A new study published in Emerging Infectious Diseases finds that outpatients are a “major reservoir” of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), helping drive MRSA incidence at hospitals even as providers attempt to prevent and contain such infections

Researchers from Christian-Albrechts-University and the University Medical Center Schleswig-Holstein in Germany reported in the journal Antimicrobial Agents and Chemotherapy on their study that identified a new antimicrobial peptide that demonstrates activity against a variety of bacteria, including methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. The researchers identified the antimicrobial peptide arminin 1a from the ancient metazoan organism Hydra magnipapillata and found that it exhibited wide-spread activity against various bacteria. "Our data suggest that ancient metazoan organisms such as Hydra hold promise for the detection of novel antimicrobial molecules and the treatment of infections caused by the multiresistant bacteria," said the researchers.

Preoperative cleansing of the patient's skin with chlorhexidine–alcohol is superior to cleansing with povidone–iodine for preventing surgical-site infection after clean-contaminated surgery.

The number of surgical-site S. aureus infections acquired in the hospital can be reduced by rapid screening and decolonizing of nasal carriers of S. aureus on admission.

Methicillin-resistant Staphylococcus aureus is spread by patients who are transferred or move between hospitals. Researchers from the University Medical Center in Groningen, the Netherlands, and colleagues said screening people who are repeatedly admitted to different hospitals could help significantly curb the transmission rate of the drug-resistant bug.

 Preventing catheter-associated bloodstream infections in pediatric intensive care units requires a focus on daily maintenance, rather than maximizing insertion-bundle compliance alone. U.S. researchers used historical control data and an interrupted time-series design to lead a multi-institutional study involving 29 PICUs from 27 hospitals. The average baseline catheter-associated blood stream infection rate was 5.4 per 1,000 central-line days at the start of the study, dropping to 4.3 per 1,000 central-line days during the program’s first three months. Overall, there was a 43 percent decrease in catheter-associated blood stream infection rates over the course of the study

The attributable impact of S. aureus and methicillin-resistance on outcomes of surgical patients is substantial. Preventing a single case of SSI due to MRSA can save hospitals as much as $60,000.

Use of a new genetic profiling tool that was able to distinguish closely related strains of methicillin-resistant Staphylococcus aureus and shed light on how the bacteria spread. Researchers from the University of Cambridge, the Wellcome Trust Sanger Institute and colleagues said having the ability to track how MRSA mutates should help spark novel infection control strategies that can be applied to other emerging superbugs. The researchers used high-throughput DNA sequencing technologies to analyze a common strain of the bacteria known as ST239, and said the technology allowed them to construct a rough genetic evolutionary tree for the strain.

A recent review of 1,096 adult patients who had a central line in place concluded that the use of closed infusion containers resulted in a significantly reduced rate of central line-associated bloodstream infections when they were compared with open infusion containers. This article noted that open infusion containers are commonly used throughout the world. The open-label, prospective cohort study was conducted in four intensive care units in Mexico and published in the Annals of Clinical Microbiology and Antimicrobials.

ICU catheter-related infections can be prevented, a Keystone ICU initiative that kept rates at nearly zero for three years in Michigan hospitals showed. By implementing low-tech measures such as removing unnecessary catheters and handwashing, the hospitals saw no rebound in catheter-related infections, Peter J. Pronovost of Johns Hopkins and colleagues reported online in British Medical Journal. The researchers found that in the first 18 months of their initiative, catheter-related infections dropped from an average of 7.7 per 1,000 catheter days to zero. Three years later, infection rates remained near zero, with an average of 1.1 per 1,000 catheter days. The results show that hospitals are mistaken in thinking these infections are inevitable, Pronovost said.

An Expert Panel of the Infectious Diseases Society of America released new guidelines on how to diagnose, prevent and treat catheter-associated urinary tract infection in adults. The guidelines, published in Clinical Infectious Diseases, are targeted at doctors in all medical specialties who perform direct patient care. The panel said that there are many holes in the knowledge about catheter-associated infections, partly due to the poor quality of many clinical trials, and its new guidelines aim to fill those holes.

In 2006, hospital-acquired pneumonia and sepsis took 48,000 lives in the U.S. and cost $8.1 billion. Patients who contracted sepsis following surgery were about 20 percent likely to die; stayed in the hospital an average 11 days longer; and cost $32,900 per patient. Hospital-acquired pneumonia patients, meanwhile, were about 11 percent likely to die; stayed in the hospital an average 14 days longer; and cost $46,400 per patient 

The overall incidence of both MRSA colonization and MRSA infection increased 17-fold in Canadian hospitals from 1995 to 2007. There has also been a dramatic increase in cases of community-associated MRSA infection due to the CMRSA-10 (USA300) clone. Continued surveillance is needed to monitor the ongoing evolution of MRSA colonization or infection in Canada and globally.

