Generalized and Prolonged Use of Gentamicin-Lock Therapy Reduces Hemodialysis Catheter-Related Infections Due to Gram Negatives.

INTRODUCTION: The incidence of catheter-related bloodstream infections (CRBSI) ranges from 2.2 to 5.5 episodes per 1,000 catheter-days. Our aim was to evaluate the utility of a generalized and prolonged gentamicin-lock therapy in patients undergoing hemodialysis (HD) in a third-level hospital for the reduction in CRBSI. METHODS: A prospective cohort analyzed before and after intervention. During intervention periods after each HD-session, the catheter lumens were locked with gentamicin/heparin for all patients compared to nonintervention periods were the same procedure was performed without gentamicin. Active surveillance was performed for HD CRBSI. Microbiologic assessment and epidemiological data were gathered. Continuous hand hygiene and water quality monitoring were performed. RESULTS: The rates of CRBSI were reduced from 1.28 to 0.2 cases per 1,000 catheter-days when the lock therapy was employed (p = 0.001) The greatest reduction was for CRBSI caused by Pseudomonas aeruginosa were no cases were recorded during the intervention periods (p = 0.001). There was a significant reduction in the total number of isolates; Gram-negative bacterial species (-97.2%) and Gram-positive bacterial species (-61.5%) although only the former reached statistical significance (p = 0.0001). The difference in the absolute risk reduction was 20.56% (95% CI 14.46-26.66%), the calculated Number Needed to Treat was 5 (95% CI 3.8-6.9). No adverse effects were noted. CONCLUSION: In the current study, gentamicin-lock therapy was associated with a significant reduction in CRBSI specially with P. aeruginosa and other Gram-negative bacteria. It proved to be safe and effective intervention when applied to the entire population of HD patients.

Enhanced influenza vaccination among healthcare personnel prevents cases despite community burden.

INTRODUCTION: Influenza vaccination for healthcare personnel is not obligatory in Mexico, and compliance relies on promotion and persuasion. The objective of this study was to determine the impact of influenza vaccination compliance on the reduction of influenza and influenza-like illness among healthcare personnel throughout two consecutive influenza seasons. METHODOLOGY: A retrospective study comparing cases of influenza and influenza-like illness among vaccinated and unvaccinated healthcare personnel registered in a Mexican 500-bed University Hospital surveillance and immunization registry during seasons 2015-16 and 2016-17. RESULTS: Total influenza immunization compliance was 21.3% and 42.7%, respectively. Reduction of the number of influenza-like illness (58 in 2015-16 and 15 in 2016-17; P = 0.0001) and confirmed influenza cases (28 in 2015-16 and 13 in 2016-17; P = 0.036) was evident. During 2016-17, influenza activity in the community was higher than 2015-16 (4800 and 1338 cases, respectively). CONCLUSIONS: Increased influenza vaccination compliance among healthcare personnel was associated with reduction of the overall number of influenza and influenza-like illness cases, even in the setting of high activity of the disease in the community through 2016-17 and reported suboptimal vaccine effectiveness during both seasons.

Outcomes of Clostridium difficile-infected patients managed in a common isolation unit compared with isolation in their bed of diagnosis.

Cohorting Clostridium difficile infection (CDI) patients is a strategy which has not been thoroughly evaluated. We compared clinical characteristics and outcomes of CDI patients treated in a common isolation unit (CIU) versus those treated in their bed of diagnosis. Patients treated in the CIU showed lower mortality rates and antibiotic usage; however, a higher recurrence rate was reported.

Early hearing loss detection in rheumatoid arthritis and primary Sjögren syndrome using extended high frequency audiometry.

The aim of this study is to evaluate the hearing behavior of rheumatoid arthritis (RA) and primary Sjögren syndrome (PSS) patients and compare them with a healthy control group and with each other. A comparative cross-sectional study was performed with a group of 117 female RA patients, a group of 60 female PSS patients, and a 251 female healthy control group. Every subject underwent a series of studies including high-frequency audiometry, speech audiometry, and tympanometry. The high-frequency audiometry measured 250 to 16,000 Hz. The 117 patients with RA and the 60 with PSS were diagnosed according to American College of Rheumatology criteria / ACR 2010, and the validated classification of the American-European Consensus Group. Hearing loss was present in 36.8% of the RA group in 500-3000 Hz, 68.4% in 4000-8000 Hz, and 94.9% in 10,000-16,000 Hz. Hearing loss was present in 60% of the PSS group in 500-3000 Hz, 70% in 4000-8000 Hz, and 100% in 10,000-16,000 Hz. The hearing impairment prevalence of both groups was significantly different (p < 0.05) when compared with the healthy control group. We also compared the hearing thresholds between RA and PSS patients, finding a significant hearing threshold increase in 500-3000 Hz of the PSS group. This study consolidates the association between RA and PSS with hearing impairment. A deeper hearing loss was reported in PSS than in RA patients, demonstrating a greater auditory and speech recognition repercussion.

