Agents of nosocomial bacteremia and microorganisms ısolated from blood cultures in an ıntensive care unit patients

Amaç: Nozokomiyal infeksiyonlar içinde nozokomiyal bakteriyemiler önemli bir yer tutmaktadır. Biz bu çalışmada 1998 yılı boyunca reanimasyon ünitesinde izlenen hastalara ait kan kültürlerinde üreyen mikroorganizmalar ile bu hastalarda tanımlanan nozokomiyal bakteriyemi etkenlerini birlikte değerlendirmeyi amaçladık. Yöntem: 1998 yılı boyunca izlenen hastalara ait 557 kan kültürü BACTEC 9120 (Becton Dickinson, ABD) otomatize kan kültür sisteminde izlenmiştir. Kateter kültürleri ise Maki ’nin tanımladığı semikantitatif yöntemle yapılmıştır. Bulgular: Nozokomiyal bakteriyemi etkenleri içinde gram negatif basillerin % 63 oranı ile ön planda olduğu belirlenmiştir. Bu üniteden gelen kan kültürlerinde izole edilen mikroorganizmalar içinde de gram negatif basillerin oranı % 57 olarak bulunmuştur. Sonuç: Reanimasyon ünitesinde tanımlanan nozokomiyal bakteriyemi etkenlerinin dağılımında, yoğun bakım ünitelerinde beklendiği üzere gram negatif basillerin ön planda olduğu, bunu gram pozitif kokların izlediği belirlenmiştir. Kan kültürlerinde üreyen mikroorganizmalar irdelendiğinde ise (klinik olarak anlamlı bulunmayan gram pozitif koklara ait üremelerden dolayı yine ikinci sırada yer almakla birlikte) gram pozitif kokların oranı biraz daha yüksek bulunmuştur.Objective: Blood-stream infections consist a high proportion of nosocomial infections. Blood cultures and nosocomial bacteremia agents were evaluated in patients hospitalized in our reanimation unit during 1998. Material and Method: A total of 557 blood cultures were observed in automatic culture system BACTEC 9120 (Becton Dickinson, USA) whereas catheter cultures were evaluated according to Makis semi-quantitative method. Results: Gram negative bacilli constituted 63 % of all nosocomial blood-stream infection agents and 57 % of all microorganisms isolated from blood cultures. Conclusion: As expected in intensive care units, gram negative bacteria were the leading agents of nosocomial bacteremia

Will Hemoglobin Threshold for Transfusion be 7 g/dL Instead of 9 g/dL in Septic Shock?

Transfusions of red blood cells (RBCs) remain controversial in patients with septic shock but, recommended in septic shock and the majority of these patients receive RBCs transfusion in the intensive care unit (ICU). However, benefit and harm of RBCs have not been clearly established in this group of patients yet. The purpose of this short communication is to draw attention to new clinical studies performed in patients with septic shock. Holst and colleagues now provide definitive evidence that a restrictive approach to blood transfusion not only reduced blood use by half but also did not cause harm. In this multicenter, parallel-group trial, they randomly assigned patients in the intensive care unit (ICU) who had septic shock and a hemoglobin concentration of 9 g/dL per deciliter or less to receive 1 unit of leuko-reduced red cells when the hemoglobin level was 7 g/dL or less (lower threshold) or when the level was 9 g/dL or less (higher threshold) during the ICU stay. The primary outcome measure was death by 90 days after randomization. Holst et al. conclude that there are no significant differences in terms of mortality and rates of ischemic events and use of life support when considering different hemoglobin thresholds in patients with septic shock. Much like the results of the Transfusion Requirements in Septic Shock (TRISS) trial by Holst et al., approximately 50% less blood was administered in the restrictive strategy group than in the liberal-strategy group. In two recently published multicenter RCTs, “Protocolized Care for Early Septic Shock (ProCESS)” and the “Australasian Resuscitation in Sepsis Evaluation (ARISE)” trials also evaluated the results of early goal-directed therapy (EGDT) versus protocol-based standard therapy or usual care in patients with septic shock. These trials included a transfusion threshold of a hematocrit of 30% when central venous oxygen saturations remained below 70% in the EGDT group. In contrast to the triggers, in the EGDT group, protocol-based standard therapy group and usual-care group, hemoglobin level was less than 7.5 g per deciliter recommended packed red-cell transfusion. The clinical protocols of the two trials included a transfusion threshold of a hematocrit of 30% when central venous oxygen saturations remained below 70% in EGDT group. There were no significant differences in 90-day mortality, 1-year mortality, or the need for organ support between groups despite the fact that twice the number of patients in the goal-directed groups as in the usual-care groups were administered blood. At least, these four trials confirm that there is no difference in outcomes between restrictive vs. liberal transfusion targets. It implies that hemoglobin is not a discriminating factor for survival in septic shock

