ABSTRACT
OBJECTIVE: To describe the relationship between the use of central and peripheral venous catheters and the risk of nosocomial, primary, laboratory-confirmed bloodstream infection (BSI) for neonates with a birth weight less than 1,500 g (very-low-birth-weight [VLBW] infants). METHODS: Cox proportional hazard regression analysis with time-dependent variable was used to determine the risk factors for the occurrence of BSI in a cohort of VLBW infants. We analyzed previously collected surveillance data from the German national nosocomial surveillance system for VLBW infants. All VLBW infants in 22 participating neonatal departments who had a complete daily record of patient information were included. RESULTS: Of 2,126 VLBW infants, 261 (12.3%) developed a BSI. The incidence density for BSI was 3.3 per 1,000 patient-days. The multivariate analysis identified the following significant independent risk factors for BSI: lower birth weight (hazard ratio [HR], 1.1-2.2), vaginal delivery (HR, 1.5), central venous catheter use (HR, 6.2) or peripheral venous catheter use (HR, 6.0) within 2 days before developing BSI, and the individual departments (HR, 0.0-4.6). CONCLUSIONS: After adjusting for other risk factors, use of peripheral venous catheter and use of central venous catheter were significantly related to occurrence of BSI in VLBW infants.
Subject(s)
Bacteremia , Catheterization, Central Venous/adverse effects , Catheterization, Peripheral/adverse effects , Cross Infection/diagnosis , Fungemia , Viremia , Bacteremia/diagnosis , Bacteremia/microbiology , Catheterization, Central Venous/statistics & numerical data , Catheterization, Peripheral/statistics & numerical data , Catheters, Indwelling/adverse effects , Cross Infection/microbiology , Cross Infection/virology , Female , Fungemia/diagnosis , Fungemia/microbiology , Humans , Infant, Newborn , Infant, Very Low Birth Weight , Male , Proportional Hazards Models , Risk Factors , Viremia/diagnosis , Viremia/virologyABSTRACT
OBJECTIVE: To describe the epidemiology of nosocomial outbreaks published in the scientific literature. DESIGN: Descriptive information was obtained from a sample of 1,022 published nosocomial outbreaks from 1966 to 2002. METHODS: Published nosocomial outbreaks of the most important nosocomial pathogens were included in the database. A structured questionnaire was devised to extract information in a systematic manner on nosocomial outbreaks published in the literature. The following items were used: the reference, type of study (case reports or studies applying epidemiologic or fingerprinting methods), type of microorganism, setting, patients and personnel involved, type of infection, source of infection, mode of transmission, risk factors identified, and preventive measures applied. RESULTS: Bloodstream infection was the most frequently identified type of infection (37.0%), followed by gastrointestinal infection (28.5%) and pneumonia (22.9%). In 37% of the outbreaks, the authors were not able to identify the sources. The most frequent sources were patients (25.7%), followed by medical equipment or devices (11.9%), the environment (11.6%), and the staff (10.9%). The mode of transmission remained unclear in 28.3% of the outbreaks. Transmission was by contact in 45.3%, by invasive technique in 16.1%, and through the air in 15.0%. The percentage of outbreaks investigated by case-control studies or cohort studies over the years was small (21% and 9%, respectively, for the whole time period). CONCLUSION: Outbreak reports in the literature are a valuable resource and should be used for educational purposes as well as for preparing outbreak investigations.
Subject(s)
Cross Infection , Disease Outbreaks/statistics & numerical data , Adolescent , Adult , Algorithms , Child , Cross Infection/epidemiology , Cross Infection/mortality , Cross Infection/prevention & control , Databases, Factual , Humans , Methicillin Resistance , Middle Aged , Periodicals as Topic , Staphylococcus aureus/drug effects , Staphylococcus aureus/pathogenicityABSTRACT
OBJECTIVE: We sought to determine the cause and mode of transmission of a cluster of bloodstream infections as a result of Klebsiella pneumoniae. DESIGN AND SETTING: We conducted a prospective cohort study in a neonatal intensive care department from May 1999 to December 2000. METHODS: We performed surveillance of nosocomial infections, and clinical and environmental investigations. RESULTS: During an 8-week period, 5 cases of K pneumoniae bloodstream infections were observed, at least 3 of them belonging to the same genotype. Before the second case developed any symptoms of infection, the same strain had also been found in the patient environment. Intervention measures were, therefore, immediately introduced. Further cases, however, occurred in the following weeks. Even after further intervention activities and the end of the outbreak, the same strain was discovered in environmental samples from a stethoscope and a nurse's hand. CONCLUSIONS: Even where there is acute awareness of the problem and a generally high infection control level in a department, it is difficult to change behavior in such a way that further nosocomial infections can be totally excluded.
