Widmer, A.

International Journal of Infectious Diseases

Elsevier - Publisher Connector 

Prevention of Surgical Infections 

(Inv
t
e
n
H
T
g
e
c
H
(
a
c
B
I
p
o
a
e
p
s
d
2
P
A
S
m
i
e
S
d
c
t
I
a
t
o
u
v
a
d
g
T
r
n
I
i
E
t
s13th International Congress on Infectious Diseases Abstracts
27.002
Preventing Catheter-Related Bloodstream Infections
T.M. Perl
Johns Hopkins University, Baltimore, MD, USA
The use of non-tunneled central venous catheters is increas-
ing among patients in all settings including intensive care
units as they enhance medical care. However, catheters
and their placement provide an opportunity for bacteria
to enter the bloodstream causing infection, or a catheter-
associated bloodstream infection (CABSI). These infections
contribute signiﬁcantly to patient morbidity and mortality
and are costly to healthcare systems. However, they are pre-
ventable. While evidence based guidelines to prevent these
infections exist, they are complicated and have been dif-
ﬁcult to implement in the healthcare setting. The salient
elements have not been systematically translated into a for-
mat so that 1) healthcare workers know what they need
to do, 2) institutions know how to facilitate the behavior
with supplies and 3) the outcomes are communicated to the
healthcare workers. The science behind a simple ‘‘bundle of
non-technologic but infection prevention and control inter-
ventions’’ which can be used in resource limited and rich
settings includes the use of 1) hand hygiene prior to placing
the line, 2) a chlorhexidine based skin preparation prior at
the insertion site of the line, 3) the subclavian vein site over
other sites for line placement whenever medical feasible,
4) full barrier drapping of the patient during the proce-
dure, and 5) daily attempts to remove the line. In addition,
appropriate line care and dressing use once the insertion
is completed were taught. In this paper we will use the
experience at an institution and in several other settings to
demonstrate how to operationalize such an intervention. We
will look at the impact on CABSI rates in adult and pediatric
settings.
The intervention can be put in context of a behavioral
modiﬁcation model proposed by Rodgers et al. In this model
elements of the intervention include factors that enhance
knowledge and facilitate behavior and attitude change. We
will review enabling factors primarily from the institution
that will improve behavior and we will look at techniques to
reinforce behavior.
doi:10.1016/j.ijid.2008.05.080
27.003
Relevant Vaccines for Health Care Workers
S. Ponce de Leon
Birmex, Ministry of Health, Mexico City, Mexico
Immunization among HCWs has two purposes, both which
allow for better prevention. Immunization’s ﬁrst purpose is
to protect HCWs from several infectious diseases they may
be exposed to through professional activities. A second pur-
pose is to minimize the odds of infecting the patients they
are taking care of. It should be clear that both objectives are
extremely important and should be a priority to any health
system. Another consideration is the importance of estab-
lishing this preventive measure in low-income regions where
u
T
t
c
aited Papers) e15
he shortage of HCWs is aggravated due to infectious dis-
ases (Hepatitis B and C, TB) affecting these professionals.
The landscape of public health has plenty of examples of
eglected situations. In developing regions the protection of
CWs has been ignored in the most ﬂagrant circumstances.
here is a lack of regulations to establish vaccination pro-
rams and the protection needed for accidental injuries.
Any health care service or system should establish an
mployee health program in collaboration with the infection
ontrol department that includes a vaccination schedule for
CWs. It is essential that vaccines for Hepatitis B, Inﬂuenza
yearly), Measles, Mumps, Rubella, Tetanus and Diphteria
re administered. According to regional epidemiological
ircumstances other vaccines may be considered, such as
