1. 

Davies P. Back to the basics of wound care: why nurses should question theirpractice. Prof Nurse. 2004 Oct; 20(2):29-31. Review.

2. 

Vincent JL, Chierego M, Struelens M, Byl B. Infection control in the intensive care unit. Expert Rev Anti Infect Ther. 2004 Oct;2(5):795-805. Review.

Free University of Brussels, Department of Intensive Care, Erasme Hospital, Brussels, Belgium.  jlvincen@ulb.ac.be

Nosocomial infections are common in many hospital departments, but particularly so on the intensive care unit, where they affect some 20 to 30% of patients. While early diagnosis and appropriate treatment are, of course, important, perhaps the greatest challenge is in the application of techniques to limit the development of such infections. This review will briefly discuss some of the background pathophysiology and epidemiology of nosocomial infection, and then focus on general and infection-specific preventative strategies individually and as part of broader infection-control programs with infection surveillance.

3. 

Warren DK, Hill HA, Merz LR, Kollef MH, Hayden MK, Fraser VJ, Fridkin SK. Cycling empirical antimicrobial agents to prevent emergence of antimicrobial-resistant Gram-negative bacteria among intensive care unit patients. Crit Care Med. 2004 Dec; 32(12):2450-6.

Department of Medicine, Washington University School of Medicine, St. Louis, MO 63110, USA. dwarren@im.wustl.edu

OBJECTIVE: To determine the impact of the rotation of antimicrobial agents on the rates of infection, intestinal colonization, and acquisition with antimicrobial-resistant Gram-negative bacteria. DESIGN: Pre- and postintervention design. SETTING: A 19-bed, medical intensive care unit. PATIENTS: Individuals admitted to the study unit for >48 hrs. INTERVENTIONS: After a 5-month baseline observation period, four classes of antimicrobial agents with Gram-negative activity were cycled at 3- to 4-month intervals for 24 months. MEASUREMENTS AND MAIN RESULTS: The primary outcome was the acquisition rate of antimicrobial resistance among Enterobacteriaceae and Pseudomonas aeruginosa obtained from rectal swab cultures performed on admission, weekly during the patients' stay, and at discharge. Rates and microbiology of nosocomial bloodstream infections and ventilator-associated pneumonia were also compared between baseline and cycling periods. The cycling program resulted in a significant change in prescribing practices; the predominant agent used changed with each cycle. Among study patients who were not already colonized with a resistant organism, the rate of acquisition of enteric colonization with bacteria resistant to any of the target drugs remained stable during the cycling period for P. aeruginosa (relative rate, 0.96; 95% confidence Interval, 0.47-2.16) and Enterobacteriaceae (relative rate, 1.57; 95% confidence interval, 0.80-3.43). Hospital-wide, P. aeruginosa from routine clinical cultures resistant to the target drugs increased during the cycling period. The proportion of Gram-negative bacteria isolated from cases of nosocomial bloodstream infection (29% baseline vs. 26% cycling; p = .11) and ventilator-associated pneumonia (80% vs. 41%; p = .06) did not significantly differ. CONCLUSIONS: In this study, antimicrobial cycling did not result in a significant change in enteric acquisition of resistant Gram-negative bacteria among intensive care unit patients.

4. 

Kukino J, Naito T, Mitsuhashi K, Oshima H, Sekiya S, Isonuma H, Watanabe K, Dambara T, Hayashida Y. Susceptibility of medical students to vaccine-preventable viral diseases: a serological study. J Infect Chemother. 2004 Dec; 10(6):335-7.

Department of General Medicine, Juntendo University School of Medicine, 2-1-1 Bunkyo-ku, Tokyo 113-8421, Japan.

