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  • 1
    Electronic Resource
    Electronic Resource
    Infection control practices in intensive care units of 14 European countries (1996)
    Springer
    Intensive care medicine 22 (1996), S. 872-879 
    Details
    ISSN: 1432-1238
    Keywords: Intensive care units ; Nosocomial infections ; Control measures ; Compliance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective To evaluate compliance with recommended patient-care practices for the prevention of hospital-acquired infections (HAI) in the intensive care unit (ICU). Design European descriptive survey by questionnaire mailed to all the directors of ICUs. Patients and participants A total of 1642 general ICUs with more than three beds in 14 countries were contacted; 1005 units participated in the study (overall response rate of 61.2%). Measurements and results Data on the general characteristics of the hospital and of the ICU, surveillance activities, and patient-care practices relevant to the control of HAIs were collected. Compliance varied significantly by the type of practice evaluated. Comprehensive programs adopting all the recommended preventive practices for specific infections were maintained in a very low proportion of units, ranging from 18% for antibiotic policy to 39% for urinary tract infections. Moreover, 14% of the units claimed to adopt three or more practices that are clearly unsafe, and only 35% of the units claimed not to adopt any risky practice. The presence of an infection control nurse was significantly associated with a lower frequency of substandard care. A great variability was observed by country in the adoption of 29 patient-care practices, mostly for practices for which clear-cut guidelines are lacking. Conclusion Interpretation of data is made difficult by the lack of consensus among experts with respect to some of the practices investigated. Nevertheless, the implementation of standard practices for preventing HAIs is far from satisfactory in the hospitals surveyed, even in a high priority hospital area such as intensive care. Documented European guidelines could be worth-while in increasing awareness of the ICU staff. The availability of at least one infection control nurse in each hospital should be strongly advocated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02044110
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
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  • 2
    Electronic Resource
    Electronic Resource
    Early and late onset bacteremia have different risk factors in trauma patients (1996)
    Springer
    Intensive care medicine 22 (1996), S. 735-741 
    Details
    ISSN: 1432-1238
    Keywords: Trauma ; Early bacteremia ; Late bacteremia ; Polymicrobial bacteremia ; Abdominal injury ; Intravascular catheters
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective The aim of this study was to identify risk factors and to describe epidemiological patterns for early—(EOB) and late—onset bacteremias (LOB) after trauma. Design A prospective study conducted on 141 consecutive trauma patients. Setting A general intensive care unit (ICU) of a university hospital. Patients All multiple trauma patients admitted to our general intensive care unit (ICU) from December 1990 to May 1992 were prospectively enrolled in the study. The following information was collected for each patient and recorded in a computer database: demography, severity of trauma according to the Abbreviated Injury Scale (AIS), severtity of trauma according to the Glasgow Coma Scale (GCS), presence of pneumothorax, pulmonary contusion, rib fractures, hemothorax, and abdominal trauma, use of mechanical ventilation, and placement of central venous catheters. Bacteremias were defined as EOB when onset occurred within 96 h after trauma, and as LOB when appearing after 96 h from trauma. Results Thirty-seven patients developed bacteremia during their ICU stay (26%): 11 (29.7%) EOB and 26 (70.3%) LOB. Gram-positive cocci were isolated more frequently in EOB than in LOB (x 2=4.1,P=0.04). The risk of EOB was significantly increased by the presence of pulmonary contusion [relative risk (RR) 15.0; confidence interval (CI) 1.99-113.25], pneumonia before the onset of bacteremia (RR 3.56; CI 1.17-10.69), AIS score greater than 32 and an abdominal injury score greater than 9 (RR 3.11; CI 1.02-9.49), while intravascular catheters and mechanical ventilation did not represent risk factors for EOB. LOB had a very different pattern and their risk was significantly increased by exposure to intravascular catheters (RR 4.96; CI 1.23-19.94) and to mechanical ventilation lasting more than 7 days (RR 3.6; CI 1.6-8.1). Conclusions Scoring with the AIS of the abdominal and thoracic trauma at admission to the ICU appears a useful tool for identifying trauma patients at increased risk of EOB. A rigorous policy of catheter placement and maintenance as a means of reducing late bacteremias in trauma patients is essential.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709514
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
