To evaluate the risk of phlebitis associated with chlorhexidine-coated polyurethane catheters in peripheral veins.

A randomized, double-blinded trial comparing chlorhexidine-coated polyurethane catheters with uncoated polyurethane catheters.

A university hospital.

Adult medicine and surgery patients.

Certified registered nurse anesthetists or an infusion team consisting of nurses and physicians inserted the catheters. Catheter insertion sites were scored twice daily for evidence of phlebitis. At the time catheters were removed, a quantitative blood culture was performed, and catheters were sonicated for quantitative culture.

Of 221 evaluable catheters, phlebitis developed in 18 (17%) of 105 coated catheters, compared to 27 (23%) of 116 uncoated catheters (relative risk [RR], 0.74; 95% confidence interval [CI95], 0.43-1.26; P=.32). By survival analysis, chlorhexidine-coated catheters had a lower risk of phlebitis during the first 3 days (P=.06), but not when all catheters were considered in both patient groups (P=.31). In the absence of catheter colonization, the incidence of phlebitis was 21% (16/76) and 24% (20/86) for coated and uncoated catheters, respectively (P=.85), whereas in the presence of catheter colonization, the incidence of phlebitis was 14% (1/7) and 80% (4/5) for coated and uncoated catheters, respectively (RR, 0.18; CI95, 0.03-1.15; P=.07).

The risk of phlebitis in the presence of catheter colonization was 82% lower for chlorhexidinecoated polyurethane catheters compared to otherwise identical uncoated catheters.

To determine the relation between prior exposure to specific antimicrobials and acquisition of gram-negative bacilli resistant to multiple ß-lactam and aminoglycoside antibiotics among long-term-care patients.

Case-control study. Cases were patients from whom multiply resistant Enterobacteriaceae or Pseudomonas aeruginosa were isolated; controls were patients from whom nonresistant bacteria of the same species were isolated. Prospectively defined risk factors included underlying illness, activity level, presence of decu-bitus ulcers, presence of indwelling devices, and prior exposure to specific antimicrobial agents. Resistant and control isolates of P aeruginosa were compared using pulsed-field gel electrophoresis (PFGE) of genomic DNA after digestion with XbaI.

390-bed long-term Veterans' Affairs facility.

We identified 35 patients with multiply resistant Enterobacteriaceae and 24 patients with multiply resistant P aeruginosa. Of the resistant Enterobacteriaceae, 87% of isolates were resistant to piperacillin, 55% to ceftazidime, and 90% to gentamicin. Acquisition of multiply resistant Enterobacteriaceae was associated with presence of decubitus ulcers (odds ratio [OR], 12.2; 95% confidence interval [CI95], 3.3-44.2; P=.0002) and prior receipt of ampicillm (OR, 13.7; CI95, 2.2-84; P=.005). Of resistant isolates of P aeruginosa, 88% were resistant to piperacillin, 25% to ceftazidime, 42% to imipenem, and 67% to ciprofloxacin. Isolation of a multiply resistant P aeruginosa was associated with total days of antimicrobial exposure (OR, 1.07; CI95, 1.01-1.12; P=.011) and not with prior receipt of any individual agent. Eleven multiply resistant isolates shared a common PFGE pattern.

In our long-term-care facility, acquisition of multiply resistant Enterobacteriaceae was associated with the presence of decubitus ulcers and prior exposure to ampicillin. Acquisition of resistant P aeruginosa was associated with total antibiotic exposure. Molecular typing of P aeruginosa isolates implicated patient-to-patient transmission of a limited number of resistant strains.

To determine the incidence of, and risk factors for, nosocomial infections in neonates during and after treatment with extracorporeal membrane oxygenation (ECMO).

A retrospective cohort study of all infants treated with ECMO during a 4-year period.

26 neonates experiencing 32 nosocomial infections, and 54 neonates with no nosocomial infections.

A large, urban children's hospital.