As a measure for the prevention and control of nosocomial infections in medical school students, we examined the students' titers of antibodies to measles, rubella, varicella, and mumps viruses to determine whether vaccination was required. We also analyzed and discussed correlations among antibody titers to the viruses. Subjects were 363 Juntendo University students, ranging from freshmen to seniors. EIA was used to measure IgG antibody titers. Eight subjects (2.2%) had negative titers for measles, 36 (9.9%) for rubella, 8 (2.2%) for varicella, and 10 (2.7%) for mumps. Seronegative subjects were vaccinated against each virus and high seroconversion rates were obtained: 100% for measles and rubella, 67% for varicella, and 89% for mumps. In addition, we used Pearson's test to search for correlations among the antibody titers for each virus. A weak correlation was observed among antibody titers for measles, rubella, and mumps but not for varicella. These results suggest that MMR vaccine might be effective in people with low levels of antibody to measles, rubella, and mumps.

5. 

Pajkos A, Vickery K, Cossart Y. Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and decontamination? J Hosp Infect. 2004 Nov; 58(3):224-9.

Department of Infectious Diseases and Immunology, University of Sydney and The Australian Centre for Hepatitis Virology, Sydney, NSW 2006, Australia.

We predicted that biofilm would form on surfaces of endoscope tubing in contact with fluids, and may be difficult to remove by current washing procedures. Its presence may protect micro-organisms from disinfectant action and contribute to failure of decontamination prior to re-use. Tubing samples removed from 13 endoscopes that had been sent to an endoscope-servicing centre were examined for the presence of biofilm and bacteria by scanning electron microscopy. Biological deposits were present on all samples tested. Biofilm (bacteria plus exopolysaccharides matrix) was present on the suction/biopsy channels of five of 13 instruments, and was very extensive on one of these. Bacteria and microcolonies were often but not necessarily associated with surface defects on the tubing. All 12 air/water channels examined showed biofilm, and this was extensive on nine samples. Routine cleaning procedures do not remove biofilm reliably from endoscope channels, and this may explain the unexpected failure of decontamination encountered in practice despite good adherence to infection control guidelines.

6.  

Hall J, Hodgson G, Kerr KG. Provision of safe potable water for immuno- compromised patients in hospital. J Hosp Infect. 2004 Oct; 58(2):155-8.

Department of Infection Control, Leeds Teaching Hospitals Trust, Leeds, UK.

We conducted a survey of hospital drinking water provision for patients with immunocompromising conditions in 15 Trusts in the north of England. Ten trusts replied, reporting on provision of drinking water in 14 separate units. Of these, nine provided only tap water to all patients, irrespective of underlying condition. In two units, iced water, with ice from commercially available makers, was used. Five units distinguished between neutropenic and non-neutropenic patients, with the former group receiving cooled, boiled water (three units), sterile water and sterile water or carbonated water (one unit each). No unit provided filtered water. Water in jugs was changed daily, twice daily or only when empty in seven, three and four units, respectively. On 10 units, patients were allowed to provide their own drinking water, but no unit provided written advice to patients on potable water. A survey within our own Trust revealed similar inter-unit disparity. The options for potable water provision were reviewed, taking into account: microbiological quality, organoleptic (perceived taste/smell) acceptability, cost and factors relating to staff safety and patient confidentiality [as it was possible for human immunodeficiency virus (HIV) seropositive patients on some wards to be identified because they were provided with cooled, boiled water]. It concluded that end-line commercially available water filters were the optimal way to provide drinking water to immunocompromised patients in hospital.

Diagnosis, Diagnostics, Immunodiagnosis & Immunodiagnostics:  

11645.    Combes A, Luyt CE, Fagon JY, Wollf M, Trouillet JL, Gibert C, Chastre J; PNEUMA Trial Group. Impact of methicillin resistance on outcome of Staphylococcus aureus ventilator-associated pneumonia. Am J Respir Crit Care Med. 2004 Oct 1;170(7):786-92. Epub 2004 Jul 08.

11646.   Conroy FJ. Preventing the spread of MRSA: ...and the role of practices such as phlebotomy is worth considering. BMJ. 2004 Oct 23;329(7472):978.

11647.    Corona A, Wilson AP, Grassi M, Singer M. Prospective audit of bacteraemia management in a university hospital ICU using a general strategy of short-course monotherapy. J Antimicrob Chemother. 2004 Oct;54(4):809-17.