Correlation between rapid HIV testing and fourth-generation ELISA results for HIV detection among pregnant patients in the delivery room.

OBJECTIVE: To analyze the usefulness of rapid HIV testing in pregnant patients in the delivery room. METHODS: This prospective study compared a rapid test and a fourth-generation enzyme-linked immunoassay (ELISA) for HIV screening among pregnant patients admitted in labor with an unknown HIV status at a university hospital in Mexico between July 2015 and February 2016. Pearson correlation analysis was performed, and the diagnostic accuracy of the two tests was assessed with HIV RNA polymerase chain reaction (PCR) as the reference method. RESULTS: Overall, 534 patients were included. With a signal-to-cutoff (S/CO) value of 1.0 or more as a diagnostic criterion, 6 (1.1%) patients had a positive ELISA result. Three had a negative rapid test and three had a positive test (r=0.705). With an S/CO value of 2.0 or more as cutoff, 4 (0.7%) patients had a positive ELISA result. Three had a positive rapid test and one had a negative test (r=0.865). Only three of six patients with an S/CO of 1.0 or more were confirmed to have HIV by RNA PCR. CONCLUSION: The rapid test showed a strong correlation with the fourth-generation ELISA. Therefore, rapid testing is a useful tool in the delivery room for patients with unknown HIV status.

Enhancement of hand hygiene compliance among health care workers from a hemodialysis unit using video-monitoring feedback.

BACKGROUND: The importance of hand hygiene in the prevention of health care-associated infection is well known. Experience with hand hygiene compliance (HHC) evaluation in hemodialysis units is scarce. METHODS: This study was a 3-phase, prospective longitudinal intervention study during a 5-month period in a 13-bed hemodialysis unit at a university hospital in Northern Mexico. The unit performs an average of 1,150 hemodialysis procedures per month. Compliance was evaluated by a direct observer and a video assisted observer. Feedback was given to health care workers in the form of educational sessions and confidential reports and video analysis of compliance and noncompliance. RESULTS: A total of 5,402 hand hygiene opportunities were registered; 5,201 during 7,820 minutes of video footage and 201 by direct observation during 1,180 minutes. Lower compliance during the baseline evaluation was observed by video monitoring compared with direct observation (P <0.05). Discrepancy between both methods was 29.2% (0.4%-59.8%); the average improvement in compliance during the study was 30.6% (range, 7.3%-75.5%). Global and Individual results for each subject revealed a statistically significant Improvement in the majority. Noncompliance according to WHO's 5 Moments for HH was greater for moment 5 (30.1%). We estimated that a health care worker in a hemodialysis unit could take 22-44.3% of working hours for proper hand hygiene compliance. CONCLUSIONS: Video-assisted monitoring of hand hygiene is an excellent method for the evaluation of HHC in a hemodialysis unit; enhanced HHC can be achieved through a feedback program to the hemodialysis staff that includes video examples and confidential reports.

Association between early influenza vaccination and the reduction of influenza-like syndromes in health care providers.

A comparison of 2 different influenza seasons (2013-2014 and 2014-2015) where early vaccination among health care providers (HCPs) in the latter was the difference. Differences in leave of absence because of influenza-like illness (ILI) (52 vs 15 [total number of leave of absence issued], P < .001) and total days of lost work (218 vs 68, P < .001) were found for the 2013-2014 and 2014-2015 seasons, respectively. An association between earlier influenza vaccination among HCPs and a reduction in ILI, leave of absence, and days of lost work was found.

Hand hygiene compliance in patients under contact precautions and in the general hospital population.

INTRODUCTION: Hand hygiene (HH) is the single most important intervention for preventing hospital-acquired infections. Contact precautions are a series of actions that infection control units take to reduce the transmission of nosocomial pathogens. METHODS: We conducted an observational study of HH compliance. Observations were stratified as opportunities in patients under contact precautions and in the general hospital population. Trained infection control personnel performed all direct evaluations. RESULTS: A total of 3,270 opportunities were recorded. HH compliance was statistically higher in patients on contact precautions than in the overall population (70.3% vs 60.4%; P = .0001). Critical care areas had higher HH compliance when patients were isolated by contact precautions. Medical wards were statistically lower in HH when patients were under contact precautions. Respiratory technicians had the highest HH compliance in both overall performance and in patients under contact precautions. Medical students had a lower HH compliance in both evaluations (P < .001). CONCLUSIONS: We noted greater compliance with HH practices when patients were under contact precaution in comparison with the overall hospital population. The difference was stronger in intensive care areas and lower among medical students.