Infection control strategies in a neonatal intensive care unit in Argentina

Kurlat, Isabel; Corral, G.; Oliveira, Francimar Tinoco de; Farinella, Giovanna; Álvarez, Evelyn

doi:10.1016/s0195-6701(98)90094-9

Cited by 30 publications

(28 citation statements)

References 6 publications

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“…According to this analysis of the 6 above-described sequential interventional studies conducted in limited-resource countries, unsophisticated, elementary infection control measures may reduce the incidence of CLABSIs significantly, amounting to a reduction from 6.5-46.0 cases per 1000 CL days to 2.4-12.4 cases per 1000 CL days [31,32,38,49,57,63]. However, this reduced rate is by no means comparable to the lower CLABSI rates identified in industrialized countries.…”

Section: Discussionmentioning

confidence: 91%

Central Line–Associated Bloodstream Infections in Limited‐Resource Countries: A Review of the Literature

Rosenthal¹

2009

CLIN INFECT DIS

104

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Central line-associated bloodstream infections (CLABSIs) are considered a significant cause of mortality in hospitalized patients; however, the incidence of CLABSIs in limited-resource countries has not been explored analytically. Likewise, the appropriate interventions to prevent, control, and reduce CLABSIs have yet to be analyzed thoroughly. This review demonstrates that the CLABSI rate ranged from 1.6 to 44.6 cases per 1000 central line days in adult and pediatric intensive care units (ICUs) and from 2.6 to 60.0 cases per 1000 central line days in neonatal ICUs and is associated with significant extra mortality, with an odds ratio ranging from 2.8 to 9.5. The results of 6 sequential prospective interventional studies showed that hand hygiene and educational programs were related to a significant reduction in CLABSI rates. CLABSI rates in limited-resource countries are higher than US National Healthcare Safety Network benchmark rates and have a significant impact on mortality. Studies showing successful interventions for a reduction in CLABSIs are few. Subsequently, it can be inferred that additional epidemiological studies need to be conducted to achieve an appreciation of the effects of CLABSIs and to develop more-definitive approaches for CLABSI prevention in the form of practical, low-cost, low-technology measures that are feasible to implement in limited-resource countries.

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Section: Discussionmentioning

confidence: 91%

Central Line–Associated Bloodstream Infections in Limited‐Resource Countries: A Review of the Literature

Rosenthal¹

2009

CLIN INFECT DIS

104

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“…But only thorough clinical epidemiologic and microbiologic investigation with the use of molecular epidemiology technology coupled with prompt intervention can help us to detect the source and stop the spread of the A. baumannii outbreak, which we lack. A. baumannii is known for its ability to survive for long periods on dry surfaces, and outbreaks in intensive care units mediated through environmental contamination by this organism have been reported [14][15][16][17]. Although resistance always emerged after considerable pressure form antibiotic use, molecular typing approaches demonstrated that the rapid emergence of PDRAB was less likely caused by the acquisition of different resistant whether it occurred when the first patient carrying type B COS-AB was admitted in burn ward, or it was generated under antibiotic pressure gradually.…”

Section: Discussionmentioning

confidence: 99%

The molecular epidemiological study of colistin-only-sensitive strains in multi-drug resistant Acinetobacter baumannii

et al. 2007

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This paper reported the epidemiology of the colistin-only-sensitive Acinetobacter baumannii (COS-AB) in a tertiary teaching hospital in China. We analyzed the clinical data of 136 COS-AB isolates from June 2004 to May 2005 and collected 66 A. baumannii isolates in which 33 strains were COS-AB, and the rest were non-COS-AB. Random amplified polymorphic DNA (RAPD) analysis (primer ERIC2 and 272) showed that all COS-AB were identical, while pulsed-field gel electrophotesis (PFGE) analysis showed two separate genotypes of these COS-AB which were distinctly different from that of non-COS-AB. The COS-AB from burn wards showed the identical PFGE pattern which was distinguished from the genotype of COS-AB in other departments, mainly surgical systems. The cross-infection was severe and strict methods of disinfection and sterilization should be implemented. Meanwhile, the epidemiology of COS-AB in environment and patients should be closely monitored. The PFGE analysis is a reliable method of A. baumannii typing.