11648.    Davies P. Back to the basics of wound care: why nurses should question their practice. Prof Nurse. 2004 Oct;20(2):29-31. Review.

11649.    Dobbins BM, Kite P, Catton JA, Wilcox MH, McMahon MJ. In situ endoluminal brushing: a safe technique for the diagnosis of catheter-related bloodstream infection. J Hosp Infect. 2004 Nov;58(3):233-7.

11650.    Ferroni A, Beauvais R, Colomb V, Gaillard JL, Berche P, Hubert P, Poisson-Salomon AS.  Strategies for the diagnosis and treatment of bacteraemia in children with central venous catheters: an analysis. J Hosp Infect. 2004 Oct;58(2):128-36.

11651.    Hampton S. Nursing management of urinary tract infections for catheterized patients. Br J Nurs. 2004 Nov 11-24;13(20):1180-4. Review.

11652.    Kang CI, Kim SH, Park WB, Lee KD, Kim HB, Kim EC, Oh MD, Choe KW. Bloodstream infections due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for mortality and treatment outcome, with special emphasis on antimicrobial therapy. Antimicrob Agents Chemother. 2004 Dec;48(12):4574-81.

11653.    Keith DD, Garrett KM, Hickox G, Echols B, Comeau E. Ventilator-associated pneumonia: improved clinical outcomes. J Nurs Care Qual. 2004 Oct-Dec;19(4):328-33; quiz 334-5.

11654.    Laupland KB, Kirkpatrick AW, Church DL, Ross T, Gregson DB. Intensive-care-unit-acquired bloodstream infections in a regional critically ill population. J Hosp Infect. 2004 Oct;58(2):137-45.

11655.    McDonald LC, Hageman JC. Vancomycin intermediate and resistant Staphylococcus aureus. What the nephrologist needs to know. Nephrol News Issues. 2004 Oct;18(11):63-4, 66-7, 71-2 passim. Review.

11656.    McGuire W, Clerihew L, Fowlie PW. Infection in the preterm infant. BMJ. 2004 Nov 27;329(7477):1277-80. Review.

11657.    Ostrosky-Zeichner L. Prophylaxis or preemptive therapy of invasive candidiasis in the intensive care unit? Crit Care Med. 2004 Dec;32(12):2552-3.

11658.    Randolph AG, Reder L, Englund JA. Risk of bacterial infection in previously healthy respiratory syncytial virus-infected young children admitted to the intensive care unit. Pediatr Infect Dis J. 2004 Nov;23(11):990-4.

11659.    Rupp ME, Fitzgerald T, Marion N, Helget V, Puumala S, Anderson JR, Fey PD. Effect of silver-coated urinary catheters: efficacy, cost-effectiveness, and antimicrobial resistance. Am J Infect Control. 2004 Dec;32(8):445-50.

11660.    Singhi SC, Reddy TC, Chakrabarti A. Oral itraconazole in treatment of candidemia in a pediatric intensive care unit. Indian J Pediatr. 2004 Nov;71(11):973-7.

11661.    Taneja N, Emmanuel R, Chari PS, Sharma M. A prospective study of hospital-acquired infections in burn patients at a tertiary care referral centre in North India. Burns. 2004 Nov;30(7):665-9.

11662.    Tekerekoglu MS, Durmaz R, Ay S, Cicek A, Kutlu O. Epidemiologic and clinical features of a sepsis caused by methicillin-resistant Staphylococcus epidermidis (MRSE) in a pediatric intensive care unit. Am J Infect Control. 2004 Oct;32(6):362-4.

11663.    Vincent JL, Chierego M, Struelens M, Byl B. Infection control in the intensive care unit. Expert Rev Anti Infect Ther. 2004 Oct;2(5):795-805. Review.

11664.    Warren DK, Hill HA, Merz LR, Kollef MH, Hayden MK, Fraser VJ, Fridkin SK. Cycling empirical antimicrobial agents to prevent emergence of antimicrobial-resistant Gram-negative bacteria among intensive care unit patients. Crit Care Med. 2004 Dec;32(12):2450-6.

