Dick E. Zoutman

Total and attributable costs of surgical-wound infections at a Canadian tertiary-care center

OBJECTIVE To determine the total and attributable costs of surgical-wound infections in a Canadian teaching hospital. DESIGN Retrospective incidence series study with chart review and examination of resource utilization attributable to wound infection. The charts of inpatients with wound infections were examined using the Appropriateness Evaluation Protocol (AEP), a validated chart review instrument designed to determine appropriateness of care, modified for wound infections. SETTING A university referral center in Canada. PATIENTS Medical records were abstracted from patients with wound infections who underwent an inpatient clean or clean-contaminated procedure during 1991. MEASUREMENTS During the wound-infection treatment period, the hospital costs associated with providing care were tabulated for all inpatient days and for outpatient and emergency visits. Costs taken into account included nursing salary and benefits, nonphysician professional services, operating room time, laboratory, pharmacy, supplies, ancillary tests, and hotel costs. RESULTS We identified 108 wound infections. Twenty-two patients required 28 surgical procedures related to a wound infection. Inpatient days totalled 1,116, costing

Exposure to hospital roommates as a risk factor for health care-associated infection.

394,337. Fifty-five emergency and 42 clinic visits occurred, costing

A canadian survey of prophylactic antibiotic use among hip-fracture patients

27,193. By applying the AEP to the inpatient days, 833 days, or 10.2 days per case, were directly attributable to the wound infection. The hospital costs for inpatient care attributable to wound infections were

Chikungunya-related arthritis: Case report and review of the literature

321,533 in total, or

Optimizing antibiotics in residents of nursing homes: protocol of a randomized trial.

3,937 per infection. Costs were distributed as follows: nursing, 51%; hotel, 14%; pharmacy, 10%; laboratory, 9%; emergency and outpatient clinic, 6%; professional services, 5%; operating room, 3%; and ancillary tests, 2%. CONCLUSIONS Wound infections contribute markedly to extra days of hospitalization and related costs. The AEP method is applied easily to determine attributable days of care and costs of wound infections, which are necessary to calculate the cost-benefit of infection control programs.

Effectiveness of a novel ozone-based system for the rapid high-level disinfection of health care spaces and surfaces

BACKGROUND Numerous patient- and hospital-level characteristics have been established as risk factors for the transmission of health care-associated infections (HAIs). Few studies have quantitatively assessed the impact of exposure to hospital roommates on the acquisition of infections. This study evaluated the association between roommate exposures and the risk of HAIs. METHODS A retrospective cohort of adult patients admitted to a Canadian teaching hospital between June 30, 2001, and December 31, 2005, was studied. Exposures were characterized as total daily roommate exposures and daily unique roommate exposures. Outcomes examined were methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Clostridium difficile. RESULTS The number of roommate exposures per day was significantly associated with MRSA and VRE infection or colonization (MRSA: hazard ratio [HR] = 1.10, 95% confidence interval [CI] = 1.05 to 1.15; VRE: HR = 1.11, 95% CI = 1.02 to 1.21), and with C difficile infection (HR = 1.11, 95% CI = 1.03 to 1.19). A significant association also was found for number of unique roommate exposures per day and VRE (HR = 1.15, 95% CI = 1.02 to 1.28). CONCLUSIONS The significant associations found between daily roommate exposures and the infection outcomes suggest a possible role for limiting patient-to-patient contact in an infection prevention and control program in this facility. These findings have implications for the deployment and design of acute care hospitals.

Risk factors for SARS transmission from patients requiring intubation: a multicentre investigation in Toronto, Canada.

OBJECTIVE To study how surgical prophylactic antibiotics (SPAs) were utilized in the perioperative management of surgery for hip fractures. DESIGN Retrospective chart review of randomly selected medical records. SETTING Twenty-two hospitals (teaching, nonteaching, community, and large urban referral centers) from across Canada. PATIENTS Patients admitted in 1990 with a diagnosis of hip fracture. METHODS Complete medical records of 438 patients were examined; 352 cases who underwent surgical repair of a fractured hip with insertion of prosthetic material were included in analysis. Perioperative SPA use was assessed by abstracting the agent(s) chosen, dosages, time given with respect to the incision, and duration of postoperative use. Fourteen patient and process-of-care variables related to SPA were examined. RESULTS 247 (70%) of 352 cases did not receive a dose of SPA 2 hours preoperatively. Ten percent of preoperative SPA was administered either too early or during the procedure. In 91 (39%) of 231 cases receiving SPA, the first dose was not administered until the end of the procedure. Preoperative SPA consisted of a parenteral first-generation cephalosporin for 94% of cases. SPAs were continued more than 24 hours postoperatively in 78% of cases. Lack of a written order for SPA, being a nonteaching hospital, and shorter duration of surgical procedure were predictive of failure to receive SPA in an effective manner. CONCLUSIONS Most hip-fracture-surgery patients did not receive effective antibiotic prophylaxis as required to prevent serious wound infections. This important variable can be included for surveillance, so that corrective measures can be taken to assure effective prophylactic antibiotic administration.

