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Most Cited Journal of Hospital Infection Articles
The most cited articles published since 2008, extracted from Scopus.
The role of environmental cleaning in the control of hospital-acquired infectionVolume 73, Issue 4, December 2009, Pages 378-385
Dancer, S.J. Increasing numbers of hospital-acquired infections have generated much attention over the last decade. The public has linked the so-called 'superbugs' with their experience of dirty hospitals but the precise role of environmental cleaning in the control of these organisms remains unknown. Until cleaning becomes an evidence-based science, with established methods for assessment, the importance of a clean environment is likely to remain speculative. This review will examine the links between the hospital environment and various pathogens, including meticillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, norovirus, Clostridium difficile and acinetobacter. These organisms may be able to survive in healthcare environments but there is evidence to support their vulnerability to the cleaning process. Removal with, or without, disinfectants, appears to be associated with reduced infection rates for patients. Unfortunately, cleaning is often delivered as part of an overall infection control package in response to an outbreak and the importance of cleaning as a single intervention remains controversial. Recent work has shown that hand-touch sites are habitually contaminated by hospital pathogens, which are then delivered to patients on hands. It is possible that prioritising the cleaning of these sites might offer a useful adjunct to the current preoccupation with hand hygiene, since hand-touch sites comprise the less well-studied side of the hand-touch site equation. In addition, using proposed standards for hospital hygiene could provide further evidence that cleaning is a cost-effective intervention for controlling hospital-acquired infection. © 2009 The Hospital Infection Society. Share on facebookShare on twitterShare on google_plusone_shareShare on linkedinShare on blogger
Role of hand hygiene in healthcare-associated infection preventionVolume 73, Issue 4, December 2009, Pages 305-315
Allegranzi, B. | Pittet, D. Healthcare workers' hands are the most common vehicle for the transmission of healthcare-associated pathogens from patient to patient and within the healthcare environment. Hand hygiene is the leading measure for preventing the spread of antimicrobial resistance and reducing healthcare-associated infections (HCAIs), but healthcare worker compliance with optimal practices remains low in most settings. This paper reviews factors influencing hand hygiene compliance, the impact of hand hygiene promotion on healthcare-associated pathogen cross-transmission and infection rates, and challenging issues related to the universal adoption of alcohol-based hand rub as a critical system change for successful promotion. Available evidence highlights the fact that multimodal intervention strategies lead to improved hand hygiene and a reduction in HCAI. However, further research is needed to evaluate the relative efficacy of each strategy component and to identify the most successful interventions, particularly in settings with limited resources. The main objective of the First Global Patient Safety Challenge, launched by the World Health Organization (WHO), is to achieve an improvement in hand hygiene practices worldwide with the ultimate goal of promoting a strong patient safety culture. We also report considerations and solutions resulting from the implementation of the multimodal strategy proposed in the WHO Guidelines on Hand Hygiene in Health Care. © 2009 The Hospital Infection Society. Share on facebookShare on twitterShare on google_plusone_shareShare on linkedinShare on blogger
Extended-spectrum β-lactamase-producing organismsVolume 73, Issue 4, December 2009, Pages 345-354