Aaron Milstone of Johns Hopkins Children’s Center and colleagues have discovered hospitals may cut the risk of life-threatening bloodstream infections in newborns with peripherally inserted central venous catheters if they replace the device about every 30 days. Researchers reported in the journal Pediatrics that the daily risk of falling ill with a dangerous bacterial infection rose by 33 percent day at about day 35 and continued to be elevated thereafter in babies needing the device over the long term.

Seriously injured intensive care patients can reduce their risk of developing certain types of infections by bathing with antiseptic-soaked washcloths, according to a new study by Heather L. Evans of the Harborview Medical Center in Seattle and colleagues. In the study, published in the Archives of Surgery, the researchers used antiseptic-free disposable cloths to bathe ICU patients daily for six months, and then used the antiseptic, or chlorhexidine, cloths for another six months. They found that antiseptic bathing reduced the patients’ chances of developing catheter-related bloodstream infections as well as the risk of ventilator-associated pneumonia caused by MRSA.

Nearly 40 percent of reported gastrointestinal infections are Clostridium difficile infections, which is rapidly becoming a critical issue in health care, according to preliminary data collected from nursing homes. Researchers at the Pennsylvania Patient Safety Authority and colleagues looked at infection data submitted from state nursing homes and found that from 1993 to 2001, hospital discharges with CDI increased by 74 percent, while cases nearly doubled from 2001 to 2005 with a 102 percent increase in patients discharged with CDI.

Researchers from Johns Hopkins Children’s Center recently reported in the journal Emerging Infectious Diseases that community-acquired methicillin-resistant Staphylococcus aureus is increasingly turning up in children hospitalized in the intensive care unit. Six percent of patients admitted to the pediatric intensive care unit between 2007 and 2008 were colonized with MRSA. Sixty percent of the 72 children who tested positive for MRSA were found the have the community-acquired strain.

The Association for the Advancement of Medical Instrumentation’s Sterility Assurance Levels Working Group, WG 90, presented a poster on acceptable sterilization assurance levels for new products at the U.S. Centers for Disease Control Decennial meeting on March 19.  The poster presentation concluded that new and emerging health care products need to incorporate a variety of SALs in order to be terminally sterilized, labeled as sterile and still function as intended.

Article on a new antibacterial wound dressing developed by researchers from the University of Bath in England. The new dressing contains tiny vesicles that appear to be similar to cells that bacteria would infect. This statement noted that when bacteria attack the vesicles, an antibacterial agent is released that kills them. The dressing has been shown to be effective against a species of Staphylococcus and a member of the Pseudomonas group.

The Centers for Disease Control and Prevention said Thursday that health care workers are at risk from the chemicals used in hospitals and other facilities to prevent microbial colonization and infections. However, the risk is low and the side effects that were observed were both mild and temporary, the agency added in its Morbidity and Mortality Weekly Report. The data came from a recent analysis of information from California, Louisiana, Michigan and Texas from 2002 through 2007. The CDC during the period noted 401 cases of work-related illness associated with antimicrobial pesticide exposures in health care settings, and 61 percent were identified through workers’ compensation systems.

The New England Journal of Medicine published findings from researchers at Massachusetts General Hospital that suggested gram-negative bacteria play a significant role in about 30 percent of hospital-acquired infections in the U.S. The findings showed that such bacteria were the predominant players in 47 percent of ventilator-associated pneumonia cases and 45 percent of urinary tract infections. The researchers noted that almost any gram-negative bacteria can cause bloodstream infection if an adequate portal of entry is present.

Clostridium difficile, a germ that causes terminal intestinal infections in hospital patients and was thought to spread only by contact with contaminated surfaces, can also travel through the air, according to a study by British researchers published in Clinical Infectious Diseases. Mark H. Wilcox of the University of Leeds and colleagues repeatedly tested 10 patients with symptomatic illness over a 10-hour period, and the air nearby seven of them was positive for C. difficile, generally during visiting hours or when there was activity in patient rooms, such as food delivery or bedding changes. Surfaces around 90 percent of the patients were also contaminated. The scientists stressed, however, that there is no evidence that C. difficile can be contracted through inhalation; the germs just float on the air, landing in places where more people can touch them.

Hospitals across the country are experiencing a decline in infections from central line catheters, according to a report by the CDC. In 2009, the Department of Health and Human Services initiated a program aimed at reducing health care-related infections, with one of the goals being to reduce central line infections by 50 percent by 2013. The study was conducted to track the progress of this program, and it found an 18 percent dip in central line-associated bloodstream infections across 17 states during the first half of 2009, compared with the three previous years

Researchers from Duke University and Tumaini University in Tanzania have found that community-acquired bloodstream infections may be linked to high rates of in-hospital fatality in African settings. A meta-analysis of 22 studies involving nearly 58,300 patients - 15,200 adults and 43,100 children - found that 13.5 percent of adults and 8.2 percent of adults had bloodstream infections. There was an overall in-hospital case-fatality rate of 18.1 percent in those with bloodstream infections.

