Surveillance of nosocomial infection (NI) and the use of reference data for comparison is recommended to improve the quality of patient care. In addition to standardization according to device use, another stratification of reference data according to patients' severity-of-illness scores is often required for benchmarking in intensive care units (ICUs).

To determine whether severity-of-illness scores on admission to the ICU are sufficient data for predicting the development of NI.

This study was performed in an interdisciplinary ICU at a teaching hospital. Two scores were studied: the Acute Physiology and Chronic Health Evaluation (APACHE) II scoring system and the Therapeutic Intervention Scoring System (TISS). The patient's clinical condition was evaluated on admission and reevaluated daily during the period before the development of NI. In addition, we recorded the number of intubations for every patient-day, the age and sex of the patients, and their history of operations. The Fisher exact test and the stepwise multiple logistic regression model were applied to identify significant predictors of NI.

During a 12-month period, 270 patients with ICU stays of more than 24 hours were included in the study. Sixty-nine NIs were identified (incidence, 25.6 cases per 100 patients [95% confidence interval, 19.9-32.3]). A mean APACHE II score and a mean TISS score above the median for these scores, duration of ventilation above the median in the period before the development of NI, and patient age were significantly associated with the development of NI; the score data on admission provided a clearly poorer prediction.

The APACHE II and TISS scores on admission are not useful predictors for NI in ICUs.

To identify characteristics of encounters between healthcare workers (HCWs) and patients that correlated with hand hygiene adherence among HCWs.

Observational study.

Intensive care unit in a Veterans Affairs hospital.

HCWs.

There were 767 patient encounters observed (48.6% involved nurses, 20.6% involved physicians, and 30.8% involved other HCWs); 39.8% of encounters involved patients placed under contact precautions. HCW contact with either the patient or surfaces in the patient's environment occurred during all encounters; direct patient contact occurred during 439 encounters (57.4%), and contact with environmental surfaces occurred during 710 encounters (92.6%). The median duration of encounters was 2 minutes (range, <1 to 51 minutes); 33.6% of encounters lasted 1 minute or less, with no significant occupation-associated differences in the median duration of encounters. Adherence with hand hygiene practices was correlated with the duration of the encounter, with overall adherences of 30.0% after encounters of ≤1 minute, 43.4% after encounters of >1 to ≤2 minutes, 51.1% after encounters of >3 to ≤5 minutes, and 64.9% after encounters of >5 minutes (P < .001 by the x2 for trend). In multivariate analyses, longer encounter duration, contact precautions status, patient contact, and nursing occupation were independently associated with adherence to hand hygiene recommendations.

In this study, adherence to hand hygiene practices was lowest after brief patient encounters (ie, <2 minutes). Brief encounters accounted for a substantial proportion of all observed encounters, and opportunities for hand contamination occurred during all brief encounters. Therefore, improving adherence after brief encounters may have an important overall impact on the transmission of healthcare-associated pathogens and may deserve special emphasis in the design of programs to promote adherence to hand hygiene practices.

Vancomycin-resistant Enterococcus organisms (VRE) have emerged as common nosocomial pathogens, but few population-based data are available on the impact of invasive VRE infections.

We assessed the incidence of invasive VRE infections and predictors of mortality among patients identified during prospective, population-based surveillance performed in the metropolitan statistical area (MSA) of Atlanta, Georgia.

From July 1997 through June 2000, a total of 192 patients who resided in the Atlanta MSA developed an invasive VRE infection, for a rate of 1.57 cases per 100,000 person-years. The incidence of invasive VRE disease significantly increased from 0.91 cases per 100,000 person-years during the first year of the study to 1.73 cases per 100,000 person-years during the third year of the study (P<.001). Rates of invasive VRE infection were significantly higher among African American patients than white patients (2.59 vs 0.70 cases per 100,000 person-years; P < .001). Blood was the most common sterile site from which VRE was recovered (161 [83%] of 193 isolates), followed by deep surgical sites (17 [9%]), peritoneal fluid (10 [5%]), pleural fluid (3 [2%]), and cerebrospinal fluid (1 [0.5%]). In multivariate analysis, a Charlson comorbidity index of 5 or greater, previous receipt of antibiotic therapy, having 2 or more sets of blood cultures positive for VRE, and receipt of central parenteral nutrition were independent predictors of mortality, whereas receipt of an antibiotic with in vitro activity against the VRE isolate was associated with a decreased risk of mortality. Molecular typing revealed 38 different pulsed-field gel electrophoresis patterns, but the 2 most common pulsed-field gel electrophoresis types were found at 3 Emory University-affiliated hospitals.

