Posts filed under ‘Prevencion y Control de Infecciones’

The prevention of Prosthetic Joint Infection (PJI)- 12 modifiable risk factors

The Bone & Joint Journal January 2019 V.101-B N.1 Suppl.A P.3-9

K. Alamanda, B. D. Springer

Aims

Prosthetic joint infection (PJI) remains a serious complication that is associated with high morbidity and costs. The aim of this study was to prepare a systematic review to examine patient-related and perioperative risk factors that can be modified in an attempt to reduce the rate of PJI.

Materials and Methods

A search of PubMed and MEDLINE was conducted for articles published between January 1990 and February 2018 with a combination of search terms to identify studies that dealt with modifiable risk factors for reducing the rate of PJI. An evidence-based review was performed on 12 specific risk factors: glycaemic control, obesity, malnutrition, smoking, vitamin D levels, preoperative Staphylococcus aureus screening, the management of anti-rheumatic medication, perioperative antibiotic prophylaxis, presurgical skin preparation, the operating room environment, irrigant options, and anticoagulation.

Results

Poor glycaemic control, obesity, malnutrition, and smoking are all associated with increased rates of PJI. Vitamin D replacement has been shown in preliminary animal studies to decrease rates of PJI. Preoperative Staphylococcus aureus screening and appropriate treatment results in decreased rates of PJI. Perioperative variables, such as timely and appropriate dosage of prophylactic antibiotics, skin preparation with chlorohexidine-based solution, and irrigation with dilute betadine at the conclusion of the operation, have all been associated with reduced rates of PJI. Similarly, aggressive anticoagulation and increased operating room traffic should be avoided to help minimize risk of PJI.

Conclusion

PJI remains a serious complication of arthroplasty. Surgeons should be vigilant of the modifiable risk factors that can be addressed in an attempt to reduce the risk of PJI.

FULL TEXT

https://online.boneandjoint.org.uk/doi/full/10.1302/0301-620X.101B1.BJJ-2018-0233.R1

PDF

https://online.boneandjoint.org.uk/doi/pdf/10.1302/0301-620X.101B1.BJJ-2018-0233.R1

 

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January 20, 2019 at 11:06 am

Healthcare-associated infections: bacteriological characterization of the hospital surfaces in the University Hospital of Abomey-Calavi/so-ava in South Benin (West Africa).

BMC Infect Dis. January 7, 2019 V.19 N.1 P.28.                   

 

Afle FCD1, Agbankpe AJ2, Johnson RC3, Houngbégnon O4, Houssou SC5, Bankole HS4.

Author information

1 Interfaculty Center of Training and Research in Environment for Sustainable Development, University of Abomey-Calavi, 01, PO, Box 1463, Cotonou, Benin. cyrafle@yahoo.fr.

2 Research Unit in Applied Microbiology and Pharmacology of Natural Substances, Research Laboratory in Applied Biology, Polytechnic School of Abomey-Calavi University, University of Abomey-Calavi, 01, PO, Box 2009, Cotonou, Benin.

3 Interfaculty Center of Training and Research in Environment for Sustainable Development, University of Abomey-Calavi, 01, PO, Box 1463, Cotonou, Benin.

4 Bacteriology Laboratory of the Ministry of Public Health, 01, PO, Box 418, Cotonou, Benin.

5 Faculty of Human Sciences, University of Abomey Calavi, Cotonou, Benin.

Abstract

BACKGROUND:

Healthcare-associated infections have become a public health problem, creating a new burden on medical care in hospitals. The emergence of multidrug-resistant bacteria poses a difficult task for physicians, who have limited therapeutic options. The dissemination of pathogens depends on “reservoirs”, the different transmission pathways of the infectious agents and the factors favouring them. Contaminated environmental surfaces are an important potential reservoir for the transmission of many healthcare-associated pathogens. Pathogens can survive or persist in the environment for months and be a source of infection transmission when appropriate hygiene and disinfection procedures are inefficient. The aim of this study was to identify bacterial species from hospital surfaces in order to effectively prevent healthcare-associated infections.

