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ABSTRACT: PURPOSE: In a previous observational intervention study, we achieved a more than 100 % increase in overall hand hygiene (HH) compliance in the hemodialysis setting by increasing the number of hand rubs (HR) performed and concomitantly optimizing HH standard operating procedures (SOPs). SOPs were mainly aimed at reducing the number of avoidable opportunities due to a less than perfect workflow. However, the long-term sustainability of this successful intervention was not evaluated. The present study was carried out to evaluate the long-term effects of our previous successful intervention. METHODS: We conducted a follow-up observational study 1 year after the first intervention study in the same hemodialysis unit to assess the sustainability. No HH-related interventions were performed in the 1 year between studies. The main outcome was HH compliance, and the secondary outcome was opportunities per hemodialysis procedure. RESULTS: A total of 1,574 opportunities for HH and 871 hand rubs (HR) were observed during the follow-up observational study. Overall, compliance was 55 %, which was significantly than that at the end of the first study (62 %; p < 0.0001), but significantly higher than that at the start and mid-term phases of the first study (37 and 49 %, p < 0.0001). Both the decrease in HH opportunities and the increase in HR were sustained over the course of this observational study. The number of avoidable opportunities in the present study was similar to that at the end of the previous study. Thus, in 320 opportunities (20 %), gloves were worn instead of HR performed, representing 46 % of all missed HR. CONCLUSIONS: Despite a decrease in HH compliance compared to the last postintervention period, a multifaceted intervention focusing on standardization and workflow optimization resulted in a sustained improvement in HH. We therefore propose that standardization of the hemodialysis workflow aimed at improving HH is a promising avenue for improving the quality of patient care and outcome.
Infection 02/2013; · 2.66 Impact Factor
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ABSTRACT: Antibiotikaresistente Bakterien als Erreger nosokomialer Infektionen stellen eine zunehmende Herausforderung im Gesundheitswesen
dar. Intensivstationen repräsentieren dabei ein Zentrum für ihre Entstehung, Selektion und Weiterverbreitung. Ursachen liegen
in der erhöhten Morbidität des Patientenklientels, der Zunahme invasiver Maßnahmen, dem unkritischer Einsatz von Antibiotika
und der mangelnden Compliance mit den Hygienestandards. Die Komplexität der Problematik wird bedingt durch die Individualität
des Eigenschaftsprofils der verschiedenen Erreger, Unterschieden in ihrer Verbreitung und Dynamik in Abhängigkeit von der
Art der Einrichtung und der Region sowie die Schwierigkeit der Detektion einiger Resistenzmechanismen. Während die MRSA-Rate
in Deutschland nicht weiter zunimmt, steigt der Anteil an resistenten gramnegativen Erregern, insbesondere vom ESBL-Phänotyp
an. Vor dem Hintergrund mangelnder therapeutischer Alternativen sind die Etablierung rationaler antibiotischer Therapieregime
und die Implementierung von Strategien zur Transmissionsprävention erforderlich. Zur effizienten Umsetzung sind die Priorisierung
der Resistenzthematik sowie eine Fokussierung der vorhandenen Ressourcen notwendig.
Antibiotic-resistant pathogens causing healthcare-associated infections pose an increasing public health challenge. Intensive
care units represent a center for their generation, selection, and transmission due to the increased morbidity of patients,
the increasing number of invasive procedures, inappropriate antibiotic usage, and non-compliance with standard infection control
practices. This problem is made more complex because of varying levels of antibiotic resistance depending on the type of healthcare
facility, the geographic area, differences between the individual resistant pathogens, and the difficulties associated with
detecting some resistance mechanisms. While MRSA epidemics have leveled off in Germany, the rate of Gram-negative pathogens
becoming resistant, especially those of the ESBL-phenotype, is steadily increasing. Since treatment options are limited, the
establishment of improved antibiotic regimens as well as the implementation of cross-transmission prevention strategies is
urgently needed. However, all attempts to meet this public health challenge will only work if this matter is prioritized and
appropriate levels of resources are allocated and then used efficiently.