Evaluation of hospital and patient factors that influence the effective administration of surgical antimicrobial prophylaxis.

INTRODUCTION Chikungunya fever often presents with severe arthritis/arthralgias, high fever, myalgias, headache, and maculopapular rash (Chow et al., 2011 [1]; Das et al., 2010 [2]; Mizuno et al., 2011 [3]; Powers, 2010 [4]; Sissoko et al., 2010 [5]; Staples et al., 2009 [6]). Persistent arthritis/arthralgias commonly develop after symptomatic infection and are the most common long-term complication (Chow et al., 2011 [1]; Powers, 2010 [4]; Sissoko et al., 2010 [5]; Staples et al., 2009 [6]). The small joints are most often affected in a symmetric pattern that can mimic adult rheumatoid arthritis (RA) (Mizuno et al., 2011 [3]; Bouquillard and Combe, 2009 [7]; Chabbra et al., 2008 [8]; Jaffar-Bandjee et al., 2009 [9]; Simon et al., 2007 [10]). OBJECTIVE We present a case of Chikungunya virus (CHIKV)-induced arthritis and review the literature surrounding Chikungunya-induced arthritis/arthralgias and associated musculoskeletal (MSK) manifestations. METHODS A Medline search was completed from 1946--November 2011. Key words included Chikungunya virus and arthritis. A PubMed search was completed from 1996--November 2011. Search terms included Chikungunya virus, etiology, and fever. Searches were limited to humans and English language publications. Additional relevant articles were obtained from the reference lists.

Environmental cleaning resources and activities in Canadian acute care hospitals

BackgroundAntibiotics are frequently prescribed for older adults who reside in long-term care facilities. A substantial proportion of antibiotic use in this setting is inappropriate. Antibiotics are often prescribed for asymptomatic bacteriuria, a condition for which randomized trials of antibiotic therapy indicate no benefit and in fact harm. This proposal describes a randomized trial of diagnostic and therapeutic algorithms to reduce the use of antibiotics in residents of long-term care facilities.MethodsIn this on-going study, 22 nursing homes have been randomized to either use of algorithms (11 nursing homes) or to usual practise (11 nursing homes). The algorithms describe signs and symptoms for which it would be appropriate to send urine cultures or to prescribe antibiotics. The algorithms are introduced by inservicing nursing staff and by conducting one-on-one sessions for physicians using case-scenarios. The primary outcome of the study is courses of antibiotics per 1000 resident days. Secondary outcomes include urine cultures sent and antibiotic courses for urinary indications. Focus groups and semi-structured interviews with key informants will be used to assess the process of implementation and to identify key factors for sustainability.

Compliance with NCCLS approved standard M22-A2 for bacteriologic media quality assurance: a survey of 124 Ontario microbiology laboratories.

BACKGROUND Vapor-based fumigant systems for disinfection of health care surfaces and spaces is an evolving technology. A new system (AsepticSure) uses an ozone-based process to create a highly reactive oxidative vapor with broad and high-level antimicrobial properties. METHODS Ozone gas at 50-500 ppm was combined with 3% hydrogen peroxide vapor in a test chamber and upscaled in rooms measuring 82 m3 and 90 m3 in area. Test organisms included methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococcus, Escherichia coli, Pseudomonas aeruginosa, Clostridium difficile, and Bacillus subtilis spores dried onto steel discs or cotton gauze pads. RESULTS The combination of 80-ppm ozone with 1% hydrogen peroxide vapor achieved a very high level of disinfection, with a ≥6 log10 reduction in the bacteria and spores tested on steel discs and MRSA tested on cotton gauze during a 30- to 90-minute exposure. The entire system was scalable such that it achieved the same high level of disinfection in both the 81-m3 and 90-m3 rooms in 60-90 minutes. CONCLUSION The ozone hydrogen peroxide vapor system provides a very high level of disinfection of steel and gauze surfaces against health care-associated bacterial pathogens. The system is an advanced oxidative process providing a rapid and effective means of disinfecting health care surfaces and spaces.