Surveillance of hospital-acquired infections in an intensive care department-the benefit of the full-time presence of an infection control nurse.

In the 42-bed intensive care department of a teaching hospital, the creation of a full-time infection control nurse post was followed by a 42% reduction in device-related hospital-acquired infection rates over a period of three years, and 33% reduction over a period of five years. Permanent surveillance accompanied by revision of procedures and bedside teaching were key factors in the improvement of quality of care. In the specific setting of an intensive care department, this study validates the previous conclusions reached in the SENIC study and emphasizes the essential role played by the infection control nurse in the care of critically ill patients.

The organization of infection control in Belgium.

The authors describe the organization of infection control in Belgium with respect to official regulations, the tasks and the training of the infection control doctor and of the infection control nurse, functioning of the infection control committee, the financing and the availability of guidelines.

Evaluation of chlorhexidine and silver-sulfadiazine impregnated central venous catheters for the prevention of bloodstream infection in leukaemic patients: a randomized controlled trial.

It has been suggested that central venous catheters impregnated with antiseptics such as chlohexidine and silver-sulfadiazine reduce the risk of catheter-related bacteraemia in intensive care patients. Patients suffering from haematologic malignancy treated by chemotherapy through a central venous catheter are at even greater risk of catheter-related bacteraemia. A prospective double-blind randomized controlled trial was performed in order to investigate the effectiveness of chlorhexidine and silver-sulfadiazine impregnated catheters (CH-SS) in these patients. A total of 680 catheters (13,826 catheter days) were inserted, of which 338 were antiseptic impregnated. Bloodstream infection was observed in 105 cases with an overall risk of 7.6 per 1000 catheter days. Thirty-two infections (30.5%) were catheter-related, corresponding to a risk of 2.3 per 1000 catheter days. There was no statistically significant different between the overall rates of bloodstream infection for impregnated and non-impregnated catheters (14.5 vs. 16.3%). The incidence of catheter-related infection was also similar in both groups (5 vs. 4.4%) and there was no difference in the time of the onset of bacteraemia in the two groups. It is concluded that the use of CH-SS catheters in patients with haematologic malignancy reduces neither the overall risk of bloodstream infection, nor the catheter-related infection rate, nor the delay for the occurrence of infection.

An outbreak of Ochrobactrum anthropi bacteraemia in five organ transplant patients.

Nosocomial bacteraemia caused by Ochrobactrum anthropi occurred over a 1-month period in five organ transplant recipients, four of whom were in the same renal and pancreatic transplant unit. Bacteraemia occurred with cyclosporin A, azathioprine and steroids, and with a rabbit anti-thymocyte globulin (RATG) during the induction phase. RATG appeared to be the only common factor among the five cases. Over the period described, 71.4% of all patients receiving RATG developed O. anthropi bacteraemia. Three patients presented with fever and chills during or shortly after RATG infusion. Analysis of residues of the infusion, and the used vials of RATG, showed the presence of O. anthropi in concentrations of between 20 and 1000 cfu ml-1 in 5.3% of samples. Unused vials were found to be heavily contaminated with either O. anthropi or Microbacterium spp. in 23.5% of samples. All positive vials were of one particular lot number suggesting a malfunction in the manufacturing process. Many parenteral drugs such as the RATG used here do not contain preservatives and, although aseptically prepared, will not withstand thermal sterilization. Bacterial contamination of these small volume medications is not always easily detectable by conventional methods. This outbreak highlights the need for accurate quality control testing to detect small inocula that may occur during or after the manufacturing process.

A study on absenteeism among hospital personnel.

This is a retrospective study on absenteeism in a large teaching hospital covering the calender years 1982 and 1983. The number of personnel under study is 2.700 divided in six professional categories: administrative employees, qualified nurses, non-qualified nurses, laboratory technicians, caterers, cleaners. A 30% sample was chosen by the method of stratified sampling. Data were collected for each person on personal and professional factors. Absence data were collected for each person and were analysed by computer techniques. Females form the majority of the sample (82%). The overall absence rate was 9%; on excluding maternity leave it was around 6%. Female workers have double the pregnancy rate of employees and double their absence rate (maternity leave excluded). Both younger age groups have a high frequency of absence. A consistantly higher absenteeism was observed in females than in males even after the exclusion of pregnancy. Nationality had only a slight influence. The effects of seasonal variations was observed: increase in the winter and decrease in the summer. The factor education showed a direct relationship with absenteeism, the higher the education, the lower the absenteeism and vice versa. In order to detect which factors significantly influence absenteeism, each isolated factor was first considered. 'Marital status' appeared to be the most significant. On the multifactorial analysis, only education was found to be highly significant. Profession appeared also significant but is correlated to education. From these data, the probability of absenteeism can be determined. Propositions are made for an effective registration of absences and some approaches to reduce absenteeism are discussed.