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Nosocomial Infection—The Irreducible Minimum

Published online by Cambridge University Press:  02 January 2015

G.A.J. Ayliffe
G.A.J. Ayliffe*
Affiliation:
Department of Medical Microbiology, Medical School, Birmingham, and the Hospital Infection Research Laboratory, Dudley Road HospitalBirmingham, England
*
Department of Medical Microbiology, Medical School, Birmingham, B15 2TJ England
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Extract

Prevalence surveys in different countries have shown that about 1 in 10 hospitalized patients at any one time have acquired an infection and the incidence of infection is usually about 3% to 5%. Can this infection rate be significantly reduced and is there an irreducible minimum below which further reduction cannot be obtained? Cross-infection could probably be almost eliminated by the use of plastic isolators or life islands, and endogenous infections reduced by the wider and more rational prophylactic use of topical and systemic antimicrobial agents, and possibly a range of vaccines. However, the use of these techniques on all patients would clearly be impractical and too expensive for use in the foreseeable future. Excessive isolation techniques would have a detrimental psychological effect on many patients. In addition, failure to eradicate the organisms of the normal flora might be associated with more infections caused by antibiotic-resistant bacteria, fungi and viruses which would be more difficult to treat. Even if organisms could be eradicated, morbidity and mortality might not be correspondingly reduced. Priorities must therefore be set on the most effective use of staff and finances. These not only involve a consideration of infection, but all areas of clinical practice, eg, costs of cardiac transplants and provision of geriatric facilities. It therefore seems likely that little additional finance will be available for control of infection, other than possibly for transmissible infections with high mortality such as AIDS.

Type
Research Article
Information
Infection Control & Hospital Epidemiology , Volume 7 , supplement S2: Proceedings of the Second ICI/Stuart Workshop , February 1986 , pp. 92 - 95
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1986