Falagas, M.E. | Karageorgopoulos, D.E. Extended-spectrum β-lactamases (ESBLs), which hydrolyse extended-spectrum cephalosporins and are inhibited by clavulanic acid, are spreading among Enterobacteriaceae. The CTX-M enzymes are replacing SHV and TEM enzymes as the prevalent type of ESBLs, principally in community-acquired infections caused by Escherichia coli. Associated infectious syndromes include mainly urinary tract infections, and secondly bloodstream and intra-abdominal infections, and may be serious enough to warrant hospitalisation. Affected patients commonly have various underlying risk factors. This is also observed in hospital-acquired infections. The rates of ESBL-expression among nosocomial Enterobacteriaceae isolates, particularly Klebsiella pneumoniae, have risen substantially in several countries. The hospital epidemiology of these infections is often complex; multiple clonal strains causing focal outbreaks may co-exist with sporadic ones. Relevant infection-control measures should focus on reducing patient-to-patient transmission via the inanimate environment, hospital personnel, and medical equipment. Wise use of antibiotics is also essential. The available therapeutic options for the treatment of ESBL-associated infections are limited by drug resistance conferred by the ESBLs, along with frequently observed co-resistance to various antibiotic classes, including cephamycins, fluoroquinolones, aminoglycosides, tetracyclines, and trimethoprim/sulfamethoxazole. Relevant clinical data regarding the effectiveness of different regimens for ESBL-associated infections are limited. Although certain cephalosporins may appear active in vitro, associated clinical outcomes are often suboptimal. β-Lactam/β-lactamase inhibitor combinations may be of value, but the supporting evidence is weak. Carbapenems are regarded as the agents of choice, and may be more effective than fluoroquinolones for serious infections. Tigecycline and polymyxins have substantial antimicrobial activity against ESBL-producing Enterobacteriaceae, and, along with fosfomycin, merit further evaluation. © 2009 The Hospital Infection Society. Share on facebookShare on twitterShare on google_plusone_shareShare on linkedinShare on blogger
Acinetobacter: an old friend, but a new enemyVolume 73, Issue 4, December 2009, Pages 355-363
Towner, K.J. Acinetobacter emerged as a significant nosocomial pathogen during the late 1970s, probably as a consequence, at least in part, of increasing use of broad-spectrum antibiotics in hospitals. Most clinically significant isolates belong to the species Acinetobacter baumannii or its close relatives, with many infections concentrated in intensive care, burns or high dependency units treating severely ill or debilitated patients. Large outbreaks can occur in such units, involving the infection or colonisation of numerous patients by specific epidemic strains of A. baumannii. Recently, a particular problem has concerned cross-infection of injured military patients repatriated from combat regions of the world (e.g. Iraq and Afghanistan). Carbapenems have previously been the treatment of choice for infected patients, but increasing reports worldwide now describe A. baumannii isolates resistant to all conventional antimicrobial regimens. Data to support therapeutic use of the limited number of new antimicrobial agents (e.g. tigecycline) with in-vitro activity against these pathogens are still very limited. Detailed advice concerning prevention and control of outbreaks caused by multidrug-resistant strains of acinetobacter is available from the UK Health Protection Agency. In addition to antibiotic prescribing policies and audit, these measures focus on reinforcing standard infection control procedures and precautions, with particular attention to thorough cleaning of patient areas to take account of the long-term survival of acinetobacter after drying and inadequate disinfection. Despite these measures, the problem continues to escalate, with many hospitals worldwide now reporting outbreaks caused by multidrug-resistant strains of acinetobacter. © 2009 The Hospital Infection Society. Share on facebookShare on twitterShare on google_plusone_shareShare on linkedinShare on blogger
Four Country Healthcare Associated Infection Prevalence Survey 2006: overview of the resultsVolume 69, Issue 3, July 2008, Pages 230-248
