Impact of CVC bundles implementation compliance on hospital acquired infections in an ICU setting in a teaching hospital, Kuw

Central line-associated bloodstream infections [CLABSIs] cause substantial morbidity and incur excess costs. The use of a central line insertion bundle has been shown to reduce the incidence of CLABSI. Surveillance for CLABSI was conducted by trained infection control team using National Health Safety Network case definitions and device-day measurement methods. During the intervention period, nursing staff used a postinsertion care bundle consisting of daily inspection of the insertion site; site care if the dressing was wet, soiled, or had not been changed for 7 days; documentation of on-going need for the catheter; proper application of a chlorohexidine gluconate-impregnated sponge at the insertion site; performance of hand hygiene before handling the intravenous system; and application of an alcohol scrub to the infusion hub for 15 seconds before each entry

Results: During the preintervention period, there were 5367 documented catheter-days and 80 CLABSIs, for an incidence density of 14.9 CLABSIs per 1000 catheter-days. After implementation of the interventions, there were 5052 catheter-days and 56 CLABSIs ,for an incidence density of 11.08 per 1000 catheter-days

Conclusion: This study demonstrates that implementation of a central venous catheter postinsertion care bundle was associated with a reduction in CLABSI in an intensive care area setting

Early detection of neonatal sepsis, dilemma of diagnosis

Background and objectives: Accurate identification of neonatal sepsis is an increasing problem facing neonatologists due to non specific clinical signs with no existing single reliable marker of infection. Molecular assays for the detection of bacterial DNA in the blood represent possible diagnostic tools for early identification of bacterial causes. Procalcitonin [PCT] is a promising marker distinguishing between infection and inflammation which cannot be differentiated by acute phase proteins as C-reactive protein [CRP]. The aim of the study was to compare results of blood cultures with eubacterial PCR, PCT and CRP as early markers of neonatal sepsis

Subjects and methods: In this study, neonates with clinically suspected sepsis admitted to neonatal intensive care unit [NICU] in Mansoura University Children Hospital were included. Based on blood culture positive results, they were divided into 2 groups: proven sepsis and clinical sepsis. Comparing the 2 groups, sensitivity and specificity for, PCR, PCT and CRP were evaluated. Using receiver operating characteristic [ROC] curves, threshold value for both PCT and CRP were estimated

Results: Out of 141 neonates with clinically suspected sepsis, 56 (39.7%) were confirmed as proven sepsis. Compared to blood culture, the diagnosis of bacterial proven sepsis by PCR revealed 100 % sensitivity and 93% specificity. This study revealed that PCT >6.5 ng/ml had 83.9% sensitivity and 98.8% specificity, whereas CRP >3.5 mg/dl had 83.9%, sensitivity and 8l.2%specificity for diagnosing sepsis

Conclusion: This study confirms the value of PCR and PCT as rapid diagnostic tools for early detection of neonatal sepsis?

Human metapneumovirus in hospitalized infants and young children with acute respiratory tract infection in mansoura university children's hospital

Background: Acute respiratory tract infections [ARTI] are an important cause of childhood morbidity and mortality worldwide. Human metapneumovirus [hMPV] is now recognized as a major cause of ARTI in children. Objective: The objective "was to describe the clinical role and clinical features of hMPV in infants and young children hospitalized due to ARTI in Mansoura University Children's Hospital [MUCH]. Methods: Infants and children younger than 36 months old, admitted to MUCH with symptoms and signs of ARTI from December 20 JO to May 2011, were prospectively enrolled. Nasal wash aspirate specimens were collected for virus culture and for RT-PCR. The clinical features as well as radiological findings were recorded and analyzed. Results: A total of 54 infants and children with mean age 12.28 +/- 9.81 months were enrolled. There were 30 [55.56%] males and 24 [44.44%] females. HMPV was detected in 12 [22.22%] of the 54 patients studied by RT-PCR and only 3 of them were detected in viral culture. All patients with hMPV were less than 12 months of age. Nine [75%] of the hMPV positive cases were diagnosed as acute bronchiolitis and the remaining 3 [25%]) as pneumonia. Oxygen therapy was needed in 66.7% [n=36] of patients. Chest X-ray was abnormal in 77.78% [n=42] of patients. As regards seasonal distribution of hMPV, 66.66% of cases [8 patients] were observed in spring months while the remaining 4 hMPV positive cases [33.34%] were observed in winter months. None of patients included required ventilatory support or admission to intensive care unit. All patients achieved full recoveiy without j one-term sequelae after a mean duration of hospitalization of 5.56 +/- 0.78 days. Conclusions: HMPV is an important cuase of ARTI /;-; infants and young children. PCR is a rapid, sensitive and accurate method for diagnosis when compared to virus isolation by cell culture?