Denise M. Korniewicz of the University of Miami and Maher El-Masri of the University of Windsor in Canada have found that nurses and other health care providers often do not comply with hand hygiene guidelines prior to and after procedures. They noted in the journal Applied Nursing Research that compliance was higher with high-risk procedures and when health care providers were exposed to blood. Korniewicz and El-Masri evaluated hand hygiene practices observed during 612 procedures performed by 67 health care professionals at an oncology hospital.

Patients who have had major chest or head operations are at an increased risk of developing post-surgical staphylococcus aureus infections. The findings are based on a review of 81,267 patients who underwent 96,455 orthopedic, cardiothoracic, plastic surgery or neurosurgery procedures at nine locations between 2003 and 2006. There were 454 staph infections among the patients, with the highest rates of bloodstream infections occurring in patients who had chest surgery, while the highest rates of surgical site infections occurred in patients who had brain operations. Deverick Anderson, lead author from Duke University Medical Center, said additional preventions for cardiovascular or neurosurgical procedures may be needed.

Overall, 46 of 68 ASCs (67.6%; 95% confidence interval [CI], 55.9%-77.9%) had at least 1 lapse in infection control; 12 of 68 ASCs (17.6%; 95% CI, 9.9%-28.1%) had lapses identified in 3 or more of the 5 infection control categories. Common lapses included using single-dose medication vials for more than 1 patient (18/64; 28.1%; 95% CI, 18.2%-40.0%), failing to adhere to recommended practices regarding reprocessing of equipment (19/67; 28.4%; 95% CI, 18.6%-40.0%), and lapses in handling of blood glucose monitoring equipment (25/54; 46.3%; 95% CI, 33.4%-59.6%).

Conclusion  Among a sample of US ASCs in 3 states, lapses in infection control were common.

Lee E. Morrow of Creighton University and colleagues have discovered that cases of ventilator-associated pneumonia in critically ill patients in hospitals were cut in half after patients were given probiotic bacteria. The study involved 138 critically ill patients from a single hospital, who were either given placebo or the probiotic Lactobacillus rhamnosus. Donald Craven of the Lahey Clinic Medical Center in Burlington, Mass., said the results "hold promise for trying to prevent an infection that has serious morbidity, mortality and is a major factor for hospital costs that we’re trying to contain."

Among hospitals in the Premier Inc Perspective Database reporting SCIP performance, adherence measured through a global all-or-none composite infection-prevention score was associated with a lower probability of developing a postoperative infection. However, adherence reported on individual SCIP measures, which is the only form in which performance is publicly reported, was not associated with a significantly lower probability of infection.

Racial differences in severe sepsis are explained by both a higher infection rate and a higher risk of acute organ dysfunction in black than in white individuals.

Methicllin-resistant Staphylococcus aureus infections in children have spiked from two to 21 cases per 1,000 hospital admissions between 1999 and 2008. The findings, based on a review of more than 64,000 children treated for a staph infection in 25 U.S. children’s hospitals, showed that the rate of staph infections has more than doubled in the time period. However, the findings indicated that most of the infections were acquired at schools, locker rooms and gyms, and not health care settings. The study also showed that the use of the antibiotic clindamycin increased threefold, with 63 percent of such infections being treated with the drug in 2008.

Scientists at the National Institute of Allergy and Infectious Diseases have identified and isolated a new toxin called LukGH that laboratory studies indicate is a potent killer of human immune cells and could be a key factor in the severity of MRSA infections in otherwise healthy people. The research project was intended to identify all the surface proteins of USA300, the most common community-associated strain of MRSA. The scientists said they are not sure of the full contribution of LukGH to the severity of MRSA infection, but LukGH is the only MRSA toxin currently known to promote the destruction of human neutrophils after the bacteria have been ingested by the immune cells designed to destroy them.

J. Hsu from the University of Wisconsin School of Medicine and Public Health at Madison and colleagues reported  that antimicrobial stewardship, glove use, hand hygiene and disposable thermometers should be used routinely to prevent Clostridium difficile infection. However, they reported that environmental disinfection and probiotics should be studied further. To make their recommendations, the investigators searched multiple computerized databases and performed manual searches to retrieve relevant articles.

Interfering with the function of the cell membrane protein called programmed death 1 improved survival in a clinically relevant model of severe infection, a discovery that could pave the way for new drugs that reduce the severity of blood infections leading to sepsis. Researchers at the Washington University School of Medicine in St. Louis and colleagues said a study of mice showed that PD-1 inhibits the ability of the immune system to fight infection by suppressing the function of immune cells, and therefore blocking PD-1 can restore the ability of the host to combat infections and also help improve chances for survival.

The National Conference of State Legislatures has released a new report that offers lessons on infection-reporting data from nine of the states that first required medical facilities to report health care-associated infections. The NCSL looked at state laws passed from 2005 to 2009 and interviewed state lawmakers, health care providers and other related groups in Alabama, Colorado, Delaware, Illinois, Massachusetts, New Hampshire, Oregon, Pennsylvania and Washington. Since 2005, the number of states that require health care facilities to report HAIs has jumped from six to 27.