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“…One study that used a before group as a control group 38 reported a significant reduction (P 5 .05) of bloodstream infections. In the remaining studies without a comparison control, one 37 reported a significant reduction (P , .003) in the bacteremia rate; two 34,36 reported a significant reduction (P 5 .003 and P 5 .002, respectively) in MRSA rates; one 32 reported a decrease in VRE rates; and one 33 reported a significant decrease (P , .05) in C difficile. In addition to the lack of clarity on the role of hand hygiene in all of these studies, 4 out of 8 studies exhibited at least 1 fatal design flaw (Table 4).…”

Section: Category 3 Infection Control Practicesmentioning

confidence: 97%

An integrative review of the current evidence on the relationship between hand hygiene interventions and the incidence of health care–associated infections

Backman

Zoutman

Marck

2008

American Journal of Infection Control

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Background: The objectives of this integrative review were to critically examine the overall state of the current evidence on the relationship between hand hygiene interventions and the incidence of health care-associated infections (HCAIs) in acute care and long-term care settings, and offer recommendations for future directions in the field based on our findings. Methods: We searched for original research and reviews of research published between January 1, 1996, and July 31, 2006. Studies were identified through the electronic databases Medline, CINAHL, EMBASE, PUBMED, the Cochrane Library, and through expert consultation. Our comprehensive search strategy included all English articles for which hand hygiene or handwashing-related terms were combined with HCAIs. All studies that investigated a relationship between hand hygiene practices and HCAIs in acute care facilities were considered. These hand hygiene practices included the initiation of multimodal hand hygiene initiatives, the introduction of alcohol sanitizers, the implementation or changes of the infection control practices or infection control policies, and other organizational interventions. Studies only examining hand hygiene compliance, efficacy of alcohol hand gels, plain soap, and antimicrobial soap in reducing bacteria count recovered from hands were excluded. Results: Of the 1120 articles retrieved, 35 publications, including 4 reviews of research discussed at the outset of this article, met our inclusion criteria. The remaining 31 eligible original studies included 18 (58.07%) before and after studies without control groups, 4 (12.90%) before and after studies with a control group, 3 (9.68%) cohort studies with no control group, 4 (12.90%) cohort studies with a control group, and 2 (6.45%) randomized trials. Over 50% (16 or 31) of the studies were conducted in the U.S. Two independent reviewers conducted independent evaluations of all eligible studies, critiquing and scoring each study using a rating scale for examining the fatal flaws of quasi-experimental and before and after studies. Conclusions: There is a lack of rigorous evidence linking specific hand hygiene interventions with the prevention of HCAIs. The varied nature of the interventions used and the diverse factors affecting the acquisition of HCAIs make it difficult to show the specific effect of hand hygiene alone. The most frequent methodologies currently used in this research area are before and after observational studies without a control comparison group. Based on these findings, we recommend that researchers used a modified version of Larson's 2005 criteria to guide the design and conduct of future before and after observational studies in this area. We also argue that as we accumulate stronger evidence of which interventions are most effective, we need to develop additional research approaches to study how organizations succeed and fail in fostering the uptake of evidence-based hand hygiene interventions. (Am J Infect Control 2008;36:333-48.)

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Infection control strategies in a neonatal intensive care unit in Argentina

Cited by 30 publications

References 6 publications

Central Line–Associated Bloodstream Infections in Limited‐Resource Countries: A Review of the Literature

Central Line–Associated Bloodstream Infections in Limited‐Resource Countries: A Review of the Literature

The molecular epidemiological study of colistin-only-sensitive strains in multi-drug resistant Acinetobacter baumannii

An integrative review of the current evidence on the relationship between hand hygiene interventions and the incidence of health care–associated infections

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