Intensivmedizin + Notfallmedizin 04/2012; 46(7):466-473.
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ABSTRACT: Surgical site infections are mainly caused by bacteria from the patients' skin or gut flora representing endogenous infections. In orthopedic and trauma surgery the skin commensals dominate and as a consequence Gram-positive bacteria are the main pathogens, particularly S. aureus. Additionally and especially in the case of foreign body infections, less virulent pathogens, e.g. coagulase-negative staphylococci play an important role. Due to newer microbiological techniques in detecting pathogens the spectrum of causative organisms is steadily increasing. As known for other nosocomial infections the relevance of multidrug resistant bacteria in surgical site infections is growing and the key player is methicillin-resistant S. aureus (MRSA); however vancomycin-resistant enterococci (VRE), extended spectrum betalactamases and/or carbapenemases producing enterobacteria and recently even panresistant Acinetobacter baumannii isolates have to be considered.
Der Orthopäde 01/2012; 41(1):6-10. · 0.51 Impact Factor
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ABSTRACT: Viral gastroenteritis is common on pediatric wards, increasing the need for adherence with hand hygiene recommendations in order to prevent cross-transmission. Therefore, we investigated hand hygiene reflecting complete work-day activities on pediatric wards and focused on the influence of viral gastroenteritis. There are, so far, no studies representing complete working days on pediatric wards or addressing the influence of viral gastroenteritis.
This was a prospective, observational study (144 h in each group) on hand hygiene behavior in the care for children with and without suspected or proven viral gastroenteritis.
We documented 40 and 30 hand hygiene opportunities per patient-day for ward-associated healthcare workers for children with and without viral gastroenteritis, respectively (P = 0.316). Healthcare workers' compliance with hand hygiene recommendations was significantly higher in children with viral gastroenteritis compared to those without, i.e., 72 versus 67% (P = 0.033), especially among physicians, being 92 versus 50% (P = 0.032). Compliance tended to be higher after patient contact than before, especially in the children with gastroenteritis (78 vs. 62%; P = 0.083).
We conclude that viral gastroenteritis seemed to increase the number of daily opportunities for hand hygiene and did significantly increase compliance. In particular, this effect was seen after patient contact. Further research might address the awareness of undiagnosed transmissible diseases in order to prevent cross-transmissions.
Infection 06/2011; 39(4):359-62. · 2.66 Impact Factor
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ABSTRACT: Respiratory infection and failure is a commonly encountered problem in intensive care unit (ICU) patients. However, despite the accumulating body of evidence to suggest that herpes simplex virus type 1 (HSV-1) is associated with pneumonia, the exact role played by this virus in this process is still not fully understood. Therefore, to identify patients at risk, we have conducted a case-control study to characterize patients with HSV-1-positive pneumonia.
Between 2007 and 2009, all patients with suspected viral pneumonia were tested for the presence of herpes viruses using a PCR assay approach with respiratory specimens. To identify possible associations, risk factors, and impact of HSV, HSV-1-positive ICU patients (n = 51) were compared to age-, gender-, and department- and season-matched HSV-negative patients (n = 52).
HSV-positive patients differed significantly from the HSV-negative ones only in terms of time of mechanical ventilation (13 vs. 6 days, respectively; p = 0.002). Subgroup analysis in the patients aged >60 years and in those without bacterial detection revealed a similar trend (p = 0.01 and p = 0.004, respectively). Mortality did not differ between the groups or between the HSV-1-positive patients treated with aciclovir and those who were not. A viral load >10E+05 geq/ml was associated with mechanical ventilation (20/21 vs. 17/29; p = 0.004), acute respiratory distress syndrome (ARDS; 19/21 vs. 18/29; p = 0.005), sepsis (18/21 vs. 14/29; p = 0.008), detection of a bacterial pathogen in the same specimen (10/21 vs. 4/29; p = 0.01) and longer ICU stay (25 vs. 30 days; p = 0.04).
