M G R Hendrix

Publications of M G R Hendrix

• Impact on clinical decision making of quality control standards applied to sputum analysis in COPD.

  Authors: M C Telgen, M G J Brusse-Keizer, P D L P M van der Valk, J van der Palen, H A M Kerstjens, M G R Hendrix

  Respiratory medicine. 03/2011; 105(3):371-6.

  Sputum analysis is important in COPD exacerbation management. We determined whether application of stringent quality control criteria for sputum samples had an impact on culture results. We analyzedSputum analysis is important in COPD exacerbation management. We determined whether application of stringent quality control criteria for sputum samples had an impact on culture results. We analyzed sputum samples of 108 patients during stable COPD and during exacerbations. To all samples quality control standards and culture interpretation rules according to the American Society of Microbiologists (ASM) were applied. In sputum exacerbation samples considered appropriate according to ASM quality standards, criteria for infection (40%) were met more often compared to inappropriate samples (13%) (p < 0.001). The same pattern was observed when applying these rules to sputum samples obtained during stable disease, (50% vs. 18%, p < 0.001). There was no difference in the percentage of infectious cultures obtained during the stable state and exacerbations. Applying stringent quality control criteria to sputum samples can have a profound effect on the labeling of sputum samples as infectious, and therefore on clinical decision making.

• Cross-border comparison of the admission prevalence and clonal structure of meticillin-resistant Staphylococcus aureus.

  Authors: R Köck, L Brakensiek, A Mellmann, F Kipp, M Henderikx, D Harmsen, I Daniels-Haardt, C von Eiff, K Becker, M G R Hendrix, A W Friedrich

  The Journal of hospital infection. 02/2009;

  Since patient exchange between hospitals sharing a common catchment area might favour regional spread of meticillin-resistant Staphylococcus aureus (MRSA), the reliable detection of patientsSince patient exchange between hospitals sharing a common catchment area might favour regional spread of meticillin-resistant Staphylococcus aureus (MRSA), the reliable detection of patients colonised at admission is crucial. This, hospitals in the Dutch-German border area EUREGIO MRSA-net aim at synchronising their local MRSA standards in order to prevent unidentified inter-hospital as well as cross-border spread. This assumes enhanced knowledge of MRSA prevalence and risk factors associated with MRSA carriage at admission. We conducted nasal MRSA screening of all inpatients admitted to 39 German hospitals (in the period 1 November to 30 November 2006) and to one Dutch hospital (in the period 1 July to 30 September 2007) in the EUREGIO MRSA-net. A total of 390 MRSA cases were detected among 25 540 patients screened. The admission prevalence was 1.6 MRSA/100 patients (6.5% of all S. aureus) in the German and 0.5 MRSA/100 patients (1.4% of all S. aureus) in the Dutch part of the border region. Overall, the predominating S. aureus protein A gene (spa) sequence types were t003, t032 and t011. One isolate (t044) carried Panton-Valentine leukocidin (PVL) encoding genes. Altogether, 79% and 67% of all MRSA patients in the German and Dutch regions respectively, were identifiable by the classical nosocomial risk factors assessed. In patients lacking all risk factors assessed, spa types t011 and t034 were predominant (P<0.001).

• Relation of sputum colour to bacterial load in acute exacerbations of COPD.

  Authors: M G J Brusse-Keizer, A J Grotenhuis, H A M Kerstjens, M C Telgen, J van der Palen, M G R Hendrix, P D L P M van der Valk

  Respiratory medicine. 12/2008;

  BACKGROUND: When COPD patients present with an exacerbation, one cannot verify a bacterial cause of an exacerbation without time-consuming laboratory analyses. This makes it difficult to decide upBACKGROUND: When COPD patients present with an exacerbation, one cannot verify a bacterial cause of an exacerbation without time-consuming laboratory analyses. This makes it difficult to decide up front if antibiotic treatment is needed. Therefore, in clinical practice sputum colour and purulence are often used. OBJECTIVE: To determine whether sputum colour and purulence, assessed by the Stockley colour chart, correlated with overall bacterial load in COPD patients admitted for an exacerbation. To check the robustness of the colour and purulence assessment, we correlated the changes in these parameters and the corresponding change in bacterial load in sputum over the first seven days of hospitalisation. METHODS: Twenty-two COPD patients admitted to the hospital for an exacerbation were included. During the first seven days daily sputum samples were collected. RESULTS: A very weak association between bacterial load and sputum colour was found. There was no difference in bacterial load between patients with purulent sputum or not. Also, no consistent relationship between change in sputum colour and change in bacterial load during admission was found. CONCLUSIONS: The very weak association between bacterial load and sputum colour confirms concerns over the usefulness of the colour chart. The distinction between purulent and mucoid sputum at exacerbation is insufficient for distinction between patients who are likely to benefit from antibiotic therapy and those who are not. Complementary studies are needed to determine which other, easily measurable factors can be used as predictors for an indication for use of antibiotics; sputum colour is not the one.

• EUREGIO MRSA-net Twente/Münsterland--a Dutch-German cross-border network for the prevention and control of infections caused by methicillin-resistant Staphylococcus aureus.

