Bala Hota

Contamination, Disinfection, and Cross-Colonization: Are Hospital Surfaces Reservoirs for Nosocomial Infection?

Abstract Despite documentation that the inanimate hospital environment (e.g., surfaces and medical equipment) becomes contaminated with nosocomial pathogens, the data that suggest that contaminated fomites lead to nosocomial infections do so indirectly. Pathogens for which there is more-compelling evidence of survival in environmental reservoirs include Clostridium difficile, vancomycin-resistant enterococci, and methicillin-resistant Staphylococcus aureus, and pathogens for which there is evidence of probable survival in environmental reservoirs include norovirus, influenza virus, severe acute respiratory syndrome—associated coronavirus, and Candida species. Strategies to reduce the rates of nosocomial infection with these pathogens should conform to established guidelines, with an emphasis on thorough environmental cleaning and use of Environmental Protection Agency—approved detergent-disinfectants.

Hospital and Societal Costs of Antimicrobial-Resistant Infections in a Chicago Teaching Hospital: Implications for Antibiotic Stewardship

BACKGROUND Organisms resistant to antimicrobials continue to emerge and spread. This study was performed to measure the medical and societal cost attributable to antimicrobial-resistant infection (ARI). METHODS A sample of high-risk hospitalized adult patients was selected. Measurements included ARI, total cost, duration of stay, comorbidities, acute pathophysiology, Acute Physiology and Chronic Health Evaluation III score, intensive care unit stay, surgery, health care-acquired infection, and mortality. Hospital services used and outcomes were abstracted from electronic and written medical records. Medical costs were measured from the hospital perspective. A sensitivity analysis including 3 study designs was conducted. Regression was used to adjust for potential confounding in the random sample and in the sample expanded with additional patients with ARI. Propensity scores were used to select matched control subjects for each patient with ARI for a comparison of mean cost for patients with and without ARI. RESULTS In a sample of 1391 patients, 188 (13.5%) had ARI. The medical costs attributable to ARI ranged from

Are Community-Associated Methicillin-Resistant Staphylococcus aureus (MRSA) Strains Replacing Traditional Nosocomial MRSA Strains?

18,588 to

Effectiveness of Gloves in the Prevention of Hand Carriage of Vancomycin-Resistant Enterococcus Species by Health Care Workers after Patient Care

29,069 per patient in the sensitivity analysis. Excess duration of hospital stay was 6.4-12.7 days, and attributable mortality was 6.5%. The societal costs were

Left Ventricular Assist Device—Related Infection: Treatment and Outcome

10.7-

Effectiveness of routine patient cleansing with chlorhexidine gluconate for infection prevention in the medical intensive care unit.

15.0 million. Using the lowest estimates from the sensitivity analysis resulted in a total cost of

Quality of traditional surveillance for public reporting of nosocomial bloodstream infection rates.

13.35 million in 2008 dollars in this patient cohort. CONCLUSIONS The attributable medical and societal costs of ARI are considerable. Data from this analysis could form the basis for a more comprehensive evaluation of the cost of resistance and the potential economic benefits of prevention programs.

Costs attributable to healthcare-acquired infection in hospitalized adults and a comparison of economic methods.

BACKGROUND Recent studies have suggested that community-associated methicillin-resistant Staphylococcus aureus (MRSA) infection is encroaching on health care settings. We describe the epidemiology of hospital-onset community-associated MRSA bloodstream infections using phenotypic and genotypic analysis. METHODS Using an update of an established rule derived from antibiotic susceptibilities, we inferred genotypes (i.e., community [CG] or hospital [HG]) for 208 MRSA isolates from hospital-onset (>72 h after hospital admission) bloodstream infections during 2000-2006. We compared demographic characteristics, risk factors, and outcomes of patients infected with CG or HG strains. RESULTS Total hospital-onset MRSA bloodstream infection incidence density rates for the periods January 2000-June 2003 and July 2003-December 2006 (0.215 cases per 1000 patient-days and 0.207 cases per 1000 patient-days, respectively) were stable (risk ratio, 1.0; 95% confidence interval, 0.7-1.3; P = .79, period 2 vs. period 1). However, the risk that these bloodstream infections were due to CG strains doubled (risk ratio, 1.9; 95% confidence interval, 1.2-3.1; P = .01), whereas the risk due to HG strains decreased (risk ratio, 0.7; 95% confidence interval, 0.46-0.93; P = .02). After adjustment for comorbidities in multivariate analysis, no significant risk factors for or outcomes of infections due to CG versus HG strains were detected. Patients infected with HG strains showed a trend toward later day of acquisition of a positive blood culture, and those infected with CG strains showed trend toward greater risk of intensive care unit admission. CONCLUSION Although total hospital-onset MRSA bloodstream infection rates were relatively stable during 2000-2006, CG strains were responsible for an increasing proportion of cases (from 24% to 49%), suggesting replacement of traditional hospital-associated strains. For most risk factors and outcomes, patients infected with CG and HG strains were similar, suggesting that, thus far, CG strains are behaving like their traditional hospital-associated counterparts.

Prevention of bloodstream infections by use of daily chlorhexidine baths for patients at a long-term acute care hospital.

Gloving reduces acquisition of vancomycin-resistant Enterococcus species (VRE) on the hands, and it should be considered for routine inpatient care, even for contact with the intact skin of patients who may be colonized with VRE. However, gloving does not completely prevent contamination of the hands, and hand washing is necessary after glove removal.

Delay of Active Antimicrobial Therapy and Mortality among Patients with Bacteremia: Impact of Severe Neutropenia

BACKGROUND Left ventricular assist device (LVAD) implantation has become an effective treatment option for patients with severe heart failure awaiting transplantation. Significant infection rates have been reported among LVAD recipients. However, few reports have focused specifically on device infection, its treatment, and the impact of LVAD-related infection on clinical outcome. METHODS Forty-six LVAD-related infections were diagnosed in 38 (50%) of 76 patients who underwent LVAD implantation as a bridge to transplantation. Twenty-nine episodes of LVAD-related bloodstream infection (BSI) (including 5 that were cases of LVAD endocarditis) and 17 episodes of local LVAD infection were identified. RESULTS Diabetes mellitus appeared to increase the risk of BSI among patients with LVAD infection. LVAD-related infection delayed transplantation, as reflected by longer device-support times (a mean duration +/- SEM of 182.8+/-31.1 days, compared with 66.3+/-8.8 days; P<or=.001). Continuous antimicrobial treatment before, during, and after transplantation was associated with fewer relapses than was a limited course of antibiotics (P<.001). A trend for longer hospital stays after receipt of a transplant and increased early mortality was observed in the cohort with LVAD-related infection, although long-term survival was similar to that associated with patients without LVAD-related infection. Posttransplantation invasive vancomycin-resistant Enterococcus faecium (VREF) infection was diagnosed in 6 patients with LVAD-related infection; 4 of these patients died. No VREF infections were identified in patients without LVAD-related infection. CONCLUSIONS Our observations suggest that LVAD-related infection is common and may require antimicrobial therapy before, during, and after transplantation, but that it does not prevent successful transplantation. However, patients with LVAD-related infection appear to be at increased risk for invasive VREF infection, which may contribute to early mortality after transplantation.