Agents of Hospital Infections and Antibiotic Usage in an Intensive Care Unit

This study was planned to evaluate both the agents of hospital infections and antimicrobial treatment observed in 100 (50 + 50) patients hospitalized at intensive care unit of Anesthesiology and Reanimation Department of Ankara University Medical Faculty during 1998 and 1999. Also the assessment of infection control measures and principles of rational antibiotic usage established at the beginning of 1998 was aimed. When hospital infection agents were analyzed, 7.6%, 5.2% and 3.7% increases were observed for Acinetobacter baumannii, methicillin resistant Staphylococcus aureus and Enterococcus spp. respectively in 1999 comparatively for 1998. Antimicrobial administration was evaluated in terms of DDD (defined daily dosages)/1000 hospitalization days suggested by WHO. 105 hospital infections in 1998 and 56 hospital infections in 1999 were observed. Antimicrobial usage was 260.2 DDD/1000 hospital days for 1998 and 243.6 DDD/1000 hospital days for 1999. The first three antibiotics preferred in 1998 were cephalosporins (28.1%), glycopeptides (20.6%) and carbapenems (18.5%) whereas in 1999 the first three were aminoglycosides (25.9%), carbapenems (21.5%) and glycopeptides (19.6%). Aminoglycoside and carbapenem preference was increased during 1999 because of highly occurence of A. baumannii among the infective agents

Impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach, over 8 years, in 11 cities of Turkey

Aims: To evaluate the effectiveness of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Hand Hygiene Approach in Turkey and analyse predictors of poor hand hygiene compliance. Design: An observational, prospective, interventional, before-and-after study was conducted from August 2003 to August 2011 in 12 intensive care units (ICU) of 12 hospitals in 11 cities. The study was divided into a baseline and a follow-up period and included random 30-minute observations for hand hygiene compliance in ICU. The hand hygiene approach included administrative support, supplies availability, education and training, reminders in the workplace, process surveillance, and performance feedback. Results: We observed 21,145 opportunities for hand hygiene. Overall hand hygiene compliance increased from 28.8% to 91% (95% CI 87.6–93.0, p 0.0001). Multivariate and univariate analyses showed that several variables were significantly associated with poor hand hygiene compliance: males vs. females (39% vs. 48%; 95% CI 0.79–0.84, p 0.0001), ancillary staff vs. physicians (35% vs. 46%, 95% CI 0.73–0.78, p 0.0001), and adult vs. pediatric ICUs (42% vs. 74%, 95% CI 0.54–0.60, p 0.0001). Conclusions: Adherence to hand hygiene was significantly increased with the INICC Hand Hygiene Approach. Specific programmes should be directed to improve hand hygiene in variables found to be predictors of poor hand hygiene compliance

Impact of a multidimensional infection control approach on central line-associated bloodstream infections rates in adult intensive care units of 8 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC)

Background: Central line-associated bloodstream infections (CLABs) have long been associated with excess lengths of stay, increased hospital costs and mortality attributable to them. Different studies from developed countries have shown that practice bundles reduce the incidence of CLAB in intensive care units. However, the impact of the bundle strategy has not been systematically analyzed in the adult intensive care unit (ICU) setting in developing countries, such as Turkey. The aim of this study is to analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce the rates of CLAB in 13 ICUs of 13 INICC member hospitals from 8 cities of Turkey

Impact of a multidimensional infection control approach on central line-associated bloodstream infections rates in adult intensive care units of 8 cities of Turkey: findings of the International Nosocomial Infection Control Consortium (INICC)