  Authors: A W Friedrich, I Daniels-Haardt, R Köck, F Verhoeven, A Mellmann, D Harmsen, J. E. van Gemert-Pijnen, K Becker, M G R Hendrix

  Euro surveillance : bulletin européen sur les maladies transmissibles = European communicable disease bulletin. 09/2008; 13(35).

  Methicillin-resistant Staphylococcus aureus (MRSA) is associated with increased mortality and morbidity and a leading cause of hospital-acquired infections. Community-acquired (CA)-MRSA are a growingMethicillin-resistant Staphylococcus aureus (MRSA) is associated with increased mortality and morbidity and a leading cause of hospital-acquired infections. Community-acquired (CA)-MRSA are a growing concern worldwide. In the last 10 years, an increase in the MRSA rate from 2% to approximately 23% has been observed in Germany, while a rate under 5% has been recorded for many years in the Netherlands and Scandinavia. In the Netherlands in particular, MRSA rates have become very low in stationary care due to a consistent 'search and destroy' policy. The main focus in Germany lies on hospital-acquired MRSA, whereas the Netherlands focus on the control of the importation of MRSA cases from abroad and on CA-MRSA. As MRSA in hospitals and in the community can be a problem in cross-border health care, the European Union-funded EUREGIO MRSA-net project was established in the bordering regions Twente/Achterhoek, the Netherlands and Münsterland, Germany. The main aim of the project is the creation of a network of the major health care providers in the EUREGIO and the surveillance and prevention of MRSA infections. A spa-typing network was established in order to understand the regional and cross-border dissemination of epidemic and potentially highly virulent MRSA genotypes. As the reduction of differences in health care quality is an important prerequisite for cross-border health care, a transborder quality group comprising hospitals, general practitioners, public health authorities, laboratories, and insurerance companies has been established since 2005 equalising the quality criteria for the control of MRSA on both sides of the border.

• [EUREGIO-projekt MRSA-net Twente/Münsterland. Creation of a regional network to combat MRSA]

  Authors: I Daniels-Haardt, F Verhoeven, A Mellmann, M G R Hendrix, J E C Gemert-Pijnen, A W Friedrich

  Gesundheitswesen (Bundesverband der Ärzte des Öffentlichen Gesundheitsdienstes (Germany)). 12/2006; 68(11):674-8.

  Over the last years, Germany has observed an increase in the prevalence of methicillin-resistant Staphylococcus (MRSA) in all S. aureus isolates from 2 % to about 25 % whereas in The Netherlands thisOver the last years, Germany has observed an increase in the prevalence of methicillin-resistant Staphylococcus (MRSA) in all S. aureus isolates from 2 % to about 25 % whereas in The Netherlands this proportion has continuously been kept below 1 % thanks to a consistent "search & destroy" policy. Both countries increasingly register so-called community-acquired (CA) MRSA which are a threat also to the healthy population without any known risk factor for MRSA carriership. The EUREGIO project "MRSA-net Twente/Münsterland" has made it its main goal to set up a German-Dutch network serving as a basis for a quality association which includes all those who are actively involved in health care provision on both sides of the border and to implement a coordinated strategy for MRSA control and prevention. The project is being carried out with the financial support of the European Union under the INTERREG-IIIA Community initiative and of the Ministry of Economics of the State of North Rhine-Westphalia. The epidemiological backbone of the MRSA-net is a genetic-based MRSA typing strategy (spa-typing) which has been developed by the Institute for Hygiene, University Hospital, Münster and which allows regional and cross-border comparability of laboratory results. The Faculty of Behavioural Sciences of the University of Twente examines MRSA hygiene protocols with regard to their acceptability and realisability with the intention of developing user-friendly, target group-oriented MRSA protocols for the EUREGIO. The health departments involved in the project play a central role in the coordination of the network partners in the municipalities. By performing their function of surveillance in accordance with Sections 23 and 36 of the Infectious Disease Control Act they provide an important contribution to enhancing MRSA control and prevention strategies. Thanks to its cross-border cooperation and exchange of knowledge and technology the EUREGIO project "MRSA-net" contributes to controlling the proliferation of MRSA in the EUREGIO and thus to removing obstacles to the free cross-border movement of patients and personnel.

• Effectiveness of protocols for preventing occupational exposure to blood and body fluids in Dutch hospitals.

  Authors: J van Gemert-Pijnen, M G R Hendrix, J van der Palen, P J Schellens

  The Journal of hospital infection. 03/2006; 62(2):166-73.

  Compliance of different healthcare workers (HCWs) (nurses, physicians, laboratory technicians and cleaners) with protocols to prevent exposure to blood and body fluids (BBF) was studied.Compliance of different healthcare workers (HCWs) (nurses, physicians, laboratory technicians and cleaners) with protocols to prevent exposure to blood and body fluids (BBF) was studied. Questionnaires were used to assess perception of risks, familiarity with protocols, motivation and actual behaviour. Performance of the protocols in practice was also tested. The practical test provided more reliable results than the questionnaire. HCWs overestimated their knowledge and skills, and compliance was influenced by risk perception. HCWs encountered problems with comprehension, acceptability and applicability of protocols, especially for post-exposure precautions. Protocols are not tailored to the differences in knowledge, risk perception and practical needs of different professional groups, probably because HCWs have rarely been involved in writing them and they are governed more by legal considerations than applicability. Most HCWs experienced a lack of organizational support to aid compliance. To improve compliance, we recommend information and training on risk management and individual responsibilities regarding the safety of coworkers and patients, participation of HCWs in protocol development, and support of management to avoid reversion to previous habitual behaviour.