Despite several associations with high viral load, the clinical outcome of HSV-1-positive ICU patients did not differ significantly from the clinical outcome of HSV-negative patients. This finding indicates that HSV-1 viral loads in respiratory specimens are a symptom of a clinically poor condition rather than a cause of it. Longitudinal and therapy studies are therefore needed to distinguish between HSV-1 as a causative pathogen and HSV-1 as a bystander of pneumonia/ARDS.
Infection 10/2010; 38(5):401-5. · 2.66 Impact Factor
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ABSTRACT: Hand hygiene is considered to be the single most effective measure to prevent healthcare-associated infection. Although there have been several reports on hand hygiene compliance, data on patients with multidrug-resistant (MDR) organisms in special isolation conditions are lacking. Therefore, we conducted a prospective observational study of indications for, and compliance with, hand hygiene in patients colonised or infected with meticillin-resistant Staphylococcus aureus (MRSA) or extended-spectrum β-lactamase (ESBL)-producing enterobacteria in surgical intensive and intermediate care units. Hand disinfectant used during care of patients with MRSA was measured. Observed daily hand hygiene indications were higher in MRSA isolation conditions than in ESBL isolation conditions. Observed compliance rates were 47% and 43% for the MRSA group and 54% and 51% for the ESBL group in the surgical intensive care unit and the intermediate care unit, respectively. Compliance rates before patient contact or aseptic tasks were significantly lower (17-47%) than after contact with patient, body fluid or patient's surroundings (31-78%). Glove usage instead of disinfection was employed in up to 100% before patient contact. However, compliance rates calculated from disinfectant usage were two-fold lower (intensive care: 24% vs 47%; intermediate care: 21% vs 43%). This study is the first to provide data on hand hygiene in patients with MDR bacteria and includes a comparison of observed and calculated compliance. Compliance is low in patients under special isolation conditions, even for the indications of greatest impact in preventing healthcare-associated infections. These data may help to focus measures to reduce transmission of MDR bacteria and improve patient safety.
The Journal of hospital infection 10/2010; 76(4):320-3. · 3.01 Impact Factor
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ABSTRACT: Data on time-dependency of external ventricular drainage (EVD)- and lumbar drainage (LD)-associated meningoventriculitis (MV) are scarce and discussions on the subject are controversial; no data exist for infection rates (IR) relative to drainage-days. For this reason, we conducted an observational study to determine time-dependent IRs and to perform a risk factor analysis.
All patients (n = 210) requiring an EVD or LD during an 18-month period in 2007 and 2008 were enrolled and characterized. Data on type and duration of drainage, ICP measurement, number of drainage manipulations, hospital stay and time point of MV were analysed statistically.
A total of 34 MV cases were reported with 17 for each kind of drainage accounting for an IR of 7.5 and 24.7 MV/1000 EVD- and LD-days, respectively. Of these, 28/34 MV (82%) occurred within the first 12 days, and IRs were highest between days 4 and 9. Longer drainage duration (>5 and >9 days, respectively) was correlated with a significant lower risk of MV (p = 0.03; p < 0.001). In this study, significant risk factors for MV were LD [vs. EVD, OR: 2.3 (1.1-4.7); p = 0.01], a previous MV [OR: 7.0 (2.1-23.3); p = 0.002], and neoplasm [OR: 11.6 (3.4-39); p = 0.001]. Simultaneous drainage, ICP and a previous drainage showed no influence on infection.
To the best of our knowledge, this study is the first to provide data on time dependency of EVD- and LD-associated MV-IR based on drainage-days. However, because of the limited scale of our study, it would be desirable to confirm these results in a more powerful larger study. In conclusion, we recommend that future efforts should be made to better identify preventable risk factors as well as to define time periods of higher risk for the difficult-to-diagnose MV infection as a first step in profiling high risk patients.
Infection 03/2010; 38(3):205-9. · 2.66 Impact Factor
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ABSTRACT: Bloodstream infections (BSI) with gram-negative bacteria (GNB) are one of the most serious infections in the hospital setting, a situation compounded by the increasing antibiotic resistance of gram-negative bacteria causing BSI. The aim of the study was to assess the impact of antibiotic multiresistance of GNB in BSI on mortality rates and length of stay (LOS).
