The high rate of blood donor exposure for critically ill neonates.

The purpose of this study was to determine the number and volume of red blood cell (RBC) transfusions and the number of donors a newborn is exposed to during his or her newborn intensive care unit (NICU) stay. On one day at the Medical University of South Carolina (MUSC) and two days at the University of Virginia Hospital (UVH) all babies who had or were receiving RBCs comprised the study group. Patient records were reviewed at discharge. Fifty-two (70%) of the 75 NICU babies had or were receiving RBCs and were enrolled. The average number of RBC transfusions was nine (range 1 to 28, median 7) and the average transfusion volume was 16.5 ml (range 5 to 60) for a total volume of 148 ml transfused during a NICU stay. Each baby was exposed to an average of 6.9 donors (range 1 to 25, median 6.5). The practice of splitting RBC packs to share among different infants and of giving multiple small volume transfusions maximizes donor exposure and transfusion-related infectious risks in this population.

The relationship between surgeon experience and endometritis after cesarean section.

We studied 294 primary cesarean section and repeat cesarean section deliveries with premature rupture of membranes which occurred over a two year period to determine if an association existed between postoperative endometritis and the level of physician training. The results of preliminary analysis revealed that a relationship existed between the level of physician training and the presence of endometritis (p less than 0.01). Endometritis rates for patients under the care of attending physicians, chief residents and residents serving as the primary surgeon were six, 13 and 24 per cent, respectively. Stepwise discriminant function analysis allowed us to account for the contribution of independent risk factors for endometritis. When surgeon experience was evaluated with other risk factors, the presence of a resident serving as the lead surgeon and the age of the patient were the only significant predictors of endometritis (p = 0.046 and 0.007, respectively). The clinical and biologic relevance of the actual age difference between infected and noninfected patients (22 years for infected patients versus 25 years for noninfected patients) is not readily apparent. However, in this study, the identification of a resident acting as a lead surgeon has been shown to be a new independent risk factor for predicting endometritis. This study demonstrates the need for the evaluation of training programs for residents who serve as the principal surgeon for patients who underwent cesarean section.

Nosocomial bloodstream infections: secular trends in a statewide surveillance program in Virginia.

Over a 7-year period (1978-1984) the authors studied the rates of nosocomial bloodstream infections in acute-care hospitals participating in a statewide surveillance network in Virginia. A total of 4,617 hospital-acquired bloodstream infections were documented among 1,807,989 patients at risk for an overall rate of 25.5 cases per 10,000 patient admissions/discharges (annual range = 22.1 to 30.7). Compliance of reporting for Virginia hospitals averaged 58% (1 to 5 monthly reports in a study year), and 39% (greater than or equal to 6 monthly reports annually). Significant changes in bloodstream infection rates (cases per 10,000 patient admissions/discharges) due to specific pathogens included the following: coagulase-negative staphylococci increased from a rate of 1.3 to 4.5 (P = .0003), and those due to all gram-positive cocci increased from a rate of 7.5 to 11.4 (P = .03). Candida species increased from a rate of 0.1 to 1.5 (P = .005). The data show a continuing rise of nosocomial Candida BSI and clearly document the re-emergence of gram-positive cocci as major nosocomial bloodstream pathogens.

Catheter-associated bacteriuria. Failure to reduce attack rates using periodic instillations of a disinfectant into urinary drainage systems.

We assessed the efficacy of periodic instillations of hydrogen peroxide into urinary drainage systems in the prevention of catheter-associated bacteriuria in a prospective and randomized clinical study of 668 patients with indwelling urethral catheters. Bacteriuria was documented in 68 (10%) of the 668 patients after a mean duration of four days of catheterization. There was no difference between the hydrogen peroxide group and the control group in the mean duration of catheterization before the onset of bacteriuria, in the attack rate for bacteriuria, or in the spectrum of etiologic agents recovered. Bag contamination with the same organism responsible for bacteriuria preceded infection in only five (7%) of the 68 patients, three patients using hydrogen peroxide and two in the control group. We conclude that infections arising intraluminally from contamination of the drainage bag are uncommon among catheterized patients and that the periodic instillation of disinfectants into closed sterile drainage systems is not effective in reducing the incidence of catheter-associated bacteriuria.