RESUMO
Ultraviolet (UV) light has destructive activity against pathogenic bacteria including Clostridioides difficile spores. Portable pulsed-xenon UV disinfecting devices were implemented for terminal room cleaning in 6 units of our academic hospital with high C. difficile infection (CDI) rates. CDI rates were measured in a 9-month period before and a 9-month period after device implementation. Despite documented administration of UV disinfection for 87% of terminal room cleaning, no impact on CDI rates was detected.
Assuntos
Clostridioides difficile , Infecção Hospitalar , Raios Ultravioleta , Clostridioides , Infecção Hospitalar/prevenção & controle , Atenção à Saúde , Desinfecção , Humanos , Centros de Atenção Terciária , XenônioRESUMO
Sepsis mortality may be improved by early recognition and appropriate treatment based on evidence-based guidelines. An intervention was developed that focused on earlier identification of sepsis, early antimicrobial administration, and an educational program that was disseminated throughout all hospital units and services. There were 1331 patients with sepsis during the intervention period and 1401 patients with sepsis during the control period. After controlling for expected mortality, patients in the intervention period had 30% lower odds of dying (odds ratio = 0.70, 95% confidence interval [CI] = 0.57 to 0.84). They also had 1.07 fewer days on average in the intensive care unit (95% CI = -1.98 to -0.16), 2.15 fewer hospital days (95% CI = -3.45 to -0.86), and incurred on average $1949 less in hospital costs, although the effect on costs was not statistically significant. Continued incremental improvement and sustainment is anticipated through organizational oversight, continued education, and initiation of an automated electronic sepsis alert function.
Assuntos
Capacitação em Serviço/organização & administração , Unidades de Terapia Intensiva/organização & administração , Melhoria de Qualidade/organização & administração , Sepse/terapia , Centros Médicos Acadêmicos/organização & administração , Algoritmos , Anti-Infecciosos/administração & dosagem , Protocolos Clínicos , Comorbidade , Prática Clínica Baseada em Evidências , Feminino , Preços Hospitalares , Mortalidade Hospitalar , Humanos , Unidades de Terapia Intensiva/economia , Tempo de Internação , Masculino , Pacotes de Assistência ao Paciente , Sepse/mortalidade , Resultado do TratamentoRESUMO
BACKGROUND: Patients colonized with methicillin-resistant Staphylococcus aureus (MRSA) are at increased risk for invasive infection compared with noncolonized patients; however, the magnitude of risk for MRSA surgical site infection (SSI) is unclear. To aid in planning of infection prevention strategies, we sought to assess the incidence of MRSA SSI in MRSA carriers. METHODS: We conducted a retrospective cohort study at our tertiary care center of inpatients who underwent MRSA polymerase chain reaction (PCR) screen of the nares within 30 days before a National Healthcare Safety Network principal procedure between April 2008 and July 2010. RESULTS: The rate of MRSA SSI was 1.86% in the MRSA PCR-positive group (n = 431) and 0.20% in the MRSA PCR-negative group (n = 9432). Multivariate analysis identified MRSA PCR-positive status as an independent risk factor for MRSA SSI (odds ratio, 9.20; 95% confidence interval, 3.81-20.47; P < .0001); other risk factors included duration of surgery ≥137 minutes, American Society of Anesthesiologists score ≥3, and abdominal surgery. CONCLUSIONS: Surgical patients with a positive nasal MRSA PCR screen had a 9-fold greater odds of developing a subsequent MRSA SSI compared with patients with a negative nasal MRSA PCR screen. The incidence of MRSA SSI in PCR-positive patients was low (1.86%), however, and identifying subsets of patients at greatest risk for SSI may help target decolonization and other interventions.