Smyth, E.T.M. | McIlvenny, G. | Enstone, J.E. | Emmerson, A.M. | Humphreys, H. | Fitzpatrick, F. | Davies, E. | Newcombe, R.G. | Spencer, R.C. A survey of adult patients was conducted in February 2006 to May 2006 in acute hospitals across England, Wales, Northern Ireland and the Republic of Ireland to estimate the prevalence of healthcare-associated infections (HCAIs). A total of 75 694 patients were surveyed; 5743 of these had HCAIs, giving a prevalence of 7.59% (95% confidence interval: 7.40-7.78). HCAI prevalence in England was 8.19%, in Wales 6.35%, in Northern Ireland 5.43% and in the Republic of Ireland 4.89%. The most common HCAI system infections were gastrointestinal (20.6% of all HCAI), urinary tract (19.9%), surgical site (14.5%), pneumonia (14.1%), skin and soft tissue (10.4%) and primary bloodstream (7.0%). Prevalence of MRSA was 1.15% with MRSA being the causative organism in 15.8% of all system infections. Prevalence of Clostridium difficile was 1.21%. This was the largest HCAI prevalence survey ever performed in the four countries. The methodology and organisation used is a template for future HCAI surveillance initiatives, nationally, locally or at unit level. Information obtained from this survey will contribute to the prioritisation of resources and help to inform Departments of Health, hospitals and other relevant bodies in the continuing effort to reduce HCAI. © 2008 The Hospital Infection Society. Share on facebookShare on twitterShare on google_plusone_shareShare on linkedinShare on blogger
Pseudomonas aeruginosa: a formidable and ever-present adversaryVolume 73, Issue 4, December 2009, Pages 338-344
Kerr, K.G. | Snelling, A.M. Pseudomonas aeruginosa is a versatile pathogen associated with a broad spectrum of infections in humans. In healthcare settings the bacterium is an important cause of infection in vulnerable individuals including those with burns or neutropenia or receiving intensive care. In these groups morbidity and mortality attributable to P. aeruginosa infection can be high. Management of infections is difficult as P. aeruginosa is inherently resistant to many antimicrobials. Furthermore, treatment is being rendered increasingly problematic due to the emergence and spread of resistance to the few agents that remain as therapeutic options. A notable recent development is the acquisition of carbapenemases by some strains of P. aeruginosa. Given these challenges, it would seem reasonable to identify strategies that would prevent acquisition of the bacterium by hospitalised patients. Environmental reservoirs of P. aeruginosa are readily identifiable, and there are numerous reports of outbreaks that have been attributed to an environmental source; however, the role of such sources in sporadic pseudomonal infection is less well understood. Nevertheless there is emerging evidence from prospective studies to suggest that environmental sources, especially water, may have significance in the epidemiology of sporadic P. aeruginosa infections in hospital settings, including intensive care units. A better understanding of the role of environmental reservoirs in pseudomonal infection will permit the development of new strategies and refinement of existing approaches to interrupt transmission from these sources to patients. © 2009 The Hospital Infection Society. Share on facebookShare on twitterShare on google_plusone_shareShare on linkedinShare on blogger
Meta-analysis to assess risk factors for recurrent Clostridium difficile infectionVolume 70, Issue 4, December 2008, Pages 298-304
Garey, K.W. | Sethi, S. | Yadav, Y. | DuPont, H.L. Clostridium difficile infection (CDI) is the most common cause of hospital-acquired diarrhoea. It is estimated that 15-20% of patients experience recurrence of CDI. A limited number of studies have looked at the risk factors for recurrent CDI. We conducted a meta-analysis of observational studies and randomised controlled trials (RCTs) to assess risk factors for recurrent CDI. Studies were identified using the PubMed database and search terms 'Clostridium difficile associated diarrhoea' or 'pseudomembranous colitis'. Both observational studies and RCTs were included. In all, 1215 studies were identified of which 48 met the inclusion criteria. Twelve studies involving 1382 patients with CDI met the complete eligibility requirements. Odds ratios and information on study quality were abstracted by two investigators independently. To be included in the analysis, each risk factor was required to be evaluated by at least three separate studies. Continued use of non-C. difficile antibiotics after diagnosis of CDI (OR: 4.23; 95% CI: 2.10-8.55; P < 0.001), concomitant receipt of antacid medications (OR: 2.15; 95% CI: 1.13-4.08; P = 0.019), and older age (OR: 1.62; 95% CI: 1.11-2.36; P = 0.0012) were significantly associated with increased risk of recurrent CDI. Significant prognostic risk factors were identified as risk factors for CDI recurrence. Additional or novel interventions may be required for these patients to prevent CDI recurrence. © 2008 The Hospital Infection Society. Share on facebookShare on twitterShare on google_plusone_shareShare on linkedinShare on blogger