The setting was the University Hospital Aachen, a 1,500-bed tertiary-care hospital with over 100 ICU beds providing maximal medical care in all disciplines. We performed a 5-year hospital-wide matched cohort study (January 1996 to February 2001) in which 71 cases and 99 controls were enrolled. Matching criteria were sex, age and GNB isolated in blood cultures. Multiresistance was defined as resistance against at least two different classes of antibiotics such as penicillins (+beta-lactamase-inhibitor), third-generation cephalosporins, fluoroquinolones or carbapenems.
BSI were mainly nosocomially acquired, and cases of BSI with multiresistant bacteria were associated with a higher mortality (p=0.0418) and a prolonged LOS in the intensive care unit (ICU) (p=0.0049). Risk factors for BSI with multiresistant GNB were antibiotic treatment (p=0.0191) and mechanical ventilation (p=0.0283).
Multiresistance of GNB causing BSI was associated with higher mortality rates and longer LOS in ICU. The initial antibiotic therapy was significantly more often inadequate and might have had an impact on overall mortality. Thus, an effective strategy to administer an appropriate initial empirical antibiotic therapy, especially in patients with risk factors, must be sought. Moreover, the overall usage of antimicrobials must be limited and infection control guidelines should be followed to reduce the emergence and transmission of multiresistant GNB.
Infection 03/2008; 36(1):31-5. · 2.66 Impact Factor
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ABSTRACT: Invasive fungal infections are associated with a high mortality and have been increasing in incidence over the last few decades. Candidemia and, less commonly, invasive pulmonary aspergillosis are the most relevant fungal infections in critical care medicine. Risk factors for systemic Candida infections are the use of broad-spectrum antibiotics, a prolonged stay in an intensive care unit and gastrointestinal injury or surgery. Invasive aspergillosis usually occurs in immunocompromised patients. The diagnosis of invasive fungal infections remains challenging. The therapeutic spectrum includes fluconazol, conventional and liposomal amphotericin B, and the recently introduced agents caspofungin and voriconazol. For rational and cost-effective use, the clinician requires precise knowledge of the indications and limitations of these agents. This review focuses on the diagnostic and therapeutic options in severe Candida infections and invasive aspergillosis.
Der Anaesthesist 11/2005; 54(10):1047-64; quiz 1065-6. · 0.99 Impact Factor
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ABSTRACT: Invasive Pilzinfektionen sind mit einer hohen Letalitt verbunden, und ihre Inzidenz steigt in den letzten Jahrzehnten an. Die Fungmie mit Candidaspezies und seltener die invasive pulmonale Aspergillose sind dabei die intensivmedizinisch bedeutsamsten Krankheitsbilder. Zu den Risikofaktoren fr systemische Candidainfektionen zhlen z.B. Breitspektrumantibiotika, eine lange intensivmedizinische Behandlung und eine Verletzung/Operation im Bereich des Gastrointestinaltraktes. Immunsupprimierte Patienten sind typischen Risikopatienten fr eine invasive Aspergillusinfektion. Whrend die Diagnostik von invasiven Pilzinfektionen den Arzt weiterhin vor erhebliche Schwierigkeiten stellt, konnten in den letzten Jahren die Therapieoptionen verbessert werden. Neben Fluconazol, konventionellem und liposomalem AmphotericinB stehen neue Prparate wie Caspofungin und Voriconazol zur Verfgung. Um Antimykotika rational und kosteneffektiv einzusetzen, bentigt der Arzt Kenntnisse ber ihre Indikationen und Grenzen. In diesem Beitrag sollen die Diagnostik und die aktuellen Therapieoptionen von intensivmedizinisch relevanten Aspergillus- und Candidainfektionen dargestellt werden.Invasive fungal infections are associated with a high mortality and have been increasing in incidence over the last few decades. Candidemia and, less commonly, invasive pulmonary aspergillosis are the most relevant fungal infections in critical care medicine. Risk factors for systemic Candida infections are the use of broad-spectrum antibiotics, a prolonged stay in an intensive care unit and gastrointestinal injury or surgery. Invasive aspergillosis usually occurs in immunocompromised patients. The diagnosis of invasive fungal infections remains challenging. The therapeutic spectrum includes fluconazol, conventional and liposomal amphotericin B, and the recently introduced agents caspofungin and voriconazol. For rational and cost-effective use, the clinician requires precise knowledge of the indications and limitations of these agents. This review focuses on the diagnostic and therapeutic options in severe Candida infections and invasive aspergillosis.
