Literature Update - June, 2005
Compiled by Dr Deb Friedman, VICNISS ID Physician
Healthcare-associated Infections in German Nursing Home Residents
Researchers in Germany (S.T. Engelhart et al, J Hosp Infect 2005;60 (1):46-50) have performed prospective surveillance for
healthcare-associated infections (HCAIs) among residents of a 103-bed nursing home over a period of one year. The overall
incidence of HCAIs was 6.0 per 1000 resident-days, with respiratory tract infections, gastroenteritis, skin/soft tissue
infections and UTIs representing 94% of all HCAIs. In addition, residents with pneumonia were 5 times more likely to die
than residents with other infections. The authors concluded that HCAIs are a serious health problem in German nursing home residents.
Obviously surveillance for nosocomial or healthcare-associated infections in long-term care facilities is time-consuming,
and many facilities would lack the required resources. In addition, the infection rate is not surprising given the fact that
the mean age of residents was 83 years in this study, and about one-third of all residents were incontinent for urine.
However, if our nursing homes are anything like the one studied in Germany, there may well be some infection control
interventions (such as vaccination against influenza and pneumococcal infection, and limiting the use of indwelling
urinary catheters) which could make a difference.
Infections in Long-term-care Facilities
The March 2005 issue of Infection Control Hospital Epidemiology devotes much attention to infections in long-term-care
facilities (LTCF).
A group from Utah described their surveillance methodologies for measuring infection rates in a cohort of LTCF to enable
comparisons between facilities (Stevenson KB, et al. Infect Control Hosp Epidemiol 2005;26(3):231-238). In addition, two
original articles describe the persistence of multidrug-resistant Streptococcus pneumoniae in a
facility caring for AIDS patients.
Stevenson et al, report a mean nosocomial infection rate of 3.64 infections per 1000 resident days, (which is lower than
the rate of 6 infections per 1000 resident days in the German study). The commonest infections were respiratory, and skin
and soft tissue. Although they initially compared individual infection rates with pooled means (as in the NNIS system), they
found that a more sensitive method was to compare individual rates with an aggregate of all other facilities.
An editorial, (Bradley SF. Infect Control Hosp Epidemiol 2005;26(3):227-230) gives a detailed overview of infections and
surveillance in LTCF. The author points out several challenges to performing surveillance in LTCF:
- The ICC is often only part-time, and thus many infections may be missed.
- Many staff in LTCF are less highly trained in surveillance and infection detection than in hospitals.
- Less observations and laboratory investigations are performed on patients in LTCF, which can pose difficulties in making
the diagnosis of a nosocomial infection.
Water Disinfection to Control Legionella
A group in Switzerland (D.S. Blanc et al. J Hosp Infect 2005;60 (1):69-72) compared methods for water disinfection in two
of their hospital water tanks. There was no significant difference in the proportion of samples positive for
Legionella spp. after ozonation or copper-silver ionization. However, they found that an
increase in water temperature from 50 to 65 °C significantly reduced Legionella isolates.
They concluded that while ozone can be a powerful disinfectant, its use for Legionella control was not efficient.
Copper–silver ionization is potentially effective, provided that a sufficient concentration of the ions is achieved,
although this might not be possible because of limits imposed by national water regulations. Maintaining the water
temperature above 50 °C in both networks proved to be the most effective control measure in their hospital.
Ventriculostomy-associated Infections
If you work at a hospital which performs neurosurgery, then you might be interested in a study of ventriculostomy-associated
infections (VAI) performed in Saudi Arabia (Arabi Y, et al. Am J Infect Control 2005;33(3):137-143). The researchers detected
an infection rate of 32 per 1000 catheter days, and the risk of infection was associated with repeat catheter insertion, the
number of catheter days and repeat catheter insertion. Placement of the ventriculostomy outside the operating room
(such as, in ICU) was associated with a trend toward higher VAI. Routine surveillance cultures of CSF were no more likely
to detect infection than cultures obtained when clinically indicated.
These are results that are in keeping with common sense, and may be of interest to the neurosurgeons at your hospital.
Hand-hygiene Behaviour, Attitudes and Beliefs in First Year Clinical Medical Students
Researchers in London have reported on the attitudes, beliefs and compliance of 200 first year medical students with hand
hygiene (Hunt DCE, et al. J Hosp Infection 2005;59 (4):371-373). These students had been given three infection control
educational sessions during the year, and their hand hygiene practices were observed during their end of year examinations
over two days. On the first day there were no posted reminders about hand hygiene, but on the second day signs were posted
reminding students to wash hands. In addition, they were asked to complete a questionnaire.
There was an improvement in the use of handrub between days 1 and 2 (9% versus 27%), but questionnaires revealed that
students greatly over-rated their compliance with hand hygiene. In addition, 20–30% of students were unclear of the
role of hand hygiene in preventing the spread of enteric infections and antimicrobial resistance.
When asked about factors which prevented them from performing hand hygiene, one-quarter of students thought that nobody
else washed their hands, suggesting a negative influence of some role models after only a year of clinical education, underlining
the importance of good clinical practice by teachers.
The low compliance reported in this study of first year clinical students is similar to that of doctors and final year
students, which suggests that education to remedy this should begin early.