ISSN:0951-7375    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Pneumonia continues to be the most common fatal nosocomial infectious disease, associated with about 80,000 deaths in the United States annually. Some debate regarding crude versus attributable mortality from nosocomial pneumonia continues, but minimally 17,000 deaths are directly attributable to nosocomial pneumonia. Recent observations have, in fact, questioned whether patients in the intensive care unit die because of pneumonia or have pneumonia because they are dying. The role of gastric pH elevating agents, such as H2blockers or antacids, as risk factors for nosocomial pneumonia remains controversial. A recent meta-analysis of past reports suggests that such an association is not yet well proven. The use of invasive diagnostic methods, such as bronchoscopy with quantitative cultures, also continues to merit attention. False-positive and false-negative results, lack of a gold standard for assuring reliability of this methodology, plus the time and expense involved present open issues preventing widespread use of this methodology. Prophylactic use of nonabsorbable antibiotics in mechanically ventilated patients to prevent pneumonia and hopefully mortality remains under investigation. Numerous reports using this approach have offered widely conflicting results. Given the added expense of this methodology, final recommendations for routine use cannot be made.

ISSN:0951-7375    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Legionella pneumophilais an infrequent cause of pneumonia in most hospitals. However, it can survive in all types of aquatic environments and actually thrive in warm water that exists in potable water systems and cooling towers of large buildings. Colonization of these water systems is not often associated with causing disease. Unfortunately, colonizations of these systems occasionally lead to exposure of susceptible patients and outbreaks of infection. These organisms can be difficult to eradicate from the water systems, and the outbreaks can be resistant to control efforts. This report summarizes the role ofL. pneumophilaas a nosocomial pathogen, its ecologic niche within hospitals, and methods of surveillance and control of these infections among patients within institutions.

ISSN:0951-7375    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Urinary tract infection associated with the use of an indwelling urethral catheter is the most frequent cause of nosocomial infection. Between 10% and 20% of patients develop bacteriuria during a 2- to 4-day period of catheterization. Most episodes of bacteriuria occur when enteric bacteria colonizing the periurethral area migrate retrogradely into the bladder along the outside of the catheter in the periurethral mucus sheath. Some species of bacteria are uniquely capable of adhering to catheter materials and forming encrustations that can seed bladder urine and obstruct urine flow. Strategies to prevent catheter-associated urinary tract infection have been designed to interrupt the chain of infection; unfortunately, none have been successful in significantly lowering infection rates. Investigations are ongoing for new catheter materials and agents that prevent the adherence of bacteria to the catheter or bladder epithelium. Until these products are available, the best strategies to prevent infection are avoidance and closed, sterile catheter care.

ISSN:0951-7375    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Organisms causing nosocomial infections come from either endogenous or exogenous sources. Endogenous infections are caused by the patient's own flora, whereas exogenous infections result from transmission of organisms from a source other than the patient. The reuse of medical instruments and devices bears a significant risk of transmitting exogenous infections. Failure to employ appropriate disinfection or sterilization measures has been responsible for several nosocomial outbreaks. Depending on the nature of the medical device and its intended use, infection control policies must identify appropriate disinfection techniques.

ISSN:0951-7375    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Coagulase-negative staphylococci are increasingly implicated as causes of septicemia, peritonitis, and endocarditis. Various methods of epidemiologic typing have been assessed, usually in combination. Biotyping and phage typing show poor discrimination or typability; antibiotic resistance typing is often helpful, but the newer electrophoretic methods including protein patterns, plasmid analysis, and restriction enzyme digestion are widely advocated. New methods include pyrolysis mass spectrometry, monoclonal antibodies, and susceptibility to desferrioxamine. Slime production was widely examined, but its significance remains unclear. A new phage set forStaphylococcus saprophyticushas been prepared.

ISSN:0951-7375    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Hepatitis C virus is the major etiologic agent of non-A, non-B hepatitis. With recent anti-hepatitis C virus assays, the prevalence of anti-hepatitis C virus in blood donors and in recipients of transfusion can be assessed. Evidence for hepatitis C virus transmission is especially marked in multitransfused patients. Second-generation assays incorporating viral structural and nonstructural antigens show significantly increased sensitivity compared with first-generation tests based on a nonstructural antigen. Without confirmatory assays, even second-generation tests have a poor predictive value in populations with a low prevalence of hepatitis C virus. The rates of posttransfusion hepatitis vary markedly in different parts of the world. In countries like Japan, anti-hepatitis C virus screening has had a particularly marked effect in reducing posttransfusion hepatitis. Other agents, including mutants of hepatitis B virus, also have a residual role in the causation of posttransfusion hepatitis.

ISSN:0951-7375    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Handwashing or disinfection is considered to be one of the most important methods of preventing the spread of infection, but good clinical trial data are not available to allow a choice between agents to make a decision on the optimal time for washing. Techniques for testing hand disinfection are described in several papers. Recommended application time of the washing or disinfecting agent range from 30 seconds to 5 minutes for preoperative hand disinfection (surgical) and from 8 seconds to 1 minute for ward handwashing or disinfection (hygienic). In laboratory tests, alcoholic solutions are usually the most effective for both surgical and hygienic hand disinfection, but antiseptic-detergents (chlorhexidine and povidone-iodine) or soap and water for ward handwashing are still often preferred.Escherichia coliis commonly applied to the hands as a test organism for hygienic hand disinfection in Europe, although other organisms,eg, Staphylococcus aureus,hospital strains of gram-negative bacilli or enterococci, or viruses require consideration. Preparations containing the same concentration of active agent may vary both in antimicrobial efficacy and in staff acceptability.

ISSN:0951-7375    

出版商:OVID    

年代:1992

数据来源: OVID

摘要:

Hospital-acquired infections (HAIs) have been a serious problem ever since patients were first congregated in hospitals. Apart from causing considerable morbidity, mortality, and disruption of work, HAIs are a drain on expensive resources. The main lesson derived from the past several decades of experience and research is that prevention and control of HAIs requires an organized and ongoing management system. An important aspect of this system is an effective surveillance program that involves continuous monitoring of HAIs. The purpose of this article is to present a concise review of recently reported methods of surveillance for HAIs, with comments on the efficacy of various methods.

ISSN:0951-7375    

出版商:OVID    

年代:1992

数据来源: OVID

ISSN:0951-7375    

出版商:OVID    

年代:1992

数据来源: OVID