Efficacy of Infection Control Interventions in Reducing the Spread of Multidrug-Resistant Organisms in the Hospital Setting

Multidrug-resistant organisms (MDRO) continue to spread in hospitals globally, but the population-level impact of recommended preventive strategies and the relative benefit of individual strategies targeting all MDRO in the hospital setting are unclear. To explore the dynamics of MDRO transmission in the hospital, we develop a model extending data from clinical individual-level studies to quantify the impact of hand hygiene, contact precautions, reducing antimicrobial exposure and screening surveillance cultures in decreasing the prevalence of MDRO colonization and infection. The effect of an ongoing increase in the influx of patients colonized with MDRO into the hospital setting is also quantified. We find that most recommended strategies have substantial effect in decreasing the prevalence of MDRO over time. However, screening for asymptomatic MDRO colonization among patients who are not receiving antimicrobials is of minimal value in reducing the spread of MDRO

MRSA prevalence in european healthcare settings: a review

<p>Abstract</p> <p>Background</p> <p>During the past two decades, methicillin-resistant <it>Staphylococcus aureus </it>(MRSA) has become increasingly common as a source of nosocomial infections. Most studies of MRSA surveillance were performed during outbreaks, so that results are not applicable to settings in which MRSA is endemic. This paper gives an overview of MRSA prevalence in hospitals and other healthcare institutions in non-outbreak situations in Western Europe.</p> <p>Methods</p> <p>A keyword search was conducted in the Medline database (2000 through June 2010). Titles and abstracts were screened to identify studies on MRSA prevalence in patients in non-outbreak situations in European healthcare facilities. Each study was assessed using seven quality criteria (outcome definition, time unit, target population, participants, observer bias, screening procedure, swabbing sites) and categorized as 'good', 'fair', or 'poor'.</p> <p>Results</p> <p>31 observational studies were included in the review. Four of the studies were of good quality. Surveillance screening of MRSA was performed in long-term care (11 studies) and acute care (20 studies). Prevalence rates varied over a wide range, from less than 1% to greater than 20%. Prevalence in the acute care and long-term care settings was comparable. The prevalence of MRSA was expressed in various ways - the percentage of MRSA among patients (range between 1% and 24%), the percentage of MRSA among <it>S. aureus </it>isolates (range between 5% and 54%), and as the prevalence density (range between 0.4 and 4 MRSA cases per 1,000 patient days). The screening policy differed with respect to time points (on admission or during hospital stay), selection criteria (all admissions or patients at high risk for MRSA) and anatomical sampling sites.</p> <p>Conclusions</p> <p>This review underlines the methodological differences between studies of MRSA surveillance. For comparisons between different healthcare settings, surveillance methods and outcome calculations should be standardized.</p

La identidad latinoamericana: proceso contradictorio de su construcción- deconstrucción- reconfiguración dentro de contextos globales

Este artículo aborda la difícil y contradictoria formación, consolidación y cambios experimentados por la identidad latinoamericana desde una perspectiva antropológica y holística. Se la ubica en los contextos de la emergencia del Sistema-mundo con la conquista y colonización, de las luchas de la época de la independencia y su actual reconfiguración en el escenario de la globalización transnacional y de las alternativas en marcha. La óptica adoptada podríamos llamarla dinámica-sintética, la cual ve la identidad como un proceso abierto en permanente cambio en donde dinámicas contradictorias interactúan en la construcción-deconstrucción-reconfiguración de la identidad latinoamericana ubicada en contextos históricos específicos. Nuestra identidad colectiva continental es analizada como el resultado de las complejas tensiones de dinámicas civilizacionales diferentes y de fuerzas geopolíticas contrarias. Se combinan la dialéctica y la dialógica que posibilitan que elementos diferentes y contrarios se reconcilien en síntesis innovadoras y también abren un espacio de diálogo para que lo compartido no solamente no niegue lo específico, sino que interactúen positivamente. En otros términos, ponen en interrelación el nosotros y los otros , lo nacional y lo continental , lo local y lo global . Lo que permite comprender mejor nuestro proceso nominativo continental incluyente : hispanoamericano , iberoamericano , latinoamericano