Rates of invasive methicillin-resistant Staphylococcus aureus infection in U.S. hospitals have fallen over the past few years. In the Journal of the American Medical Association, this study showed that the number of cases of MRSA in nine metro areas declined 16 percent between 2005 and 2008; however, the rates of skin and soft tissue infections remained largely unchanged. The researchers said their findings suggest that efforts aimed at preventing MRSA, such as promoting better hand-washing among health care workers and testing for MRSA when patients are admitted to the hospital, are paying off.

A study examined 7,000 patients undergoing elective, inpatient orthopedic procedures at New England Baptist Hospital in Boston who were screened for methicillin-sensitive Staphlylococcus aureus and MRSA. Patients who tested positive were instructed via pre-op phone calls to apply mupiricin ointment to the interior of each naris, and patients who still carried MRSA after the application of the ointment were treated with standard MRSA isolation precautions in addition to pre-op antibiotics. The study showed that the surgical site infection rate dropped 59 percent when the prescreening program was in place. The researchers suggested the drop in SSIs was likely due to the ability of clinicians to switch preoperative antibiotic prophylaxis to vancomycin, as well as the treatments with the ointment. The researchers concluded that prescreening programs are "feasible and can lead to significant reductions in postoperative rates of surgical site infection."

Differences in reported hand hygiene compliance rates were assessed on the basis of the unit affiliation of observers. In 2 hospitals, unit-based observers more often reported higher compliance rates than did non–unit-based observers (79% vs 58.6%; difference, 20.4%; P<.001). Nonstandardized data collection methods contribute to the variability in hand hygiene compliance rates.

Direct observation cannot be considered the gold standard for assessing hand hygiene, because there was no relationship between the observed adherence and the number of dispensing episodes or the volume of product used. Other means to monitor hand hygiene adherence, such as electronic devices and measurement of product usage, should be considered.

A report from New Hampshire health officials showed that patients developed 134 infections in 2009 from central lines, as well as from heart, colon and knee surgeries. Officials said the number of infections was 26 percent lower than expected based on national data. Portsmouth Regional Hospital, however, reported 16 infections related to coronary artery bypass graft surgery, which is nearly twice the amount of infections expected for a hospital of its size. Martha Wassel, infection control director for the hospital, said the facility has created a task force to promote and ensure the use of best practices for hand hygiene, the timing of antibiotic use, operating room procedures and patient education. Jose Montero, director of public health at the Department of Health and Human Services, said the state could also improve its rate of influenza vaccinations among health care workers, noting that overall state vaccination rate among health care workers was 70 percent, but 10 hospitals had rates significantly lower than the national average.

Jonathan S. Dordick of the Rensselaer Polytechnic Institute and colleagues have developed a nanoscale coating for surgical equipment, hospital walls and other surfaces that safely rids the surface of MRSA.  100 percent of MRSA in solution was killed within 20 minutes of contact with a surface painted with latex paint laced with the coating. The coating is toxic only to MRSA. It does not rely on antibiotics, nor does it leach chemicals into the environment.

Researchers discovered that systems that remind hospital staff to remove catheters can reduce the rate of catheter-associated urinary tract infections by 52 percent. In a meta-analysis of interventional studies that used reminders to indicate that a urinary catheter was in use or stop orders to prompt catheter removal in patients, the researchers found no evidence that the reminders would lead to catheters being removed too early. The researchers said that hospitals should consider "nurse-empowered" catheter stop orders, which allow nurses to remove urinary catheters based upon set criteria and without a direct order from a physician.

A study led by researchers at the Institute of Hygiene and Environmental Medicine at Ernst-Moritz-Arndt University in Greifswald, Germany, has confirmed previous research that asserted bacterial migration through unnoticed microperforations in surgical gloves occurs in surgery, adding that it occurs frequently. The researchers used an established design to measure bacterial migration from the operating site through a punctured glove, and they reported that in a consecutive series of 20 procedures, microperforations were discovered on the outer surgical glove 10 percent of the time in a median wearing duration of 100 minutes, and perforations were found in 81 percent of cases on the nondominant hand.

Duke University Medical Center researchers said they found that surgically implanted antibiotic-infused sponges do not reduce the rate of sternal wound infections in patients who have had heart surgery. Gentamicin-collagen sponges, approved in 54 countries, not including the U.S., are used in more than 1 million people. The study of 1,502 heart surgery patients found there was no significant difference in the overall rates of sternal wound infections between people who received sponges and those who did not.

Research led by investigators at the University of Illinois at Chicago has found that the standards for detecting and treating drug-resistant staph infections varies from hospital to hospital, but the majority comply with national guideline recommendations. The study, which was funded by a grant from the Agency for Healthcare Research and Quality and published in the American Journal of Health-System Pharmacist, employed a 61-question survey that was sent to pharmacy directors at 263 acute care hospitals in the U.S. to discover policies and practices in regards to methicillin-resistant Staphylococcus aureus. Of the 102 that responded, 43 percent reported a standard procedure for screening patients for the bacteria.

