[Show abstract][Hide abstract] ABSTRACT: The Dutch Health Care Inspectorate investigated the preparedness of Dutch hospitals for the emergence of antibiotic resistance, and concluded that hospitals are not well prepared and are insufficiently aware that infection prevention is a prerequisite for patient safety. These conclusions are based on observations of process indicators of current practice guidelines, without including the available outcome indicators that demonstrate the persistently low incidence of infections with antibiotic resistant bacteria in Dutch hospitals. The conclusions may have negative effects on the quality of infection prevention in Dutch hospitals. Therefore, it is advisable to use outcome indicators rather than process indicators to evaluate the quality of infection prevention.
Nederlands tijdschrift voor geneeskunde 01/2014; 158:A7395.
[Show abstract][Hide abstract] ABSTRACT: Methicillin-resistant Staphylococcus aureus (MRSA) has rapidly emerged worldwide, affecting both healthcare and community settings, and intensive livestock industry. The efficient control of MRSA strongly depends on its adequate laboratory detection. This guideline provides recommendations on the appropriate use of currently available diagnostic laboratory methods for the timely and accurate detection of MRSA in patients and healthcare workers. Herewith, it aims to standardise and improve the diagnostic laboratory procedures that are used for the detection of MRSA in Dutch medical microbiology laboratories.
European Journal of Clinical Microbiology 07/2013; · 3.02 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Typing of MRSA remains necessary in order to assess whether transmission of MRSA occurred and to what extend infection prevention measures need to be taken. Raman spectroscopy (SpectraCellRA [SCRA], RiverD International, Rotterdam, The Netherlands) is a recently developed tool for bacterial typing. In this study, the performance (typeability, discriminatory power, reproducibility, workflow and costs) of the SCRA system was evaluated for typing of MRSA strains isolated from patients who were infected with or colonized by MRSA and their household members.We analyzed a well-documented collection of 113 MRSA strains, collected from 54 households. The epidemiological relationship between the MRSA strains within one household was used as the "gold standard". PFGE was used for discrepancy analysis.Results of SCRA analysis on the strain level corresponded with epidemiological data for 108 of 113 strains; a concordance of 95.6%. When results were analyzed at the household level, results of SCRA were correct for 49 out of 54 households; a concordance of 90.7%. Concordance on strain level with epidemiological data for PFGE was 93.6% (103/110 isolates typed). Concordance on household level with epidemiological data for PFGE was 93.5% (49/53 households analyzed). When PFGE is regarded as the reference standard, Raman spectroscopy would come to identical conclusions in 100 of 105 cases (95.2%).Reproducibility of SCRA was found to be 100%.We conclude that the SpectraCellRA system is a fast, easy to use and highly reproducible typing platform for outbreak analysis that can compete with the currently used typing techniques.
Journal of clinical microbiology 02/2013; · 4.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: In a prospective observational study of bacteremic patients we ascertained the influence of different parts of culture results on the correctness of empirical antibiotic therapy. Ninety-three bacteremic patients requiring antibiotic treatment were included. Patients who had consultations with an infectious disease consultation service before they became bacteremic received microbiologically correct empirical antibiotic therapy more often than those who did not have such consultations (75% versus 53%; P = 0.03). As a direct result of Gram staining, 92% of all patients received microbiologically correct antibiotic therapy.
Journal of clinical microbiology 03/2012; 50(6):2066-8. · 4.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The Netherlands is known for its low methicillin-resistant Staphylococcus aureus (MRSA) prevalence. Yet MRSA with no link to established Dutch risk factors for acquisition, MRSA of unknown origin (MUO), has now emerged and hampers early detection and control by active screening upon hospital admittance. We assessed the magnitude of the problem and determined the differences between MUO and MRSA of known origin (MKO) for CC398 and non-CC398. National MRSA Surveillance data (2008-2009) were analysed for epidemiological determinants and genotypic characteristics (Panton-Valentine leukocidin, spa). A quarter (24%) of the 5545 MRSA isolates registered were MUO, i.e. not from defined risk groups. There are two genotypic MUO groups: CC398 MUO (352; 26%) and non-CC398 MUO (998; 74%). CC398 MUO needs further investigation because it could suggest spread, not by direct contact with livestock (pigs, veal calves), but through the community. Non-CC398 MUO is less likely to be from a nursing home than non-CC398 MKO (relative risk 0.55; 95% CI 0.42-0.72) and Panton-Valentine leukocidin positivity was more frequent in non-CC398 MUO than MKO (relative risk 1.19; 95% CI 1.11-1.29). Exact transmission routes and risk factors for non-CC398 as CC398 MUO remain undefined.
