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Antecedentes: Las infecciones respiratorias bajas nosocomiales son, en cuanto a frecuencia, costos e impacto en la salud, las de mayor importancia en los servicios médicos generales y quirúrgicos. Se han identificado factores protectores o de riesgo; otros han sido asociados, ya que se hallan presentes más a menudo entre los afectados, como en el caso de la nutrición por gastrostomía. Objetivo: Determinar la asociación entre la nutrición por gastrostomía y el desarrollo de infecciones respiratorias bajas en pacientes adultos sin ventilación mecánica, y modelar el riesgo de dichas infecciones en función del tiempo. Métodos: Estudio de cohorte prospectiva, con seguimiento intrahospitalario y domiciliario de 90 días a pacientes con nutrición por gastrostomía y pacientes no expuestos a dicho soporte nutricional hasta la presencia de infecciones respiratorias bajas o censura. Análisis estadístico mediante el método de Kaplan-Meier y el modelo de riesgos proporcionales de Cox. Resultados: Se incluyó en el estudio a 128 sujetos (64 en cada cohorte). El 62,5% de los expuestos y el 32,8% de los no expuestos presentaron durante el seguimiento infecciones respiratorias bajas (p = 0,0008). La nutrición por gastrostomía aumentó al 180% el riesgo de desarrollar infecciones respiratorias bajas (HR: 2,8; IC 95%: 1,64-4,77; p = 0,0001), en comparación con los no expuestos, asociación que aumentó al ajustarse por variables de confusión e interacción (HR: 4,6; IC 95%: 1,95-8,42; p = 0,0000). Conclusión: La nutrición por gastrostomía representa un factor de riesgo para el desarrollo de infecciones respiratorias bajas en adultos sin ventilación mecánica, y dicho riesgo varía en función del tiempo Background: Nosocomial lower respiratory infections are the most frequent and expensive nosocomial infections in general medical and surgical services, and they are the ones which have the greatest impacts on patients’ health. Some risk factors and some protective factors have been clearly identified while others have others have been associated since they are present in greater frequency among those affected. One of these is percutaneous endoscopic gastrostomy (PEG) feeding. Objectives: The objectives of this study were to determine the association between PEG feeding and the development of lower respiratory tract infections in adult patients without mechanical ventilation and to model risk as a function of time. Methods: This study was a prospective cohort study with follow-up of patients in the hospital and at home for 90 days. Gastrostomy fed patients and patients without PEG feeding were studied to determine whether lower respiratory infections developed. The Kaplan Meier estimator and Cox proportional hazards model were used for statistical analysis of data. Results: A total of 128 subjects, two cohorts of 64 patients each, were included. 62.5% of the patients with PEG feeding and 32.8% of those without PEG feeding developed lower respiratory infections during follow-up (p = 0.0008). PEG feeding increased the risk of developing lower respiratory infections by 180% (HR: 2.8, 95% CI: 1.64 - 4.77, p=0.0001) over the risk of patients without PEG feeding. This association increased when adjusted for confounding variables and interaction (HR: 4.6, 95% CI: 1.95 - 8.42, p=0.0000). Conclusion: PEG feeding represents a risk factor for the development of lower respiratory tract infections in adults without mechanical ventilation. This risk varies over time

Cross infection is a global health problem. The cost for cross infection increases every year. Florence Nightingale focused her attention on preventing cross infections by using good hygiene and as a nurse that is one of your more important tasks. Nurses have guidelines for how hygiene should be implemented in practice. The aim of this study is to investigate factors that influence nurses´ compliance to guidelines regarding hygiene. A literature review was used to analyze scientific articles related to the topic. The result showed that education increases nurses´ compliance to follow guidelines. Furthermore compliance to hand hygiene was higher after contact with the patient then before. The result also showed that the nurses were more worried about attracting an infection from the patient then giving an infection to the patient. The studies revealed that nurses want more education about guidelines and the latest research on the subject. The authors think that nurses need more education about hygiene in order to understand the importance of following guidelines. Nurses also need time for both reading updated information infection control and implementing the hygiene guidelines more frequently in practice.