Surgical site infections: epidemiology, microbiology and preventionVolume 70, Issue SUPPL. 2, November 2008, Pages 3-10
Owens, C.D. | Stoessel, K. Surgical site infections (SSIs) are defined as infections occurring up to 30 days after surgery (or up to one year after surgery in patients receiving implants) and affecting either the incision or deep tissue at the operation site. Despite improvements in prevention, SSIs remain a significant clinical problem as they are associated with substantial mortality and morbidity and impose severe demands on healthcare resources. The incidence of SSIs may be as high as 20%, depending on the surgical procedure, the surveillance criteria used, and the quality of data collection. In many SSIs, the responsible pathogens originate from the patient's endogenous flora. The causative pathogens depend on the type of surgery; the most commonly isolated organisms are Staphylococcus aureus, coagulase-negative staphylococci, Enterococcus spp. and Escherichia coli. Numerous patient-related and procedure-related factors influence the risk of SSI, and hence prevention requires a 'bundle' approach, with systematic attention to multiple risk factors, in order to reduce the risk of bacterial contamination and improve the patient's defences. The Centers for Disease Control and Prevention guidelines for the prevention of SSIs emphasise the importance of good patient preparation, aseptic practice, and attention to surgical technique; antimicrobial prophylaxis is also indicated in specific circumstances. Emerging technologies, such as microbial sealants, offer the ability to seal and immobilise skin flora for the duration of a surgical procedure; a strong case therefore exists for evaluating such technologies and implementing them into routine clinical practice as appropriate. © 2008 The Hospital Infection Society. Share on facebookShare on twitterShare on google_plusone_shareShare on linkedinShare on blogger
Economic healthcare costs of Clostridium difficile infection: A systematic reviewVolume 74, Issue 4, April 2010, Pages 309-318
Ghantoji, S.S. | Sail, K. | Lairson, D.R. | DuPont, H.L. | Garey, K.W. Clostridium difficile infection (CDI) is the leading cause of infectious diarrhoea in hospitalised patients. CDI increases patient healthcare costs due to extended hospitalisation, re-hospitalisation, laboratory tests and medications. However, the economic costs of CDI on healthcare systems remain uncertain. The purpose of this study was to perform a systematic review to summarise available studies aimed at defining the economic healthcare costs of CDI. We conducted a literature search for peer-reviewed studies that investigated costs associated with CDI (1980 to present). Thirteen studies met inclusion and exclusion criteria. CDI costs in 2008 US dollars were calculated using the consumer price index. The total and incremental costs for primary and recurrent CDI were estimated. Of the 13, 10 were from the USA and one each from Canada, UK, and Ireland. In US-based studies incremental cost estimates ranged from $2,871 to $4,846 per case for primary CDI and from $13,655 to $18,067 per case for recurrent CDI. US-based studies in special populations (subjects with irritable bowel disease, surgical inpatients, and patients treated in the intensive care unit) showed an incremental cost range from $6,242 to $90,664. Non-US-based studies showed an estimated incremental cost of $5,243 to $8,570 per case for primary CDI and $13,655 per case for recurrent CDI. Economic healthcare costs of CDI were high for primary and recurrent cases. The high cost associated with CDI justifies the use of additional resources for CDI prevention and control. © 2009 The Hospital Infection Society. Share on facebookShare on twitterShare on google_plusone_shareShare on linkedinShare on blogger
A review of dental implants and infectionVolume 72, Issue 2, June 2009, Pages 104-110
