Moisturizing body milk as a reservoir of Burkholderia cepacia: outbreak of nosocomial infection in a multidisciplinary intensive care unit.

BACKGROUND: An outbreak of severe nosocomial Burkholderia cepacia infections in patients admitted to intensive care unit (ICU), including investigation of the reservoir, is described. METHODS: Over a period of 18 days, isolates of Burkholderia cepacia were recovered from different biological samples from five patients who were admitted to a multidisciplinary 18-bed intensive care unit. Isolation of B. cepacia was associated with bacteraemia in three cases, lower respiratory tract infection in one and urinary tract infection in one. Contact isolation measures were instituted; new samples from the index patients and adjacent patients were collected; and samples of antiseptics, eau de Cologne and moisturizing body milk available in treatment carts at that time were collected and cultured. RESULTS: B. cepacia was isolated from three samples of the moisturizing body milk that had been applied to the patients. Three new hermetically closed units, from three different batches, were sent for culture; two of these were positive as well. All strains recovered from environmental and biological samples were identified as belonging to the same clone by pulsed-field gel electrophoresis. The cream was withdrawn from all hospitalization units and no new cases of B. cepacia infection developed. CONCLUSION: Moisturizing body milk is a potential source of infection. In severely ill patients, the presence of bacteria in cosmetic products, even within accepted limits, may lead to severe life-threatening infections.

[Taking decisions at the end of life. A survey of the attitude of critically ill patients against death]. / Toma de decisiones al final de la vida. Encuesta sobre la actitud ante la muerte en el paciente crítico.

BACKGROUND AND OBJECTIVE: An attitude of refusal regarding death still persists in our society and the majority of patients do not usually take decisions related to the end of life. SUBJECTS AND METHOD: From June 1st to December 31st, 2000, 88 first-degree relatives were interviewed concerning patient's preparation before his/her death. Patients considered to be candidates to take decisions about end of life were those with poor quality of life and previously admitted to the intensive care unit (ICU). Relatives were interviewed regarding organ donation, vital willingness, legal representative, civil willingness and patient's knowledge of disease and wish to limit therapeutic efforts in case of extreme severity. Previous quality of life was measured according to the Karnofsky scale. RESULTS: 20% patients had donated organs, none had vital willingness and 44% had civil willingness. When patients were divided into groups of those with and without legal willingness, vital representative, and willgness to donate organs and to limit therapeutic effort, there were no statistically significant differences except for patients with vital representatives who were significantly younger. CONCLUSIONS: Society needs to advance progressively towards the acceptance and preparation of death, so that decisions taken at the end of life, particularly in the ICUs, may represent, as accurately as possible, a patient's scale of values.

Toma de decisiones al final de la vida. Encuesta sobre la actitud ante la muerte en el paciente crítico / Taking decisions at the end of life. A survey of the attitude of critically ill patients against death

FUNDAMENTO Y OBJETIVO: En nuestra sociedad persiste una actitud de rechazo hacia la muerte, con la dificultad de que los pacientes tomen decisiones relacionadas con el final de la vida. SUJETOS Y MÉTODO: Desde junio a diciembre de 2000, los familiares de primer grado de los primeros 88 pacientes ingresados fueron entrevistados acerca de la preparación del paciente hacia la muerte. Los pacientes considerados para tomar decisiones sobre el final de la vida fueron aquéllos con mala calidad de vida e ingreso previo en la unidad de cuidados intensivos (UCI). Los familiares fueron entrevistados sobre donación de órganos, testamento vital, representante legal, testamento civil, así como el deseo de limitar el esfuerzo terapéutico en caso de extrema gravedad. La calidad de vida previa se midió según la escala de Karnofsky. RESULTADOS: El 20 por ciento de los pacientes expresó su voluntad de donar sus órganos, ninguno tenía testamento vital y el 44 por ciento había hecho testamento civil. Cuando los pacientes fueron divididos en grupos según tuvieran o no testamento civil, representante vital, deseo de donar sus órganos y de limitar el esfuerzo terapéutico, no se encontraron diferencias estadísticamente significativas entre ambos grupos, excepto para los pacientes con representante vital, que fueron los más jóvenes. CONCLUSIÓN: Es preciso que la sociedad avance progresivamente hacia la aceptación de la muerte, para que las decisiones que se tomen en el final de la vida, particularmente en la UCI, representen lo más adecuadamente posible la escala de valores del paciente. (AU)