Der Anaesthesist 09/2005; 54(10):1047-1066. · 0.99 Impact Factor
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ABSTRACT: We assessed data on the epidemiology of nosocomial infections (NIs) in a 14-bed neurosurgical intensive care unit (NSICU) and used surveillance data for the promotion of quality improvement activities.
Prospective periodic surveillance was performed over five 3-month periods between July 1998 and October 2002 on all patients admitted with a length of stay > 24 hours.
763 patients with a total of 4,512 patient days and a mean length of stay of 5.9 days were enrolled within the 15-month study period. A total of 93 NIs were identified in 82 patients. Urinary tract infections (24.7%), pneumonia (23.6%), and bloodstream infections (17.2%) were the most frequent NIs recorded. Device-associated incidence rates were 6.0 (3.8-9.0, CI(95%)) for urinary tract infection, 4.4 (2.4-7.4, CI(95%)) for bloodstream infection, and 10.3 (6.3-15.9, CI(95%)) for pneumonia per 1,000 days at risk. For improvement of infection control-related processes, evidence-based infection control guidelines were established and an NSICU nurse was designated to be responsible for infection control issues on the ward. In addition, several infection control problems arose during the observation periods and were rapidly responded to by introducing specific intervention strategies.
Periodic surveillance is a valuable tool for assessing the epidemiology of NIs in the NSICU setting as well as for promoting the initiation of quality improvement activities.
Infection 07/2005; 33(3):115-21. · 2.66 Impact Factor
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ABSTRACT: The serum bactericidal test measures the highest level of an antibiotic-containing serum dilution at which 99.9% of bacteria are killed. In this study the serum bactericidal activity of piperacillin/tazobactam was determined for bacteria often involved in severe infections. In earlier studies titres >/=1:8 in the serum bactericidal tests correlated well with clinical success in the treatment of endocarditis and osteomyelitis as well as bacterial eradication.
Blood samples of 6 healthy volunteers were taken before and 1 and 4 h after piperacillin/tazobactam (4.5 g) administration. Serum concentrations and serum bactericidal activity were determined for 10 strains each of Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli, both piperacillin-resistant and piperacillin-susceptible according to NCCLS guidelines.
100% of S. aureus and piperacillin-susceptible E. coli, 90% of piperacillin-resistant E. coli and 80% of P. aeruginosa were killed 1 h after drug administration. 4 h after drug administration serum bactericidal activity decreased to 60% for S. aureus, 90% for piperacillin-susceptible E. coli, 80% for piperacillin-resistant E. coli and 30% for P. aeruginosa.
Excellent serum bactericidal activity of piperacillin/tazobactam was recorded 1 h after drug administration for S. aureus, E. coli and P. aeruginosa. After 4 h limited killing rates for P. aeruginosa could be detected, which supports the idea of a combination therapy.