Pye, A.D. | Lockhart, D.E.A. | Dawson, M.P. | Murray, C.A. | Smith, A.J. Dental implants have become increasingly common for the management of tooth loss. Despite their placement in a contaminated surgical field, success rates are relatively high. This article reviews dental implants and highlights factors leading to infection and potential implant failure. A literature search identified studies analysing the microbial composition of peri-implant infections. The microflora of dental peri-implantitis resembles that found in chronic periodontitis, featuring predominantly anaerobic Gram-negative bacilli, in particular Porphyromonas gingivalis and Prevotella intermedia, anaerobic Gram-negative cocci such as Veillonella spp. and spirochaetes including Treponema denticola. The role of Staphylococcus aureus and coagulase-negative staphylococci that are typically encountered in orthopaedic infections is debatable, although they undoubtedly play a role when isolated from clinically infected sites. Likewise, the aetiological involvement of coliforms and Candida spp. requires further longitudinal studies. Currently, there are neither standardised antibiotic prophylactic regimens for dental implant placement nor universally accepted treatment for peri-implantitis. The treatment of infected implants is difficult and usually requires removal. In the UK there is no systematic post-surgical implant surveillance programme. Therefore, the development of such a project would be advisable and provide valuable epidemiological data. © 2009 The Hospital Infection Society. Share on facebookShare on twitterShare on google_plusone_shareShare on linkedinShare on blogger
Role of copper in reducing hospital environment contaminationVolume 74, Issue 1, January 2010, Pages 72-77
Casey, A.L. | Adams, D. | Karpanen, T.J. | Lambert, P.A. | Cookson, B.D. | Nightingale, P. | Miruszenko, L. | Shillam, R. | Christian, P. | Elliott, T.S.J. The environment may act as a reservoir for pathogens that cause healthcare-associated infections (HCAIs). Approaches to reducing environmental microbial contamination in addition to cleaning are thus worthy of consideration. Copper is well recognised as having antimicrobial activity but this property has not been applied to the clinical setting. We explored its use in a novel cross-over study on an acute medical ward. A toilet seat, set of tap handles and a ward entrance door push plate each containing copper were sampled for the presence of micro-organisms and compared to equivalent standard, non-copper-containing items on the same ward. Items were sampled once weekly for 10 weeks at 07:00 and 17:00. After five weeks, the copper-containing and non-copper-containing items were interchanged. The total aerobic microbial counts per cm 2 including the presence of 'indicator micro-organisms' were determined. Median numbers of microorganisms harboured by the copper-containing items were between 90% and 100% lower than their control equivalents at both 07:00 and 17:00. This reached statistical significance for each item with one exception. Based on the median total aerobic cfu counts from the study period, five out of ten control sample points and zero out of ten copper points failed proposed benchmark values of a total aerobic count of <5 cfu/cm 2. All indicator micro-organisms were only isolated from control items with the exception of one item during one week. The use of copper-containing materials for surfaces in the hospital environment may therefore be a valuable adjunct for the prevention of HCAIs and requires further evaluation. © 2009 The Hospital Infection Society. Share on facebookShare on twitterShare on google_plusone_shareShare on linkedinShare on blogger
Infection control as a major World Health Organization priority for developing countriesVolume 68, Issue 4, April 2008, Pages 285-292
Pittet, D. | Allegranzi, B. | Storr, J. | Nejad, S.B. | Dziekan, G. | Leotsakos, A. | Donaldson, L. Healthcare-associated infection affects hundreds of millions of people worldwide and is a major global issue for patient safety. It complicates between 5 and 10% of admissions in acute care hospitals in industrialised countries. In developing countries, the risk is two to twenty times higher and the proportion of infected patients frequently exceeds 25%. A growing awareness of this problem prompted the World Health Organization to promote the creation of the World Alliance for Patient Safety. Prevention of healthcare-associated infection is the target of the Alliance First Global Patient Safety Challenge, 'Clean Care is Safer Care', launched in October 2005. After 2 years, a formal statement has been signed by 72 ministries of health as a pledge of their support to implement actions to reduce healthcare-associated infection; of these, 30 are developing countries. Additional countries, mostly from the developing world, have planned to sign by the end of 2008 and will represent in total more than three-quarters of the world's population. Given the emphasis of the proposed strategy on simple and affordable solutions, the impact of the Challenge is expected to be high in developing countries. The combined efforts expected under the Challenge have the potential to save millions of lives, prevent morbidities and long-term disability for hundreds of millions of patients, and lead to major cost savings through the improvement of basic infection control measures in any healthcare setting, regardless of resources available or level of development. © 2008 The Hospital Infection Society. Share on facebookShare on twitterShare on google_plusone_shareShare on linkedinShare on blogger