  • 3
    Electronic Resource
    Electronic Resource
    Infection control practices in intensive care units of 14 European countries (1996)
    Springer
    Intensive care medicine 22 (1996), S. 872-879 
    Details
    ISSN: 1432-1238
    Keywords: Key words Intensive care units ; Nosocomial infections ; Control measures ; Compliance
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To evaluate compliance with recommended patient-care practices for the prevention of hospital-acquired infections (HAI) in the intensive care unit (ICU). Design: European descriptive survey by questionnaire mailed to all the directors of ICUs. Patients and participants: A total of 1642 general ICUs with more than three beds in 14 countries were contacted; 1005 units participated in the study (overall response rate of 61.2%). Measurements and results: Data on the general characteristics of the hospital and of the ICU, surveillance activities, and patient-care practices relevant to the control of HAIs were collected. Compliance varied significantly by the type of practice evaluated. Comprehensive programs adopting all the recommended preventive practices for specific infections were maintained in a very low proportion of units, ranging from 18% for antibiotic policy to 39% for urinary tract infections. Moreover, 14% of the units claimed to adopt three or more practices that are clearly unsafe, and only 35% of the units claimed not to adopt any risky practice. The presence of an infection control nurse was significantly associated with a lower frequency of substandard care. A great variability was observed by country in the adoption of 29 patient-care practices, mostly for practices for which clear-cut guidelines are lacking. Conclusion: Interpretation of data is made difficult by the lack of consensus among experts with respect to some of the practices investigated. Nevertheless, the implementation of standard practices for preventing HAIs is far from satisfactory in the hospitals surveyed, even in a high priority hospital area such as intensive care. Documented European guidelines could be worth- while in increasing awareness of the ICU staff. The availability of at least one infection control nurse in each hospital should be strongly advocated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050181
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
  • 4
    Electronic Resource
    Electronic Resource
    Early and late onset bacteremia have different risk factors in trauma patients (1996)
    Springer
    Intensive care medicine 22 (1996), S. 735-741 
    Details
    ISSN: 1432-1238
    Keywords: Key words Trauma ; Early bacteremia ; Late bacteremia ; Polymicrobial bacteremia ; Abdominal injury ; Intravascular catheters
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: The aim of this study was to identify risk factors and to describe epidemiological patterns for early – (EOB) and late – onset bacteremias (LOB) after trauma. Design: A prospective study conducted on 141 consecutive trauma patients. Setting: A general intensive care unit (ICU) of a university hospital. Patients: All multiple trauma patients admitted to our general intensive care unit (ICU) from December 1990 to May 1992 were prospectively enrolled in the study. The following information was collected for each patient and recorded in a computer database: demography, severity of trauma according to the Abbreviated Injury Scale (AIS), severity of coma according to the Glasgow Coma Scale (GCS), presence of pneumothorax, pulmonary contusion, rib fractures, hemothorax, and abdominal trauma, use of mechanical ventilation, and placement of central venous catheters. Bacteremias were defined as EOB when onset occurred within 96 h after trauma, and as LOB when appearing after 96 h from trauma. Results: Thirty-seven patients developed bacteremia during their ICU stay (26%): 11 (29.7%) EOB and 26 (70.3%) LOB. Gram-positive cocci were isolated more frequently in EOB than in LOB (ξ2=4.1, P=0.04). The risk of EOB was significantly increased by the presence of pulmonary contusion [relative risk (RR) 15.0; confidence interval (CI) 1.99–113.25], pneumonia before the onset of bacteremia (RR 3.56; CI 1.17–10.69), AIS score greater than 32 and an abdominal injury score greater than 9 (RR 3.11; CI 1.02–9.49), while intravascular catheters and mechanical ventilation did not represent risk factors for EOB. LOB had a very different pattern and their risk was significantly increased by exposure to intravascular catheters (RR 4.96; CI 1.23–19.94) and to mechanical ventilation lasting more than 7 days (RR 3.6; CI 1.6–8.1). Conclusions: Scoring with the AIS of the abdominal and thoracic trauma at admission to the ICU appears a useful tool for identifying trauma patients at increased risk of EOB. A rigorous policy of catheter placement and maintenance as a means of reducing late bacteremias in trauma patients is essential.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01709514
    Library Location Call Number Volume/Issue/Year Availability
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    Paper (German National Licenses)