Infection prevention in dentistry is an important topic that has gained more interest in recent years and guidelines for the prevention of cross-transmission are common practice in many countries. However, little is known about the real risks of cross-transmission, specifically in the dental healthcare setting. This paper evaluated the literature to determine the risk of cross-transmission and infection of viruses and bacteria that are of particular relevance in the dental practice environment. Facts from the literature on HSV, VZV, HIV, Hepatitis B, C and D viruses, Mycobacterium spp., Pseudomonas spp., Legionellaspp. and multi-resistant bacteria are presented. There is evidence that Hepatitis B virus is a real threat for cross-infection in dentistry. Data for the transmission of, and infection with, other viruses or bacteria in dental practice are scarce. However, a number of cases are probably not acknowledged by patients, healthcare workers and authorities. Furthermore, cross-transmission in dentistry is under-reported in the literature. For the above reasons, the real risks of cross-transmission are likely to be higher. There is therefore a need for prospective longitudinal research in this area, to determine the real risks of cross-infection in dentistry. This will assist the adoption of effective hygiene procedures in dental practice.Keywords: cross-transmission; cross-infection; dentistry; bacteria; viruses; healthcare-associated infections(Published: 12 June 2012)Citation: Journal of Oral Microbiology 2012, 4: 17659 - http://dx.doi.org/10.3402/jom.v4i0.17659

We protect ourselves from airborne cross-infection in our indoor environment by supplying fresh air to the room by natural or mechanical ventilation. The air is distributed in the room according to different principles as e.g. mixing ventilation, downward ventilation, displacement ventilation, etc. A large amount of air is supplied to the room to ensure dilution of airborne infection.The paper discusses both the macroenvironment and the microenvironment. The macroenvironment is the conditions created by the air distribution system, and the microenvironment is the conditions created by the local flow around persons in combination with the surrounding conditions.Analyses of the flow in the room (macroenvironment) show a number of parameters that play an important role in minimising of airborne cross-infection. The air flow rate to the room must be high, and the air distribution pattern can be designed to have high ventilation effectiveness. Furthermore, personalized ventilation may reduce the risk of cross-infection. Personalized ventilation can be used especially in hospital wards, aircraft cabins and, in general, where people are located at defined positions.Analyses of the flow in the microenvironment show that a number of variables are important, as e.g. distance between people, people’s posture, surrounding temperature gradients and surrounding temperature, activity level, etc.Experiments with tracer gas simulating droplet nuclei and experiments with large particles, simulating droplets are used for the study of airborne cross-infection risk and for the study of dropletborne transmission of a disease. CFD predictions are used to support these experiments.

An autoclavable air turbine handpiece, Air Flushing Clean System (AFCS) (Osada Electric Co., Ltd., Tokyo, Japan) was developed for use in dentistry with the objective of reducing cross-contamination. Its potential for bacterial contamination was investigated in vitro using two bacterial strains (Streptococcus mutants ATCC 25175 and Staphylococcus aureus FDA 209 P). In theory, this device should prevent cross-contamination of the internal water and air lines of the handpiece, by maintaining an internal positive pressure even after the turbine is stopped. In the present study, this AFCS device was found to reduce the bacterial contamination within the air turbine handpiece more effectively than the conventional handpiece used according to accepted protocol. The reduction of such contamination by the AFCS is in keeping with the recent objective of the American Dental Association to reduce cross-contamination during dental procedures.

Objectives: The aim of this study was to evaluate the attitude and susceptibility of the patients who attended to Yeditepe University Faculty of Dentistry, about the cross-infection control. Methods: A questionnaire was designed to obtain information about cross-infection control in dental practices. The study population included 450 patients (277 female, 173 male) who attended to Yeditepe University Faculty of Dentistry, in December 2010. The questionnaire collected data on socio-demographic characteristics, expectations from dentists about wearing of gloves, mask, protective cap and glass, changing and renewing of these materials, and infection control procedures before treatment. Descriptive statistical methods and Chi-square test were used to analyze data. An alpha level of 0.05 was used for all statistical analyses. Results: 100% of the patients expected from dentist to wear gloves, 98.9% of them expected to wear mask, 73% of them expected to wear protective cap, and 67.1% of them expected to wear protective glass. The 50.5% of the female respondents stated that all patients should wear protective glass, and this ratio is higher than male patients (37.6%) (p