CG, Yellow Fever, Varicella-zoster, Hepatitis A, Cholera and
nﬂuenza A H5 N1.
Surprisingly, HCWs are reluctant to accept vaccination
rograms as is shown by multiple reports for very low rates
f acceptance. This is a challenge every program needs to
ddress, and strategies to improve acceptance should be
valuated. Establishing a wide and continuous vaccination
rogram should be a high priority project in any health care
ystem.
oi:10.1016/j.ijid.2008.05.081
7.004
revention of Surgical Infections
. Widmer
University Hospital Basel, Basel, Switzerland
urgical site infections (SSIs) are the second most com-
on cause of nosocomial infections resulting in considerable
ncrease in morbidity andmortality. The U.S. Centers for Dis-
ase Control and Prevention (CDC) estimate that 500,000
SIs occur annually in the United States. Patients who
evelop SSIs are up to 60% more likely to require intensive
are, are up to 5 times more likely readmitted for complica-
ions, and twice as likely to die as patients without an SSI.
n addition, SSIs increase health care costs by $ 5—10,000
nd double mortality after procedures. Dozens of risk fac-
ors have been identiﬁed that partly predict the incidence
f SSIs. The can be basically classiﬁed in risk factors by the
nderlying diseases of the patient, risk factors of the inter-
ention, risk factors by the surgical team and management,
nd environmental factors. Multiple strategies have been
eveloped to decrease the incidence of SSIs, but many are
iven by the patient such as age and underlying diseases.
he CDC has developed key compounds that increase the
isk of SSIs: Surgery exceeding the T-time, level of contami-
ation of surgery (contaminated or dirty) and ASA score >3.
n addition, Wenzel RP and colleagues already demonstrated
n the seventies that surgical volume is associated with SSIs.
stablished risk factors are ongoing infections other than
he surgical site, insufﬁcient heating of the patient during
urgery, failure to give appropriate oxygen supply and fail-
re to give appropriate, timely antimicrobial prophylaxis.
he latter is likely the most important, but very difﬁcult
o introduce in a busy operating theatre. Common infection
ontrol practices that are poorly supported by clinical tri-
ls are laminar air ﬂow for implant surgery, hand antisepsis
e iona
p
b
d
h
i
d
t
h
b
o
l
H
k
d
N
(
2
M
-
C
R
t
2
e
t
y
v
s
g
p
ﬁ
s
i
a
i
c
a
p
n
t
o
c
r
t
d
2
L
m
S
I
b
1
H
p
t
n
m
w
t
h
m
l
C
e
a
c
w
a
c
5
w
I
H
C
a
a
w
r
t
d
2
V
L16 13th Internat
rior to surgery, and disinfection of the surgical site. Last,
ut not least, surveillance of SSIs is a well-established, well
ocumented approach to lower the incidence of SSIs. Many
ospitals still do not follow this recommendation despite
ts effectiveness. Endoscopy and robotic surgeries are new
evelopments that further help to keep rates of SSIs at
he lowest possible level. However, as patients leave the
ospital at a very early stage, post-discharge surveillance
ecomes mandatory. Many studies indicate that about 50%
f the SSIs undergo undetected unless postdischarge surveil-
ance is performed.
A lot of research has been performed in the last decade:
owever, many hospital still fail to implement these new
nowledge into clinical practice.
oi:10.1016/j.ijid.2008.05.082
ew Generation Multivalent Vaccines Designed to Do More
invited)
8.001
ultivalent Protection Against a Severe Pediatric Disease
Rotavirus
. Christie
University of the West Indies, Kingston, Jamaica
otaviruses are the foremost cause of severe gastroenteri-
is in young children, being responsible for 600,000 deaths,
million hospitalizations, 25million clinic visits, 111million
pisodes and 56% of hospitalizations for febrile gastroenteri-
is worldwide, each year. Every child is infected by age ﬁve
ears. RotateqTM is an oral, ready-to-use, 3-dose regimen
accine, containing 5 human-bovine reassortant rotavirus
erotypes given at 2, 4, 6 months of age, that is easily inte-
rated into pre-established immunization schedules. The
roduct has been studied in over 70,000 infants from all