A study  by Clive Beggs from the University of Bradford and colleagues found that under normal circumstances the risk of acquiring a pulmonary tuberculosis infection during a visit to a hospital waiting area is minimal, the risks associated with the transmission of influenza are an order of magnitude greater than for TB yet still relatively small and the risks associated with acquiring measles are high. The researchers analyzed the transmission of airborne infections in a hypothetical hospital waiting area in which occupancy levels, waiting times and ventilation rates were varied. They concluded that while the installation of air disinfection may be beneficial, it was more important to minimize waiting times and the number of susceptible individuals present to reduce infection rates

Emory University School of Medicine researchers reported in the journal Infection Control and Hospital Epidemiology that using an alcohol-based hand sanitizer to clean hands as well as stethoscopes between patients could become an accepted bedside practice. The researchers said cleaning the stethoscope with an alcohol wipe is more effective, but most clinicians consider such a move impractical and are unlikely to reliably take such precautions. A review of 84 stethoscopes showed that the median bacteria colony count dropped to 4 CFU from 34.5 CFU prior to being cleaned with the hand sanitizer. After cleaning with the alcohol wipe, the median colony count was zero CFU.

Researchers in the journal Clinical Infectious Diseases reported that vancomycin-resistant enterococci of genotype vanC appear not to be associated with outbreaks. The researchers estimated the risk of bloodstream infections in patients colonized with VRE of genotype vanC who received care from a bone marrow transplant unit for patients with leukemia. They found that infection control policy required contact isolation for patients infected with VRE of genotype vanA or vanB, but only standard precautions for patients infected with VRE of genotype vanC. The scientists concluded that carriers of VRE of genotype vanC do not require contact isolation, which could save resources and improve patient care.

A promising treatment that reduced the severity of skin and soft-tissue damage caused by USA300, the leading cause of the Staphylococcus aureus infections in the U.S., in laboratory mice has been discovered by scientists at the National Institutes of Health and the University of Chicago. The investigators accomplished the reductions by neutralizing a toxin known as alpha-hemolysin, or Hla, that is associated with S. aureus.

Fred Gordin of the Infectious Diseases Section of the Veterans Affairs Medical Center in Washington, D.C., reported in a commentary in Infection Control and Hospital Epidemiology on the evolving epidemiology of MRSA. His research team reviewed infection control data from clinical MRSA isolates during a period from 2001 to 2007. The researchers found that the number of new clinical MRSA isolates increased during the study period, from 129 to 221, and the number of HA-MRSA isolates decreased from 78 isolates to 46. Gordin said there needs to be a better understanding of the risk factors contributing to the increase in the incidence of MRSA infection, and that approaches to prevention, screening and treatment need to reflect the changing epidemiology of MRSA.

The Agency for Healthcare Research and Quality reported that the rate of hospital-acquired infections among adults declined to 2.03 per 1,000 after peaking at 2.3 per 1,000 in 2004 and 2005. The agency determined that HAIs were recorded in 0.2 percent of hospital stays in 2007. Claudia Steiner of AHRQ, who led the research, did not offer reasons for the decline, but other researchers have speculated that improved adherence to treatment guidelines and better management of risk factors for HAIs have played a factor.

Michigan-based researchers revealed that leadership plays a vital role in hospital infection prevention and control programs. Sanjay Saint of the University of Michigan and colleagues conducted a three-phase study involving the lead infection preventionists at several hospitals. The preventionists first completed a quantitative survey about health care-associated infection prevention; the second stage of the study was data collection; and the third phase was on-site interviews. The team of investigators found that successful leaders created a culture of clinical excellence and communicated it effectively to staff, and the scientists concluded that hospital epidemiologists and infection preventionists play bigger leadership roles in their facility’s patient safety activities than senior executives.

A study led by Vincent C.C. Cheng from Queen Mary Hospital in China found that compliance with infection control measures relies significantly on a personal commitment by health care workers. In the study,  Cheng and colleagues monitored the incidence of MRSA infection in a hospital’s newly renovated intensive care unit during three phases: the baseline period, after ICU renovation and after implementing a hand hygiene campaign. The researchers found that while they observed a reduction in ICU-onset MRSA infection, a significant improvement was only seen in comparisons done before and after the SARS epidemic. These findings suggest that health care workers are more likely to comply with infection control measures when they feel their personal safety is threatened, the researchers said.

David Holyoake of the University of Wolverhampton recently wrote about how a group of nursing students explored whether perceiving hand washing as a social behavior rather than merely an act of hygiene might influence how often health care workers wash their hands. The students focused on how health care centers allow cross-contamination and infections to persist and whether "shaming and blaming" could be used to encourage greater rates of hand washing. The students created a series of posters related to the concept.