Chemotherapy 04/2004; 50(1):27-30. · 1.82 Impact Factor
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ABSTRACT: We prospectively studied the difference in detection rates of multi-resistant Gram-positive and multi-resistant Gram-negative bacteria in the inanimate environment of patients harbouring these organisms. Up to 20 different locations around 190 patients were surveyed. Fifty-four patients were infected or colonized with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE) and 136 with multi-resistant Gram-negative bacteria. The environmental detection rate for MRSA or VRE was 24.7% (174/705 samples) compared with 4.9% (89/1827 samples) for multi-resistant Gram-negative bacteria (P<0.001). Gram-positive bacteria were isolated more frequently than Gram-negatives from the hands of patients (P<0.001) and hospital personnel (P=0.1145). Environmental contamination did not differ between the intensive care units (ICUs) and the general wards (GWs), which is noteworthy because our ICUs are routinely disinfected twice a day, whereas GWs are cleaned just once a day with detergent. Current guidelines for the prevention of spread of multi-resistant bacteria in the hospital setting do not distinguish between Gram-positive and Gram-negative isolates. Our results suggest that the inanimate environment serves as a secondary source for MRSA and VRE, but less so for Gram-negative bacteria. Thus, strict contact isolation in a single room with complete barrier precautions is recommended for MRSA or VRE; however, for multi-resistant Gram-negative bacteria, contact isolation with barrier precautions for close contact but without a single room seems sufficient. This benefits not only the patients, but also the hospital by removing some of the strain placed on already over-stretched resources.
Journal of Hospital Infection 03/2004; 56(3):191-7. · 3.39 Impact Factor
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ABSTRACT: Fusobacterium necrophorum, an anaerobic, gram-negative rod, belongs to the physiological flora of the oropharynx. It causes Lemierre's syndrome characterized by oropharyngeal infection, septic thrombophlebitis of the neck, in particular of the internal jugular vein, and metastatic abscesses, predominantly in the lungs. Rarely, and mainly in children, it causes meningitis. Here we report the clinical course of a 25-year-old woman with F. necrophorum meningitis. She presented with incomplete, right third nerve palsy. Within a few days, she developed fever, meningism and progressive reduction of vigilance. Cerebrospinal fluid analysis showed typical signs of bacterial meningitis. After the identification of F. necrophorum, the antibiotic treatment was changed to meropenem, which led to continuous improvement of the clinical symptoms. Due to persistent signs of inflammation in the CSF, metronidazole was added to the antibiotic regime. This case report demonstrates that F. necrophorum should always be considered in the diagnostic workup of bacterial meningitis in adults.
Der Nervenarzt 01/2004; 74(12):1118-21. · 0.68 Impact Factor
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ABSTRACT: Nosocomial infections are a common problem in intensive care therapy and have relevant influence on morbidity, mortality and associated costs. The aim of this study was to assess data on the epidemiology of nosocomial infections and related risk factors in neurological intensive care patients and to use them for internal quality management.
Prospective periodic surveillance was performed in the first quarter of the years 1999 and 2000 in two neurology intensive care units.
Within the surveillance period, 340 patients with 2443 patient days and a mean length of stay 7,6 days were enrolled. A total of 63 nosocomial infections were identified in 51 patients. In comparison with national reference data, device utilisation rates as well as device-associated nosocomial infection rates were on a higher level. By timely and interpretative feedback of the surveillance data, for the first time the unit-specific nosocomial infection situation was made clear for the ward staff. As a result, different quality management activities like establishment of evidence-based infection control guidelines, continuous surveillance for pneumonia and optimisation of empirical antibiotic therapy were initiated in both units.
The establishment of periodic surveillance proved to be a valuable tool for the promotion of quality management activities in both intensive care units.