Background: Central line-associated bloodstream infections (CLABs) have long been associated with excess lengths of stay, increased hospital costs and mortality attributable to them. Different studies from developed countries have shown that practice bundles reduce the incidence of CLAB in intensive care units. However, the impact of the bundle strategy has not been systematically analyzed in the adult intensive care unit (ICU) setting in developing countries, such as Turkey. The aim of this study is to analyze the impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional infection control approach to reduce the rates of CLAB in 13 ICUs of 13 INICC member hospitals from 8 cities of Turkey. Methods: We conducted active, prospective surveillance before-after study to determine CLAB rates in a cohort of 4,017 adults hospitalized in ICUs. We applied the definitions of the CDC/NHSN and INICC surveillance methods. The study was divided into baseline and intervention periods. During baseline, active outcome surveillance of CLAB rates was performed. During intervention, the INICC multidimensional approach for CLAB reduction was implemented and included the following measures: 1-bundle of infection control interventions, 2-education, 3-outcome surveillance, 4-process surveillance, 5-feedback of CLAB rates, and 6-performance feedback on infection control practices. CLAB rates obtained in baseline were compared with CLAB rates obtained during intervention. Results: During baseline, 3,129 central line (CL) days were recorded, and during intervention, we recorded 23,463 CL-days. We used random effects Poisson regression to account for clustering of CLAB rates within hospital across time periods. The baseline CLAB rate was 22.7 per 1000 CL days, which was decreased during the intervention period to 12.0 CLABs per 1000 CL days (IRR 0.613; 95% CI 0.43 - 0.87; P 0.007). This amounted to a 39% reduction in the incidence rate of CLAB. Conclusions: The implementation of multidimensional infection control approach was associated with a significant reduction in the CLAB rates in adult ICUs of Turkey, and thus should be widely implemented

Control Consortium findings (INICC)

Background: We evaluate the effectiveness of a multidimensional infection control approach for the reduction of catheter-associated urinary tract infections (CAUTIs) in 13 intensive care units (ICUs) in 10 hospital members of the International Nosocomial Infection Control Consortium (INICC) from 10 cities of Turkey.Methods: A before-after prospective active surveillance study was used to determine rates of CAUTI. The study was divided into baseline (phase 1) and intervention (phase 2). In phase 1, surveillance was performed applying the definitions of the Centers for Disease Control and Prevention/National Healthcare Safety Network. In phase 2, we implemented a multidimensional approach that included bundle of infection control interventions, education, surveillance and feedback on CAUTI rates, process surveillance, and performance feedback. We used random effects Poisson regression to account for clustering of CAUTI rates across time periods.Results: The study included 4,231 patients, hospitalized in 13 ICUs, in 10 hospitals, in 10 cities, during 49,644 patient-days. We recorded a total of 41,871 urinary catheter (UC)-days: 5,080 in phase 1 and 36,791 in phase 2. During phase 1, the rate of CAUTI was 10.63 per 1,000 UC-days and was significantly decreased by 47% in phase 2 to 5.65 per 1,000 UC-days (relative risk, 0.53; 95% confidence interval: 0.4-0.7; P value = .0001).Conclusion: Our multidimensional approach was associated with a significant reduction in the rates of CAUTI in Turkey. Copyright (C) 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved

International Nosocomial Infection Control Consortium (INICC) national report on device-associated infection rates in 19 cities of Turkey, data summary for 2003-2012

Background: Device-associated healthcare-acquired infections (DA-HAI) pose a threat to patient safety, particularly in the intensive care unit (ICU). We report the results of the International Infection Control Consortium (INICC) study conducted in Turkey from August 2003 through October 2012

Time-dependent analysis of extra length of stay and mortality due to ventilator-associated pneumonia in intensive-care units of ten limited-resources countries: findings of the International Nosocomial Infection Control Consortium (INICC)

Ventilator-associated pneumonias (VAPs) are a worldwide problem that significantly increases patient morbidity, mortality, and length of stay (LoS), and their effects should be estimated to account for the timing of infection. The purpose of the study was to estimate extra LoS and mortality in an intensive-care unit (ICU) due to a VAP in a cohort of 69 248 admissions followed for 283 069 days in ICUs from 10 countries. Data were arranged according to the multi-state format. Extra LoS and increased risk of death were estimated independently in each country, and their results were combined using a random-effects meta-analysis. VAP prolonged LoS by an average of 2.03 days (95% CI 1.52-2.54 days), and increased the risk of death by 14% (95% CI 2-27). The increased risk of death due to VAP was explained by confounding with patient morbidity