Prosthetic restorations that have been tried in the patient's mouth are potential sources of infection. In order to avoid cross-infection, protocols for infection control should be established in dental office and laboratory. This study evaluated the antimicrobial efficacy of disinfectants on full metal crowns contaminated with microorganisms. Full crowns cast in a Ni-Cr alloy were assigned to one control group (n=6) and 5 experimental groups (n=18). The crowns were placed in flat-bottom glass balloons and were autoclaved. A microbial suspension of each type of strain - S. aureus, P. aeruginosa, S. mutans, E. faecalis and C. albicans- was aseptically added to each experimental group, the crowns being allowed for contamination during 30 min. The contaminated specimens were placed into recipients with the chemical disinfectants (1% and 2% sodium hypochlorite and 2% glutaraldehyde) for 5, 10 and 15 min. Thereafter, the crowns were placed into tubes containing different broths and incubated at 35ºC. The control specimens were contaminated, immersed in distilled water for 20 min and cultured in Thioglycollate broth at 35ºC. Microbial growth assay was performed by qualitative visual examination after 48 h, 7 and 12 days. Microbial growth was noticed only in the control group. In the experimental groups, turbidity of the broths was not observed, regardless of the strains and immersion intervals, thus indicating absence of microbial growth. In conclusion, all chemical disinfectants were effective in preventing microbial growth onto full metal crowns. Restaurações protéticas provadas na cavidade bucal dos pacientes são fontes potenciais de infecção. Para evitar infecção cruzada, protocolos de controle de infecção devem ser estabelecidos no consultório e laboratório odontológicos. Este estudo avaliou a eficácia antimicrobiana de desinfetantes químicos em coroas metálicas contaminadas com microorganismos. Coroas totais fundidas com liga de Ni-Cr foram divididas em grupo controle (n=6) e 5 grupos experimentais (n=18). As coroas foram colocadas em balões de vidro e esterilizadas em autoclave. A suspensão microbiana de cada tipo de cepa (S. aureus, P. aeruginosa, S. mutans, E. faecalis e C. albicans) foi assepticamente adicionada a cada grupo experimental, e as coroas foram deixadas contaminar por 30 min. Os corpos-de-prova contaminados foram colocados em recipientes com os desinfetantes químicos (hipoclorito de sódio 1% e 2% e glutaraldeído) por 5, 10 e 15 min. A seguir, as coroas foram colocadas em tubos contendo diferentes meios de cultura e incubadas a 35ºC. Os corpos-de-prova do grupo controle foram contaminados, imersos em água destilada por 20 min e a seguir colocados em tubos de ensaio com meio de cultura Thioglycollate e incubados a 35ºC. A análise do crescimento microbiano foi realizada pelo exame visual qualitativo após 48 h, 7 e 12 dias. Houve crescimento microbiano apenas no grupo controle. No grupo experimental não foi observada turvação dos meios de cultura, independentemente das cepas e períodos de imersão. Conclui-se que todos desinfetantes químicos foram eficazes para prevenir o crescimento microbiano.

A two-bed hospital ward with one standing healthcare person and a ceiling-mounted lowimpulse semicircular inlet diffuser is simulated in a full-scale room. Tracer gas is used for simulating gaseous contaminants, and the concentration is measured at different air change rates and different postures of the patients. A textile partition between the beds, which is typical in a hospital ward, is used for protection of the patients in some of the experiments. Three different layouts of return openings are tested. One layout with one opening at the ceiling, another with four openings at the wall opposite to the inlet diffuser, and one with a high location of these four openings. The downward recirculating flow is on average parallel with the partition, and in most cases the partition does not decrease cross-infection. A high location of the four return openings decreases the risk of cross-infection. A two-bed hospital ward with one standing healthcare person and a ceiling-mounted lowimpulse semicircular inlet diffuser is simulated in a full-scale room. Tracer gas is used for simulating gaseous contaminants, and the concentration is measured at different air change rates and different postures of the patients. A textile partition between the beds, which is typical in a hospital ward, is used for protection of the patients in some of the experiments. Three different layouts of return openings are tested. One layout with one opening at the ceiling, another with four openings at the wall opposite to the inlet diffuser, and one with a high location of these four openings. The downward recirculating flow is on average parallel with the partition, and in most cases the partition does not decrease cross-infection. A high location of the four return openings decreases the risk of cross-infection.