Der Anaesthesist 09/2003; 52(8):690-6. · 0.99 Impact Factor
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ABSTRACT: Problematik und Fragestellung.Nosokomiale Infektionen sind eine hufige Komplikation in der Intensivtherapie und haben einen erheblichen Einfluss auf Morbiditt, Mortalitt und damit verbundene Folgekosten. Die vorliegende Studie hatte das Ziel, zeiteffektiv Daten zur Epidemiologie nosokomialer Infektionen und ihrer Risikofaktoren bei neurologischen Intensivpatienten zu ermitteln und diese fr das interne Qualittsmanagement zu nutzen.Methodik.Im jeweils 1. Quartal der Jahre 1999 und 2000 wurde eine prospektive periodische Surveillance nosokomialer Infektionen auf zwei universitren neurologischen Intensivstationen durchgefhrt.Ergebnisse.Innerhalb des Erhebungszeitraumes wurden 340 neurologische Intensivpatienten mit 2443 Liegetagen und einer mittleren Liegedauer von 7,6 Tagen untersucht. Insgesamt wurden 63 nosokomiale Infektionen bei 51 Patienten diagnostiziert. Im Vergleich zu nationalen Referenzdaten fanden sich relativ hohe Anwendungsraten fr die untersuchten invasiven Manahmen wie auch fr die entsprechenden Device-assoziierten Infektionsraten. Durch zeitnahe Auswertung, Interpretation und Rckmeldung der Daten wurde die stationsspezifische Infektionssituation erstmalig fr das Stationspersonal transparent. Als Konsequenz wurden auf beiden Stationen unterschiedliche Manahmen zur Qualittsverbesserung wie die Implementierung evidenzbasierter Hygiene-Leitlinien, die kontinuierliche Pneumonie-Surveillance sowie die Optimierung des bestehenden empirischen Antibiotikaregimes durchgefhrt.Schlussfolgerung.Die Etablierung einer periodischen Surveillance zeigte sich als wertvolle Manahme zur Frderung stationsinterner Qualittsmanagement-Aktivitten auf beiden Intensivstationen.Backround and objective.Nosocomial infections are a common problem in intensive care therapy and have relevant influence on morbidity, mortality and associated costs. The aim of this study was to assess data on the epidemiology of nosocomial infections and related risk factors in neurological intensive care patients and to use them for internal quality management.Methods.Prospective periodic surveillance was performed in the first quarter of the years 1999 and 2000 in two neurology intensive care units.Results.Within the surveillance period, 340 patients with 2443 patient days and a mean length of stay 7,6 days were enrolled. A total of 63 nosocomial infections were identified in 51 patients. In comparison with national reference data, device utilisation rates as well as device-associated nosocomial infection rates were on a higher level. By timely and interpretative feedback of the surveillance data, for the first time the unit-specific nosocomial infection situation was made clear for the ward staff. As a result, different quality management activities like establishment of evidence-based infection control guidelines, continuous surveillance for pneumonia and optimisation of empirical antibiotic therapy were initiated in both units.Conclusion.The establishment of periodic surveillance proved to be a valuable tool for the promotion of quality management activities in both intensive care units.
Der Anaesthesist 07/2003; 52(8):690-696. · 0.99 Impact Factor
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ABSTRACT: In addition to MIC and MBC tests in this study the serum bactericidal activity of 3.1 microg/ml of moxifloxacin or 5.2 microg/ml of levofloxacin was determined against ten susceptible strains of S. aureus, S. epidermidis, E. coli and K. pneumoniae. Moxifloxacin achieved markedly better activity against S. aureus and S. epidermidis as compared to levofloxacin. Activity of moxifloxacin against E. coli and K. pneumoniae was excellent but not superior to levofloxacin. In conclusion both fluorquinolones are highly effective against E. coli and K. pneumoniae, moxifloxacin being superior with respect to gram-positives like S. aureus and S. epidermidis.