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References

1.Meers, PD, Ayliffe, GAJ, Emmerson, AM, et al: Report on the survey of infection in hospitals 1980. J Hosp Infect 1981; 2(suppl).Google Scholar
2.National Nosocomial Infections Study Report 1978. Centers for Disease Control Annual Survey 1981.Google Scholar
3.Haley, RW, Culver, DH, White, JW, et al: The nationwide infection rate, a need for new vital statistics. Am J Epidemiol 1985; 121:159–167.Google Scholar
4.Burke, JF, Quinby, WC, Bondec, CL, et al: The contribution of a bacterially-isolated environment in the prevention of seriously burned patients. Ann Surg 1977; 186:377–387.Google Scholar
5.Lidwell, OM, Lowbury, EJL, Whyte, W, et al: Airborne contamination of wounds in joint replacement operations: The relationship to sepsis rates. J Hasp Infect 1983; 4:111–131.CrossRefGoogle ScholarPubMed
6.Ayliffe, GAJ: Cross-sectional surveys of infection, in Brachman, PS, Eikhoff, TC (eds). Proceedings of the International Conference on Nosocomial Infections. Chicago, American Hospital Association, 1971; 282–284.Google Scholar
7.Haley, RW, Culver, DH, White, JW, et al: The efficacy of infection surveillance and control programs in preventing nosocomial infections in US hospitals. Am J Epidemiol 1985; 121:182–205.Google Scholar
8.Casewell, MW: Surveillance of infection in hospitals. J Hosp Infect 1980; 1:293–297.Google Scholar
9.Bryan, CS, Reynolds, KL, Brenner, ER: Analysis of 1,186 episodes of gram-negative bacteremia in non-university hospitals: The effect of antimicrobial therapy. Rev Infect Dis 1983; 5:629–638.Google Scholar
10.Bibby, B, Collins, BJ, Ayliffe, GAJ: A mathematical model for assessing risk of postoperative wound infection. J Hosp Infect, to be published.Google Scholar
11.Haley, RW, Culver, DH, Meade-Morgan, W, et al: Identifying patients at high risk of surgical wound infection. A simple multivariate index of patient susceptibility and wound contamination. Am J Epidemiol 1985; 121:206–215.Google Scholar
12.Jepsen, OB, Larson, SO, Danhert, J, et al: Urinary tract infection in bacteremia in hospitalized medical patients—a European Multicenter Prevalence Survey on Nosocomial Infection. J Hosp Infect 1982; 3:241–252.CrossRefGoogle Scholar
13.Slade, N: Postoperative UTIs in urology and gynecology—a review. J R Soc Med 1980; 73:739–743.Google Scholar
14.Kunin, CM, McCormack, RC: Prevention of catheter-induced urinary tract infections by sterile closed drainage. N Engl J Med 1966; 274:1155–1161.Google Scholar
15.Gillespie, WA, Lennon, GC, Linton, KB, et al: Prevention of urinary tract infection by means of closed drainage into a sterile plastic bag. ßr Med J 1967; 3:90–92.CrossRefGoogle ScholarPubMed
16.Nordqvist, P, Ekelund, P, Edouard, L, et al: Catheter-free geriatrie care. Routines and consequences for clinical infection, care and economy. J Hosp Infect 1984; 5:298–304.CrossRefGoogle Scholar
17.Burke, JP, Jacobson, JA, Garibaldi, RA, et al: Evaluation of meaial care with poly-antibiotic ointment in prevention of urinary catheter-associated bacteriuria. J Urol 1983; 129:331–334.CrossRefGoogle ScholarPubMed
18.Maki, DG, Goldmann, DA, Rhame, FS: Infection control in intravenous therapy. Ann Intern Med 1973; 79:867–887.Google Scholar
19.Nyström, B, Larsen, SO, Danken, J, et al: Bacteremia in surgical patients with intravenous devices—a European Multicenter Incidence Study. The European Working Party on Control of Hospital Infections. J Hosp Infect 1983; 4:338–349.Google Scholar
20.Hovig, B: Lower respiratory tract infections associated with respiratory therapy and anesthesia. J Hosp Infect 1981; 2:L301–305.Google Scholar
21.Cruse, PJ, Foord, R: The epidemiology of wound infection: A 10-year prospective study of 62,939 wards. Surg Clin North Am 1980; 60:27–40.CrossRefGoogle Scholar
22.Brandberg, A, Holm, J, Hammersten, J, et al: Postoperative wound infections in vascular surgery—effect of preoperative whole body disinfection by shower-bath with Chlorhexidine soap, in Problems in the Control of Hospital Infection. Royal Society of Medicine International Congress and Symposium Series 23. London, Academic Press and RSM 1980, pp 71–72.Google Scholar
23.Simchen, S, Shapiro, M, Michel, J: Multivariate analysis of determinants of postoperative wound infection: A possible basis for intervention. Rev Infect Dis 1981; 3:678–682.Google Scholar
24.Ayliffe, GAJ, Lilly, HA, Lowbury, EJL: Decline of the hospital staphylococcus? Incidence of multiresistant S. aureus in three Birmingham hospitals. Lancet 1979; 1:538–541.Google Scholar
25.Ayliffe, GAJ, Lilly, H: Cross-infection and its prevention, in Ayliffe, GAJ, Lawrence, JC (eds): Symposium on Infection Control in Burns. J Hosp Infect 1985; 6(suppl B), 47–57.CrossRefGoogle ScholarPubMed
26.McDonald, MI, Hurse, A, Sim, KN: Methicillin-resistant Staphylococcus aureus bacteremia. Med J Aust 1981; 2:191–195.Google Scholar
27.Boyce, JM, Causey, WA: Increasing occurrence of methicillin-resistant Staphylococcus aureus in the United Slates. Infect Control 1982; 3:377–383.CrossRefGoogle Scholar
28.Keane, CT, Cafferky, MT: Re-emergence of methicillin-resistant Staphylococcus aureus causing severe infection. J Infect 1984; 9:6–16.Google Scholar
29.Steere, AC, Mallison, GF: Handwashing practices for the prevention of nosocomial infections. Ann Intern Med 1975; 83:683–690.Google Scholar
30.Reybrouk, G: Role of the hands in the spread of nosocomial infections. J Hosp Infect 1983; 4:103–110.CrossRefGoogle Scholar
31.Casewell, MW, Phillips, I: Hands as a route of transmission for Klebsiella species. Br Med J 1977;2:1315–1317.CrossRefGoogle ScholarPubMed
32.Ayliffe, GAJ: The effect of antibacterial agents on the skin. J Hosp Infect 1980; 1:111–124.Google Scholar
33.Rotter, M, Koller, W, Wewalka, G: Povidone-iodine and chlorhexidine-containing detergents for disinfection of hands. J Hosp Infect 1980; 1:149–158.Google Scholar
34.Ojajärvi, J, Makelä, P, Rantsalvo, I: Failure of hand disinfection with frequent handwashing: A need for prolonged study. J Hyg (Camb) 1977; 79:107–119.Google Scholar
35.Lowbury, EHJL, Babb, JR, Ford, RM: Protective isolation in a burn unit: The use of plastic isolators and air curtains. J Hyg (Camb) 1971; 69:529–546.Google Scholar
36.Ransjö, U: Attempts to control clothes-borne infection in a burn unit. III. An open-roofed plastic isolator or plastic aprons to prevent contact transfer of bacteria. J Hyg (Camb) 1979; 82:385–395.Google Scholar
37.Selkon, JB, Stokes, ER, Ingham, HR: The role of an isolation unit in the control of hospital infection with methicillin-resistant staphylococci. J Hosp Infect 1980; 1:41–46.Google Scholar
38.Ayliffe, GAJ, Collins, BJ, Lowbury, EJL: Ward floors and other surfaces as reservoirs of hospital infection. J Hyg (London) 1967; 65:515–536.Google ScholarPubMed
39.Buchan, A, Skinner, GRB, Fuller, A, et al: Control of herpes simplex virus infections of the genital tract by vaccination. Vaccine 1985; 3:49–53.Google Scholar