11665. Wooltorton E. Medical gels and the risk of serious infection. CMAJ. 2004 Nov 23;171(11):1348.

Pathogenesis:

11666.    Brink AJ, Feldman C, Grolman DC, Muckart D, Pretorius J, Richards GA, Senekal M, Sieling W. Appropriate use of the carbapenems. S Afr Med J. 2004 Oct;94(10 Pt 2):857-61. Review.

11667.   Cuenca J, Garcia-Erce JA, Munoz M, Izuel M, Martinez AA, Herrera A. Patients with pertrochanteric hip fracture may benefit from preoperative intravenous iron therapy: a pilot study. Transfusion. 2004 Oct;44(10):1447-52.

11668.   Cuevas O, Cercenado E, Vindel A, Guinea J, Sanchez-Conde M, Sanchez-Somolinos M, Bouza E. Evolution of the antimicrobial resistance of Staphylococcus spp. in Spain: five nationwide prevalence studies, 1986 to 2002. Antimicrob Agents Chemother. 2004 Nov;48(11):4240-5.

11669.   Duttweiler L, Nadal D, Frey B. Pulmonary and systemic bacterial co-infections in severe RSV bronchiolitis. Arch Dis Child. 2004 Dec;89(12):1155-7.

11670.   Goldrick BA. Emerging infections: respiratory syncytial virus. Am J Nurs. 2004 Nov;104(11):54-6.

11671.   Gund V, Cooper M, Parekh N. Methicillin-resistant Staphylococcus aureus in the critically ill. Br J Anaesth. 2004 Dec;93(6):872-3.

11672.   Kukino J, Naito T, Mitsuhashi K, Oshima H, Sekiya S, Isonuma H, Watanabe K, Dambara T, Hayashida Y. Susceptibility of medical students to vaccine-preventable viral diseases: a serological study. J Infect Chemother. 2004 Dec;10(6):335-7.

11673.   Majumdar S, Kirby A, Berry N, Williams C, Hassan I, Eddleston J, Burnie JP. An outbreak of imipenem-resistant Pseudomonas aeruginosa in an intensive care unit. J Hosp Infect. 2004 Oct;58(2):160-1.

11674.   Mochizuki T, Okamoto N, Yagishita T, Takuhiro K, Mashiko K, Ogawa F, Tosaka N, Kurokawa A, Yamamoto Y. Analysis of antimicrobial drug resistance of Staphylococcus aureus strains by WHONET 5: microbiology laboratory database software. J Nippon Med Sch. 2004 Oct;71(5):345-51.

11675.   O'Dowd A. MRSA cases halved within four years? Just how realistic is the new target? Nurs Times. 2004 Nov 16-22;100(46):12-3.

11676.   Pajkos A, Vickery K, Cossart Y. Is biofilm accumulation on endoscope tubing a contributor to the failure of cleaning and decontamination? J Hosp Infect. 2004 Nov;58(3):224-9.

11677.    Pastila S, Sammalkorpi KT, Vuopio-Varkila J, Kontiainen S, Ristola MA. Control of methicillin-resistant Staphylococcus aureus outbreak involving several hospitals. J Hosp Infect. 2004 Nov;58(3):180-6.

11678.   Ruef C. Selective decontamination of the digestive tract--the risks of prevention. Infection. 2004 Oct;32(5):255-6.

11679.   Tsukayama DT, van Loon HJ, Cartwright C, Chmielewski B, Fluit AC, van der Werken C, Verhoef J; RADAR trial. The evolution of Pseudomonas aeruginosa during antibiotic rotation in a medical intensive care unit: the RADAR-trial. Int J Antimicrob Agents. 2004 Oct;24(4):339-45.

11680.   Winston LG, Charlebois ED, Pang S, Bangsberg DR, Perdreau-Remington F, Chambers HF. Impact of a formulary switch from ticarcillin-clavulanate to piperacillin-tazobactam on colonization with vancomycin-resistant enterococci. Am J Infect Control. 2004 Dec;32(8):462-9.