The studies in this thesis were performed as part of the AMRIN (Antimicrobial Resistance in Indonesia) study that addressed antimicrobial resistance, antibiotic usage and infection control in Indonesia. They are the first studies that give insight into the incidence of healthcare-associated infections, determinants for carriage of resistant bacteria in Indonesian individuals and the implementation of measures for the prevention of the spread of bacteria and nosocomial infections in Indonesian hospitals.

The public health burden caused by methicillin-resistant Staphylococcus aureus (MRSA) infections is now widely recognized, and is a cause of public alarm. Effective MRSA risk management in the healthcare system as well as in the community should rely on accurate detection of reservoirs and sources of transmission, as well as on close monitoring of the impact of interventions on disease incidence and bacterial dissemination. MRSA carrier screening and disease surveillance, coupled with molecular typing, are key information tools for integrated MRSA control and individual risk assessment. These tools should be tailored to the distinct needs of local interventions and national prevention programmes. Surveillance schemes should primarily inform local staff and serve as quality assurance about MRSA risk management. New technologies, including the use of selective culture media and real-time PCR assays, allow faster detection of MRSA carriers upon admission or during stay in healthcare institutions. More research is needed to ascertain their cost-effectiveness for MRSA control. Likewise, tremendous progress has been made concerning molecular typing methods, with optimization and standardization of sequence-based technologies offering broad applicability and high throughput. However, no single S. aureus typing method is yet providing fully reliable information within the range of discrimination needed for public health action. Further refinement of genotyping methods and international harmonization of surveillance and typing schemes must be achieved to facilitate global MRSA control.

International audience; The genus Pneumocystis comprises uncultured, highly diversified microfungal organisms able to attach specifically to type-1 alveolar epithelial cells and to proliferate in pulmonary alveoli provoking severe pneumonitis. The pathogenic potential of Pneumocystis species, especially of the human-associated Pneumocystis jirovecii, has stimulated a growing interest in these peculiar microfungi. However, a comprehensive understanding of basic biology and pathogenic power of Pneumocystis organisms calls for their recognition as natural, complex entities, without reducing them to their pathogenic role. For many years, the entity named "Pneumocystis carinii" was considered like an anecdotal pulmonary pathogen able to cause pneumonia in immunosuppressed hosts. Only for the last years, marked genetic divergence was documented among the Pneumocystis strains of different mammals. Cross-infection experiments showed that Pneumocystis species are stenoxenous parasites. Mainly on the basis of the Phylogenetic Concept of Species, Pneumocystis strains were considered as genuine species. Five species were described: P. carinii and Pneumocystis wakefieldiae in rats, P. jirovecii in humans, Pneumocystis murina in mice, and Pneumocystis oryctolagi in rabbits. They also present distinctive phenotypic features. Molecular techniques have revealed a high prevalence of Pneumocystis colonization in wild mammals, probably resulting from active airborne horizontal and vertical (transplacental or aerial) transmission mechanisms. Cophylogeny is the evolutionary pattern for Pneumocystis species, which dwelt in the lungs of mammals for more than 100 million years. Consistently, Pneumocystis organisms exhibit successful adaptation to colonize the lungs of both immunocompromised and healthy hosts that can act as infection reservoir. Pneumocystis pneumonia, rarely reported in wild mammals, seems to be a rather unfrequent event. A larger spectrum of Pneumocystis infections related to the heterogeneous level of immune defence found in natural populations, is, however, expected. Pneumocystis infection of immunocompetent hosts emerges therefore as a relevant issue to human as well as animal health.

