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Journal Watch
Australian Infection Control
Journal Watch Journal Watch presents a brief description of articles recently published in other journals and thought to be of relevance or interest to the Ale readership. Readers are encouraged to refer to the full article for complete information.
Handheld computer surveillance Urinary tract infection (UTI) has been shown to be an independent risk factor for morbidity in hospitalised patients. The most significant risk factor associated with UTI is the presence of an indwelling urinary catheter. Fadey et al. examined the accuracy and cost effectiveness of using handheld personal digital assistants (PDAs) and computer based surveillance compared with standard surveillance methodologies for catheter-associated UTI. The study was conducted over a 1 month period in the medical intensive care unit (MICU) in a 1000 bed tertiary care hospital in Baltimore, USA. All adult patients requiring an indwelling Foley catheter in the MICU for more than 48 hours were eligible. UTI cases were identified by the infection control professional (ICP) using a system of paper and electronic medical record review. Daily rounds were made to accurately record urinary catheter days and the findings were manually entered onto a database. The PDA computer methodology included a daily upload of MICU patient census data onto the PDA and a daily review of bedside charts to collect urinary catheter days. These data were entered onto the PDA and later downloaded into a database. Both the PDA method and the active surveillance identified eight cases of UTI; however, due to a program error, the PDA erroneously attributed two cases to another unit. The authors estimated, that compared to the PDA, active surveillance required an extra 6.5 hours each week. Further, if used in only one speciality unit, the PDA method would save 8.5 weeks per year but take up to 4 years to realise any financial cost savings. The findings of this study should be interpreted with caution as the authors acknowledge a number of limitations. The study period of 1 month resulted in detection of only eight UTI cases in total. Validation of the findings would require a longer study period and a larger subset of patients. Although rectified, a program error resulted in the PDA erroneously attributing two cases to a unit other than MICU. Further, the PDA method is unable to capture clinically diagnosed UTIs, i.e. those diagnosed without laboratory confirmation. Lastly, the time savings calculations provided in this study cannot be relied upon as the time required for an ICP to conduct the surveillance described in this study may vary substantially depending on the ICP's experience and knowledge.
Far!ey j, Srinivasan A, Richards A, Song X, McEachen j & Per! T. Handheld computer surveillance: shoe-leather epidemiology in the 'palm' of your hand. AjlC 2005; 33(8):444-449. Vol 10
Issue 4
December 2005
Yankauer suction catheter colonisation Person-to-person transfer of pathogenic organisms in the health care setting may be aided by environmental fomites such as contaminated equipment - for example, stethoscopes, gowns, gloves and personal pagers. This study investigated the prevalence of contamination of Yankauer suction catheters in intensive care units (ICUs). A convenience sample of 20 Yankauer suction catheters from patient bedsides in three ICUs was collected and cultured over a 3 month period. Each ICU had a policy for the disposal of catheters that ranged from daily to dispose 'when visibly soiled'. During the study, 11 catheters were found stored in the designated bedside holders; however, other catheters were discovered placed on medical equipment, in a patient's bed and laying on the floor. The majority (80%) of catheters had one or more pathogens isolated, including Staphylococcus aureus (25%), of which 60% were methicillin-resistant, and Candida species (30%). Further, 25% of pathogens isolated were enteric Gram-negative rods such as Pseudomonas aeruginosa, Escherichia coli and one vancomycinresistant Enterococcus species. The authors suggest that the high level of colonisation of catheters with pathogenic bacteria and fungi was not unexpected given that the catheters are used to suction the oropharynx and nasal secretions. However, they draw attention to the high risk of environmental contamination when there is contact with colonised catheters that are not placed back into designated holders. They propose that health care workers contaminated by these environmental fomites may transfer the pathogens to patients or staff. The authors advocate the implementation of infection control strategies to reduce the risk of health care worker and environmental contamination, including hand hygiene before and after procedures, the use of gloves when handling Yankauer suction catheters, storing of Yankauer catheters in designated holders between use, and review of local hospital policy in regard to catheter handling and disposal.
Brown M & Willms D. Colonization of Yankauer suction catheters with pathogenic organisms. AjlC 2005; 33(8):483-485 .
