Effectiveness of a multidimensional approach for prevention of ventilator-associated pneumonia in 11 adult intensive care units from 10 cities of Turkey: Findings of the International Nosocomial Infection Control Consortium (INICC)

Purpose: To evaluate the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on the reduction of ventilator-associated pneumonia (VAP) in adult patients hospitalized in 11 intensive care units (ICUs), from 10 hospitals, members of the INICC, in 10 cities of Turkey. Methods: A prospective active before-after surveillance study was conducted to determine the effect of the INICC multidimensional approach in the VAP rate. The study was divided into two phases. In phase 1, active prospective surveillance of VAP was conducted using the definitions of the Centers for Disease Control and Prevention National Health Safety Network, and the INICC methods. In phase 2, we implemented the multidimensional approach for VAP. The INICC multidimensional approach included the following measures: (1) bundle of infection control interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback of VAP rates, and (6) performance feedback of infection control practices. We compared the rates of VAP obtained in each phase. A time series analysis was performed to assess the impact of our approach. Results: In phase 1, we recorded 2,376 mechanical ventilator (MV)-days, and in phase 2, after implementing the multidimensional approach, we recorded 28,181 MV-days. The rate of VAP was 31.14 per 1,000 MV-days during phase 1, and 16.82 per 1,000 MV-days during phase 2, amounting to a 46 % VAP rate reduction (RR, 0.54; 95 % CI, 0.42-0.7; P value, 0.0001.) Conclusions: The INICC multidimensional approach was associated with a significant reduction in the VAP rate in these adult ICUs of Turkey. © 2013 Springer-Verlag Berlin Heidelberg

Severe community-acquired pneumonia requiring intensive care unit [Yogun baki{dotless}m gerektiren agi{dotless}r toplum kökenli pnömoni]

Severe community-acquired pneumonia (CAP) has been defi ned as requiring intensive care unit (ICU) admission because of vasopressors which necessitate shock and/or mechanical ventilation in acute respiratory failure. In the present review, fi rstly CAP is explained in general terms and then the suggestions for ICU required pneumonia in the latest international and national guidelines will be summarized

Investigation of the virulence genes in methicillin-resistant Staphylococcus aureus strains isolated from biomaterial surfaces [Biyomalzeme yüzeylerinden izole edilen metisiline dirençli Staphylococcus aureus suşlar?nda virülar?s genlerinin araşt?r?lmas?]

PubMed ID: 18444560Staphylococci are the most important agents of nosocomial infections originating from biomaterials. The aim of this study was to investigate the presence of virulence genes and their phenotypic expressions in 11 methicillin-resistant Staphylococcus aureus strains isolated from the surfaces of clinically used biomaterials of 48 thorasic intensive-care unit patients. By the use of specific primers, the presence of genes encoding the attachment and biofilm production (icaA, icaC, bap), methicillin resistance (mecA), enterotoxins A-E (sea, seb, sec, sed, see), toxic shock syndrome toxin (tst), exfoliative toxins A and B (eta and etb), alpha- and beta-hemolysins (hla and hlb), staphylococcal exotoxin-like protein-1 (set1), proteases (sspA, sspB, aur, serine proteaz gene), lipase (geh) and the regulatory genes (sarA and agrCA) were investigated by polymerase chain reaction (PCR). The phenotypic properties of the isolates such as biofilm formation, antibiotic susceptibility, extracellular protease and lipase production were also evaluated. None of the isolates were found to be biofilm and/or slime producers, however, all strains were found to have icaA gene which is responsible for biofilm formation. Nevertheless the presence of icaC and bap genes that are also responsible for biofilm formation were not detected. All the strains have had mecA gene and were resistant to oxacillin, penicilin G and gentamicin, while 10 were also resistant to erythromycin and nine were also resistant to ofloxacin. The isolates were susceptible to vancomycin, teicoplanin and co-trimoxazole. Screening of toxin and regulatory genes revealed that all the strains harboured sea, set1, hla, hlb and sarA genes. The phenotypic tests for the determination of extracellular protease production revealed that all the strains formed very weak zones on skim milk and milk agar plates, and yielded negative results on casein agar plates. Furthermore, all strains were found to harbour sspA, sspB, aur and serine protease genes. Tween 20, Tween 80 and tributyrin containing media were used to detect lipase production and all strains gave late-positive results (on the third day of incubation), although they all lacked for lipase gene (geh). As a result, S.aureus strains isolated from biomaterial surfaces yielded positivity for some of the tested virulence genes, of which some of them have not been expressed phenotypically. Although there were some limitations in the study, it could be concluded that the presence of these virulence genes in S.aureus strains might be considered as potential threats especially in intensive care unit patients

The efficacy of incentive spirometry in patients with COPD

WOS: 000230551100012PubMed ID: 15955148Objective: Although incentive spirometry (IS) is frequently used to prevent postoperative pulmonary complications, its efficacy in patients with COPD has not been documented. The aim of this study was to evaluate the effects of IS on pulmonary function tests, arterial blood gases, dyspnoea and health-related quality of life in patients hospitalized for COPD. Methodology: A total of 27 consecutive patients (mean age, 68.4 +/- 7.9 years; 26 males) admitted for COPD exacerbations were recruited for the study. In total, 15 (IS treatment group) used IS for 2 months, together with medical treatment. The remaining 12 (medical treatment group) were given only medical treatment. Pulmonary function and blood gases were measured. Assessment of dyspnoea by visual analogue scale (VAS) and quality of life using the St. George's Respiratory Questionnaire (SGRQ) were performed at admission and after 2 months of treatment. Results: The activity, impact and total scores for the SGRQ improved (all P <= 0.0001), PaCO2 values decreased (P = 0.02), PaO2 and PAO(2) values increased (P = 0.02 and P = 0.01, respectively) in the IS treatment group. However, there were no significant differences between the measurements made pretreatment and after 2 months of medical therapy in the medical treatment group, with regards to pulmonary function, blood gases, SGRQ scores and VAS. Conclusion: The use of IS appears to improve arterial blood gases and health-related quality of life in patients with COPD exacerbations, although it does not alter pulmonary function parameters

Glaucoma associated with metered-dose bronchodilator therapy

WOS: 000171557600014PubMed ID: 1160175

Detection of aerial microfungus flora potential opportunist infection agent, in the intensive care unit of the chest disease department of a hospital in izmir

The biodiversity and concentrations of different genera of indoor airborne fungi, a potential opportunist infection factor, in the respiratory intensive care unit of the pulmonary diseases department, medical faculty of Ege University, were investigated. To accomplish the purpose, air samples were collected at 4 different points of intensive care unit for 10 days with a Merck MAS 100 air sampler. After identification of isolates obtained from 566 microfungal colonies counted, 12 different species belonging to 8 genera were determined (Aspergillus, Pénicillium, Alternaria, Cladosporium, Mucor, Rhizopus, Fusarium, and Trichodermd). In this study, aimed to emphasize the importance of monitoring the presence of airborne fungal flora, particularly Aspergillus spp, in the departments of a hospital where patients of high-risk groups were hospitalized, we could not isolate A.fumigatus, an opportunist pathogen. by psp