Improving implementation of infection control guidelines to reduce nosocomial infection rates: pioneering the report card.

BACKGROUND: Two detailed checklists were developed, based on published infection control guidelines, for daily use by infection control practitioners in departments and operating rooms. AIM: To assess the impact of the checklists on nosocomial infection rates in three hospitals over the course of one year. METHODS: The checklists included 20 subheadings (± 150 items). Project nurses conducted rounds in the study (but not control) departments; during each round, the nurses selected 15-20 items for observation, marked the checklists according to appropriateness of observed behaviour and provided on-the-spot corrective education. Rates of adherence to the checklist, antibiotic use, number of obtained and positive cultures, and positive staff hand and patient environment cultures were reported monthly as a report card to relevant personnel and administrators. The rate of nosocomial infections was determined in the first and last months. RESULTS: The baseline nosocomial infection rate was similar in the study and control departments: 37/345 (11%) and 26/270 (10%) respectively. In the last month, the rate in the study department decreased to 16/383 (4%) (P<0.01); in the control it decreased insignificantly to 21/248 (8%) (not significant). No significant trends were detected in the number of obtained cultures, positive cultures, or antibiotic use. Adherence to guidelines ranged from 75% to 94% between the hospitals (P<0.001): the overall rate increased from 80% to 91% (P<0.01). CONCLUSIONS: The use of checklists during the conduct of infection control rounds, combined with monthly reports, was associated with a significant decrease in nosocomial infections in study departments.

Age alone is not a risk factor for left atrial thrombus in atrial fibrillation.

OBJECTIVE: Advanced age is an indication for anticoagulation in patients with atrial fibrillation though it is not clear that elderly patients have a higher prevalence of left atrial thrombus. The purpose of this study was to clarify whether advanced age represents a risk for left atrial thrombus formation irrespective of other clinical variables. DESIGN: Observational study in patients with atrial fibrillation undergoing a transoesophageal echo scan for various clinical indications. SETTING: University-affiliated cardiology service in a general hospital. PATIENTS: Results are reported in 381 patients, 257 aged less than 75 years (Gr. A) and 124 aged 75 years or more (Gr. B). RESULTS: Thrombi were detected by TOE in 30 patients (7.9%), 21 from group A and nine from group B (8.1% vs 7.2%, p = NS). No thrombi were detected in patients with lone atrial fibrillation. Among patients with either valvular or nonvalvular atrial fibrillation, left atrial thrombus presence was not related to age or anticoagulation status. CONCLUSIONS: In patients with atrial fibrillation, age itself does not predict the presence of left atrial thrombus and the only identifiable risk factor seems to be the existing cardiac pathology.

Sex differences in management and outcome after acute myocardial infarction in the 1990s: A prospective observational community-based study. Israeli Thrombolytic Survey Group.

BACKGROUND: Previous studies have suggested that women with acute myocardial infarction (AMI) are less aggressively managed than are men. The aim of this study was to assess sex differences in medical and invasive coronary procedures (angiography, PTCA, and CABG) in AMI patients admitted to cardiac care units (CCUs) in Israel in the mid 1990s and their association with early and 1-year prognosis. METHODS AND RESULTS: We studied 2867 consecutive AMI patients (2125 men, 74%) hospitalized in all 25 CCUs in Israel from 3 prospective nationwide surveys conducted in 1992, 1994, and 1996. Women were, on average, older than men (69 versus 61 years, P:<0.0001) and had a higher prevalence of hypertension, diabetes, Killip class >/=II on admission, and in-hospital complications. Women received aspirin and beta-blockers less often than did men, but these differences were not significant after age adjustment. The unadjusted rates of thrombolysis, angiography, and PTCA/CABG use were lower in women than in men but not after covariate adjustment: 42% versus 48% (adjusted odds ratio [OR] 0.92, 95% CI 0.77 to 1.11), 23% versus 31% (OR 0.88, 95% CI 0.70 to 1.09), and 15% versus 19% (OR 0.93, 95% CI 0.72 to 1.19), respectively. The 30-day mortality was higher in women than in men (17.6% versus 9.6%, respectively; OR 1.39, 95% CI 1.06 to 1.82), but the 30-day to 1-year mortality rate was not (9.1% versus 5.6%, respectively; hazard ratio 1.18, 95% CI 0.84 to 1.66). CONCLUSIONS: This prospective nationwide observational community-based study of consecutive AMI patients hospitalized in the CCUs in the mid 1990s indicates that women fare significantly worse than do men at 30 days but not thereafter at 1-year. The difference in 30-day outcome was not influenced by the use of different therapeutic modalities, including thrombolysis and invasive coronary procedures, but was rather due to the older age and greater comorbidity of women; these findings seem also to explain the less frequent use of invasive procedures in women.

Use of streptokinase for lysis of a mobile left ventricular thrombus--report of a case and review of the literature.

One-third of patients with acute anterior wall infarction develop left ventricular apical thrombi. Mobile thrombi carry the highest risk of systemic embolization, particularly in the early phase after the acute infarction. We report here on a young patient in whom a protruding and mobile left ventricular thrombus was detected on two-dimensional echocardiogram 1 week after an acute antero-septal infarction. Intravenous administration of relatively low doses of streptokinase was followed within 14 h by complication-free resolution and disappearance of the thrombus.

The effect of nicergoline on the lower urinary tract muscle.

Two series of experiments were performed to determine whether nicergoline possesses an alpha-adrenergic blocking action on the lower urinary tract musculature in dogs and humans. One series consisted of in vivo studies of urethral pressure profile recordings in 19 female dogs, and their responses to adrenergic stimulation with noradrenaline or methoxamine, alone and following administration of nicergoline. The other series consisted of in vitro isometric studies of 61 strips of human prostate, and the establishment of dose response curves to nor-adrenaline alone and in the presence of various concentrations of nicergoline. In both sets of experiments clear evidence of an alpha-adrenergic blocking effect was obtained. From the in vitro experiments, the Kb of nicergoline was calculated as less than or equal to 9 X 10(-9) M.

The alpha-adrenergic blocking effect of prazosin on the human prostate.

The effect of prazosin on the adrenergic receptors in the human prostatic adenoma and prostatic capsule was investigated by an in vitro isometric technique. The results showed an alpha-adrenergic blocking action on both tissues. The cholinergic response of the capsule and the direct response of the adenoma were not affected. It is suggested that prazosin may prove preferable to phenoxybenzamine for clinical use as a prostatic alpha blocking agent, because of the selective action on the alpha1 receptors.