    Fulltext
  • 5
    Electronic Resource
    Electronic Resource
    Risk factors for nosocomial sepsis in newborn intensive and intermediate care units (1996)
    Springer
    European journal of pediatrics 155 (1996), S. 315-322 
    Details
    ISSN: 1432-1076
    Keywords: Key words Neonatal sepsis ; Incidence ; Risk factors ; Neonatal ; intensive care units
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract A multicentre prospective study was performed to estimate the incidence of hospital infections and to identify the most relevant risk factors for sepsis in a large and unselected population of high-risk newborns. The study involved 49 neonatal intensive care units and 17 neonatal intermediate care units in Italy. Newborns were followed up from admittance to the units until discharge. Data on demographics and clinical characteristics, exposure to the principal invasive procedures, and onset of infectious complications were prospectively collected. Only infections developing after 48 h from admittance to the unit were recorded. A multiple logistic regression was performed to identify which factors were independently associated with sepsis. Among the 8263 newborns included in the analysis, the incidence of infected newborns was 14.4 per 100 newborns and 0.9/100 days of stay. The incidence of infections was 19.1/100 newborns and 1.2/100 days of stay. Sepsis represented 15.4% of all infections (incidence 2.9/100 newborns and 0.2/100 days of stay). The following factors were independently associated with sepsis: umbilical catheterization, both through the vein and the artery for more than 5 days; mechanical ventilation for more than 5 days; necrotizing enterocolitis; birth weight equal to or less than 2500 g; nasogastric tube; total parenteral nutrition; and transfer from other hospitals. Umbilical catheters accounted for the highest proportion of sepsis (62%), followed by arterial catheters (31%), nasopharyngeal cannulae (26%), tracheal cannulae (20%), and nasal cannulae (20%). The population attributable risk for the other procedures was less than 10%. Conclusion This study demonstrates that in a large and unselected newborn population, several host factors and invasive procedures are independently associated with an increased risk of sepsis. After adjustment for clinical severity, intravascular catheterization and assisted ventilation were found to be responsible for a considerable proportion of observed sepsis. They should therefore be considered as priorities for interventions, aimed both at reducing unnecessary use and promoting more strict compliance with aseptic practices.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310050408
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    Paper (German National Licenses)
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  • 6
    Electronic Resource
    Electronic Resource
    Risk factors for nosocomial sepsis in newborn intensive and intermediate care units (1996)
    Springer
    European journal of pediatrics 155 (1996), S. 315-322 
    Details
    ISSN: 1432-1076
    Keywords: Neonatal sepsis ; Incidence ; Risk factors ; Neonatal intensive care units
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Abstract A multicentre prospective study was performed to estimate the incidence of hospital infections and to identify the most relevant risk factors for sepsis in a large and unselected population of high-risk newborns. The study involved 49 neonatal intensive care units and 17 neonatal intermediate care units in Italy. Newborns were followed up from admittance to the units until discharge. Data on demographics and clinical characteristics, exposure to the principal invasive procedures, and onset of infectious complications were prospectively collected. Only infections developing after 48 h from admittance to the unit were recorded. A multiple logistic regression was performed to identify which factors were independently associated with sepsis. Among the 8263 newborns included in the analysis, the incidence of infected newborns was 14.4 per 100 newborns and 0.9/100 days of stay. The incidence of infections was 19.1/100 newborns and 1.2/100 days of stay. Sepsis represented 15.4% of all infections (incidence 2.9/100 newborns and 0.2/100 days of stay). The following factors were independently associated with sepsis: umbilical catheterization, both through the vein and the artery for more than 5 days; mechanical ventilation for more than 5 days; necrotizing enterocolitis; birth weight equal to or less than 2500 g; nasogastric tube; total parenteral nutrition; and transfer from other hospitals. Umbilical catheters accounted for the highest proportion of sepsis (62%), followed by arterial catheters (31%), nasopharyngeal cannulae (26%), tracheal cannulae (20%), and nasal cannulae (20%). The population attributable risk for the other procedures was less than 10%. Conclusion This study demonstrates that in a large and unselected newborn population, several host factors and invasive procedures are independently associated with an increased risk of sepsis. After adjustment for clinical severity, intravascular catheterization and assisted ventilation were found to be responsible for a considerable proportion of observed sepsis. They shoudl therefore be considered as priorities for interventions, aimed both at reducing unnecessary use and promoting more strict compliance with aseptic practices.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02002720