Clinical Microbiology and Infection 08/2011; 18(7):656-61. · 4.58 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The prevalence of meticillin-resistant Staphylococcus aureus (MRSA) carriage at hospital admission in The Netherlands was 0.03% in 1999-2000. The aim of the present study was to assess whether the prevalence of MRSA carriage in The Netherlands has changed over the last few years. In five Dutch hospitals, 6496 unique patients were screened for nasal S. aureus carriage at hospital admission by microbiological culture between 1 October 2005 and 7 June 2007. In total, 2036 of 6496 (31.3%) patients carried S. aureus in their nose, and seven of 6496 (0.11%) patients were nasal carriers of MRSA. Compared with 1999-2000, the prevalence of MRSA carriage in the Dutch population at hospital admission has increased more than three fold; however, this increase was not significant (P=0.06, Fisher's exact test). This prevalence is still among the lowest in the world, probably as a result of the stringent Dutch infection control policy, and the restrictive use of antibiotics in The Netherlands.
The Journal of hospital infection 07/2011; 79(3):198-201. · 3.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Nosocomial infections are a frequent concern in healthcare. Despite the available knowledge on nosocomial infections and preventive measures, outbreaks of infections continue to occur. An outbreak of severe sepsis in patients who underwent minor procedures in an operating theatre during two consecutive days is described and analysed in this study. We performed a retrospective cohort study using epidemiological data in order to investigate the source of infection together with microbiological and on-site investigations and interviews. Seven patients met the case definition of postoperative systemic inflammatory response syndrome (SIRS). All other patients operated on over the same period served as controls. Of the risk factors investigated, general anaesthesia and propofol were statistically significant (P=0.003). Klebsiella pneumoniae and Serratia marcescens were cultured from opened vials of propofol, propofol-related devices and from blood cultures from two of the patients. These strains were genotypically indistinguishable. Lapses in aseptic preparation, handling and storage of the propofol were observed, and were the most probable cause of the extrinsic contamination. The daily procedure of handling propofol was not performed according to the manufacturer's recommendations, the main departure being the use of a single-use vial for multiple patients. This study documents the risk of infection due to contaminated propofol and the importance of having written guidelines for its handling.
The Journal of hospital infection 11/2010; 76(3):225-30. · 3.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Compliance with hand hygiene guidelines by hospital physicians and nurses is universally low and there is a need to apply powerful intervention methods from social sciences in order to improve compliance. One method is the formation of implementation intentions (or action planning) in which concrete 'if then' plans are formulated to link an environmental cue with performance of an intended behavioural action. This pilot study explored the practicality and effects of action planning on the hand hygiene behaviour (HHB) of nurses in an ICU and surgical ward of a university teaching hospital. A pre-post test design was used, and 17 nurses were invited to participate. A trained researcher observed HHB of nurses before and three weeks after the intervention in which action plans were formulated. Frequencies were calculated and logistic regression analysis was performed to assess changes in HHB. Of the 17 participants, 10 (seven in surgical ward, three in ICU) had complete data and were included in the analyses. In total, 283 potential moments for hand hygiene were identified, 142 in the surgical ward and 141 in the ICU. HHB increased from 9.3% at baseline to 25.4% post intervention (odds ratio: 3.3; confidence interval: 1.7-6.5; P<0.001). Although this was a small scale study, the results show promise for the use of action planning to improve the HHB of nurses in the short term. Action planning has shown success in closing the intention-behaviour gap in other fields, and its use for improving HHB in healthcare should be further investigated.
The Journal of hospital infection 10/2010; 76(2):161-4. · 3.01 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: With this prospective observational follow-up study of 165 methicillin-resistant Staphylococcus aureus (MRSA)-positive individuals (23 health care workers and 142 patients), we determined that our MRSA eradication therapy protocol results in a high success rate (81%). Five or more negative culture sets give a predictive value for MRSA eradication therapy success of >90%. Furthermore, MRSA colonization, at least in the throat, and the presence of wounds just before the start of MRSA eradication therapy are associated with MRSA eradication therapy failure.