Objective The present study was aimed at determining device-associated infection rates, device use rates and the microbiologic profile of nosocomial infections in a tertiary neonatal intensive care unit (ICU) in Bogotá, Colombia. Methods Prospective nosocomial infection surveillance was implemented in a neonatal intensive care unit for 11 months in line with the High Risk Nursery component of the Colombian Nosocomial Infection Surveillance programme. Patient-days, length of stay, device use rates and device-associated nosocomial infection rates were calculated. Results 1 998 device days were observed among 2 890 patient days during the 11 months' surveillance. Central venous catheter-related bloodstream infection was the most common device-associated infection for all birth-weight categories. 69,2 % and 100 % of all coagulase negative staphylococci and Staphylococcus aureus infections were methicillin resistant strains and all gram negative rods were susceptible to third generation cephalosporins, carbapenems, ciprofloxacin and piperacillin-tazobactam. Device-associated infection and device use rates in the ICU were higher than Colombian Nosocomial Infection Surveillance reports for October 2004 and reports from Colombia and other Latin-American countries. Conclusions This surveillance identified blood-stream infection as being the most common infection in the ICU in question. Efforts should thus be directed at establishing suitable infection-control practices. Objetivo El objetivo del presente estudio fue determinar las tasas de infección asociadas a dispositivos médicos, las tasas de utilización y el perfil microbiológico de las infecciones hospitalarias en una unidad de terapia intensiva neonatal en Bogotá-Colombia. Métodos Un sistema de vigilancia de infección hospitalaria fue implementado en la unidad de terapia intensiva neonatal de un hospital de tercer nivel durante un periodo de 11 meses de acuerdo al componente neonatal del sistema de vigilancia de infección hospitalaria de los estados unidos. Se calcularon los días pacientes, los días de estancia, las tasas de utilización y de infección asociadas a dispositivos invasivos. Resultados Un total de 1 998 días dispositivos fueron observados entre 2 890 días paciente durante los 11 meses de vigilancia. La infección asociada a catéter central fue la infección más frecuente entre las diferentes categorías de peso neonatal. El 69,2 % y el 100 % de todos los Staphylococos coagulasa negativa y Staphylococcus aureus fueron resistentes a meticilina respectivamente, y todos los bacilos gram negativos fueron susceptibles a las Cefalosporinas de tercera generación, Carbapenemicos, Ciprofloxacina y a Piperacilina-Tazobactam. Las tasas de infección asociada a dispositivos invasivos y las tasas de utilización en nuestra unidad fueron superiores al reporte de octubre del 2004 del sistema de vigilancia de infección hospitalaria de los estados unidos y de otros trabajos realizados en Colombia y en Latinoamérica. Conclusiones Este proceso de vigilancia ha permitido identificar que las infecciones del torrente sanguíneo comprende el principal problema de nuestra unidad y por tal motivo la necesidad de implementar adecuadas medidas de control de infecciones para disminuir la ocurrencia de esta infección debe ser la prioridad de nuestra institución.

Systematic analyses of infections in critical illness are sparse and mostly restricted to specific infection categories. Thus, a prospective study was carried out in a medical-surgical ICU during 14 months on patients whose ICU stay was longer than 48 h. The prospectively gathered data included detailed patient history, infection survey, severity of illness scores (APACHE II, SOFA), resource use, short-term and long-term outcome and quality of life following hospital discharge. Altogether 335 patients were included, of whom 251 (74.9%) had an infection on admission; 59.3% had a community-acquired infection (CAI) and 40.7% a hospital-acquired infection (HAI), while 84 (25.1%) did not have any infection (NI). APACHE II scores and ICU or hospital mortality rates did not differ between the groups. The median hospital stay was longer in the HAI than in the CAI or NI groups. Eighty (23.9%) of the 335 patients developed an ICU-acquired infection (48 per 1000 patient days): ventilator-associated pneumonia (VAP) in 33.8% of the cases, central catheter-related (CRI) or primary bloodstream infections in 6.3% and urinary tract infections in 1.3%, while the corresponding device-related incidences per 1000 days were 18.8, 2.2 and 0.5, respectively. ICU-acquired infection was an independent risk factor for hospital mortality. It doubled the risk for hospital mortality in patients with an infection on admission and caused a threefold the risk in patients without an infection on admission and an almost fourfold increase in the use of nursing resources. Of the 272 hospital survivors, 83 (30.5%) died after discharge during the median follow-up of 17 weeks. Infection status on admission or during the ICU stay did not affect long-term mortality. ICU-acquired infection did not have an impact on patients’ quality of life. The current general level of health compared to the status before ICU admission did not differ between the groups, either. Only 36% of those employed resumed their previous jobs. Three-fourths of patients had an infection on admission, while nearly one fourth acquired an ICU infection. The high VAP rate suggests a need for re-evaluation of preventive measures, whereas the low CRI indicates more successful prevention. ICU-acquired infection was a significant risk factor for hospital mortality, but did not affect patients’ long-term survival or quality of life.