• Performance of methicillin-resistant Staphylococcus aureus protocols in Dutch hospitals.

  Authors: J van Gemert-Pijnen, M G R Hendrix, J van der Palen, P J Schellens

  American journal of infection control. 10/2005; 33(7):377-84.

  BACKGROUND: Although numerous studies have stressed the importance of compliance with methicillin-resistant Staphylococcus aureus (MRSA) protocols with regard to cost reduction and a saferBACKGROUND: Although numerous studies have stressed the importance of compliance with methicillin-resistant Staphylococcus aureus (MRSA) protocols with regard to cost reduction and a safer environment for health care workers and patients, an evaluation of the usability of the protocols themselves is lacking. In this study, we evaluated the usability and performance of those protocols. METHODS: The performance of MRSA protocols was examined in 5 Dutch hospitals by means of a questionnaire (n = 63), followed by a practical test (n = 50), in a stratified random sample of 3 types of health care workers (physicians, nursing staff, and cleaning personnel). The questionnaire consisted of constructs related to exposure to risk, risk perception, knowledge of and attitude toward the protocols and safety preventive measures, self-reported behavior, and social and organizational support. The practical test consisted of "what if" scenarios that simulate the actual use of the protocol as a guideline for solving infection problems. The health care workers were asked to verbalize their thoughts and actions while using the protocol. RESULTS: The questionnaire demonstrated adequate knowledge of and attitude toward the MRSA protocols. However, the practical test revealed that the majority of respondents had problems with the accessibility, comprehensibility, applicability, and acceptability of the protocols. Problems not only occurred because of unclear information about the preventive measures and a poor infrastructure but also because of preventive measures that conflict with principles in providing care. CONCLUSION: The protocols do not reflect the practical needs of the health care workers. In view of the different decisions that health care workers have to take in various circumstances, it would be impracticable to use the same MRSA protocol for all hospital staff. Finally, the practical test provided more reliable results than the questionnaire.

• MRSA in nursing homes in the Netherlands 1989 to 1998: a developing reservoir?

  Authors: W Goettsch, E Geubbels, W Wannet, M. G. R. Hendrix, J.H.T. Wagenvoort, A.J De Neeling

  Euro surveillance : bulletin europeen sur les maladies transmissibles = European communicable disease bulletin. 04/2000; 5(3):28-31.

  The prevalence of methicillin resistant Staphylococcus aureus (MRSA) in Dutch nursing homes in 1998 was higher than that found in 1989 to 1997. The increased prevalence of MRSA could lead toThe prevalence of methicillin resistant Staphylococcus aureus (MRSA) in Dutch nursing homes in 1998 was higher than that found in 1989 to 1997. The increased prevalence of MRSA could lead to colonisation outside these nursing homes. A study of the prevale

• Increasing resistance to fluoroquinolones in Escherichia coli from urinary tract infections in The Netherlands

  Authors: W Goettsch, W van Pelt, N Nagelkerke, M. G. R. Hendrix, A. G. M. Buiting, P L Petit, L. J. M. Sabbe, A. J. A. van Griethuysen, A J de Neeling

  In continuous surveillance of routine samples from five Dutch laboratories, we studied resistance to the antibiotics most commonly prescribed for urinary tract infections (UTI) in The Netherlands,In continuous surveillance of routine samples from five Dutch laboratories, we studied resistance to the antibiotics most commonly prescribed for urinary tract infections (UTI) in The Netherlands, namely norfloxacin, amoxycillin, trimethoprim and nitrofurantoin, from 1989 to 1998 in >90000 Escherichia coli isolates. Resistance to norfloxacin increased from 1.3% in 1989 to 5.8% in 1998. Multiresistance, defined as resistance to norfloxacin and at least two of the other three antibiotics, increased from 0.5% in 1989 to 4.0% in 1998. Multivariate analysis of the norfloxacin resistance demonstrated that this yearly increase (the odds ratio was 1.0 in 1989, 1.6 in 1992, 2.9 in 1995 and 6.1 in 1998) was independent of other determinants of resistance to norfloxacin, such as age, gender and origin of the isolate. Analysis of strata, classified by year, age and gender, demonstrated an association between prescription of fluoroquinolones (defined daily doses per case of UTI) and resistance to norfloxacin in E. coli ( P < 0.001). There was no significant association with the prescription of nitrofuran derivatives (nitrofurantoin) and trimethoprim with or without sulphamethoxazole. The yearly increase of resistance to fluoroquinolones in E. coli from UTI may stem from increased prescription of fluoroquinolones for UTI. Resistance of E. coli to these agents is likely to increase further as fluoroquinolone use increases in future.