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Australian Infection Control
Bloodstream infection in nursing homes This article is a review of changes in the epidemiology of blood stream infection (BSI) in long-term care facilities for the elderly in North America. A high morbidity and mortality associated with BSI remains among the population of the USA despite the use of potent antimicrobial therapy. The author notes that, even though BSI is associated with the greatest increase in death rate in the past 20 years, it is infrequently studied in the nursing home population where the clients are frail and debilitated. The author conducted a Medline search for the period 1980-2003. There were only seven studies of nursing home acquired BSI over this time period. The overall incidence of nursing home acquired BSI was low, at 0.3 episodes per 1000 resident care days. The studies revealed that urinary tract infections were responsible for at least 50% of the episodes of BSI and that the bacteriology did not change over the 20 year period, with Gram-negative bacteria accounting for approximately 50% of episodes. During the period 1997-2000, resistance to fluoroquinolones and broad spectrum penicillins and cephalosporins was uncommon in the Gram-negative isolates. Multi-resistant Staphylococclls aurells (MRSA) was the most common resista nt organism; th e most recent studies have found that more than 75% of episodes of nursing home acquired S. aI/reus BSI were caused byMRSA, which is cause for concern. BSI secondary to urinary tract infections had the lowest mortality rate, whereas episodes due to pneumonia resulted in the highest death rate. The author concluded that there had been little change in the epidemiology of nursing home acquired BSI in the last 20 yea rs, which s upports the conclusion that blood cultures should not routinely be taken in nursing homes. Mylotte j. Nursing home acquired blood stream infection. Infect Cont Hosp Epidemiol 2005; 26:833-837.
Alcohollchlorhexidine hand hygiene and MRSA This Australian study at Austin Hea lth in Victoria evaluated the results of an intervention trial of the introduction of alcohol/chlorhexidine hand hygiene solution (DeBug) together with improved environmental cleaning and targeted patient decolonisation measures (Operation Clean Start). The study measured health care worker (HCW) hand hygiene compliance, volume of product used, prevalence of patient and HeW colonisa tion, environmental MRSA contamination, rates of MRSA clinkal infection and rates of laboratory detection of ESBL-producing E. coli and Klebsiella spp. In the study wards, significant improvements in hand hygiene co mpliance were observed at 12 months (from 21 % preintervention to 42% post-intervention), and use of DeBug increased five-fold. There was no decrease in the patient or HeW colonisation rates in the study wards at 12 months postintervention, except in the ICU; however, the rate of total clinical MRSA isolations declined significantl y between 28 and 36
•
months post-intervention. The monthly rate of MRSA bacteraemia also declined significantly over the sa me period (a 57% reduction). A similar decline was also observed in the total number of clinical isolates of ESBL-producing E. coli and Klebsieffa spp. The authors were able to demonstrate significant positive effects of the program, despite this not including increased patient screening and isolation of colonised patients. In a companion article in another journal, the same group reported on the occupational health and safety aspects of the widespread use of the DeBug hand hygiene product. They found that cutaneous adverse rea ctions amongst HeWs were infrequent (1 per 72 years of HCW exposure) and were not influenced by the duration or inte nsity of use, but were associated with the presence of irritant contact dermatitis. }ohnson P, Martin R, Burrell L, Grabsch E, Kirsa 5, O'Keeffe}, Mayall B, Edmonds 0, Barr VI-; Bolger C, Naidoo H & Grayson L. Efficacy of an aIcohol!chlorhexidine and hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. eMjA rapid online publication 12 Oct 2005. available from: http://www.mja.com. au/public/issues/183 _10 _2111 05/joh 10507Jm.html Graham M, Nixon R, Burrell L, Bolger C, }ohnson P & Grayson L. Low rates of cutaneous adverse reactions to alcohol-based hand hygiene solution during prolonged use in a large teaching hospital. Antimicrob Agents Chemother 2005; 49:4404-5.
Erratum In the article 'Comparative efficacy of medical instrument
cleaning products in digesting some blood proteins' published in Australian Infection Control (Vol 10, Issue 3, September 2005, p103-109) the funding source was ommited. Funding support for trus study was obtained from 3M Health Care.
Peer Reviewers 2005 In 2005, peer reviews were conducted for Australian Infection COlltrol by the following people;
Helen Cadwallader
Cathryn Murphy
eel ia Cooper
John Pearman
Louise Davis
Megan Reilly
Joan Faoagall Gabby lrvine
Tom Riley Karen Sla ter
David Looke Rhea Martin
Jenny Stackelroth
Paul Smollen
Brad McCall
Michael Whitby
Mary Lou McLaws
Irene Wilkinson
The Australian Infection Control Association would like to thank all reviewers for their contribution to Australian
Infection Control.
