 3.1-3.9) with a variation of 0-8.9% between hospitals. The commonest NI were: urinary tract infection (42.1%), lower respiratory tract infection (20.6%), surgical site infections (15.8%) and primary sepsis (8.3%). The highest prevalence rate (15.3%) was found in intensive care ward patients, followed by surgery (3.8%), general medicine (3.0%) and gynaecology/obstetrics (1.4%). The infection rate varied significantly with hospital size. A microbiology laboratory report was only available for 56.5% of patients thought to have an NI, and there were remarkable differences between hospitals with and without an on-site microbiology laboratory. Because of this and other methodological reasons the NI prevalence rates reported here may represent the absolute minimum of nosocomially infected patients in Germany.

Cross Infection↗
PubMed1998

Device-associated nosocomial infection surveillance in neonatal intensive care using specified criteria for neonates.

Agreement on criteria for defining nosocomial infections is essential when surveillance is intended for quality assurance. The CDC criteria for patients < 12 months old were compared with locally developed criteria for neonates in a 10-month study of nosocomial infections in a Berlin University hospital. Six hundred and seventy-seven neonates were observed prospectively for 11,936 patient days. The overall nosocomial infection incidence rate was 13.2%. Because of the observed strength of agreement between the CDC and local criteria for central line-associated primary bloodstream infections and for ventilator-associated pneumonias (recommended by the NNIS system for inter-hospital comparisons) and the preference of the clinicians for the local criteria, we decided to use the latter for an ongoing surveillance system which nonetheless would retain the possibility for comparison with NNIS-data.

Bacteremia↗
PubMed1998

Prevalence of primary bloodstream infections in representative German hospitals and their association with central and peripheral vascular catheters.

The prevalence of noncentral and central lines and the prevalence of nosocomial primary bloodstream infections was investigated in 72 representative German hospitals (NIDEP Study). Data from a total of 14,966 patients were documented. On the prevalence day, it amounted to 23.9% for noncentral and 5.1% for central lines. The total prevalence of nosocomial primary bloodstream infections was 0.3%, 8.3% of all nosocomial infections recorded were primary bloodstream infections. The device utilization rate of vascular catheters was retrospectively observed for both the prevalence day and another 6 days. The device utilization rate was 27.3% for peripheral and 6.1% for central catheters with higher rates in west Germany. The associated incidence density of primary nosocomial bloodstream infections per 1000 catheter-days was 0.3 for noncentral and 0.8 for central lines. In 61.4%, the primary bloodstream infections were microbiologically confirmed. In 52.6% of cases, Gram-positive bacteria were isolated (Staphylococcus aureus: 15.8%, other coagulase negative Staphylococcus species: 34.2%) and in 47.4%, Gram-negative ones (mostly: Escherichia coli: 13.2% and Klebsiella species: 10.5%). Prevention to reduce nosocomial bloodstream infections is possible by antimicrobial establishing specially trained infusion therapy teams, using antimicrobial or antiseptic impregnated bloodstream catheters and a strict review of the indication for a vascular catheter together with a minimization of catheter days.

Bacterial Infections↗
PubMed1998

Importance of the surveillance method: national prevalence studies on nosocomial infections and the limits of comparison.

OBJECTIVE: To demonstrate the limits of comparison of national prevalence rates of nosocomial infections. DESIGN AND SETTING: Critical analysis of prevalence rates and methods of the Nosocomial Infections in Germany (NIDEP) study and other prevalence surveys with particular attention to the selection of patients, the qualification and training of the investigators, and the methods of identifying nosocomial infections. RESULTS: The lowest prevalence rate was found in Germany (3.5%), the highest in Belgium (9.3%). These differences may not be accurate, because variations in methods allow for differing explanations. CONCLUSIONS: Because of numerous methodological factors, comparison of infection rates between countries should be avoided. In contrast to other prevalence studies, the methodology of the German-NIDEP study permits registration of only certain infections, which is the main reason for the low rate.

Cross Infection↗
PubMed1998

Experience with two validation methods in a prevalence survey on nosocomial infections.

OBJECTIVE: To determine whether an investigator effect remained on the first German study on the prevalence of nosocomial infections Nosokomiale Infektionen in Deutschland Erfassung und Prävention (NIDEP), despite extensive validation efforts. DESIGN: Two validation methods were applied: bedside validation and validation by case studies. In both cases, the results of the four investigators were compared with the diagnosis of gold standard observers. SETTING: Validation measures were applied before, intermittently, during, and at the end of the surveillance period in 72 acute-care hospitals with 14,966 patients. RESULTS: The overall sensitivity in the bedside-validation periods was 89.0%; the overall specificity was 99.5%. For validation by case studies, overall sensitivity was 95.6%, and overall specificity was 92.8%. At the end of the surveillance, a remarkable investigator effect was found. CONCLUSION: Despite validation results that were assessed as satisfactory, based on available literature, an investigator effect was observed. This underlines the need for data validation and the formulation of recommendations for data validation. Clarification of the Centers for Disease Control and Prevention criteria for pneumonia and primary bloodstream infection and the inclusion of some diagnostic test results may reduce or prevent an investigator effect in future studies.