The Methodist Hospital in Texas found that sepsis is 10 times more common and more deadly than other surgical complications, such as heart attacks and blood clots. The number of people who have died from sepsis has nearly doubled in the last 20 years in the U.S., the report found. Sepsis is the No. 1 cause of organ failure and mortality in general surgery units, and about 934,000 people in the U.S. will be afflicted with sepsis by the end of the year. The study reviewed 363,897 general surgical patients in the American College of Surgeons National Surgical Quality Improvement Program database

Residential addresses could be useful for differentiating health care-acquired from community-acquired MRSA infections, although methods for categorizing residence type based on electronic medical records have not been widely documented. In this study, researchers were seeking to establish a process to aid in distinguishing health care-associated from community-associated MRSA infections by analyzing patient addresses to identify if residence noted at the time of positive culture was linked to a health care facility or other institutional location.

Postoperative high blood sugar levels may increase the risk for infection at the surgical site in patients having general surgery. The study examined 1,561 patients, including 559 who had vascular surgery, 226 who had colorectal surgery and 776 who had a type of general surgery other than colorectal. Age, emergency status, physical status as classified by the American Society of Anesthesiologists, time in surgery, diabetes and high postoperative blood glucose were all factors that appeared to be associated with surgical site infections, but factors other than postoperative blood glucose level were not significant predictors of infection. "In conclusion, we found postoperative hyperglycemia to be the most important risk factor for surgical site infection in general and colorectal cancer surgery patients, and serum glucose levels higher than 110 milligrams per deciliter were associated with increasingly higher rates of post-surgical infection," the researchers wrote.

A new study by the Centers for Disease Control and Prevention’s Prevention Epicenter Program found that growing rates of Clostridium difficile infection could indicate a regional problem, rather than an issue at a single health care institution. In the study, the researchers compared CDI incidence rates from 2000 to 2006 among five U.S. academic medical centers. They found that during the period, overall incidence rates of CDI increased, whether the infections were health care facility-onset, community-onset or health care facility-associated. Additionally, the researchers discovered significant differences in the total incidence rate among health care institutions for each surveillance definition of CDI.

A group of infectious-disease organizations is urging the health care industry to adopt a new prevention framework that it says can eliminate health care-associated infections.  The group outlined the key elements of the framework. These include data collection, evidence-based practices, systemwide infection prevention strategies and enhanced medical knowledge, the paper’s authors said, among whom are representatives from the CDC and the Society for Healthcare Epidemiology of America.

Yale University researchers reported that they were able to introduce foreign small molecules into the cell wall of Staphylococcus aureus bacteria. The researchers focused on introducing biotin, fluorescein and azide into the bacteria, and they noted that the procedure could be applied to naturally occurring bacteria in the human body. The researchers said the findings could lead to better approaches for fighting drug-resistant bacteria or allow for the observation of the progression of disease in the human body in real time.

New government data show MRSA to be more prevalent in the U.S. than in the UK, and that Americans are more than six times as likely as Britons to contract the superbug in their communities, although rates of hospital infections are about equal.  The government statistics found that about 29 per 100,000 people in the U.S. contract a MRSA bloodstream infection every year, compared with 11 Britons.

This paper was written to help preventionists explain inherent constraints in using administrative data to identify such infections. Specifically, the paper said the exclusive use of administrative data is not exact and does not facilitate real-time implementation of useful prevention methods. Moreover, the paper calls for the adoption of the CDC/National Healthcare Safety Network's standardized definitions.

The rate of adherence to hand hygiene practices among health care workers increased 6 percent following the institution of a multifaceted intervention, However, the incidence of MRSA colonization did not fall. Researchers conducted their study in three tertiary care hospitals in Ontario, Canada. Of the 30 total hospital units studied, 15 were randomly assigned to the intervention technique, which included performance feedback, small-group teaching seminars and posters, and the other 15 were assigned usual practice. Hand hygiene adherence in the intervention group was 48.2 percent, compared with 42.6 percent in the control group.

A study has been launched by researchers at the Medical College of Georgia to identify how to optimize communications in health care settings to avert fatal catheter-related bloodstream infections. According to the CDC, such infections, which annually cause 28,000 deaths and generate $9 billion in health care costs, are preventable if correct practices are adhered to. However, "while some hospitals have succeeded in implementing these standards, many have not," said Pavani Rangachari, the principal investigator on the study. Therefore, Rangachari and her team have been given a two-year, $100,000 grant from the Department of Health and Human Services’ Agency for Healthcare Research and Quality to analyze hospital communication logs in an attempt to pinpoint why some protocols are more successful than others at preventing infections.

Erik Dubberke of the Division of Infectious Diseases in the Department of Medicine at Washington University School of Medicine in St. Louis said that the wearing of gloves when caring for a patient with a Clostridium difficile infection is the single recommended practice graded "A-I." As evidence, Dubberke pointed to a 1990 study performed prior to the introduction of universal and standard precautions that randomized four wards with similar baseline rates of CDI. Some of the wards continued with standard of care, while others implemented an education campaign instructing nurses to wear gloves. The study showed a statistically significant decrease in CDI incidence in the intervention wards.

