Incidence of surgical site infections cannot be derived reliably from point prevalence survey data in Dutch hospitals

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The use of typing methods and infection prevention measures to control a bullous impetigo outbreak on a neonatal ward

<p>Abstract</p> <p>Background</p> <p>We describe an outbreak of Bullous Impetigo (BI), caused by a (methicillin susceptible, fusidic acid resistant) <it>Staphylococcus aureus</it> (SA) strain, <it>spa-</it>type t408, at the neonatal and gynaecology ward of the Jeroen Bosch hospital in the Netherlands, from March-November 2011.</p> <p>Methods</p> <p>We performed an outbreak investigation with revision of the hygienic protocols, MSSA colonization surveillance and environmental sampling for MSSA including detailed typing of <it>SA</it> isolates. <it>Spa</it> typing was performed to discriminate between the SA isolates. In addition, Raman-typing was performed on all t408 isolates.</p> <p>Results</p> <p>Nineteen cases of BI were confirmed by SA positive cultures. A cluster of nine neonates and three health care workers (HCW) with <it>SA</it> t408 was detected. These strains were MecA^-, PVL^-, Exfoliative Toxin (ET)A^-, ETB⁺, ETAD^-, fusidic acid-resistant and methicillin susceptible. Eight out of nine neonates and two out of three HCW t408 strains yielded a similar Raman type. Positive t408 HCW were treated and infection control procedures were reinforced. These measures stopped the outbreak.</p> <p>Conclusions</p> <p>We conclude that treatment of patients and HCW carrying a predominant SA t408, and re-implementing and emphasising hygienic measures were effective to control the outbreak of SA t408 among neonates.</p

Exploring determinants of hand hygiene compliance in LTCFs: a qualitative study using Flottorps’ integrated checklist of determinants of practice

Background: Elderly residents in long-term care facilities (LTCFs) are vulnerable to healthcare-associated infections. Although hand hygiene is a leading measure for preventing infection, the compliance of healthcare workers is low. The aim of this study is to identify determinants that influence hand hygiene compliance of nursing staff in LTCFs. This information on determinants can eventually be used to develop a tailored implementation strategy for LTCFs. Methods: This is an explorative, descriptive study using qualitative methods.

National laboratory-based surveillance system for antimicrobial resistance: a successful tool to support the control of antimicrobial resistance in the Netherlands

An important cornerstone in the control of antimicrobial resistance (AMR) is a well-designed quantitative system for the surveillance of spread and temporal trends in AMR. Since 2008, the Dutch national AMR surveillance system, based on routine data from medical microbiological laboratories (MMLs), has developed into a successful tool to support the control of AMR in the Netherlands. It provides background information for policy making in public health and healthcare services, supports development of empirical antibiotic therapy guidelines and facilitates in-depth research. In addition, participation of the MMLs in the national AMR surveillance network has contributed to sharing of knowledge and quality improvement. A future improvement will be the implementation of a new semantic standard together with standardised data transfer, which will reduce errors in data handling and enable a more real-time surveillance. Furthermore, the

Estimation of the serial interval of pertussis in Dutch households

Contains fulltext : 137947.pdf (publisher's version ) (Open Access)Increasing incidence has led to the re-appearance of pertussis as a public health problem in developed countries. Pertussis infection is usually mild in vaccinated children and adults, but it can be fatal in infants who are too young for effective vaccination (</=3months). Tailoring of control strategies to prevent infection of the infant hinges on the availability of estimates of key epidemiological quantities. Here we estimate the serial interval of pertussis, i.e the time between symptoms onset in a case and its infector, using data from a household-based study carried out in the Netherlands in 2007-2009. We use statistical methodology to tie infected persons to probable infector persons, and obtain statistically supported stratifications of the data by person-type (infant, mother, father, sibling). The analyses show that the mean serial interval is 20 days (95%CI: 16-23 days) when the mother is the infector of the infant, and 28 days (95%CI: 23-33 days) when the infector is the father or a sibling. These time frames offer opportunities for early mitigation of the consequences of infection of an infant once a case has been detected in a household. If preventive measures such as social distancing or antimicrobial treatment are taken promptly they could decrease the probability of infection of the infant

Pre-admission clinical course of meningococcal disease and opportunities for the earlier start of appropriate intervention: a prospective epidemiological study on 752 patients in the Netherlands, 2003-2005.

Contains fulltext : 71412.pdf (publisher's version ) (Closed access)To improve the timeliness of health care delivery to patients with meningococcal disease, the early disease evolution and clinical manifestation at admission were studied in all 752 patients with invasive meningococcal disease in the Netherlands in 2003-2005. Eighty-eight percent (88%) had serogroup B disease. The case fatality rate (CFR) was 6.7% overall, but reached 16% among adults over 50 years of age. The CFR was similar for serogroups B (6.3%) and C (5.2%). Admission followed 17 h (median) after the onset of symptoms. The CFR in patients admitted within 12 h, 12-18 h, 18-36 h or >36 h after the first symptoms was 10.2, 7.8, 3.5 and 2.2%, respectively. Only 60% of patients had skin lesions, and admission followed 2 h (median) later. Earlier recognition can be achieved when non-petechial clues are included in the diagnosis. A short duration of disease before admission is a simple tool in the recognition of patients with severe disease

Vroege kenmerken en klinisch beloop van meningokokkenziekte in Nederland na invoering van Meningokokken C-vaccinatie.,[Early characteristics and clinical course of meningococcal disease in the Netherlands following the introduction of meningococcal C vaccination]

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Association between human papillomavirus vaccine uptake uptake and cervical cancer screening in the Netherlands: Implications for future impact on prevention

Several countries recently added human papillomavirus (HPV) vaccination to cervical cancer screening in the effort to prevent cervical cancer. They include the Netherlands, where both programs are free. To estimate their combined future impact on cancer prevention, information is needed on the association between participation in vaccination now and in screening in the future and on what groups are at risk for nonparticipation. We studied the association between participation in screening by mothers and in vaccination by their daughters. Girls' vaccination status was matched by house-address with their mothers' screening participation. We estimated the effect on cancer incidence by means of computer simulation. We investigated risk groups for nonparticipation using multivariable multilevel logistic regression and calculated population-attributable fractions. Our results, based on 89% of girls invited for vaccination in 2009 (n = 337,368), show that vaccination status was significantly associated with mothers' screening participation (odds ratio: 1.54 [95% confidence interval: 1.51–1.57]). If a mother's screening is taken as proxy of a girl's future screening, only 13% of the girls will not participate in either program compared to 23% if screening alone is available. The positive association between vaccination and screening resulted in slightly lower model estimates of the impact of vaccination on cancer incidence, compared to estimates assuming no association. Girls with nonwestern ethnicities, with young mothers, who live in urban areas with low socioeconomic status, are at risk for nonparticipation. A significant part of potential nonscreeners may be reached through HPV vaccination. Estimates made before vaccination was introduced only slightly overestimated its impact on cervical cancer incidence