11681.   Yaman A, Tasova Y, Kibar F, Inal AS, Saltoglu N, Buyukcelik O, Kurtaran B, Dundar IH.  Investigation of the antibiotic susceptibility patterns of pathogens causing nosocomial infections. Saudi Med J. 2004 Oct;25(10):1403-9.

11682. Hospital hygiene sweeps resistance under the carpet. Lancet Infect Dis. 2004 Dec;4(12):713.

Therapy:

11683.    Akerman N. Preventing the spread of MRSA: ...the epidemiological nature of the problem should be tackled... BMJ. 2004 Oct 23;329(7472):978.

11684.    Akioyame M, Radford P. Precautions against infection from anaesthetic procedures. Anaesthesia. 2004 Oct;59(10):1026; discussion 1026-7.

11685.    Arya SC, Agarwal N, Agarwal S, George S, Singh K. Nosocomial infection: hospital infection surveillance and control. J Hosp Infect. 2004 Nov;58(3):242-3.

11686.    Coelho J, Woodford N, Turton J, Livermore DM. Multiresistant acinetobacter in the UK: how big a threat? J Hosp Infect. 2004 Nov;58(3):167-9. Review.

11687.    Cromer AL, Hutsell SO, Latham SC, Bryant KG, Wacker BB, Smith SA, Bendyk HA, Valainis GT, Carney MC. Impact of implementing a method of feedback and accountability related to contact precautions compliance. Am J Infect Control. 2004 Dec;32(8):451-5.

11688.    Dale BA. Preventing the spread of MRSA: all frontline staff need to be involved... BMJ. 2004 Oct 23;329(7472):978.

11689.    Dealler S. Methicillin-resistant Staphylococcus aureus infections and colonizations in an intensive care unit apparently stopped by environmental factors. J Hosp Infect. 2004 Nov;58(3):238.

11690.   Dellamonica J, Boisseau N, Goubaux B, Raucoules-Aime M. Comparison of manufacturers' specifications for 44 types of heat and moisture exchanging filters. Br J Anaesth. 2004 Oct;93(4):532-9.

11691.    Drinka PJ. Long term tracking of methicillin-resistant Staphylococcus aureus in a large skilled nursing facility. J Am Geriatr Soc. 2004 Nov;52(11):1968.

11692.    Hall J, Hodgson G, Kerr KG. Provision of safe potable water for immunocompromised patients in hospital. J Hosp Infect. 2004 Oct;58(2):155-8.

11693.   Ingham HR. Role of isolation unit in MRSA control. J Hosp Infect. 2004 Oct;58(2):161-2.

11694.    Kelly L, Clark K. The effectiveness of training and taste testing when using respirator masks. J Hosp Infect. 2004 Nov;58(3):240-1.

11695.    Liyanage C, Egbu C. FM services have vital role. Health Estate. 2004 Oct;58(9):47-54.

11696.    Nandrup-Bus I. There is not enough evidence to recommend the widespread use of topical antimicrobials on the umbilical cord stump. J Hosp Infect. 2004 Oct;58(2):165.

11697.    Newsom SW. MRSA--past, present, future. J R Soc Med. 2004 Nov;97(11):509-10.

11698.    Rogues AM, Placet-Thomazeau B, Parneix P, Vincent I, Ploy MC, Marty N, Merillou B, Labadie JC, Gachie JP. Use of antibiotics in hospitals in south-western France. J Hosp Infect. 2004 Nov;58(3):187-92.

11699.    Rosato AE, Tallent SM, Edmond MB, Bearman GM. Susceptibility of coagulase-negative staphylococcal nosocomial bloodstream isolates to the chlorhexidine/silver sulfadiazine-impregnated central venous catheter. Am J Infect Control. 2004 Dec;32(8):486-8.

11700.   Schleder BJ, Pinzon L. You can make a difference in 5 minutes. Evid Based Nurs. 2004 Oct;7(4):102-3.

11701. Woodford EM, Wilson KA, Marriott JF. Professionals' awareness of operational antibiotic prescribing controls in UK NHS hospitals. J Hosp Infect. 2004 Nov;58(3):193-9.