The antimicrobial activity of copper and copper alloys against nosocomial pathogens and Mycobacterium tuberculosis isolated from healthcare facilities in the Western Cape: an in-vitro studyVolume 68, Issue 1, January 2008, Pages 45-51
Mehtar, S. | Wiid, I. | Todorov, S.D. Clinical isolates of meticillin-resistant Staphylococcus aureus (MRSA), Klebsiella pneumoniae, Pseudomonas aeruginosa, Acinetobacter baumannii, Candida albicans and Mycobacterium tuberculosis (MTB) were tested against copper (Cu) and its alloys. Stainless steel and polyvinylchloride (PVC) were used as controls. The amount of Cu required to inhibit test isolates at room temperature (24 °C) and at 4 °C was determined. At room temperature, Cu, DZR Brass (Cu 62%, Pb 2.5%, arsenate 0.13% and Zn 22.5%) and Brass 70/30 (Cu 70% and zinc 30%) inhibited C. albicans and K. pneumoniae at 60 min; nickel silver (NiAg) inhibited C. albicans at 60 min and K. pneumoniae at 270 min. P. aeruginosa was inhibited by Brass 70/30 and nickel silver (NiAg) at 180 min and at 270 min by Cu and DZR. Cu and DZR inhibited A. baumannii at 180 min while the other alloys were effective at 360 min. Stainless steel and PVC showed little or no inhibitory activity. Two M. tuberculosis strains, one isoniazid resistant (R267) and the other multidrug resistant (R432), demonstrated growth inhibition with Cu of 98% and 88% respectively compared with PVC; the other alloys were less active. Time to positivity (TTP) for R267 was >15 days with Cu and 11 days for the other alloys; with R432 it was 5 days. Effective inhibition of nosocomial pathogens and MTB by Cu and alloys was best when the Cu content was >55%. © 2007 The Hospital Infection Society. Share on facebookShare on twitterShare on google_plusone_shareShare on linkedinShare on blogger
Nasal carriage of S. aureus increases the risk of surgical site infection after major heart surgeryVolume 68, Issue 1, January 2008, Pages 25-31
Muñoz, P. | Hortal, J. | Giannella, M. | Barrio, J.M. | Rodríguez-Créixems, M. | Pérez, M.J. | Rincón, C. | Bouza, E. Staphylococcus aureus is the main cause of surgical site infection (SSI) after major heart surgery (MHS), with the patient's endogenous flora as the principal source. However, the influence of nasal carriage of S. aureus on the development of SSI after MHS has not been established and Centers for Disease Control and Prevention guidelines do not make a recommendation for or against decolonisation. We performed a one-year observational study in which patients undergoing MHS were screened for nasal carriage of S. aureus before surgery. Cases of SSI were recorded and the risk factors of patients with and without SSI were analysed. During the study period, 357 patients were included in the protocol. Ninety-six patients (27%) were found to be nasal carriers of S. aureus and nine (9.4%) of these had meticillin-resistant (MRSA) strains. The overall incidence of SSI was 6.4%, with 4.2% for mediastinitis and 2.2% for superficial SSI. Nasal carriers of S. aureus had a significantly higher incidence of SSI than non-carriers (12.5% vs 5%, P = 0.01). Among MRSA carriers, the incidence of SSI reached 33% (P < 0.001). S. aureus was responsible for 64% of SSIs. Multivariate analysis showed that the independent factors for SSI were S. aureus nasal carriage [relative risk (RR): 3.1; 95% confidence interval (CI): 1.4-7.3; P = 0.009], reoperation (RR: 3.1; 95% CI: 1.8-19.2; P = 0.04) and diabetes mellitus (RR: 5.9; 95% CI: 1.8-19.2; P = 0.003). Nasal carriage of S. aureus significantly increases the rate of nosocomial SSI after MHS and decolonisation strategies should be implemented in this population. © 2007 The Hospital Infection Society. Share on facebookShare on twitterShare on google_plusone_shareShare on linkedinShare on blogger