METHODS:

Samples were taken from surfaces at the University Hospital of Abomey-Calavi/So-Ava in South Benin (West Africa). To achieve the objective of this study, 160 swab samples of hospital surfaces were taken as recommended by the International Organization for Standardization (ISO 14698-1). These samples were analysed in the bacteriology section of the National Laboratory for Biomedical Analysis. All statistical analyses were performed using SPSS Statistics 21 software. A Chi Square Test was used to test the association between the Results of culture samples and different care units.

RESULTS:

Of the 160 surface samples, 65% were positive for bacteria. The frequency of isolation was predominant in Paediatrics (87.5%). The positive samples were 64.2% Gram-positive bacteria and 35.8% of Gram-negative bacteria. Staphylococcus aureus predominated (27.3%), followed by Bacillus spp. (23.3%). The proportion of other microorganisms was negligible. S. aureus and Staphylococcus spp. were present in all care units. There was a statistically significant association between the Results of culture samples and different care units (χ2 = 12.732; p = 0.048).

CONCLUSION:

The bacteria found on the surfaces of the University Hospital of Abomey-Calavi/So-Ava’s care environment suggest a risk of healthcare-associated infections. Adequate hospital hygiene measures are required. Patient safety in this environment must become a training priority for all caregivers.

FULL TEXT

https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-018-3648-x

PDF

https://bmcinfectdis.biomedcentral.com/track/pdf/10.1186/s12879-018-3648-x

January 11, 2019 at 8:46 am

Are methicillin-susceptible Staphylococcus aureus carriers protected from methicillin-resistant Staphylococcus aureus infections?

Clinical Microbiology and Infection January 2019 V.25 N.1 P.4–5

Regev-Yochay

The association between Staphylococcus aureus nasal carriage and staphylococcal disease was reported decades ago [1] when carriage was found to be a predisposing factor for furunculosis.

Since then several studies have shown that people who suffer from recurrent staphylococcal skin infections are frequently S. aureus carriers.

The source of 80% of nosocomial S. aureus bacteraemia episodes are caused by the endogenous carried strain [2].

Thus, being an S. aureus carrier puts an individual at risk of developing S. aureus infections by the strain they carry….

FULL TEXT

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(18)30487-7/fulltext

PDF

https://www.clinicalmicrobiologyandinfection.com/article/S1198-743X(18)30487-7/pdf

January 6, 2019 at 6:50 pm

Molecular analysis of bacterial contamination on stethoscopes in an intensive care unit

Infect Control Hosp Epidemiol. December 12, 2018

Background

Culture-based studies, which focus on individual organisms, have implicated stethoscopes as potential vectors of nosocomial bacterial transmission. However, the full bacterial communities that contaminate in-use stethoscopes have not been investigated.

Methods

We used bacterial 16S rRNA gene deep-sequencing, analysis, and quantification to profile entire bacterial populations on stethoscopes in use in an intensive care unit (ICU), including practitioner stethoscopes, individual-use patient-room stethoscopes, and clean unused individual-use stethoscopes. Two additional sets of practitioner stethoscopes were sampled before and after cleaning using standardized or practitioner-preferred methods.

Results

Bacterial contamination levels were highest on practitioner stethoscopes, followed by patient-room stethoscopes, whereas clean stethoscopes were indistinguishable from background controls. Bacterial communities on stethoscopes were complex, and community analysis by weighted UniFrac showed that physician and patient-room stethoscopes were indistinguishable and significantly different from clean stethoscopes and background controls. Genera relevant to healthcare-associated infections (HAIs) were common on practitioner stethoscopes, among which Staphylococcus was ubiquitous and had the highest relative abundance (6.8%–14% of contaminating bacterial sequences). Other HAI-related genera were also widespread although lower in abundance. Cleaning of practitioner stethoscopes resulted in a significant reduction in bacterial contamination levels, but these levels reached those of clean stethoscopes in only a few cases with either standardized or practitioner-preferred methods, and bacterial community composition did not significantly change.