Chemotherapy 06/2003; 49(1-2):33-5. · 1.82 Impact Factor
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ABSTRACT: Fusobacterium necroforum, ein anaerobes gramnegatives Bakterium, ist Teil der physiologischen Rachenflora. Es ist Verursacher des Lemierre-Syndroms, charakterisiert durch oropharyngeale Infektion, septische Thrombophlebitis im Halsbereich, vor allem der V.jugularis interna, und septische Streuherde, bevorzugt in der Lunge. Eine bakterielle Meningitis ist selten und grtenteils bei Kindern zu beobachten. Wir prsentieren den Verlauf einer 25-jhrigen Patientin mit F.necroforum-Meningitis. Zwei Tage nach Auftreten einer inkompletten Okulomotoriusparese entwickelte die Patientin septische Temperaturen, Meningismus, eine Anisokorie und Vigilanzminderung. Im Liquorstatus zeigten sich typische Befunde einer bakteriellen Meningitis. Aufgrund eines Hirndems wurde eine externe Liquordrainage angelegt. Nach Identifikation von F.necroforum aus Blutkulturen wurde die initial breite Antibiose auf Meropenem umgestellt. Vier Tage spter konnte die Patientin extubiert werden. Angesichts persistierender Entzndungszeichen im Liquor wurde die Antibiose mit Metronidazol erweitert. Der Fall demonstriert, dass F.necroforum als seltener Verursacher einer bakteriellen Meningitis auch bei Erwachsenen in Betracht gezogen werden muss.Fusobacterium necrophorum, an anaerobic, gram-negative rod, belongs to the physiological flora of the oropharynx. It causes Lemierre's syndrome characterized by oropharyngeal infection, septic thrombophlebitis of the neck, in particular of the internal jugular vein, and metastatic abscesses, predominantly in the lungs. Rarely, and mainly in children, it causes meningitis. Here we report the clinical course of a 25-year-old woman with F.necrophorum meningitis. She presented with incomplete, right third nerve palsy. Within a few days, she developed fever, meningism and progressive reduction of vigilance. Cerebrospinal fluid analysis showed typical signs of bacterial meningitis. After the identification of F.necrophorum, the antibiotic treatment was changed to meropenem, which led to continuous improvement of the clinical symptoms. Due to persistent signs of inflammation in the CSF, metronidazole was added to the antibiotic regime. This case report demonstrates that F.necrophorum should always be considered in the diagnostic workup of bacterial meningitis in adults.
Der Nervenarzt 01/2003; 74(12):1118-1121. · 0.68 Impact Factor
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ABSTRACT: In clinical practice, scientific evidence about infection control is often ignored and hygiene rituals are followed.
Within an evidence-based infection control program, a quarterly rotating surveillance program for nosocomial infections was implemented in 4 intensive care units (ICUs) at the Aachen University Hospital, Germany.
For the first time, the unit-specific nosocomial infection situation was made clear to the clinical staff by interpretive feedback of the surveillance data. This led to an increased awareness of infection control and a critical review of hygiene practices. After the first surveillance period, the hygiene practices of each ICU were revised and modified. The Centers for Disease Control and Prevention/Hospital Infection Control Practices Advisory Committee guidelines for the prevention of nosocomial infections were adopted and established in tight collaboration with the ward staff.
Within the surveillance process, communication and team spirit between infection control and patient care personnel showed a remarkable improvement. Awareness and compliance with hospital hygiene and infection control practices could be raised without directive interaction.
American Journal of Infection Control 05/2001; 29(2):89-93. · 2.40 Impact Factor
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ABSTRACT: The objective of this study was to evaluate the moistened swab technique vs. Rodac plates for detecting Gram-positive and Gram-negative bacteria in the inanimate environment. Over a period of 22 months, the environment of 190 patients infected or colonized with MRSA, VRE or multiresistant Gram-negative bacteria was sampled in turn. MRSA and VRE could be detected with either method in 33 out of 54 (61.1%) patient rooms in 174 out of 706 (24.6%) environmental samples. However, multiresistant Gram-negative bacteria were found in 42 out of 136 (30.9%) rooms with a very low frequency of 89 out of 1827 (4.9%) environmental samples (p < 0.0001). The sensitivity of the swab technique for Gram-positive cocci was 54% (94/174) vs. 69.5% (121/174) for the Rodac plates, ([CI95%], 47-61% vs. 62-76%, p < 0.05). In contrast, the sensitivity of the swab technique for Gram-negative bacteria was 74.2% (66/89) vs. 42.7% (38/89) for the Rodac plates, ([CI95%], 64-83% vs. 32-54%, p < 0.05). In conclusion, environmental contamination with Gram positive cocci is detected more often than with Gram-negative bacteria. For the detection of Gram-positive cocci, Rodac plates are superior to the swab technique; whereas Gram-negative rods can be detected more often by the swab technique. All these results proved to be statistically significant.
International Journal of Hygiene and Environmental Health 03/2001; 203(3):245-8. · 3.81 Impact Factor