Survival of Clostridium difficile on copper and steel: futuristic options for hospital hygieneVolume 68, Issue 2, February 2008, Pages 145-151
Weaver, L. | Michels, H.T. | Keevil, C.W. Clostridium difficile is rapidly becoming a major cause of hospital-acquired infections worldwide, due in part to transmission of the faecal pathogen between contaminated hands and contact surfaces. Accordingly, this study evaluated survival of C. difficile vegetative cells and spores on the contact surface commonly found in healthcare settings, stainless steel, compared to five copper alloys (65-100% copper content). C. difficile requires prolonged incubation to grow and therefore the total number and number of viable cells was estimated using a fluorescence dual-staining technique. For viability assessment the redox dye 5-cyano-2,3-ditolyl tetrazolium (CTC) was used to measure metabolic activity. Results demonstrated that copper alloys with a copper content >70% provide a significant reduction in survival of C. difficile vegetative cells and spores on copper alloys compared with stainless steel. Complete death of spores was observed after 24-48 h on copper alloys whereas no significant death rate was observed on stainless steel even after 168 h. The use of CTC gave comparable results to culture and offers a more rapid viability analysis (8 h) than culture. The results suggest that using copper alloys in hospitals and other healthcare facilities could offer the potential to reduce spread of C. difficile from contaminated surfaces. © 2007 The Hospital Infection Society. Share on facebookShare on twitterShare on google_plusone_shareShare on linkedinShare on blogger
A modified ATP benchmark for evaluating the cleaning of some hospital environmental surfacesVolume 69, Issue 2, June 2008, Pages 156-163
Lewis, T. | Griffith, C. | Gallo, M. | Weinbren, M. Hospital cleaning continues to attract patient, media and political attention. In the UK it is still primarily assessed via visual inspection, which can be misleading. Calls have therefore been made for a more objective approach to assessing surface cleanliness. To improve the management of hospital cleaning the use of adenosine triphosphate (ATP) in combination with microbiological analysis has been proposed, with a general ATP benchmark value of 500 relative light units (RLU) for one combination of test and equipment. In this study, the same test combination was used to assess cleaning effectiveness in a 1300-bed teaching hospital after routine and modified cleaning protocols. Based upon the ATP results a revised stricter pass/fail benchmark of 250 RLU is proposed for the range of surfaces used in this study. This was routinely achieved using modified best practice cleaning procedures which also gave reduced surface counts with, for example, aerobic colony counts reduced from >100 to <2.5 cfu/cm 2, and counts of Staphylococcus aureus reduced from up to 2.5 to <1 cfu/cm 2 (95% of the time). Benchmarking is linked to incremental quality improvements and both the original suggestion of 500 RLU and the revised figure of 250 RLU can be used by hospitals as part of this process. They can also be used in the assessment of novel cleaning methods, such as steam cleaning and microfibre cloths, which have potential use in the National Health Service. © 2008 The Hospital Infection Society. Share on facebookShare on twitterShare on google_plusone_shareShare on linkedinShare on blogger
Hospital outbreak caused by Klebsiella pneumoniae producing KPC-2 β-lactamase resistant to colistinVolume 76, Issue 1, September 2010, Pages 70-73
Kontopoulou, K. | Protonotariou, E. | Vasilakos, K. | Kriti, M. | Koteli, A. | Antoniadou, E. | Sofianou, D. We describe a hospital outbreak caused by colistin-resistant Klebsiella pneumoniae producing KPC-2 β-lactamase in two distinct medical centres. Seven clinical isolates of K. pneumoniae exhibiting resistance to carbapenems were collected from patients with hospital-acquired infection. All isolates were phenotypically positive for carbapenemase activity but negative for metallo-β-lactamase production. PCR analysis using specific primers for blaKPC, blaSHV, blaTEM and blaCTX-M demonstrated that all clinical strains of K. pneumoniae from hospital A and one isolate from hospital B were genetically related and carried blaKPC-2 in addition to blaSHV-12. In contrast, the remaining isolate carried blaSHV-5 with blaKPC-2 and yielded a different profile. These results indicate the clonal spread of KPC producers between hospitals as well as the acquisition of KPC genes by different K. pneumoniae strains. All isolates were resistant to carbapenems, β-lactams, ciprofloxacin, aminoglycosides and colistin, but intermediately susceptible to tigecycline and susceptible to gentamicin. The infection was fatal in five cases. The emergence of colistin-resistant K. pneumoniae possessing blaKPC-2 underscores the implementation of strict control measures to prevent their dissemination of these organisms in hospitals. © 2010 The Hospital Infection Society. Share on facebookShare on twitterShare on google_plusone_shareShare on linkedinShare on blogger
