Alma Tostmann

Reduced rate of intensive care unit acquired gram-negative bacilli after removal of sinks and introduction of 'water-free' patient care

BackgroundSinks in patient rooms are associated with hospital-acquired infections. The aim of this study was to evaluate the effect of removal of sinks from the Intensive Care Unit (ICU) patient rooms and the introduction of ‘water-free’ patient care on gram-negative bacilli colonization rates.MethodsWe conducted a 2-year pre/post quasi-experimental study that compared monthly gram-negative bacilli colonization rates pre- and post-intervention using segmented regression analysis of interrupted time series data. Five ICUs of a tertiary care medical center were included. Participants were all patients of 18xa0years and older admitted to our ICUs for at least 48xa0h who also received selective digestive tract decontamination during the twelve month pre-intervention or the twelve month post-intervention period. The effect of sink removal and the introduction of ‘water-free’ patient care on colonization rates with gram-negative bacilli was evaluated. The main outcome of this study was the monthly colonization rate with gram-negative bacilli (GNB). Yeast colonization rates were used as a ‘negative control’. In addition, colonization rates were calculated for first positive culture results from cultures taken ≥3, ≥5, ≥7, ≥10 and ≥14xa0days after ICU-admission, rate ratios (RR) were calculated and differences tested with chi-squared tests.ResultsIn the pre-intervention period, 1496 patients (9153 admission days) and in the post-intervention period 1444 patients (9044 admission days) were included. Segmented regression analysis showed that the intervention was followed by a statistically significant immediate reduction in GNB colonization in absence of a pre or post intervention trend in GNB colonization. The overall GNB colonization rate dropped from 26.3 to 21.6 GNB/1000 ICU admission days (colonization rate ratio 0.82; 95%CI 0.67–0.99; Pxa0=xa00.02). The reduction in GNB colonization rate became more pronounced in patients with a longer ICU-Length of Stay (LOS): from a 1.22-fold reduction (≥2xa0days), to a 1.6-fold (≥5xa0days; Pxa0=xa00.002), 2.5-fold (for ≥10xa0days; Pxa0<xa00.001) to a 3.6-fold (≥14xa0days; Pxa0<xa00.001) reduction.ConclusionsRemoval of sinks from patient rooms and introduction of a method of ‘water-free’ patient care is associated with a significant reduction of patient colonization with GNB, especially in patients with a longer ICU length of stay.

0.2% chlorhexidine acetate as skin disinfectant prevents skin lesions in extremely preterm infants: a preliminary report.

Objective The skin disinfectant ‘0.5% chlorhexidine gluconate in 70% alcohol’ (0.5% CHG-70% alc) may cause skin lesions in extremely preterm infants (gestational age <26u2009weeks). In April 2013, 0.2% chlorhexidine gluconate solution in acetate (0.2% CHG-acetate) was introduced as skin disinfectant for extremely preterm infants in our neonatal intensive care units. We aimed to compare the incidence of skin lesions and central line-associated bloodstream infection (CLABSI) among extremely preterm infants when using 0.5% CHG-70% alc and 0.2% CHG-acetate. Design Retrospective pre-post comparison cohort study. Patients All electronic patient records of extremely preterm infants born between January 2011–March 2013 (‘0.5% CHG-70% alc’ cohort) and April 2013–October 2015 (‘0.2% CHG-acetate’ cohort) were reviewed. Main outcome measures The incidence of skin lesions and CLABSI. Skin lesions were defined as the presence of erythema, blisters, excoriation, oedema or induration. CLABSI was defined according to the definition of the US Centers for Disease Control and Prevention. Results The incidence of skin lesions was 22% (95% CI 11% to 37%) in the ‘0.5% CHG-70% alc’ cohort (n=41) and 5% (95% CI 1% to 15%; p=0.02) in the ‘0.2% CHG-acetate’ cohort (n=41). The incidence of CLABSI was the same in both groups (28%; 95%u2009CI 14% to 46% in ‘0.5% CHG-70% alc’ vs 27%; 95%u2009CI 14% to 44% in ‘0.2% CHG-acetate’; p=0.98). Conclusions Using 0.2% CHG-acetate as skin disinfectant in extremely preterm infants resulted in statistically significant reduction of skin lesions, without increasing the risk of CLABSI as compared with 0.5% CHG-70% alc.

