Literature Update - November, 2004
Compiled by Dr Deb Friedman, VICNISS ID Physician
Control of Vancomycin-resistant Enterococci in a Hospital
The infection control team in a Taiwanese hospital (J. -T. Wang et al, Journal of Hospital Infection 2004;58:97-103) has
published their experience with control of vancomycin-resistant enterococci between 1997 and 2000.
When they instituted strict contact isolation and cohorting for all infected or colonised patients, and screened other
ward contacts, they found that they were able to control the spread of VRE and reduce their overall rate to 0.03-0.09 per
1000 discharges. However, when these measures were no longer in place in 2001, their VRE infection rate more than doubled.
The guidelines from the Hospital Infection Control Practice Advisory Committee, which include surveillance cultures,
contact isolation and cohorting, are effective for control of VRE spread.
Postdischarge Surveillance: The Impact on Surgical Site Infection Incidence
A Brazilian hospital infection control team has published their experience with postdicharge surveillance for SSI (A. C.
Oliveira et al, American Journal of Infection Control 2004;32:358-61).
When discharged from the hospital, patients were instructed to attend an outpatient clinic on the eighth postoperative
day to remove stitches and change dressings. A nurse from infection control was present during this time for evaluation and
surveillance. The patients were interviewed while in the clinic. Patients were also instructed to go to the outpatient clinic
at any time before the eighth day if changes suspicious for SSIs were detected at the surgical site.
They performed this postdischarge surveillance over an eight month period, and found that more than 70% of SSIs were
detected postdischarge. In addition, they found that this group of patients with postdischarge SSIs were more likely to
have operations of duration 2-5 hours, and a hospitalisation period between 2 to 5 days.
The authors recommend that postdischarge surveillance of SSIs should be adopted as a routine by hospital infection control
committees in order to improve the detection of SSIs.
Obviously, most infection control teams have at the very least considered performing postdischarge surveillance, or have
experimented with it over the years. While it would make a major impact on the detection of SSIs it is extremely labour
intensive, and the absence of uniform methodology will always be a limitation of the usefulness of the data collected.
High Rate of Bacterial Contamination of Expressed Breast Milk
Researchers in China commenced screening of expressed breast milk (EBM) from mothers who had neonates in the neonatal
intensive care unit (D. K. Ng et al, Journal of Hospital Infection 2004;58:.146-50). Of 59 samples from 23 mothers, 63%
were contaminated with a growth of pathogens, or had a total bacterial count of >105 cfu/mL.
This is a very high rate of contamination compared with other published data, and the authors suspect that it may be
related to the Chinese tradition of avoiding bathing for one month after childbirth.
Obviously, the big question that this raises is whether or not the feeding of contaminated EBM to babies has negative
consequences. The answer is that there is some evidence that contaminated EBM could be responsible for sepsis or necrotising
enterocolitis. For this reason, feeding of EBM to neonates was delayed when the results of these cultures were known, and
was only commenced when the milk was no longer contaminated.
So what approach should our hospitals take in regard to the culturing of EBM? It appears likely that screening of EBM
(other than for research purposes) is only indicated in response to an increase in neonatal sepsis, when it becomes of
clinical relevance.