Literature Update - January, 2005
Compiled by Dr Deb Friedman, VICNISS ID Physician
Risks to Healthcare Workers from Glutaraldehyde Alternatives in High-level Disinfection
A group from Canada recently surveyed 64 hospitals to assess whether they used glutaraldehyde or an alternative product in high-level disinfection (K. Rideout et al. J Hosp Infection 2005;59:4-11).
They found that 80% of 64 hospitals used high-level disinfection; 49% used glutaraldehyde alone and 51% had introduced alternatives (ortho-phthalaldehyde (OPA), and a mixture of hydrogen peroxide and peracetic acid). The reason stated for using an alternative was concerns about health risks from glutaraldehyde, however most hospitals had little knowledge about the potential adverse effects of the alternative agents.
The authors searched the literature and manufacturers data and report that although all products irritate the skin and respiratory tract, OPA is a potential dermal and respiratory sensitiser but hydrogen peroxide and peracetic acid do not cause allergic reactions. They caution that high-level disinfectants all have some adverse effects, and these need to be considered when choosing an agent.
Safety Devices for Preventing Percutaneous Injuries Related to Phlebotomy
Researchers in France sought to determine the effectiveness of 2 protective devices in preventing needlestick injuries to health
care workers performing phlebotomy (Anne-Marie Rogues et al. Am J Infection Control 2004;32:441-4).
Products evaluated included resheathable winged steel needles (SafetyLok, Becton Dickinson) and Vacutainer blood-collecting tubes
with recapping sheaths (SafetyLok, Becton Dickinson). Needlestick injury rates were compared before and after introducing these
devices.
Phlebotomy procedures accounted for 19.4% of all percutaneous injuries in the preintervention period and 12% in the
postintervention period (RR, O.62; 95% CI, 0.51-0.72; P < .001). Needlestick-related
injuries incidence rate decreased significantly after the implementation of the 2 safety devices, representing a 48%
decline in incidence rate overall.
Obviously this study does is limited by the fact that compliance with the use of these products was not known,
and also, it is not clear whether improved compliance with universal precautions contributed to the reduction in
injuries. Nonetheless, adds to the existing body of literature about safety devices and their effectiveness.
Costs Associated with Hospital-acquired Bacteraemia
Although much data exists to support the fact that nosocomial bloodstream infections (BSI) are expensive, researchers from Belgium
have studied the extra costs associated with nosocomial BSI ( M. Pirson et al . J Hosp Infection 2005;59:33-40).
They found that t he incidence of BSI was 6.6 per 10,000 patient days, and patients with a hospital-acquired BSI experienced
a significantly longer stay (average 21.1 days, P <0.001), a significantly higher mortality
(average 32.2%, P <0.01), and cost significantly more (average €12,853 {22,194.83 AUD},
P <0.001) than similar patients without bacteraemia. They further analysed these costs by bodily
system, and by type of cost. They found that patients had increased medical (pathology, radiology, antibiotics, physiotherapy)
and non-medical costs, and that digestive (gastrointestinal) system costs were highest in patients with BSI compared with patients
without BSI.
The authors do not seek to explain why the digestive costs are so high, but nonetheless this study indicates yet again that
prevention of nosocomial BSI is important, as it will save both lives and money.
Staphylococcus aureus and Wounds: A Review of Tea Tree Oil as a Promising Antimicrobial
Melaleuca alternifolia oil (tea tree oil), an essential oil, has demonstrated promising efficacy in
treating infections due to Staphylococcus (Linda Halcón et al, Am J Infection Control 2004;32:402-8). This paper is a review
of the existing literature on the topic of tea tree oil, and supports the contention that further large controlled trials on this
product are reasonable. It appears to have a use in treating chronic wounds, and also in decolonising patients with MRSA.
Promoting Quality Through Surveillance of Surgical Site Infections: Five Prevention Success Stories
Don’t we all wish that we had success stories to report about how our surveillance for SSI had led to a reduction in SSI
rate? Several hospitals in the Netherlands have published their success stories! (Eveline L.P.E. Geubbels et al. Am J Infection
Control 2004;32:424-30).
Faced with Orthopaedic SSI rates in excess of the National average they reviewed their operating theatre practices in detail,
made changes and found a reduction in SSI. These success stories are certainly worth reading in detail, as many of their methods
are those that we too should employ when faced with the same scenario.