RESUMEN
BACKGROUND: Urinary tract infections (UTIs) account for 30% to 40% of nosocomial infections resulting in morbidity, mortality, and increased length of hospital stay. OBJECTIVE: To assess the efficacy of a silver-alloy, hydrogel-coated latex urinary catheter for the prevention of nosocomial catheter-associated UTIs. METHODS: A 12-month randomized crossover trial compared rates of nosocomial catheter-associated UTI in patients with silver-coated and uncoated catheters. A cost analysis was conducted. RESULTS: There were 343 infections among 27,878 patients (1.23 infections per 100 patients) during 114,368 patient-days (3.00 infections per 1000 patient-days). The relative risk of infection per 1000 patient-days was 0.79 (95% confidence interval, 0.63-0.99; P =.04) for study wards randomized to silver-coated catheters compared with those randomized to uncoated catheters. Infections occurred in 291 of 11,032 catheters used on study units (2.64 infections per 100 catheters). The relative risk of infection per 100 silver-coated catheters used on study wards compared with uncoated catheters was 0.68 (95% confidence interval, 0.54-0.86; P =.001). Fourteen catheter-associated UTIs (4.1%) were complicated by secondary bloodstream infection. One death appeared related to the secondary infection. Estimated hospital cost savings with the use of the silver-coated catheters ranged from $14,456 to $573,293. CONCLUSIONS: The risk of infection declined by 21% among study wards randomized to silver-coated catheters and by 32% among patients in whom silver-coated catheters were used on the wards. Use of the more expensive silver-coated catheter appeared to offer cost savings by preventing excess hospital costs from nosocomial UTI associated with catheter use. Arch Intern Med. 2000;160:3294-3298.
Asunto(s)
Catéteres de Permanencia/economía , Infección Hospitalaria/economía , Infección Hospitalaria/prevención & control , Costos de Hospital , Plata , Cateterismo Urinario/instrumentación , Infecciones Urinarias/economía , Infecciones Urinarias/prevención & control , Adulto , Anciano , Aleaciones , Ahorro de Costo , Infección Hospitalaria/complicaciones , Infección Hospitalaria/etiología , Estudios Cruzados , Contaminación de Equipos , Diseño de Equipo , Femenino , Hospitales Universitarios , Humanos , Incidencia , Tiempo de Internación , Masculino , Persona de Mediana Edad , Sepsis/etiología , Cateterismo Urinario/efectos adversos , Cateterismo Urinario/economía , Infecciones Urinarias/complicaciones , Infecciones Urinarias/etiología , Virginia/epidemiologíaRESUMEN
HYPOTHESIS: That water leakage rates and protection against blood-borne pathogens should not vary as a function of latex content among Food and Drug Administration-approved gloves, allowing avoidance of unnecessary latex exposure. DESIGN AND METHODS: Eighteen different glove types were purchased and tested using the American Society for Testing Methods Standard Test for Detecting Holes in medical gloves, which involves mounting the glove on a plastic tube, pouring a liter of tap water into the glove, and visually inspecting the glove initially and after 2 minutes. Half of the gloves were tested straight from the package and half after a standardized manipulation. SETTING: A university hospital. RESULTS: Eleven sterile glove types (5 high latex content, 4 low latex content, and 2 nonlatex content), and 7 nonsterile examination glove types (2 high latex content, 2 low latex content, and 3 nonlatex content) were tested (total tested, 3720 gloves). Leakage rates were greater for examination than for surgical gloves (relative risk [RR], 1.41, 95% confidence interval [CI], 1.01-1.96), for manipulated than for unused gloves (RR, 2.89, 5% CI, 1.98-4.22), and for low latex content surgical gloves (RR, 2.58, 95% CI, 1.35-4.92) or nonlatex content surgical gloves (RR, 4.93, 95% CI, 2.35-10.32) than for high latex content surgical gloves. Significant differences were observed among low latex content surgical gloves (P=.001) and all types of examination gloves (P =.0015) especially after the standardized manipulation (leakage rates ranging from 0%-30%). CONCLUSIONS: Food and Drug Administration approval should not be interpreted as suggesting equality of different manufacturers' products. Some low latex and nonlatex content gloves are very resistant to leakage and should provide an effective barrier for preventing exposure to blood-borne pathogens, while others may not.
Asunto(s)
Guantes Quirúrgicos , Látex , Patógenos Transmitidos por la Sangre , Distribución de Chi-Cuadrado , Intervalos de Confianza , Diseño de Equipo , Falla de Equipo , Guantes Quirúrgicos/clasificación , Humanos , Ensayo de Materiales , Exposición Profesional , Factores de Riesgo , Propiedades de Superficie , Factores de Tiempo , Estados Unidos , United States Food and Drug Administration , AguaRESUMEN
Operational issues in health care ultimately lead to discussions concerning personnel. Adequate staffing, "rightsizing," compensation, scheduling, morale, supervision, and organizational structure were subjects of the questions the Clinical Pathology Laboratories at the University of Virginia Medical Center asked in 1994. The answers were found in the design of a new skill-based personnel organizational model and compensation plan.
Asunto(s)
Atención a la Salud/economía , Atención a la Salud/organización & administración , Atención a la Salud/tendencias , Humanos , Recursos HumanosRESUMEN
Catheter-related bloodstream infections increased in incidence during the past decade, causing significant morbidity, mortality, and excess hospital costs. Absence of inflammation at the catheter site in most cases makes clinical diagnosis uncertain. The relative accuracy and cost-effectiveness of different microbiologic tests for confirming that bloodstream infection is catheter related have remained unclear. A meta-analysis of published studies was conducted regarding the accuracy of diagnostic test methods using pooled sensitivity and specificity and summary receiver operating characteristic (ROC) curve analysis. The cost for each test was estimated by methods published by the College of American Pathologists. Costs of catheter replacement and antibiotic therapy for false positive results were included in the cost per accurate test result. Twenty-two studies evaluating six test methods met inclusion criteria for the meta-analysis. Accuracy increased in ROC analysis for catheter segment cultures with increasing quantitation (P = 0.03) (i.e., quantitative > semiquantitative > qualitative) largely due to an increase in specificity. The highest Youden index (mean = 0.85) was observed with quantitative catheter segment culture, the only method with pooled sensitivity and specificity above 90%. For blood culture methods, there was no statistically significant trend toward increased accuracy. The unpaired quantitative catheter blood culture offered the lowest cost per accurate test result but was only 78% sensitive. In conclusion, quantitative culture was the most accurate method for catheter segment culture, and unpaired quantitative catheter blood culture was the single most cost-effective test, especially for long-term catheters.