High-throughput whole-genome sequencing to dissect the epidemiology of Acinetobacter baumannii isolates from a hospital outbreakVolume 75, Issue 1, May 2010, Pages 37-41
Lewis, T. | Loman, N.J. | Bingle, L. | Jumaa, P. | Weinstock, G.M. | Mortiboy, D. | Pallen, M.J. Shared care of military and civilian patients has resulted in transmission of multidrug-resistant Acinetobacter baumannii (MDR-Aci) from military casualties to civilians. Current typing technologies have been useful in revealing relationships between isolates of A. baumannii but they are unable to resolve differences between closely related isolates from small-scale outbreaks, where chains of transmission are often unclear. In a recent hospital outbreak in Birmingham, six patients were colonised with MDR-Aci isolates indistinguishable using standard techniques. We used whole-genome sequencing to identify single nucleotide polymorphisms in these isolates, allowing us to discriminate between alternative epidemiological hypotheses in this setting. © 2010. Share on facebookShare on twitterShare on google_plusone_shareShare on linkedinShare on blogger
Ten years of KISS: The most important requirements for successVolume 70, Issue SUPPL. 1, October 2008, Pages 11-16
Gastmeier, P. | Sohr, D. | Schwab, F. | Behnke, M. | Zuschneid, I. | Brandt, C. | Dettenkofer, M. | Chaberny, I.F. | Rüden, H. | Geffers, C. Summary: Ten years ago, in January 1997, data collection for the German national nosocomial infection surveillance system was established, which is known by the acronym KISS (Krankenhaus-Infektions-Surveillance-System). Meanwhile KISS was able to demonstrate a beneficial effect from ongoing surveillance activities and appropriate feedback to the users in combination with reference data for ventilator associated pneumonia, primary bloodstream infections and surgical site infections. Significant reductions of infection rates between 20-30% over 3 years periods in the components for intensive care units, operative departments and neonatal intensive care units were demonstrated. Due to our experience the following requirements have to be fulfilled to keep a surveillance system successful over longer periods: close contact between the participating institutions, consideration of new developments, timely regular data feedback and constant reevaluation of the way of data presentation, data validity and demonstration of its contribution to the reduction of healthcare associated infections (HAI). The article describes in more detail how KISS tries to fulfill these requirements. © 2008 The Hospital Infection Society. Share on facebookShare on twitterShare on google_plusone_shareShare on linkedinShare on blogger
Costs of nosocomial Clostridium difficile-associated diarrhoeaVolume 70, Issue 1, September 2008, Pages 15-20
Vonberg, R.-P. | Reichardt, C. | Behnke, M. | Schwab, F. | Zindler, S. | Gastmeier, P. Nosocomial Clostridium difficile-associated disease (CDAD) is a common infection in hospitals. A matched case-control study was carried out to determine hospital-wide excess costs due to CDAD. Cases were assessed by prospective hospital-wide surveillance in a tertiary care university hospital in 2006. Nosocomial cases of CDAD (>72 h after admission) were matched to control patients without CDAD in a ratio 1:3 using the same diagnosis-related group in the same year, for a hospital stay at least as long as the time of risk of the CDAD cases before infection and a Charlson comorbidity index ±1. Data on overall costs per case were provided by the finance department. Matching was possible for 45 nosocomial CDAD cases. The difference in the length of stay showed that CDAD cases stayed significantly longer (median 7 days; P = 0.006) than their matched controls. The average cost per CDAD patient was |
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