Bias↗
PubMed1998

[Diagnostic training for the surveillance of nosocomial infections: what is possible and significant?].

The data of surveillance of nosocomial infections are used as clinical indicators of quality. Their diagnosis must therefore be accurate. One hundred medical records from surgical and intensive care patients were used to assess the accuracy of diagnosing nosocomial infections according to CDC definitions. All case histories included signs and symptoms of infection. There were 45 patients with a total of 60 nosocomial infections (18 urinary tract infections, 18 surgical site infections, 11 lower respiratory tract infections and 13 other infection types). After evaluating the medical records, 18 physicians independently decided whether or not there was a nosocomial infection and, if so, the type of underlying infection. Their results were compared to the diagnosis of two experienced physicians (gold standard). Twenty-five cases were assessed on each of four consecutive days and the results were discussed with the experienced physicians on the following morning. The discussions of the first day may thus have been influenced by the results of the following days. Overall sensitivity was 85.4% (Cl95 82.8-87.8%) and overall specificity was 97.1% (Cl95 95.8-98.0%). Among the most common types of nosocomial infections, urinary tract infections had the highest sensitivity (90.1%), followed by surgical site infections (87.3%) and lower respiratory tract infections (85.8%). The specificity for these types of infections was 98.2%, 98.9% and 99.5%, respectively. Although the method of investigation used does not fulfill the formal requirements of a validation study for diagnosing nosocomial infections, it seems useful for training in the diagnostics of nosocomial infections or for intermittent evaluation of criteria before starting surveillance activities. This method is useful for training the application of CDC definitions, particularly when the medical records are reduced to case studies that include only the basic information on determining the presence of a nosocomial infection in order to evaluate a large number of suspected cases in a short period of time.

Centers for Disease Control and Prevention, U.S.↗
PubMed1997

[Breathing circuit exchange in intensive care. Once daily once weekly?].

UNLABELLED: In an investigation of infection control methods for respirator systems in 89 randomly selected German intensive care units as a part of the NIDEP study (Nosocomial Infections in Germany--Surveillance and Prevention), it was found that respirator systems were exchanged daily in about 50% of the intensive care units. However, Craven et al. found that changing circuits (including tubing and exhalation valve and the attached humidifier) every 24 h rather than every 48 h was independently associated with the occurrence of nosocomial pneumonia. On the basis of these results and recent studies, the current situation in the literature was analyzed in order to make recommendations for exchanging ventilator circuits. METHODS: Based on the extensive analysis of the literature by the Hospital Infection Control Practices Advisory Committee (HICPAC), we could limit our investigation to the years after 1994. A MEDLINE search was done, and abstracts from congresses of the past few years were considered. The main focus of the analysis was the development of pneumonia and not the contamination of the breathing circuit. The following methodological factors were analyzed for the most important published studies: design, applied definitions of pneumonia, sample size, comparability of study groups, inclusion and exclusion criteria. The results of the different studies were compared considering the potential bias factors. RESULTS AND DISCUSSION: There were nine prospective controlled studies on this topic. In all studies, the authors tried to investigate whether a longer interval between ventilator circuit exchange (more than 48 h) is safe or whether it is possible to leave the circuits unchanged (without using breathing filters). The design and results of the available studies were analyzed. The three most important studies were compared very carefully (Table 1 and 2), and a recommendation for infection control measures for ventilator circuits was made as a modification of the HICPAC guidelines. In addition, the device-associated pneumonia rates of ventilated intensive care patients in the NIDEP study were analyzed separately according to a daily or a 48-h or longer interval of ventilator circuit exchange. For patients with daily exchange, we found a device-associated rate of 17.4 per 1000 ventilator days and for those with longer intervals a rate of 7.9 per 1000 ventilator days. Only considering those patients without heat and moisture filters, the figures were 14.8 versus 6.1. These differences were not significant because of the small number of patients investigated. CONCLUSION: The available studies show clear advantages of not routinely exchanging the ventilator circuit, including tubing, exhalation valve and the attached humidifier, more often then every 7 days for an individual patient. Based on these findings, the current practice in most German intensive care units should be reevaluated.

Clinical Trials as Topic↗
PubMed1997

An analysis of two prevalence surveys of nosocomial infection in German intensive care units.

In 1995, the results of two extensive prevalence studies on hospital-acquired infections were published. Both studies included a prevalence component for German intensive care units (ICUs), but provided very different infection rates. A comparison of the methods used revealed that the data from the ICUs included in the German section of EPIC (European Prevalence of Infection in Intensive Care), reflected the situation in the ICUs of large hospitals. The situation in ICUs with fewer than 600 beds was quite different, and led to the lower overall rate of infection as seen in the NIDEP (Nosocomial Infections in Germany-Surveillance and Prevention) study. Additionally, the NIDEP data permitted the calculation of device-associated, device-day, infection rates for urinary tract infections, pneumonia and bacteraemia. The differences between the ICUs in the two hospital groups were mainly due to a lower use of patient devices with regard to urinary catheters, central venous lines and respiratory ventilators.

Bacteremia↗
PubMed1997

Analysis of risk factors for nosocomial infections--results from the first national prevalence survey in Germany (NIDEP Study, Part 1).

An analysis of risk factors for nosocomial infections (NI) was carried out using data from the first national prevalence survey on NI in Germany. Fourteen thousand, nine hundred and sixty-six patients, with a total of 543 NI, were included. Urinary tract infections (UTI), lower respiratory tract infections (LRTI), surgical site infections (SSI) and primary septicaemia (PS) were analysed. UTI were significantly associated with unconsciousness, age, prior operation, hospital size and female sex (P < 0.1). LRTI were significantly associated with chronic airway disease, intensive care units, unconsciousness, polytrauma, prior operation, cardiovascular disease, malignancy and absence of infection on admission. The department, age, diabetes mellitus, male sex and hospital size were risk factors for SSI. The department, prior operation and unconsciousness were significantly associated with PS. An investigator effect was observed for LRTI and PS. Although no final conclusions from a risk factor analysis based on prevalence data can be drawn the results support stratification of NI for routine surveillance.

Adult↗
PubMed1996

[Nosocomial infections in Germany. Microbiological diagnosis, preventive antibiotics and antibiotic therapy].

BACKGROUND: The NIDEP-study (Nosocomial Infections in Germany-Prevalence and Prevention) is the first large multicenter survey to examine the prevalence of nosocomial infections (NI) in Germany. This part of the NIDEP-study describes the frequency and quality of the microbiological diagnosis, antimicrobial chemoprophylaxis and therapy in representative German hospitals. PATIENTS AND METHOD: Prevalence of nosocomial infections in 14 966 patients of 72 randomly selected representative German hospitals was determined. Frequency, nature and results of the microbiological diagnosis, antimicrobial chemoprophylaxis and therapy were recorded simultaneously. RESULTS: The total prevalence rate of nosocomial infections was 3.5%. The most common infections were urinary tract infections (42.1%), lower respiratory tract infections (20.6%), postoperative wound infections (15.8%), and septicemia (8.3%). Microbiological evaluation was done in 56.5% of the patients with infections. Only five of the 49 hospitals with less than 400 beds and only nine of the 23 hospitals with more than 400 beds had their own microbiological department. Antimicrobial chemotherapy was administered in 17.7% of the patients. In 35.1% of the patients who were treated with antibiotics, no clinical diagnosis of infection was made, criteria for nosocomial infections were not fulfilled or microbiological evaluation was not established. Antimicrobial chemoprophylaxis was done in one third of the patients. Prophylaxis was missed in 20.6% of patients with colorectal operations, 60.1% of appendectomies, 48% of vaginal hysterectomies, and 35.5% of total hip replacements. On the other hand antimicrobial chemoprophylaxis was frequently administered in clean procedures without increased risk of postoperative wound infections. CONCLUSION: Insufficient microbiological evaluation, inadequate perioperative antimicrobial chemoprophylaxis and administration of chemotherapy without documented infection were detected in representative German hospitals.

Anti-Bacterial Agents↗
PubMed1996

[Nosocomial infections in Germany. Their epidemiology in old and new Federal Länder].

OBJECTIVE: To determine the prevalence rate of nosocomial infections in different parts of Germany. PATIENTS AND METHODS: The study involved 14,966 patients (45.9% medical, 35.9% surgical, 14.7% obstetrical/gynaecological and 3.5% intensive care) in 72 randomly chosen German hospitals (59 in the old [i.e. previously West German] and 13 in the new [i.e. East German] Federal Lands). Using the CDC criteria for the diagnosis of nosocomial infections specially trained doctors determined whether the infection was in fact nosocomial. RESULTS: There was a 3.5% prevalence rate of nosocomial infections in the entire population (95% confidence interval 3.1-3.9%). In view of the chosen methods and the in part incorrect indication of microbiological diagnosis in the included hospital, this rate of nosocomial infection is likely to be a minimum number. The prevalence rate for the most important nosocomial infections was lower in the new Lands of Federal Germany than the older ones (total prevalence of 2.7 vs 3.6%). The difference is mainly due to the less frequent employment of various devices (e.g. peripheral vascular catheters), rather than different hygienic standards in their use. CONCLUSION: The lower prevalence rate of nosocomial infections in the new Lands, because fewer devices are employed, underlines the need constantly to test the indications for their use.

Adult↗
PubMed1996

[Nosocomial infections intensive care units. A nation-wide prevalence study].

UNLABELLED: In a large, multicenter survey in 1994, the prevalence of nosocomial infections in German hospitals was examined, predominant pathogens were identified, and possible risk factors evaluated. In this paper the results from the intensive care units (ICUs) are presented. METHODS: Seventy-two representative hospitals in Germany were selected by randomisation and divided into four different groups according to their size (< 200 beds; 200-400 beds; 400-600 beds; > 600 beds). During 10 months four especially trained doctors documented the patients clinical and laboratory data and possible endogenous and exogenous risk factors for nosocomial infections. For better evaluation, they discussed the cases with the responsible senior officers and health care workers and visited the patients. Diagnosis of nosocomial infection was based on CDC criteria. RESULTS: In 515 patients in 89 ICUs, 78 hospital-acquired infections were documented (15.3%). The most common were pneumonia (5.9%), bronchitis (2.7%), urinary tract infections (2.4%), and septicaemia (2.2%). Possible exogenous risk factors included: peripheral venous catheters (65.6%); catheterisation of the urinary tract (64.5%); central venous catheters (60.4%); gastric tubes (38.0%); wound drainage (28.6%) and artificial ventilation (27.6%). The most frequent concomitant diseases were cardiovascular (61.9%), diabetes (20.2%), malignancies (18.8%), pre-existing infections (15.3%), and chronic respiratory disease (14.0%). The prevalence of nosocomial infections was higher in hospitals with more than 600 beds than in smaller ones (28.3% versus 12.9%, P < 0.001). Predominant pathogens were Pseudomonas aeruginosa, enterococci, Staphylococcus aureus, Candida spp., Escherichia coli, and Klebsiella spp.. Fifty per cent of the ICUs changed ventilation tubes and 66.3% changed infusion sets daily; 34.8% of patients received drugs for the prevention of stress ulcers that neutralise or decrease production of gastric acid; only 7.6% received sucralfate. Routine microbiological surveillance of tracheal aspirates and urine was done by 25.9% and 24.6% of the ICUs, respectively. DISCUSSION: Nosocomial infections are seen far more often in ICUs than on normal wards due to the immuno-suppressed state of many ICU patients and the continuous use of invasive diagnostic and therapeutic procedures. Most of these infections are of endogenous origin. Other prevalence surveys have shown results comparable to ours. Daily changing of ventilation tubes is no longer necessary, but is still routine in many hospitals. Infusion sets were also changed more often than required. The use of selective decontamination of the digestive tract for the prevention of pneumonia is still controversial; in our study it was practised in only 1.5% of the cases. The most commonly used drugs for the prevention of stress ulcers were H2-receptor blocking agents, although it has been shown that sucralfate is the better choice, as it can help prevent nosocomial pneumonia. Routine microbiological surveillance of tracheal aspirates and urine was done in 25.9% and 24.6% of the ICUs. No study so far has shown that routine cultures of tracheal secretions and urine have a preventive effect regarding infection.

Adult↗
PubMed1996

[Hospital infections in gynecology and obstetrics. An inclusive prevalence study in Germany].

In a German multicenter survey, 2206 gynaecological patients in 72 randomly selected hospitals were examined for the prevalence of nosocomial infections and possible risk factors. Hospital-acquired infections were diagnosed in 1.45% of the patients. The most common localisation was the urinary tract (0.91%). Septicaemia, vaginitis and infections of the upper and lower airways were only rarely seen. The following endogenous risk factors were identified: diseases of the cardiovascular system (16.1%), malignancies (12.2%) preexisting infections (6.1%), obesity (5.9%), and diabetes (5.0%). The most common exogenous risk factors were peripheral venous catheters (19.9%), catheterisation of the urinary tract (7.2%) and wound drainage (28.6%). 49% of the patients who underwent caesarean section and 50% of the hysterectomy patients received antimicrobial chemoprophylaxis.

Adult↗