ve continents. RotateqTM has proven efﬁcacy of 98% against
evere gastroenteritis for G1-4 strains, was well tolerated,
ncluding with respect to intussusception in prelicensure
nd postmarketing surveillance, with no increase in fever,
rritability, or hematochezia, while it reduced health care
ontacts for rotaviruses by nearly 100%. RotateqTM has FDA-
pproval and is now in use in 70 countries, with application
ending in another 75 countries, worldwide. RotateqTM is
owwidely available in USA, Canada, Australia, eleven coun-
ries in Europe, Latin America, the Caribbean and also in
ther parts of the world. RotateqTM is now in the review pro-
ess for WHO-prequaliﬁcation. Given the universal nature of
otavirus gastroenteritis, this vaccine is an extremely impor-
ant public health priority.
oi:10.1016/j.ijid.2008.05.083
V
m
e
t
H
&
p
d
2
w
i
a
G
vl Congress on Infectious Diseases Abstracts (Invited Papers)
8.002
ong Term Beneﬁts of the Quadrivalent Human Papillo-
avirus Vaccine (HPV)
. Garland
The Royal Womens Hospital, Victoria, Australia
t is now realised that 99.7% of cervical cancers are caused
y oncogenic HPV infection: and worldwide HPV types 16 and
8 consistently account for 70% to 80% of cases. Moreover
PV types 16 and 18 contribute to 50% of high-grade dys-
lasias, and 25% of low-grade dysplasias. In addition, HPV is
he most common viral infection with condylomata accumi-
ata or genital warts (90% caused by HPV 6/11) being the
ost common viral sexually transmitted disease. Genital
arts peak in the mid-20 age group, commonly recur post-
reatment, and consequently are a costly burden in sexual
ealth settings, as well as causing signiﬁcant psychosocial
orbidity to those infected.
In phase III clinical trials of the quadrivalent human papil-
omavirus vaccine (6,11,16,18), vaccine HPV type-related
IN2/3, VIN 2/3 and VaIN 2/3 were used as surrogate
ndpoints in determining efﬁcacy against cervical, vulvar
nd vaginal cancers, respectively. Randomized, placebo-
ontrolled, double-blind trials involving more than 25,000
omen aged 15 - 26 years have shown up to 100% efﬁcacy
gainst HPV 6, 11, 16 and 18 related CIN2/3, AIS (adenocar-
inoma in situ), VIN, VaIN, as well as genital warts. Through
years of follow-up, the clinical efﬁcacy was maintained
ith no breakthrough cases observed in the vaccine group.
nmid adult women aged 24 - 45, the efﬁcacy of quadrivalent
PV vaccine in the prevention of HPV6/11/16/18-related
IN or external genital lesions (EGL) was 92.4%, with efﬁcacy
gainst HPV16/18-related CIN or EGL being 87.8%. Efﬁcacy
gainst HPV6/11-related CIN or EGL was 100%.
In all studies, vaccine was generally well-tolerated,
ith a signiﬁcant but slightly higher proportion of subjects
eporting one or more injection site adverse experiences
han the placebo group.
oi:10.1016/j.ijid.2008.05.084
8.003
alue of the Quadrivalent HPV Vaccine
.L. Villa
Ludwig Institute for Cancer Research, Brazil
accines provide long-term protection by inducing immune
emory - the ability to rapidly produce high antibody lev-
ls on subsequent encounters with pathogens targeted by
he vaccine. Prophylactic administration of a quadrivalent
PV (types 6/11/16/18) L1 VLP vaccine (GARDASIL®, Merck
Co., Inc.) to 16- to 23-year-olds was 96% effective in
reventing HPV 6/11/16/18 persistent infection or related
isease through 5 years of follow-up (Villa et al., Br J Cancer,
006). Sustained efﬁcacy against disease was maintained
ith no breakthrough cases of HPV 6, 11, 16 or 18-related
nfection or disease. In the same study, at the 5 year mark,
n antigen challenge was given that demonstrated that
ARDASIL® (formulated on a proprietary aluminum adju-
ant) had induced immune memory, a hallmark of vaccines


file:///data/remote/core/dit/data/elsevier/pdf/346/aHR0cDovL2FwaS5lbHNldmllci5jb20vY29udGVudC9hcnRpY2xlL3BpaS9zMTIwMTk3MTIwODAwMjA2Mw==.pdf

Prevention of Surgical Infections

Abstract

Similar works

Full text

Available Versions

Elsevier - Publisher Connector

Elsevier - Publisher Connector