Conclusions

Stethoscopes used in an ICU carry bacterial DNA reflecting complex microbial communities that include nosocomially important taxa. Commonly used cleaning practices reduce contamination but are only partially successful at modifying or eliminating these communities.

FULL TEXT

https://www.cambridge.org/core/journals/infection-control-and-hospital-epidemiology/article/molecular-analysis-of-bacterial-contamination-on-stethoscopes-in-an-intensive-care-unit/E5080DEC191CA8114D4CD564258CADE3/core-reader

December 31, 2018 at 1:03 pm

Patient- and hospital-level predictors of vancomycin-resistant Enterococcus (VRE) bacteremia in Ontario, Canada

American Journal of Infection Control November 2018 V.46 N.11 P.1266–1271

Jennie Johnstone, Cynthia Chen, Laura Rosella, Kwaku Adomako, Michelle E. Policarpio, Freda Lam, Chatura Prematunge, Gary Garber on behalf of the Ontario VRE Investigators

Highlights

  • Forty percent of patients with VRE bacteremia died within 30 days.
  • Patients with a bone marrow transplant, solid organ transplant, cancer, or who are admitted to the intensive care unit are at highest risk of VRE bacteremia.
  • Larger hospital size and teaching hospitals were independent predictors of VRE bacteremia.

Background

Data are limited on risk factors for vancomycin-resistant Enterococcus (VRE) bacteremia.

Methods

All patients with a confirmed VRE bacteremia in Ontario, Canada, between January 2009 and December 2013 were linked to provincial healthcare administrative data sources and frequency matched to 3 controls based on age, sex, and aggregated diagnosis group. Associations between predictors and VRE bacteremia were estimated by generalized estimating equations and summarized using odds ratios (ORs) and corresponding 95% confidence intervals (CIs).

Results

In total, 217 cases and 651 controls were examined. In adjusted analyses, patient-level predictors included bone marrow transplant (OR 106.99 [95% CI 12.19–939.26]); solid organ transplant (OR 17.17 [95% CI 4.95–59.54]); any cancer (OR 8.64 [95% CI 3.88–19.21]); intensive care unit (ICU) admission (OR 6.81 [95% CI 3.53–13.13]); heart disease (OR 5.27 [95% CI 2.00–13.90]); and longer length of stay (OR 1.07 per day [95% CI 1.06–1.09]). Hospital-level predictors included hospital size (per increase in 100 beds (OR 1.26 [95% CI 1.07–1.48]) and teaching hospitals (OR 3.87 [95% CI 1.85–8.08]).

Conclusions

Patients with a bone marrow transplant, solid organ transplant, cancer, or who are admitted to the ICU are at highest risk of VRE bacteremia, particularly at large hospitals and teaching hospitals.

FULL TEXT

https://www.ajicjournal.org/article/S0196-6553(18)30576-5/fulltext

PDF

https://www.ajicjournal.org/article/S0196-6553(18)30576-5/pdf

December 3, 2018 at 7:44 am

High-risk Staphylococcus aureus transmission in the operating room: A call for widespread improvements in perioperative hand hygiene and patient decolonization practices

American Journal of Infection Control October 2018 V.46 N.10 P.1134–1141

Randy W. Loftus, Franklin Dexter, Alysha D.M. Robinson

Highlights

  • Intraoperative Staphylococcus aureus multilocus sequence type 5 is hypertransmissible and pathogenic.
  • Intraoperative provider hands and patient skin surfaces are confirmed sources of sequence type 5 transmission.

Background

Increased awareness of the epidemiology of transmission of pathogenic bacterial strain characteristics may help to improve compliance with intraoperative infection control measures. Our aim was to characterize the epidemiology of intraoperative transmission of high-risk Staphylococcus aureus sequence types (STs).