30% of neonates treated with ECMO experienced at least one nosocomial infection. The rate of nosocomial infections was 10.3 per 1,000 patient-days. Risk factors significantly associated with nosocomial infection included duration of ECMO >7 days (mean, 12 vs 7 days; odds ratio [OR], 2.84; 95% confidence interval [CI95], 0.96-8.56); neonatal intensive care-unit stay >21 days (mean, 44 vs 19 days; OR, 8.73; CI95, 2.49-31.94); hospitalization >50 days (mean, 63 vs 29 days; OR, 5.44; CI95, 1.47-20.87); and surgical procedure before or during ECMO (46% vs 22%; OR, 4.58; CI95, 1.25 to 17.38).

Nosocomial infections occurred in 30% of patients undergoing ECMO. Although nosocomial infections were not associated with an increase in mortality, hospitalization was prolonged.

To compare, in subjects undergoing general surgery, two measures of intrinsic patient risk for nosocomial infection: the Study on the Efficacy of Nosocomial Infection Control (SENIC) index and the National Nosocomial Infection Surveillance (NNIS) System index.

Prospective cohort study, with follow-up for 1 month after hospital discharge.

The general surgery service of a tertiary hospital.

Surgical-site infection.

1,483 subjects aged 10 to 92 years.

During follow-up, 155 patients developed nosocomial infection, yielding a cumulative incidence of 10.5%. The NNIS index showed a linear trend with both crude and adjusted (for SENIC index) rates of surgicalwound infection. The SENIC index did not exhibit any linear trend with adjusted (for NNIS index) rates of surgical-wound infection. To delineate whether the SENIC index added explanatory information to the NNIS index (or vice versa), we regressed each variable on the other. Logistic regression analyses confirmed the results of stratified analysis: residuals of the NNIS index added discriminating ability to the SENIC index, whereas residuals of the SENIC index did not improve the predictive power of the NNIS index.

The NNIS index had a better ability than the SENIC index for discriminating and predicting risk of surgical-wound infection

To describe an outbreak of trimethoprim-sulfamethoxazole (cotrimoxazole)–resistant and methicillin-resistant Staphylococcus aureus (CMRSA) in a unit housing patients infected with the human immunodeficiency virus (HIV).

Prospective study involving patients colonized or infected with CMRSA.

15 hospitalized patients with cultures positive for CMRSA.

Isolates of CMRSA were collected and characterized. Molecular typing of the epidemic strains was carried out after total DNA extraction by restriction endonuclease analysis and random amplification of polymorphic DNA.

The epidemic was brought under control with the reinforcement of nosocomial transmission measures and with systematic nasal decontamination with mupirocin of all patients admitted to the HIV unit. Molecular typing techniques showed the existence of two epidemic strains: strain A was present in the 12 patients admitted to the HIV unit and strain B in the remaining 3 patients hospitalized elsewhere.

Cotrimoxazole may no longer be a reliable and effective alternative for glycopeptides in patients with infection caused by MRSA strains, and HIV units should be particularly alert for CMRSA strains.

To assess the accuracy of an automated data entry system employing optical scanning technology and to provide an analysis of its costs as compared to manual data entry.

The accuracy and cost of automated data entry of 100 surgical-wound infection surveillance questionnaires was compared to manual entry.

The Surgical Directorate, The Royal Hospitals, Belfast, Northern Ireland.

The use of optical scanning technology greatly improved the speed and accuracy of data entry. The time spent by the keyboard operator on data entry was reduced substantially.

For each surgical-wound infection questionnaire automatically processed, there was a saving in clerical time equivalent to $0.63. The automated data entry process resulted in a 22-fold productivity increase compared to manual data entry with validation. After validation, an error rate of <0.2 errors per 1,000 responses was detected in automatically entered data compared to a rate of 12.4 errors per 1,000 responses for manually entered data. The automated system, including validation, provided a sevenfold productivity increase compared to “quick-and-dirty” manual data entry without validation.

Hospital information technology systems may achieve total integration of data management, but realistically this would appear to be very much in the future. Until then, in view of the accuracy and substantial savings in time and money, we recommend the use of automated data entry technology. This system would be especially useful where data are transported from outlying hospitals to a central receiving center for collation and analysis.