Vol 10
Issue 4
December 2005
Journal Watch Journal Watch presents a brief description of articles recently published in other journals and thought to be of relevance or interest to the Ale readership. Readers are encouraged to refer to the full article for complete information.
Handheld computer surveillance Urinary tract infection (UTI) has been shown to be an independent risk factor for morbidity in hospitalised patients. The most significant risk factor associated with UTI is the presence of an indwelling urinary catheter. Fadey et al. examined the accuracy and cost effectiveness of using handheld personal digital assistants (PDAs) and computer based surveillance compared with standard surveillance methodologies for catheter-associated UTI. The study was conducted over a 1 month period in the medical intensive care unit (MICU) in a 1000 bed tertiary care hospital in Baltimore, USA. All adult patients requiring an indwelling Foley catheter in the MICU for more than 48 hours were eligible. UTI cases were identified by the infection control professional (ICP) using a system of paper and electronic medical record review. Daily rounds were made to accurately record urinary catheter days and the findings were manually entered onto a database. The PDA computer methodology included a daily upload of MICU patient census data onto the PDA and a daily review of bedside charts to collect urinary catheter days. These data were entered onto the PDA and later downloaded into a database. Both the PDA method and the active surveillance identified eight cases of UTI; however, due to a program error, the PDA erroneously attributed two cases to another unit. The authors estimated, that compared to the PDA, active surveillance required an extra 6.5 hours each week. Further, if used in only one speciality unit, the PDA method would save 8.5 weeks per year but take up to 4 years to realise any financial cost savings. The findings of this study should be interpreted with caution as the authors acknowledge a number of limitations. The study period of 1 month resulted in detection of only eight UTI cases in total. Validation of the findings would require a longer study period and a larger subset of patients. Although rectified, a program error resulted in the PDA erroneously attributing two cases to a unit other than MICU. Further, the PDA method is unable to capture clinically diagnosed UTIs, i.e. those diagnosed without laboratory confirmation. Lastly, the time savings calculations provided in this study cannot be relied upon as the time required for an ICP to conduct the surveillance described in this study may vary substantially depending on the ICP's experience and knowledge.
Far!ey j, Srinivasan A, Richards A, Song X, McEachen j & Per! T. Handheld computer surveillance: shoe-leather epidemiology in the 'palm' of your hand. AjlC 2005; 33(8):444-449. Vol 10
Issue 4
December 2005
Yankauer suction catheter colonisation Person-to-person transfer of pathogenic organisms in the health care setting may be aided by environmental fomites such as contaminated equipment - for example, stethoscopes, gowns, gloves and personal pagers. This study investigated the prevalence of contamination of Yankauer suction catheters in intensive care units (ICUs). A convenience sample of 20 Yankauer suction catheters from patient bedsides in three ICUs was collected and cultured over a 3 month period. Each ICU had a policy for the disposal of catheters that ranged from daily to dispose 'when visibly soiled'. During the study, 11 catheters were found stored in the designated bedside holders; however, other catheters were discovered placed on medical equipment, in a patient's bed and laying on the floor. The majority (80%) of catheters had one or more pathogens isolated, including Staphylococcus aureus (25%), of which 60% were methicillin-resistant, and Candida species (30%). Further, 25% of pathogens isolated were enteric Gram-negative rods such as Pseudomonas aeruginosa, Escherichia coli and one vancomycinresistant Enterococcus species. The authors suggest that the high level of colonisation of catheters with pathogenic bacteria and fungi was not unexpected given that the catheters are used to suction the oropharynx and nasal secretions. However, they draw attention to the high risk of environmental contamination when there is contact with colonised catheters that are not placed back into designated holders. They propose that health care workers contaminated by these environmental fomites may transfer the pathogens to patients or staff. The authors advocate the implementation of infection control strategies to reduce the risk of health care worker and environmental contamination, including hand hygiene before and after procedures, the use of gloves when handling Yankauer suction catheters, storing of Yankauer catheters in designated holders between use, and review of local hospital policy in regard to catheter handling and disposal.
Brown M & Willms D. Colonization of Yankauer suction catheters with pathogenic organisms. AjlC 2005; 33(8):483-485 .