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    Paper (German National Licenses)
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  • 7
    Electronic Resource
    Electronic Resource
    Surgical infections surveillance: Results of a sixmonth incidence study in two Italian hospitals (1991)
    Springer
    European journal of epidemiology 7 (1991), S. 641-648 
    Details
    ISSN: 1573-7284
    Keywords: Surgical wound infections ; Surveillance ; Computerized system
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In a six-month incidence study of surgical wound infections (SWI) in two Italian hospitals, 1,019 surgical patients, in three general surgery wards, and 433 surgical patients in one orthopedics ward were studied. For the SWI surveillance, the DANOP-DATA system was used: this microcomputer program was developed by Danish authors and tested in a European multicenter study coordinated by the World Health Organization in 1989. Two Italian hospitals participated in the multicenter study. The overall infection rate was 1.2 per 100 operations in orthopedics and 4.9/100 in general surgery. The risk of infection increased with age (RR = 2.06; 95% CL = 1.20–3.53), wound class (RR = 3.38; 95% CL = 1.97-5.8), length of pre-operative stay (RR = 2.71; 95% CL = 1.54-4.74), and duration of operation (RR = 2.59; 95% CL = 1.48–4.54). The infection rates ranged from 3.7 to 7.3/100 among the three general surgery wards; this variability by ward was only partially explained by differences in the age distribution of in-patients, wound class, duration of operation and length of pre-operative stay. When all these risk factors were simultaneously taken into account using a logistic regression model, the odds ratio, comparing one of the three general surgical wards with the other two, was still 2.29 (95% CL = 1.23–4.26). The observed variability can be attributed to differences, among the participating wards, in the case-mix of patients treated and/or to differences in the quality of infection control programs implemented.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00218675
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    Paper (German National Licenses)
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  • 8
    Electronic Resource
    Electronic Resource
    Surgical infections surveillance: Results of a six-month incidence study in two Italian hospitals (1992)
    Springer
    European journal of epidemiology 8 (1992), S. 484-484 
    Details
    ISSN: 1573-7284
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00158586
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    Paper (German National Licenses)
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  • 9
    Electronic Resource
    Electronic Resource
    Risk factors for acute renal failure in trauma patients (1998)
    Springer
    Intensive care medicine 24 (1998), S. 808-814 
    Details
    ISSN: 1432-1238
    Keywords: Key words Acute renal failure ; Trauma ; Rhabdomiolysis ; Mechanical ventilation ; Hemoperitoneum
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: To elucidate the risk factors for the development of acute renal failure (ARF) in severe trauma. Design: Prospective observational study. Setting: A general intensive care unit (ICU) of a university hospital. Patients: A cohort of 153 consecutive trauma patients admitted to the ICU over a period of 30 months. Results: Forty-eight (31 %) patients developed ARF. They were older than the 105 patients without ARF (p = 0.002), had a higher Injury Severity Score (ISS) (p 〈 0.001), higher mortality (p 〈 0.001), a more compromised neurological condition (p = 0.007), and their arterial pressure at study entry was lower (p = 0.0015). In the univariate analysis, the risk of ARF increased by age, ISS 〉 17, the presence of hemoperitoneum, shock, hypotension, or bone fractures, rhabdomyolysis with creatine phosphokinase (CPK) 〉 10 000 IU/l, presence of acute lung injury requiring mechanical ventilation, and Glasgow Coma Score 〈 10. Sepsis and use of nephrotoxic agents were not associated with an increased risk of ARF. In the logistic model, the need for mechanical ventilation with a positive end-expiratory pressure 〉 6 cm H2O, rhabdomyolysis with CPK 〉 10 000 IU/l, and hemoperitoneum were the three conditions most strongly associated with ARF. Conclusions: The identified risk factors for post-traumatic acute renal failure may help the provision of future strategies.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340050670
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    Paper (German National Licenses)
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