Canadian researchers have discovered in the country an infectious superbug that is deadly to people with cystic fibrosis. In a 446-patient study, researchers found about 15 percent of the subjects to be infected with the bacteria, an A strain of the P aeruginosa bug, which doubled or tripled the risk of death or the need for a lung transplant during the three-year period. Resistant to most antibiotics, the strain first was identified in Liverpool in 1996. The study said that the superbug, commonly found in showers, bathtubs and hot tubs, attacks seven out of every 1,000 cystic fibrosis patients each year.

一份針對品質評估的簡易方案

翰霍普金斯大學（Johns Hopkins University）的研究人員與同儕在重症醫學（Critical Care Medicine ）期刊中表示，醫院的重症病人若每天以 4% 的氯己定（chlorhexidine）加入洗澡水來洗澡，可減少多達 73% 的血流感染可能姓。 該計畫比較 2,650 位以氯己定入浴的病人，以及以水和肥皂洗澡的 2,670 位病人。 經此研究發現，在六家不同的醫院中以氯己定入浴的病人在抗甲氧西林金黃色葡萄球菌感染上減少 32%，在抗萬古黴素金黃色葡萄球菌感染上減少 50%。

英國倫敦衛生學及熱帶醫學院（London School of Hygiene and Tropical Medicine ）的 Brendan Wren 和其同事發現最近有遞增之勢的困難腸梭菌感染病例，是起因於基因改變而造成菌株更具毒性，而不是醫院不乾淨。 PCR-ribotype 027 菌株在過去五年中皆有案例，高毒性菌株導致更嚴重的腹瀉症狀和更高的死亡率。 將「劇毒性」菌株和較早的菌株相比，顯示出該細菌已經演變出能更適應環境的基因，更容易傳播並使患者症狀加劇。 他們的研究發現刊登在基因體生物學（Genome Biology ）期刊。

英國巴滋與倫敦國民保健信托（Barts and The London NHS Trust）的微生物學家 Michael Millar 醫生在刊於英國醫學期刊（British Medical Journal）的文章中表示，英國針對 MRSA 篩檢了所有住院病患，但是篩檢結果卻錯誤連篇。 自 2009 年 4 月起，英國所有醫院都得篩檢非緊急性開刀而住院的患者。 「篩檢每位低風險族群的問題，在於誤檢為遭到感染的人與確實感染的人一樣多，如果不是更多的話。」Millar 說道。

按照巴黎國家工藝學院（Conservatoire des Arts et Metiers）的 Laura Temime 和其同事使用數學模型來判定，「四處走動的」醫療人員，如治療師，如果忽略手部衛生，則最有可能傳播病源體；而被指派在定點的護士和醫生，比較不會傳播病源體。 研究人員使用模擬技術在三種醫療人員當中找出「超級傳播者」。 這三種群組分別為「經常接觸少數病人」、「較少接觸但接觸時卻是大量病人」以及「每天都會接觸病人一次」。 他們以這種模型來追蹤，如果有一位已感染的病人被送到有 18 個床位的病房，那麼一個多月後，各種不遵循手部衛生規範的情況會產生什麼後果。 調查結果刊登於美國國家科學院院刊上。

一篇刊登於新興傳染病（Emerging Infectious Diseases）期刊的文章，檢視了醫療機構預防 SARS、豬流感和西班牙流感（Spanish flu）傳播所耗費的成本。 依據領導研究的新加坡研究人員指出，病毒和高死亡率對於成本效益影響最大。 此研究的結論是，根據病毒與社區風險之嚴重性而制定標準化措施，也許最能有效因應未來流行病。

根據一位大力推動手術房器械例行控管的英國調查人員表示，手術進行中氣管插管的氣囊壓可能太高。

The study, by anesthesiologists at University College London, found that endotracheal tube (ETT) cuff pressures averaged 41 cm H₂O—16 cm H₂O greater than the recommended maximum level of 25 cm H₂O in the United Kingdom. Pressures that high could increase patients’ risk for sore throat, hoarseness and difficulty swallowing.

This is a retrospective analysis of the 2000 and 2001 editions of the Agency for Healthcare Research and Quality’s Nationwide Inpatient Sample database, to determine the association of S aureus infections with length of stay, total charges, and in-hospital mortality.

Preoperative cleansing of the patient's skin with chlorhexidine–alcohol is superior to cleansing with povidone–iodine for preventing surgical-site infection after clean-contaminated surgery.

The number of surgical-site S. aureus infections acquired in the hospital can be reduced by rapid screening and decolonizing of nasal carriers of S. aureus on admission.

The attributable impact of S. aureus and methicillin-resistance on outcomes of surgical patients is substantial. Preventing a single case of SSI due to MRSA can save hospitals as much as $60,000.

Patients might have a higher risk of developing invasive Staphylococcus aureus infections after cardiothoracic and neurosurgical procedures when compared with orthopedic or plastic surgical procedures, according to a study published in Infection Control and Hospital Epidemiology. Lead author Deverick Anderson and his team of researchers from Duke University Medical Center studied the postsurgical outcomes of 96,455 procedures from 11 hospitals. Included in the analysis were individuals who had undergone orthopedic, neurosurgical, cardiothoracic and plastic surgical procedures between 2003 and 2006. The breakdown of MRSA infections ranged from 62 percent following cardiothoracic surgery to 35 percent following plastic surgery, the investigators found.