The incidence of invasive VRE infection significantly increased in the Atlanta MSA during the 3-year study period, with significant racial disparities detected. Receipt of an antimicrobial agent with in vitro activity against VRE was associated with a lower mortality rate. Molecular typing results demonstrated polyclonal emergence of VRE in Atlanta.

To monitor hospital-wide trends in the prevalence of hospital-acquired infections (HAIs) in order to identify areas where the risk of infection is increasing.

Successive surveillance surveys were conducted twice yearly, from November 2001 until May 2004, to determine the prevalence of HAIs at 2 Dutch hospitals, using Centers for Disease Control and Prevention criteria.

In all, 340 HAIs were observed in 295 (11.1%) of 2,661 patients surveyed. The overall prevalence per survey varied from 10.2% to 15.6%, with no significant differences between successive surveys. In the surgical department, the prevalence of HAIs increased from 10.8 cases per 100 surgeries in November 2001 to 20.4 cases per 100 surgeries in May 2002. Further analysis revealed a high prevalence of surgical site infection among patients who had an orthopedic procedure performed. In the neurology-neurosurgery department, the prevalence increased from 13.0 cases per 100 patients in May 2002 to 26.6 cases per 100 patients in May 2003 and involved several types of infection. Further analysis retrieved exceptionally high incidences of infections associated with cerebrospinal fluid drainage. Specific infection control interventions were developed and implemented in both departments. The total cost of the surveys was estimated to be €9,100 per year.

Successive performance of surveillance surveys is a simple and cheap method to monitor the prevalence of infection throughout the hospital and appeared instrumental in identifying 2 departments with increased infection rates.

To study the bacterial population kinetics on gloved hands following hand treatment with 3 optically indistinguishable, alcohol-based surgical hand rubs, with and without supplements to delay bacterial regrowth.

Prospective, randomized, double-blind, balanced quasi-Greco-Latin square design.

Microbiology laboratory of the Medical University Vienna, Austria.

Twenty-four healthy adult volunteers without skin lesions.

The following hand rubs, all stained blue, were applied to the hands for 3 minutes: 1-propanol 60% vol/vol (A); 2-propanol 70% m/m plus chlorhexidine gluconate 0.5% wt/wt (B); 2-propanol 45% wt/wt plus 1-propanol 30% wt/wt plus mecetronium etilsulfate 0.2% wt/wt (C). As a reference formulation (R), 1-propanol 60% vol/vol, unstained, was applied for the same amount of time.

In 8 once-weekly tests, 24 subjects randomly assigned to use the 4 hand rubs in groups of 6 persons each performed hand hygiene according to the method described in European Norm 12791. Every subject used one preparation at a time, the antimicrobial effect of which was evaluated at 2 sampling times. After week 8, each volunteer had tested every preparation at every preset sampling time. All preparations were tested in parallel.

The mean pretreatment counts of viable bacteria (in colony-forming units per milliliter) in fluid samples were not significantly different between week 1 and week 8, nor between the right and left hands (analysis of variance [ANOVA], P > .1). Immediately after applying the formulation (t0), bactericidal effects of the blinded formulations A and C were equivalent to that of the reference formulation R, whereas the effect of B was questionable. The population kinetics of the flora on the hands proceeded from large and fast initial reductions of the skin flora by 2.7 log units (A), 3.1 log units (B), 3.3 log units (reference formulation), and 3.5 log units (C), to slow regrowth. However, even after 6 hours wearing gloves viable bacterial counts remained significantly (P < .01) below the baseline values (by 0.9 log [reference formulation], 1.1 log [A and B], and 1.5 log [C]). The slowest regrowth 1 and 3 hours after application (∆ from t0, 0.1 log and 0.7 log respectively) was seen with formulation C, and the slowest regrowth after 6 hours was seen with formulation B (∆ from t0, 1.6 log). These differences did, however, not reach statistical significance.

With respect to the rapid and dramatic antibacterial action of suitable alcohols at high concentrations and with appropriate neutralizers, the contribution of supplements to the delay of bacterial regrowth on gloved hands appears rather minor, if a product only exerts an immediate effect equivalent to that of the reference disinfection procedure described in EN 12791.