International Study of the Prevalence and Outcomes of Infection in Intensive Care Units

The Journal of the American Medical Association (JAMA) has taken a one-day snapshot of the number of infected patients in ICUs worldwide — and the results are not good.

Of the tens of thousands of patients surveyed, at over a thousand hospitals, in over 75 countries, more than 50% were considered infected.

The patients who had been in the ICU the longest (prior to the study day) had higher rates of infection “especially infections due to resistant staphylococci, Acinetobacter, Pseudomonas species, and Candida species”.

“The ICU mortality rate of infected patients was more than twice that of noninfected patients… as was the hospital mortality rate”.

JAMA’s conclusions? “Infections are common in patients in contemporary ICUs, and risk of infection increases with duration of ICU stay. In this large cohort, infection was independently associated with an increased risk of hospital death.”

Abstract here.

CBC coverage here.

October 18-24 is 2009’s International Infection Prevention Week (US) and National Infection Control Week (Canada).

About National Infection Control Week (Canada)

In Canada, Infection Control Week originated in 1988 to highlight infection control efforts in Canadian hospitals, long-term care facilities and in the community. It was an opportunity for infection control professionals to educate staff and the community about the importance of infection prevention and to promote the important work that was being done by infection control professionals in a visible and fun way. In 1989 the federal government proclaimed Infection Control Week as an annual event. (from CHICA-CANADA)

About International Infection Prevention Week (US)

In 1986, President Ronald Reagan proclaimed the third week in October as National Infection Control Week and called all ‘federal, state, and local government agencies, health organizations, communications, media, and people’ to take part in educational activities and programs during this designated week. (from APIC)

To mark Infection Prevention Week, APIC is hosting live webinars on Tuesday, Wednesday and Thursday of this week, each dedicated to a particular “theme” in infection prevention. Tuesday’s webinar will be on “Collaboration“; Wednesday is “Hand Hygiene“, with a special focus on guidelines; and Thursday is “Surgical Site Infection/ OR Safety“.

If you don’t attend the webinars, you can still check out APIC’s educational brochures and guides, such as Tips to Prevent and Fight the Flu, Clean Hands Save Lives and Infection Control in an Emergency/Disaster Situation.

Comic carries hygiene message

Peterborough Regional Health Centre (PRHC) officials are hoping a new comic book will help raise awareness about hand hygiene and hospital-acquired infections, such as Clostridium difficile.

The Bug Stops Here! will be released Sept. 23 at a free public event at the hospital. The comic book is for staff and visitors and is produced by PRHC.

The nine-page book is about a young girl named Sammy who goes to the hospital to visit her sick grandmother.

Along the way she learns about C. difficile, hand washing and other ways to prevent catching infections.

Full Article: here.

Scotland’s health secretary has ordered an independent public inquiry into a fatal outbreak of Clostridium difficile at a Dunbartonshire hospital.

A total of 55 people at the Vale of Leven hospital were affected by the infection, and 18 patients died, between December 2007 and June 2008.

An initial review of procedures at the hospital found “inadequate” infection controls.

Full Article:  C.diff deaths inquiry announced

Thousands of patients undergoing treatment or surgery at Scottish hospitals are to be screened for MRSA, Nicola Sturgeon, the Health Secretary, said yesterday.

The national screening programme, which follows pilot programmes by three Scottish health boards, will take place over the next 12 months and will focus on the elderly and people admitted for kidney disease, skin problems and vascular surgery, a group deemed to be most at risk. The only patients not to be screened will be psychiatric, obstetric and paediatric patients.

Ms Sturgeon made the announcement as official figures showed a drop in the number of cases of Clostridium difficile and MRSA in Scottish hospitals.

Full Article: Scottish hospitals to screen patients for superbugs

The definition of an “outbreak” was recently called into question, when a number of patients at St. Joseph’s Healthcare acquired c.difficile — but in a pattern which didn’t exactly match reporting guidelines.

This caused confusion within the hospital over whether to declare an outbreak situation, as well as highlighting the delay between an identified rise in infections, and when the public finds out about it.

Eventually, all outbreaks get reported in each hospital’s monthly filing on a public website set up by the Health Ministry. But it could be a month before the public hears about it, Baker acknowledges. Hundreds of patients and visitors could pass through a hospital in that time.

…

One definition says an outbreak occurs when three or more new cases appear within seven days in one ward. It is also an outbreak when six or more cases occur within 30 days in a single ward or unit.

But at St. Joe’s, the current C. diff outbreak was not confined to one ward. Cases were spread through the hospital.  Chief of staff Dr. David Higgins says that made it difficult to establish whether St. Joe’s was in outbreak or simply faced a seasonal rise in C. diff.

“That’s why we agonized over this for several days,” says Higgins.

Full article: What makes it an oubreak?

Five seniors with C. difficile have died at St. Joseph’s Hospital in the last month.

That is nearly one in three of those who got the bacterial infection that causes severe diarrhea.
…
C. diff is one of three outbreaks St. Joseph’s Healthcare is currently battling.

Another senior died during the first week of March from invasive Group A streptococcus, which was spreading on the geriatric psychiatry unit at the Centre for Mountain Health Services.

Three wards remain closed to visitors at the downtown hospital as St. Joseph’s tries to contain the Norwalk virus.

Full Article:  Three St. Joe’s patients die of C. diff since April 1

In a study funded by NIH, Harvard Medical School, and the Irish Health Research Board, researchers have found a method to accurately predict which patients will experience a recurrence of C.difficile infection:

The method correctly identified 77.3% of patients who had recurrent infection in a derivation cohort studied in 1998, according to Ciarán P. Kelly, M.D., of Harvard Medical School, and colleagues.

…

C. difficile has become the leading cause of hospital-acquired infectious diarrhea. It affects millions of patients a year. Multiple recurrences are common, despite successful treatment of the initial episode

“This rule is valuable in clinical practice as it defines a high-risk population in whom awareness of the risk can facilitate more prompt recognition, diagnosis, and treatment of recurrent C. difficile,” Dr. Kelly said in a statement.

The rule combines three variables: age, disease severity, and antibiotic use.

Full article:  Clinical Rule Predicts C. Diff Recurrrence

‘Super’ C. difficile outbreak linked to deaths of 13 patients

The particularly virulent new strain of C. difficile responsible for the outbreak, known as 027, can produce 20 times as much toxin as others, is known to cause a higher mortality rate and is resistant to several drugs used to combat the infection.

The New England Journal of Medicine (NEJM) has dubbed antibiotic-resistant superbugs the “champions of evolution”.  MRSA is described as “exemplif[ying] the genetic adaptation of an organism into a first-class multidrug-resistant pathogen”.

“A concerted effort on the part of academic researchers and their institutions, industry, and government is crucial if humans are to maintain the upper hand in this battle against bacteria — a fight with global consequences.”

Full Article: Antibiotic-Resistant Bugs in the 21st Century — A Clinical Super-Challenge