Methods

S aureus isolates collected from 3 academic medical centers underwent whole cell genome analysis, analytical profile indexing, and biofilm absorbance. Transmission dynamics for hypertransmissible, strong biofilm-forming, antibiotic-resistant, and virulent STs were assessed.

Results

S aureus ST 5 was associated with increased risk of transmission (adjusted incidence risk ratio, 6.67; 95% confidence interval [CI], 1.82-24.41; P?=?.0008), greater biofilm absorbance (ST 5 median absorbance ± SD, 3.08 ± 0.642 vs other ST median absorbance ± SD, 2.38 ± 1.01; corrected P?=?.021), multidrug resistance (odds ratio, 7.82; 95% CI, 2.19-27.95; P?=?.002), and infection (6/38 ST 5 vs 6/140 STs; relative risk, 3.68; 95% CI, 1.26-10.78; P?=?.022). Provider hands (n?=?3) and patients (n?=?4) were confirmed sources of ST 5 transmission. Transmission locations included provider hands (n?=?3), patient skin sites (n?=?4), and environmental surfaces (n?=?2). All observed transmission stories involved the within-case mode of transmission. Two of the ST 5 transmission events were directly linked to infection.

Conclusions

Intraoperative S aureus ST 5 isolates are hypertransmissible and pathogenic. Improved compliance with hand hygiene and patient decolonization may help to control the spread of these dangerous pathogens.

FULL TEXT

https://www.ajicjournal.org/article/S0196-6553(18)30464-4/fulltext

PDF

https://www.ajicjournal.org/article/S0196-6553(18)30464-4/pdf

December 3, 2018 at 7:40 am

Speaking up about hand hygiene failures: A vignette survey study among healthcare professionals

American Journal of Infection Control August 2018 V.46 N.8 P.870–875

David L.B. Schwappach

Highlights

  • Healthcare professionals who are confronted with breaches in infection control practices often do not speak up.
  • Likelihood to speak up is affected by profession and by hierarchy within profession.
  • Risk to patients and past voicing behaviors are key drivers for speaking up.
  • Resignation to speaking up was high and contributes to withholding voice.
  • Hospital climate explains only a minor fraction of variance in speaking-up intentions.

Background

Speaking up by healthcare professionals (HCPs) is an important resource to reduce risks to patient safety. Due to complex tradeoffs, HCPs are often reluctant to voice their concerns. A survey investigated HCPs’ likelihood to speak up.

Methods

A cross-sectional survey study among HCPs in 5 Swiss hospitals addressed speaking-up behaviors, safety climate, and likelihood to speak up about poor hand hygiene practice described in a vignette. Likelihood to speak up was analyzed using a multilevel regression model.

Results

Of surveyed HCPs (n?=?1217), 56% reported that they would speak up to a colleague with poor hand hygiene practice. Nurses as compared to doctors rated the situation as more realistic (5.25 vs 4.32, P?<?.001), felt more discomfort with speaking up (4.00 vs 3.34, P?<?.001), and reported a slightly lower likelihood of speaking up (4.41 vs 4.77, P?<?.001). Clinical function (hierarchy) was strongly associated with speaking-up behavior (P?<?.001). Higher risk of harm to the patient (P?<?.001) and higher frequencies of past speaking-up behaviors (P?=?.006) were positively associated with the likelihood to speak up. Higher frequencies of past withholding voice (P?=?.013) and higher levels of resignation (P?=?.008) were both associated with a lower likelihood to speak up.

Conclusions

Infection control interventions should empower HCPs to speak up about non-adherence with prevention practices by addressing authority gradients and risk perceptions and by focusing on resignation.

FULL TEXT

https://www.ajicjournal.org/article/S0196-6553(18)30150-0/fulltext

PDF

https://www.ajicjournal.org/article/S0196-6553(18)30150-0/pdf

December 3, 2018 at 7:35 am

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