Sabine Stamm-Balderjahn

Closure of medical departments during nosocomial outbreaks: data from a systematic analysis of the literature

Summary A total closure of an affected medical department is one of the most expensive infection control measures during investigation of a nosocomial outbreak. However, until now there has been no systematic analysis of typical characteristics of outbreaks, for which closure was considered necessary. This article presents data on features of such nosocomial epidemics published during the past 40 years in the medical literature. A search of the Outbreak Database (1561 nosocomial outbreaks in file) revealed a total of 194 outbreaks that ended up with some kind of closure of the unit (median closure time: 14 days). Closure rates (CRs) were calculated and stratified for medical departments, for causative pathogens, for outbreak sources, and for the assumed mode of transmission. Data were then compared to the overall average CR of 12.4% in the entire database. Wards in geriatric patient care were closed significantly more frequently (CR: 30.3%; P <0.001) whereas paediatric wards showed a significantly lower CR (6.1%; P =0.03). Pathogen species with the highest CR were norovirus (44.1%; P <0.001) and influenza/parainfluenza virus (38.5%; P <0.001). If patients were the source of the outbreak, the CR was significantly increased (16.7%; P =0.03). Infections of the central nervous system were most often associated with closure of the ward (24.2%; P =001). A systematic evaluation of nosocomial outbreaks can be a valuable tool for education of staff in the absence of an outbreak, but may be even more helpful for potentially cost-intensive decisions in the acute outbreak setting on the ward.

How often do asymptomatic healthcare workers cause methicillin-resistant Staphylococcus aureus outbreaks? A systematic evaluation

A systematic search was performed to identify outbreaks of methicillin-resistant Staphylococcus aureus infection and colonization caused by healthcare workers (HCWs). Of 191 outbreaks identified, 11 had strong epidemiological evidence that HCWs were the source. In 3 of these outbreaks, asymptomatic carriers were the cause. The frequent practice of screening asymptomatic HCWs should be reconsidered.

How Outbreaks Can Contribute to Prevention of Nosocomial Infection: Analysis of 1,022 Outbreaks

OBJECTIVE To describe the epidemiology of nosocomial outbreaks published in the scientific literature. DESIGN Descriptive information was obtained from a sample of 1,022 published nosocomial outbreaks from 1966 to 2002. METHODS Published nosocomial outbreaks of the most important nosocomial pathogens were included in the database. A structured questionnaire was devised to extract information in a systematic manner on nosocomial outbreaks published in the literature. The following items were used: the reference, type of study (case reports or studies applying epidemiologic or fingerprinting methods), type of microorganism, setting, patients and personnel involved, type of infection, source of infection, mode of transmission, risk factors identified, and preventive measures applied. RESULTS Bloodstream infection was the most frequently identified type of infection (37.0%), followed by gastrointestinal infection (28.5%) and pneumonia (22.9%). In 37% of the outbreaks, the authors were not able to identify the sources. The most frequent sources were patients (25.7%), followed by medical equipment or devices (11.9%), the environment (11.6%), and the staff (10.9%). The mode of transmission remained unclear in 28.3% of the outbreaks. Transmission was by contact in 45.3%, by invasive technique in 16.1%, and through the air in 15.0%. The percentage of outbreaks investigated by case-control studies or cohort studies over the years was small (21% and 9%, respectively, for the whole time period). CONCLUSION Outbreak reports in the literature are a valuable resource and should be used for educational purposes as well as for preparing outbreak investigations.

Education Against Tobacco (EAT): a quasi-experimental prospective evaluation of a multinational medical-student-delivered smoking prevention programme for secondary schools in Germany.

Objectives To evaluate the multinational medical-student-delivered tobacco prevention programme for secondary schools for its effectiveness to reduce the smoking prevalence among adolescents aged 11–15 years in Germany at half year follow-up. Setting We used a prospective quasi-experimental study design with measurements at baseline (t1) and 6 months postintervention (t2) to investigate an intervention in 8 German secondary schools. The participants were split into intervention and control classes in the same schools and grades. Participants A total of 1474 eligible participants of both genders at the age of 11–15 years were involved within the survey for baseline assessment of which 1200 completed the questionnaire at 6-month follow-up (=longitudinal sample). The schools participated voluntarily. The inclusion criteria were age (10–15 years), grade (6–8) and school type (regular secondary schools). Intervention Two 60 min school-based modules delivered by medical students. Primary and secondary outcome measures The primary end point was the difference from t1 to t2 of the smoking prevalence in the control group versus the difference from t1 to t2 in the intervention group (difference of differences approach). The percentage of former smokers and new smokers in the two groups were studied as secondary outcome measures. Results In the control group, the percentage of students who claimed to be smokers doubled from 4.2% (t1) to 8.1% (t2), whereas it remained almost the same in the intervention group (7.1% (t1) to 7.4% (t2); p=0.01). The likelihood of quitting smoking was almost six times higher in the intervention group (total of 67 smokers at t1; 27 (4.6%) and 7 (1.1%) in the control group; OR 5.63; 95% CI 2.01 to 15.79; p<0.01). However, no primary preventive effect was found. Conclusions We report a significant secondary preventive (smoking cessation) effect at 6-month follow-up. Long-term evaluation is planned.