Antimicrobial Agents and Chemotherapy 09/2010; 54(9):4020-5. · 4.57 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Coagulase-negative staphylococci (CNS) are among the most frequently isolated bacterial species in clinical microbiology, and most CNS-related infections are hospital acquired. Distinguishing between these frequently multiple-antibiotic-resistant isolates is important for both treatment and transmission control. In this study we used isolates of methicillin-resistant coagulase-negative staphylococci (MR-CNS) that were selected from a large surveillance study of the direct spread of MR-CNS. This strain collection was used to evaluate (i) Raman spectroscopy as a typing tool for MR-CNS isolates and (ii) diversity between colonies with identical and different morphologies. Reproducibility was high, with 215 of 216 (99.5%) of the replicate samples for 72 isolates ending up in the same cluster. The concordance with pulsed-field gel electrophoresis (PFGE)-based clusters was 94.4%. We also confirm that the skin of patients can be colonized with multiple MR-CNS types at the same time. Morphological differences between colonies from a single patient sample correlated with differences in Raman and PFGE types. Some morphologically indistinguishable colonies revealed different Raman and PFGE types. This indicates that multiple MR-CNS colonies should be examined to obtain a complete insight into the prevalence of different types and to be able to perform an accurate transmission analysis. Here we show that Raman spectroscopy is a reproducible typing system for MR-CNS isolates. It is a tool for screening variability within a collection of isolates. Because of the high throughput, it enables the analysis of multiple colonies per patient, which will enhance the quality of clinical and epidemiological studies.
Journal of clinical microbiology 03/2010; 48(3):736-40. · 4.23 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Nasal carriers of Staphylococcus aureus are at increased risk for health care-associated infections with this organism. Decolonization of nasal and extranasal sites on hospital admission may reduce this risk.
In a randomized, double-blind, placebo-controlled, multicenter trial, we assessed whether rapid identification of S. aureus nasal carriers by means of a real-time polymerase-chain-reaction (PCR) assay, followed by treatment with mupirocin nasal ointment and chlorhexidine soap, reduces the risk of hospital-associated S. aureus infection.
From October 2005 through June 2007, a total of 6771 patients were screened on admission. A total of 1270 nasal swabs from 1251 patients were positive for S. aureus. We enrolled 917 of these patients in the intention-to-treat analysis, of whom 808 (88.1%) underwent a surgical procedure. All the S. aureus strains identified on PCR assay were susceptible to methicillin and mupirocin. The rate of S. aureus infection was 3.4% (17 of 504 patients) in the mupirocin-chlorhexidine group, as compared with 7.7% (32 of 413 patients) in the placebo group (relative risk of infection, 0.42; 95% confidence interval [CI], 0.23 to 0.75). The effect of mupirocin-chlorhexidine treatment was most pronounced for deep surgical-site infections (relative risk, 0.21; 95% CI, 0.07 to 0.62). There was no significant difference in all-cause in-hospital mortality between the two groups. The time to the onset of nosocomial infection was shorter in the placebo group than in the mupirocin-chlorhexidine group (P=0.005).
The number of surgical-site S. aureus infections acquired in the hospital can be reduced by rapid screening and decolonizing of nasal carriers of S. aureus on admission. (Current Controlled Trials number, ISRCTN56186788.)
New England Journal of Medicine 01/2010; · 54.42 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The frequency of and risk factors for methicillin-resistant Staphylococcus aureus (MRSA) transmission from a MRSA index person to household contacts were assessed in this prospective study. Between January 2005 and December 2007, 62 newly diagnosed MRSA index persons (46 patients and 16 health care workers) and their 160 household contacts were included in the study analysis. Transmission of MRSA from an index person to household contacts occurred in nearly half of the cases (47%; n = 29). These 29 index persons together had 84 household contacts, of which two-thirds (67%; n = 56) became MRSA positive. Prolonged exposure time to MRSA at home was a significant risk factor for MRSA transmission to household contacts. In addition, MRSA colonization at least in the throat, younger age, and eczema in index persons were significantly associated with MRSA transmission; the presence of wounds was negatively associated with MRSA transmission. Furthermore, an increased number of household contacts and being the partner of a MRSA index person were household-related risk factors for MRSA acquisition from the index person. No predominant pulsed-field gel electrophoresis (PFGE) type was observed to be transmitted more frequently than other PFGE types. To date, screening household contacts and providing MRSA eradication therapy to those found positive simultaneously with the index person is not included in the "search-and-destroy" policy. We suggest including both in MRSA prevention guidelines, as this may reduce further spread of MRSA.
Journal of clinical microbiology 11/2009; 48(1):202-7. · 4.23 Impact Factor