Patients who have had major chest or head operations are at an increased risk of developing post-surgical staphylococcus aureus infections. The findings are based on a review of 81,267 patients who underwent 96,455 orthopedic, cardiothoracic, plastic surgery or neurosurgery procedures at nine locations between 2003 and 2006. There were 454 staph infections among the patients, with the highest rates of bloodstream infections occurring in patients who had chest surgery, while the highest rates of surgical site infections occurred in patients who had brain operations. Deverick Anderson, lead author from Duke University Medical Center, said additional preventions for cardiovascular or neurosurgical procedures may be needed.

Epidrual or spinal anesthesia may help curb the risk of surgical site infection when compared with the use of general anesthesia in patients undergoing total joint replacement surgery. In an editorial on the study, Daniel I. Sessler of the Cleveland Clinic Anesthesiology Institute’s Department of Outcomes Research, said the findings provide compelling epidemiologic evidence that neuraxial anesthesia reduces the risk of SSIs. The study examined 3,081 patients in Taiwan who underwent total knee and total hip replacement procedures, and it showed that SSI rates within 30 days of the procedure was 2.2 times greater in patients who had general anesthesia.

Leaving an antibiotic-soaked collagen sponge in the wound after colorectal surgery "paradoxically" seemed to cause an increase in surgical site infections. The findings of Elliott Bennett-Guerrero of Duke Clinical Research Institute in Durham, N.C., and colleagues opposed findings of an earlier study that identified a 70 percent decrease in such infections with the use of a gentamicin-collagen sponge. The study involved 602 patients undergoing open or laparoscopically assisted colorectal surgery at 39 U.S. sites.

The National Conference of State Legislatures has released a new report that offers lessons on infection-reporting data from nine of the states that first required medical facilities to report health care-associated infections. The NCSL looked at state laws passed from 2005 to 2009 and interviewed state lawmakers, health care providers and other related groups in Alabama, Colorado, Delaware, Illinois, Massachusetts, New Hampshire, Oregon, Pennsylvania and Washington. Since 2005, the number of states that require health care facilities to report HAIs has jumped from six to 27.

A study examined 7,000 patients undergoing elective, inpatient orthopedic procedures at New England Baptist Hospital in Boston who were screened for methicillin-sensitive Staphlylococcus aureus and MRSA. Patients who tested positive were instructed via pre-op phone calls to apply mupiricin ointment to the interior of each naris, and patients who still carried MRSA after the application of the ointment were treated with standard MRSA isolation precautions in addition to pre-op antibiotics. The study showed that the surgical site infection rate dropped 59 percent when the prescreening program was in place. The researchers suggested the drop in SSIs was likely due to the ability of clinicians to switch preoperative antibiotic prophylaxis to vancomycin, as well as the treatments with the ointment. The researchers concluded that prescreening programs are "feasible and can lead to significant reductions in postoperative rates of surgical site infection."

Duke University Medical Center researchers said they found that surgically implanted antibiotic-infused sponges do not reduce the rate of sternal wound infections in patients who have had heart surgery. Gentamicin-collagen sponges, approved in 54 countries, not including the U.S., are used in more than 1 million people. The study of 1,502 heart surgery patients found there was no significant difference in the overall rates of sternal wound infections between people who received sponges and those who did not.

Postoperative high blood sugar levels may increase the risk for infection at the surgical site in patients having general surgery. The study examined 1,561 patients, including 559 who had vascular surgery, 226 who had colorectal surgery and 776 who had a type of general surgery other than colorectal. Age, emergency status, physical status as classified by the American Society of Anesthesiologists, time in surgery, diabetes and high postoperative blood glucose were all factors that appeared to be associated with surgical site infections, but factors other than postoperative blood glucose level were not significant predictors of infection. "In conclusion, we found postoperative hyperglycemia to be the most important risk factor for surgical site infection in general and colorectal cancer surgery patients, and serum glucose levels higher than 110 milligrams per deciliter were associated with increasingly higher rates of post-surgical infection," the researchers wrote.

由其衍生的死亡率、住院天數過久和額外醫療成本。

此研究旨在找出造成手術傷口（SSI）的術中危險因子，藉而防止其發生。 我們評估各種術中殺菌方法及手術小組人員之行為對 SSI 造成的影響。

由多倫多市桑尼布魯克衛生科學中心（Sunnybrook Health Sciences Center）的 Nick Daneman 主導的一項研究發現，年長者病患使用 statin 類藥物與手術傷口感染的風險指數上升無關。 這分包含 469,349 位病患個案的研究發現，使用 statin 類藥物的患者感染率為 8.9%，相較於非使用 statin 類藥物患者則為 8.7%。

The Centers for Disease Control and Prevention (CDC) recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections.