Society for Healthcare Epidemiology of America Meeting Coverage
Society for Healthcare Epidemiology of America Meeting Coverage
The following is an overview of some presentations at the 2003 annual meeting of the Society for Healthcare Epidemiology of America. — Robert Muder, MD
Clostridium difficile Diarrhea (CDD)In January 2002, a major university hospital experienced a significant 2-fold increase in the incidence of CDD to 1.4 cases/1000 patient-days, from a relatively stable 3-year baseline of 0.7 cases/1000 patient-days. The outbreak persisted for 6 months and involved multiple patient wards. In July 2002 infection control instituted 2 new policies: placement of all patients with new diarrhea in contact isolated until tested for C difficile and use of hand washing rather than alcohol hand sanitizer on wards experiencing a CDD outbreak. There was an immediate two-thirds reduction in the incidence of CDD that was sustained for 4 months, the duration of reported follow-up (Hall KK, et al. Outbreak of Clostridium difficile diarrhea (CDD) controlled with infection control measures. [Abstract 5]).
Comment
This study demonstrates the efficacy of relatively simple infection control measures to reduce the rate of CDD. Isolation of diarrhea patients pending laboratory confirmation was 1 key aspect. The other was the return to soap and water. C difficile spores are not killed by 60% ethanol, the active ingredient in most hand sanitizers. Vigorous washing with soap and water physically removes spores and prevents transmission.
Legionnaires’ Disease in Long-Term CareIn a long-term VA hospital, the investigators conducted prospective microbiologic surveillance of the facility’s potable water system and screened cases of pneumonia acquired within the facility using Legionella urinary antigen testing and Legionella sputum culture.
More than 50% of the facility’s water system yielded Legionella; 3 serogroups were isolated, including serogroup 1. Of 14 cases of nosocomial pneumonia, 3 (21%) were due to L pneumophila serogroup 1. Clinical and environmental isolates were identical by PFGE testing. Following installation of a copper-silver ionization system, culture positivity of the water system was reduced to 4%; no additional cases occurred (Sarro KE, et al. Unsuspected endemic Legionnaires’ in a long-term care facility. [Abstract 9]).
Comment
Most pneumonias in the long-term care setting are treated empirically, without benefit of etiologic diagnosis. Although there is good evidence that Legionella colonization of the water system of an acute care hospital is associated with the occurrence of nosocomial Legionnaires’ disease, there are few data to support such an association in long-term care facilities. There are a handful of studies documenting the occurrence of Legionnaires’ disease in long-term care. This study raises the possibility that it may occur much more frequently than is currently recognized.
Surgical Site Infection (SSI)Richards and colleagues at the CDC analyzed data from the NNIS system from 1999-2001 to determine the effect of SSIs on outcomes for selected high-volume surgical procedures. These included cardiac surgery, coronary artery bypass, cholecystectomy, colon surgery, hip replacement, and knee replacement. The rate of SSI varied from 0.8% to 5.2% for the various procedures, with the highest rate occurring, not unexpectedly, in colon surgery. Mortality rates ranged from 0.4% to 10.3%. For each type of procedure, SSI was the most frequent cause or contributor to mortality, ranging from 44% to 79% of deaths. The effect of infection on mortality was most dramatically demonstrated by the findings for cardiac surgery, in which overall mortality was 10.3%, with 61.5% of those deaths associated with infection. Infected patients had a length of stay of 18.5 days, compared with 10.1 days for those without SSI. In the case of hip replacement, the overall mortality was low (2.2%), but 79% of deaths were due to infection (Richards CL, et al. Outcomes in patients with surgical site infections (SSIs) in the United States—Results of the National Nosocomial Infections Surveillance System. [Abstract 113]).
Comment
This study documents that SSI is the single largest contributor to mortality in surgical patients. Although both infection and mortality rates were low for the majority of procedures, tens of thousands of these procedures are performed annually. According to Medicare claims data, about 85,000 hip replacement procedures are performed in the United States annually. Based on the CDC data, this would translate into nearly 1500 infection-related deaths for a single procedure. Clearly, many of these infections are preventable. Measures that have documented efficacy in preventing SSIs need to be universally adopted. These include appropriate timing of perioperative antibiotic prophylaxis and tight control of perioperative blood glucose levels, to name but 2. In addition, the health care industry needs to identify new technology and innovative management techniques that will further reduce the burden of SSIs.
Dr. Muder is Hospital Epidemiologist Pittsburgh VA Medical Center Pittsburgh Section Editor, Hospital Epidemiology
The following is an overview of some presentations at the 2003 annual meeting of the Society for Healthcare Epidemiology of America.Subscribe Now for Access
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