PubMed · 16013200
The battle against healthcare-associated infection (HCAI) needs to be based on mandatory infection control training for all health and social care staff working in the NHS and independent sector.
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Dina Leifer. Make a clean sweep.. https://pubmed.ncbi.nlm.nih.gov/16013200/
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The incidence of vancomycin-resistant enterococci (VRE), especially E. faecium, is increasing in several German hospitals and some facilities have experienced VRE outbreaks. The German National Nosocomial Infection Surveillance System has also noticed a sharp increase in the incidence of nosocomial VRE infections per 10,000 patients from 0.5 in 2003 to 11.0 in 2005 accompanied by a rise in VRE-associated mortality. However, the reasons of this increase remain unknown. As VRE may cause severe nosocomial infections, transmission must be restricted. This article provides the guidelines as defined by the workshop of the German Society for Hygiene and Microbiology for the prevention of VRE transmission in both, endemic and epidemic, settings. The following topics are discussed: indication for VRE screening, microbiological diagnostics, general infection control measures (isolation precautions and use of protective clothing) and additional hygiene measures in the nosocomial VRE outbreak setting.
Handwashing is considered to be the most effective way of reducing cross-infection. Rates of healthcare-associated infection and the incidence of meticillin-resistant Staphylococcus aureus are higher in the UK than in many other European countries. The government has responded by introducing the 'CleanYourHandsCampaign' throughout England and Wales, based on the success of the approach employed in Geneva. Alcohol hand rub is placed at every bedside in acute hospitals, ward housekeepers should replenish supplies and feedback on compliance is provided to health workers. Posters and other promotional materials are used to remind health workers and visitors to use the hand rub. Patients are encouraged to ask health workers if they have cleaned their hands before contact. In this paper we argue that the evidence base underpinning the CleanYourHandsCampaign is incomplete. Alcohol hand rub is acknowledged as a useful adjunct to hand hygiene but it is not effective in all circumstances. There is some evidence to support the use of feedback on performance to encourage compliance but no evidence that promotional materials such as posters or patient reminders are effective. The ethics of encouraging hospital patients to take responsibility for their own safety is questioned. Much of the success in Geneva must be attributed to the attention given to contextual factors within the organization that encouraged hand rub use, especially hospital-wide 'ownership' of the initiative by managers and senior health professionals. A customized intervention from another country that fails to consider local organizational factors likely to influence the implementation of the campaign is unlikely to be effective. It is concluded that although hand hygiene is of undoubted importance, undue emphasis should not be placed on it as a 'quick fix' to solve the unacceptably high rates of healthcare-associated infection in National Health Service hospitals.
Multi-resistant bacteria are an increasing challenge for infection control in hospitals and the proportion of patients newly colonized with multi-resistant bacteria during their hospital stay can be used to assess the effectiveness of infection control measures. Current laboratory methods for estimating this require expensive additional tests. We propose an alternative statistical method to estimate the proportion of cases resulting from transmission in a hospital from the distribution of time intervals between subsequent cases. A prerequisite for the application of this method is the existence of records from regular screening of the patients during their hospital stay, usually performed in intensive care units (ICUs). We describe the method and present an example of its application using records of two multi-resistant pathogens collected in an ICU over a three-year period. The estimated proportion of cases resulting from transmission was 0.73 (95% CI: 0.56-0.90) for meticillin-resistant Staphylococcus aureus and 0.45 (95% CI 0.15-0.75) for imipenem-resistant Pseudomonas aeruginosa. The method proposed here can be used for retrospective evaluation of clinical records in order to evaluate the effectiveness of infection control measures in low endemicity settings.