•
Australian Infection Control
Bloodstream infection in nursing homes This article is a review of changes in the epidemiology of blood stream infection (BSI) in long-term care facilities for the elderly in North America. A high morbidity and mortality associated with BSI remains among the population of the USA despite the use of potent antimicrobial therapy. The author notes that, even though BSI is associated with the greatest increase in death rate in the past 20 years, it is infrequently studied in the nursing home population where the clients are frail and debilitated. The author conducted a Medline search for the period 1980-2003. There were only seven studies of nursing home acquired BSI over this time period. The overall incidence of nursing home acquired BSI was low, at 0.3 episodes per 1000 resident care days. The studies revealed that urinary tract infections were responsible for at least 50% of the episodes of BSI and that the bacteriology did not change over the 20 year period, with Gram-negative bacteria accounting for approximately 50% of episodes. During the period 1997-2000, resistance to fluoroquinolones and broad spectrum penicillins and cephalosporins was uncommon in the Gram-negative isolates. Multi-resistant Staphylococclls aurells (MRSA) was the most common resista nt organism; th e most recent studies have found that more than 75% of episodes of nursing home acquired S. aI/reus BSI were caused byMRSA, which is cause for concern. BSI secondary to urinary tract infections had the lowest mortality rate, whereas episodes due to pneumonia resulted in the highest death rate. The author concluded that there had been little change in the epidemiology of nursing home acquired BSI in the last 20 yea rs, which s upports the conclusion that blood cultures should not routinely be taken in nursing homes. Mylotte j. Nursing home acquired blood stream infection. Infect Cont Hosp Epidemiol 2005; 26:833-837.
Alcohollchlorhexidine hand hygiene and MRSA This Australian study at Austin Hea lth in Victoria evaluated the results of an intervention trial of the introduction of alcohol/chlorhexidine hand hygiene solution (DeBug) together with improved environmental cleaning and targeted patient decolonisation measures (Operation Clean Start). The study measured health care worker (HCW) hand hygiene compliance, volume of product used, prevalence of patient and HeW colonisa tion, environmental MRSA contamination, rates of MRSA clinkal infection and rates of laboratory detection of ESBL-producing E. coli and Klebsiella spp. In the study wards, significant improvements in hand hygiene co mpliance were observed at 12 months (from 21 % preintervention to 42% post-intervention), and use of DeBug increased five-fold. There was no decrease in the patient or HeW colonisation rates in the study wards at 12 months postintervention, except in the ICU; however, the rate of total clinical MRSA isolations declined significantl y between 28 and 36
•
months post-intervention. The monthly rate of MRSA bacteraemia also declined significantly over the sa me period (a 57% reduction). A similar decline was also observed in the total number of clinical isolates of ESBL-producing E. coli and Klebsieffa spp. The authors were able to demonstrate significant positive effects of the program, despite this not including increased patient screening and isolation of colonised patients. In a companion article in another journal, the same group reported on the occupational health and safety aspects of the widespread use of the DeBug hand hygiene product. They found that cutaneous adverse rea ctions amongst HeWs were infrequent (1 per 72 years of HCW exposure) and were not influenced by the duration or inte nsity of use, but were associated with the presence of irritant contact dermatitis. }ohnson P, Martin R, Burrell L, Grabsch E, Kirsa 5, O'Keeffe}, Mayall B, Edmonds 0, Barr VI-; Bolger C, Naidoo H & Grayson L. Efficacy of an aIcohol!chlorhexidine and hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection. eMjA rapid online publication 12 Oct 2005. available from: http://www.mja.com. au/public/issues/183 _10 _2111 05/joh 10507Jm.html Graham M, Nixon R, Burrell L, Bolger C, }ohnson P & Grayson L. Low rates of cutaneous adverse reactions to alcohol-based hand hygiene solution during prolonged use in a large teaching hospital. Antimicrob Agents Chemother 2005; 49:4404-5.
Erratum In the article 'Comparative efficacy of medical instrument
cleaning products in digesting some blood proteins' published in Australian Infection Control (Vol 10, Issue 3, September 2005, p103-109) the funding source was ommited. Funding support for trus study was obtained from 3M Health Care.
Peer Reviewers 2005 In 2005, peer reviews were conducted for Australian Infection COlltrol by the following people;
Helen Cadwallader
Cathryn Murphy
eel ia Cooper
John Pearman
Louise Davis
Megan Reilly
Joan Faoagall Gabby lrvine
Tom Riley Karen Sla ter
David Looke Rhea Martin
Jenny Stackelroth
Paul Smollen
Brad McCall
Michael Whitby
Mary Lou McLaws
Irene Wilkinson
The Australian Infection Control Association would like to thank all reviewers for their contribution to Australian
Infection Control.
Vol 10
Issue 4
December 2005