Bacteriology of pharyngitis in suppurative otitis media cases

Problem Addressed: unexplained persistent or recurrent bacterial pharyngitis in some patients who are suffering from infected middle ear cleft

Patients and Methods: bacteriological swabs were obtained from both ears and pharynx of thirty-seven cases with chronic otorrhea and perforation, who are complaining of recurrent or persistent sore throat. Isolation and identification of the micro-organisms were done. Isolated Gram-negative bacilli were subjected to further identification by biochemical reactions and antimicrobial susceptibility testing using modified Kirby Bauer disk diffusion method. Identical isolates from the same patient [ear and pharyngeal swabs] were subjected to further identification by genotyping using the pulsed field gel electrophoresis technique [PFGE]

Results: six cases [16%] showed identity in both phenotypes and genotypes for ear and pharyngeal samples from the same patient. Four of the isolates were Pseudomonas aeruginosa; one was Proteus mirabilis, and one was Escherichia coli. None of these three species is known to be among the primary organisms that may cause pharyngitis

Conclusion: bacterial pharyngitis in patients with chronically infected middle ear cleft may be attributed to the same organism invading the middle ear mucosa. In addition, this study highlights some organisms as pharyngeal invaders although they are not among the previously documented causes of bacterial pharyngitis. However, the study does not confirm the method of spread of these organisms between the middle ear cleft and the pharynx and does not prove whether the spread was directly via the eustachian tube, or not. The study correlates the causative organism of the middle ear infection and that infected the pharyngeal mucosa by using phenotypic and genotypic bacteriological identification and typing methods

Human papillomavirus types 16, 18 DNA, chalmydia antigen and tumour necrosis factor alpha in cervical cancer in women from Dakahlia, Egypt

Infection with human papillomavirus [HPV] and Chlamydia trachomatis are associated with cervical intraepithelial neoplasia. The recognition of HPV infection as a factor that is necessary, but not sufficient, for the development of cervical cancer has resulted in the initiation of several longitudinal studies and randomized clinical trials designed to examine the predictive value of HPV DNA testing. Forty two women were enrolled in this study [patients group] together with 20 apparently normal women [control]. For all patients and control groups, cervical swabs were taken, examined for HPV, HPV 16, HPV 18 DNA by 2 sequential PCR reactions, Chlamydia antigen and TNF-alpha by ELISA. Among 42 cases diagnosed pathologically as cervical carcinoma, HPV DNA was detected in 37 cases [88.09%]. HPV16 DNA was more common than HPV18 DNA as it was detected in 28 cases [66.7%] while HPV18 DNA was detected in 4 cases [9.5%]. There is a statistically significant difference between HPV and control cases, also HPV16 and control cases. Regarding Chlamydia antigen, 10 cases were detected out of 42 cases [23.8%] while, only 3 cases were detected in control group [15%] indicating that there is non statistically significant difference between the two groups. Regarding the pathological types of cervical carcinoma, in adenocarcinoma, HPV DNA was detected in 4 cases [80%], while in Squamous cell carcinoma [SCC], it was detected in 33 cases [89.19%]. In adenocarcinoma, HPV 16 DNA was detected in 2 cases [40%], while in SCC, it was detected in 26 cases [70.27%]. In adenocarcinoma, HPV 18 DNA was detected in 1 case [20%], while in SCC, it was detected in 3 cases [8.11%]. Regarding Chlamydia antigen, in adenocarcinoma, the antigen was detected in 1 case [20%] and in SCC, it was detected in 9 cases [24.32%]. Our results emphasized that HPV 16 was more predominant in squamous cell carcinoma, whereas type 18 was relatively high in adenocarcinoma. The level of TNF-alpha [pg/ml] was 33.81 +/-9.38 in cancer cervix cases, which was statistically significant compared to control cases [1.33 +/-0.74 [P<0.001]]. There is none statistically significant difference between adenocarcinoma [34.12 +/-12.31] and SCC [33.76 +/-9.13 [P=0.970]]. There was no significant difference regarding TNF-alpha level between HPV positive cases [34.23 +/-9.39] and HPV negative [30.66 +/-9.68 [P = 0.342]]. There was a significant difference between HPV16 [32.88 +/-8.84] and HPV18 [41.98 +/-4.32]. Also, there was no significant difference between Chlamydiae positive cases [36.62 +/-8.79] and Chlamydiae negative cases [32.93 +/-9.52 [P=0.260]]. We conclude that cervical infection with HPV but not with Chlamydia may be an important risk factor for the development of cervical cancer and TNF-alpha levels increased significantly in cervical carcinoma without special reference to the pathological type of the tumor

Surveillance for surgical site infection after cesarean section: extra-length of stay and cost of infection

Objectives: To determine the rate and extra-cost of surgical site infection [SSI] after cesarean section [C-section]

Setting: Multi-specialty 600 bed Kuwaiti governmental hospital

Patients and Methods: Women who underwent C-section during the period January through December 2005 were surveyed. Infection control staff carried out inpatient and post-discharge surveillance of post C-section SSI. Each patient diagnosed with SSI was compared to a matched control who did not develop SSI [1:1 nested case-control survey]. The matching criteria were age, wound class, American society of Anesthesiologists [ASA] score, duration of operation, date of surgery [same year] and any underlying disease process which might alter the patient's predisposition to infection. Clinical data were abstracted from patient's records. The cost of infection was calculated as the difference in cost of stay generated between cases and controls

Result: Of 1499 woman who underwent C-sections, 44 developed 56 SSIs [SSI rate 3.7%, CI 2.8-4.8]. The mean extra length of stay was 5.5 days and extra-cost due to infection was 398.7 KD per patient. The estimated cost attributable to all SSIs was 17542.8 KD during the year of surveillance

Conclusion: Estimates of the economic burden imposed by SSIs indicate that they are a substantial drain on hospital sector