Education Against Tobacco (EAT): a quasi-experimental prospective evaluation of a programme for preventing smoking in secondary schools delivered by medical students: a study protocol

Introduction A survey conducted by the German Federal Centre for Health Education in 2012 showed that 35.2% of all young adults (18–25 years) and 12.0% of all adolescents (12–17 years) in Germany are regular cigarette smokers. Most smoked their first cigarette in early adolescence. We recently reported a significantly positive short-term effect of a physician-delivered school-based smoking prevention programme on the smoking behaviour of schoolchildren in Germany. However, physician-based programmes are usually very expensive. Therefore, we will evaluate and optimise Education against Tobacco (EAT), a widespread, low-cost programme delivered by about 400 medical students from 16 universities in Germany. Methods and analysis A prospective quasi-experimental study design with two measurements at baseline (t1) and 6 months post-intervention (t2) to investigate an intervention in 10–15-year-olds in grades 6–8 at German secondary schools. The intervention programme consists of two 60-min school-based medical-student-delivered modules with (module 1) and without the involvement of patients with tobacco-related diseases and control groups (no intervention). The study questionnaire measuring smoking status (water pipe and cigarette smoking), smoking-related cognitions, and gender, social and cultural aspects was designed and pre-tested in advance. The primary end point is the prevalence of smokers and non-smokers in the two study arms at 6 months after the intervention. The percentage of former smokers and new smokers in the two groups and the measures of smoking behaviour will be studied as secondary outcome measures. Ethics and dissemination In accordance with Good Epidemiologic Practice (GEP) guidelines, the study protocol was submitted for approval by the responsible ethics committee, which decided that the study does not need ethical approval (Goethe University, Frankfurt-Main, Germany). Findings will be disseminated in peer-reviewed journals, at conferences, within our scientific advisory board and through medical students within the EAT project.

Use of information on nosocomial outbreaks for infection control

ZusammenfassungAusbrüche nosokomialer Infektionen können mit erheblicher Morbidität der betroffenen Patienten verbunden sein und zusätzlichen Zeitaufwand und Ressourcen erfordern. Außerdem können sie zu dramatischen Reaktionen bei den Krankenhausmitarbeitern, den Patienten und der Öffentlichkeit führen. Auf der anderen Seite kann die systematische Analyse von Ausbruchereignissen einen Beitrag zur Aufklärung von Infektionsquellen und Übertragungswegen leisten und Hinweise für die Prävention liefern. Darüber hinaus können die Ergebnisse von Ausbruchuntersuchungen ein wertvolles Instrument für die Fortbildung sein. Deshalb wäre eine systematische Registrierung nosokomialer Ausbrüche für alle auf dem Gebiet der Infektionsprävention im Krankenhaus Arbeitenden sehr nützlich. Der vorliegende Artikel erläutert die Notwendigkeit eines Ausbruchregisters und weist auf ein inzwischen vorliegendes Angebot zur Schließung der Lücke hin.AbstractOutbreaks of nosocomial infections can be associated with significant morbidity in the patients involved and require time, effort, and resources. In addition, they may lead to panic reactions among health care workers and patients as well as the community. However, their systematic analysis can contribute to knowledge about the sources and transmission of nosocomial infections and the best methods for prevention. Furthermore, the results of outbreak investigations may serve as a valuable tool for education. That is why a systematic register of nosocomial outbreaks would be a very useful instrument for people working in the field of nosocomial infection control. This article describes the need for a systematic collection of outbreaks published in the literature and an available possibility for filling this gap.

Der Beitrag von Ausbruchanalysen zur Prävention nosokomialer Infektionen

ZusammenfassungAusbrüche nosokomialer Infektionen können mit erheblicher Morbidität der betroffenen Patienten verbunden sein und zusätzlichen Zeitaufwand und Ressourcen erfordern. Außerdem können sie zu dramatischen Reaktionen bei den Krankenhausmitarbeitern, den Patienten und der Öffentlichkeit führen. Auf der anderen Seite kann die systematische Analyse von Ausbruchereignissen einen Beitrag zur Aufklärung von Infektionsquellen und Übertragungswegen leisten und Hinweise für die Prävention liefern. Darüber hinaus können die Ergebnisse von Ausbruchuntersuchungen ein wertvolles Instrument für die Fortbildung sein. Deshalb wäre eine systematische Registrierung nosokomialer Ausbrüche für alle auf dem Gebiet der Infektionsprävention im Krankenhaus Arbeitenden sehr nützlich. Der vorliegende Artikel erläutert die Notwendigkeit eines Ausbruchregisters und weist auf ein inzwischen vorliegendes Angebot zur Schließung der Lücke hin.AbstractOutbreaks of nosocomial infections can be associated with significant morbidity in the patients involved and require time, effort, and resources. In addition, they may lead to panic reactions among health care workers and patients as well as the community. However, their systematic analysis can contribute to knowledge about the sources and transmission of nosocomial infections and the best methods for prevention. Furthermore, the results of outbreak investigations may serve as a valuable tool for education. That is why a systematic register of nosocomial outbreaks would be a very useful instrument for people working in the field of nosocomial infection control. This article describes the need for a systematic collection of outbreaks published in the literature and an available possibility for filling this gap.