Immunity against measles, mumps, rubella, varicella, diphtheria, tetanus, polio, hepatitis A and hepatitis B among adult asylum seekers in the Netherlands, 2016

Asylum seekers are a vulnerable population for contracting infectious diseases. Outbreaks occur among children and adults. In the Netherlands, asylum seeker children are offered vaccination according to the National Immunization Program. Little is known about protection against vaccine-preventable diseases (VPD) in adult asylum seekers. In this 2016 study, we assessed the immunity of adult asylum seekers against nine VPD to identify groups that might benefit from additional vaccinations. We invited asylum seekers from Syria, Iran, Iraq, Afghanistan, Eritrea and Ethiopia to participate in a serosurvey. Participants provided informed consent and a blood sample, and completed a questionnaire. We measured prevalence of protective antibodies to measles, mumps, rubella, varicella, diphtheria, tetanus, polio type 1-3 and hepatitis A and B, stratified them by country of origin and age groups. The median age of the 622 participants was 28u202fyears (interquartile range: 23-35), 81% were male and 48% originated from Syria. Overall, seroprotection was 88% for measles (range between countries: 83-93%), 91% for mumps (81-95%), 94% for rubella (84-98%), 96% for varicella (92-98%), 82% for diphtheria (65-88%), 98% for tetanus (86-100%), 91% (88-94%) for polio type 1, 95% (90-98%) for polio type 2, 82% (76-86%) for polio type 3, 84% (54-100%) for hepatitis A and 27% for hepatitis B (anti-HBs; 8-42%). Our results indicate insufficient protection against certain VPD in some subgroups. For all countries except Eritrea, measles seroprotection was below the 95% threshold required for elimination. Measles seroprevalence was lowest among adults younger than 25u202fyears. In comparison, seroprevalence in the Dutch general population was 96% in 2006/07. The results of this study can help prioritizing vaccination of susceptible subgroups of adult asylum seekers, in general and in outbreak situations.

Integrating hepatitis B, hepatitis C and HIV screening into tuberculosis entry screening for migrants in the Netherlands, 2013 to 2015

We evaluated uptake and diagnostic outcomes of voluntary hepatitis B (HBV) and C virus (HCV) screening offered during routine tuberculosis entry screening to migrants in Gelderland and Amsterdam, the Netherlands, between 2013 and 2015. In Amsterdam, HIV screening was also offered. Overall, 54% (461/859) accepted screening. Prevalence of chronic HBV infection (HBsAg-positive) and HCV exposure (anti-HCV-positive) in Gelderland was 4.48% (9/201; 95% confidence interval (CI):u20092.37–8.29) and 0.99% (2/203; 95% CI:u20090.27–3.52), respectively, all infections were newly diagnosed. Prevalence of chronic HBV infection, HCV exposure and chronic HCV infection (HCV RNA-positive) in Amsterdam was 0.39% (1/256; 95% CI:u20090.07–2.18), 1.17% (3/256; 95% CI:u20090.40–3.39) and 0.39% (1/256; 95% CI:u20090.07–2.18), respectively, with all chronic HBV/HCV infections previously diagnosed. No HIV infections were found. In univariate analyses, newly diagnosed chronic HBV infection was more likely in participants migrating for reasons other than work or study (4.35% vs 0.83%; odds ratio (OR)u2009=u20095.45; 95% CI: 1.12–26.60) and was less likely in participants in Amsterdam than Gelderland (0.00% vs 4.48%; ORu2009=u20090.04; 95% CI: 0.00–0.69). Regional differences in HBV prevalence might be explained by differences in the populations entering compulsory tuberculosis screening. Prescreening selection of migrants based on risk factors merits further exploration.

Increase in vaccination coverage between subsequent generations of orthodox Protestants in The Netherlands

BackgroundnThe Netherlands experienced several outbreaks of vaccine preventable diseases, largely confined to an orthodox Protestant minority group. Based on religious arguments some orthodox Protestants accept vaccination, while others refuse. Their acceptance of vaccination, however, seems to be changing over time. We estimated vaccination coverage in subsequent generations of orthodox Protestants and identified determinants of the intention to vaccinate their (future) children. In 2013 orthodox Protestants in the age of 18-40 years were invited to fill out an online questionnaire on their own vaccination status, vaccination status of their parents, the vaccination status or vaccination intention for their (future) children, and possible determinants of the intention to vaccinate (future) children. Vaccination coverage of respondents parents and respondents was compared using chi-square tests. Logistic regression was used to identify determinants associated with vaccination of (future) children. In total, 981 orthodox Protestant respondents were included in the study. Vaccination coverage among the parents of respondents was 40.1% (95% CI 37.8-42.5%), among respondents 55.3% (95% CI 52.2-58.4%). This means an increase of 15.2% in one generation ( P < 0.001). About 65% of respondents vaccinated or intends to vaccinate their (future) children. Multivariate logistic regression showed that strongest predictors for vaccinating (future) children were low or moderate level of religious conservatism (OR 10.4 [95% CI 5.7-18.9] and 4.6 [95% CI 2.9-7.4], respectively), being vaccinated themselves (OR 6.0 [95% CI 4.3-8.5]) and high educational level (OR 2.5 [95% CI 1.6-4.0]). Vaccination coverage among Dutch orthodox Protestants is increasing over time.

Negative attitude and low intention to vaccinate universally against varicella among public health professionals and parents in the Netherlands: two internet surveys.

BackgroundPrior to introduction of universal varicella vaccination, it is crucial to gain insight into the willingness to vaccinate among the population. This is because suboptimal national vaccination coverage might increase the age of infection in children, which will lead to higher complication rates. We studied the attitude and intention to vaccinate against varicella among Dutch public health professionals who execute the National Immunisation Programme (NIP), and parents.MethodsMedical doctors and nurses of regional public health services (RPHS) and child health clinics (CHC), and a random sample of parents received an internet survey on varicella vaccination. Separate logistic regression models were used to identify determinants for a positive attitude (professionals) or a positive intention (parents) to vaccinate against varicella within the NIP (free of charge).ResultsThe questionnaire was completed by 181 RPHS professionals (67xa0%), 260 CHC professionals (46xa0%), and 491 parents (33xa0%). Of professionals, 21xa0% had a positive attitude towards universal varicella vaccination, while 72xa0% preferred to limit vaccination to high-risk groups only. Of parents, 28xa0% had a positive intention to vaccinate their child against varicella within the NIP. The strongest determinant for a positive attitude or intention to vaccinate against varicella among professionals and parents was the belief that varicella is a disease serious enough to vaccinate against.ConclusionsWe showed that a majority of the Dutch public health professionals and parents in this study have a negative attitude or low intention to vaccinate universally against varicella, as a result of the perceived low severity of the disease. Most participating professionals support selective vaccination to prevent varicella among high-risk groups.

Overwegingen om te kiezen voor een soa-test bij de GGD

SamenvattingPersonen uit een ‘risicogroep voor soa’ kunnen kiezen of zij een soa-test doen bij de GGD, de huisarts of een andere instelling. Wij hebben onderzocht welke overwegingen bij bezoekers van het Centrum Seksuele Gezondheid van vier GGD’en een rol hebben gespeeld bij hun keuze om voor een soa-test naar de GGD te gaan. Personen die een GGD in de regio Oost bezochten voor een soa-consult werden gevraagd een vragenlijst in te vullen als ze behoorden tot minimaal een van de volgende vier risicogroepen: mannen die seks hebben met mannen (MSM), personen gewaarschuwd voor een soa, personen met klachten passend bij een soa en jongeren onder de 25xa0jaar. Er werden 609 personen geïncludeerd. De volgende overwegingen vonden zij belangrijk in hun keuze om voor een soa-test naar de GGD te gaan: de deskundigheid van de GGD (96u202f%), het gemak van het maken van een afspraak bij de GGD (90u202f%), de anonimiteit bij de GGD (69u202f%), de gratis soa-test bij de GGD (65u202f%).AbstractIndividuals from axa0risk group can choose STI consultation at the Public Health Service (PHS), the GP or another institution. This study aimed to identify important reasons for the choice of an STI-consult at the PHS. A questionnaire was offered to clients who visited the PHS in the eastern region of the Netherlands for an STI-consult if they belong to at least one of the four risk groups: men who have sex with men (MSM), people warned for an STI, people with complaints appropriate for an STI and young people. We included 609 questionnaires. Important reasons to visit the PHS are 1)xa0expertise of the PHS (96%), 2)xa0making an appointment for an STI-consult at the PHS is easy (90%), 3)xa0anonymity at the PHS (69%) and 4)xa0free STI-testing at the PHS (65%). Analysis shows almost no difference between the risk groups.

Automatic discontinuation of isolation precautions and electronic alerts of MDRO positive patients: safe or sorry?

The Netherlands have a low prevalence of Multi drug Resistant organisms (MDRO), in part due to their national guideline concerning MDRO carriers. Apart from being flagged in Electronic Health Records, immediate isolation precautions must be taken if the last MDRO positive culture is less than 1 year ago. No clear guidance is given on duration and termination of electronic alerts and isolation precautions for MDRO positive patients.

Risk factors for enterobacter cloacae colonisation at a neonatal intensive care unit in the Netherlands.

Following an outbreak of Enterobacter cloacae complex ESBL at a neonatal intensive care unit (NICU) in a large tertiary care hospital in the Netherlands, a routine E. cloacae complex screening of all neonates was introduced. Literature on colonisation rates and risk factors for neonatal colonisation with E. cloacae are limited.

Wound leakage in the early postoperative phase correlates with surgical site infections following total hip and knee arthroplastry, a case control study

A Surgical Site Infection (SSI) following total hip or knee arthroplasty (THA/TKA) is considered to be a devastating complication, leading to prolonged hospitalization, repeated surgical intervention and often the removal of the prosthesis.