Background and aims. Dental handpiece is a source of contamination because it is in constant touch with the oral cavity. Sterilization does not seem to be sufficient to prevent penetration of microorganisms into air and water lines of the unit, because negative pressure developed by valves (which are placed in water outlets) and post shut-off inertial rotation of handpiece result in water and debris being sucked into air and water outlets of dental unit. The aim of this study was to compare dental unit contamination following use of clean head system handpieces and conventional handpieces. Materials and methods. Twenty-two dental units in the Department of Pediatric Dentistry in Shahid Beheshti Faculty of Dentistry were used for the purpose of this study. A 1.5×108 cfu/mm3 concentration of Staphylococcus epidermis (SE) was used to contaminate the air and water outlets of dental units. Ten clean head system handpieces and 10 conventional handpieces were used for 30 seconds in the above-mentioned suspension. Microbial samples were collected from the air and water lines. Culturing and colony counting procedures were carried out. Data was analyzed by t-test; a value of p< 0.01 was considered significant. Results. Results demonstrated a significantly lower SE contamination in water outlets following the use of clean head system (p< 0.01). Conclusion. A lower tendency of clean head system handpieces to transmit SE compared to conventional system makes them a better choice for infection control., Journal of Dental Research, Dental Clinics, Dental Prospects; ISSN 2008-210X

Although the exact burden of disease caused by methicillin-resistant Staphylococcus aureus (MRSA) remains largely unknown, most experts agree that MRSA infections are an important clinical and public health problem. Thousands of reports have been published during the last four decades concerning epidemiological and microbiological aspects of MRSA, but uncertainty remains about the best approach to prevent and control this worldwide plague, especially endemic MRSA. Epidemiological methods, e.g., risk scores for targeted screening upon admission, rapid molecular tests and pre-emptive isolation of high-risk patients, new decontamination regimens and restriction of certain antibiotic classes, are all promising approaches that may decrease MRSA cross-transmission; however, further evidence is needed before these strategies can be implemented on a wide scale. Control of community MRSA is an additional challenge for the future, requiring improved surveillance and contact tracing, as well as education and treatment of both infected cases and colonised contacts. This review summarises recent advances and studies that address these issues. Overall, it seems that there is no level of MRSA prevalence for which active control measures are no longer warranted.

Item does not contain fulltext Patient safety in hospital care depends on effective infection control (IC) programmes. The Antimicrobial Resistance Prevention and Control (ARPAC) study assessed the organisation, components and human resources of IC programmes in European hospitals. A questionnaire survey of policies and procedures implemented in 2001 for the surveillance and control of nosocomial infection and antibiotic resistance was completed by 169 acute-care hospitals from 32 European countries, categorised by five geographical regions. A formal IC programme existed in 72% of hospitals, and a multidisciplinary IC committee was operational in 90%. Trained IC nurses (ICNs) were present in 80% of hospitals (ranging from 54% in south-east and central-eastern Europe, to 100% in northern Europe), whereas 74% had one or more trained IC doctors (ICDs) (ranging from 46% in south-east Europe to 84% in western Europe). Median staffing levels were 2.33 ICNs/1,000 beds and 0.94 ICDs/1,000 beds. The intensity of IC programmes scored higher in centres from northern and western Europe than from other European regions. Written guidelines promoted hand hygiene for healthcare workers in 89% of hospitals, education in 85%, and audit in 46%. Guidelines recommended use of alcohol-based solutions (70%) and/or medicated/antiseptic soap (43%) for decontamination of non-soiled hands. Use of alcohol-based solutions varied according to region, from 41% in southern Europe to 100% in northern Europe, compared with use of medicated soap from 77% in southern Europe to 11% in northern Europe (p < 0.01). These findings showed that IC programmes in European hospitals suffer from major deficiencies in human resources and policies. Staffing levels for ICNs were below recommended standards in the majority of hospitals. Education programmes were incomplete and often not supported by audit of performance. Hand hygiene procedures were sub-standard in one-third of centres. Strengthening of IC policies in European hospitals should be a public health priority.

Introduction The knowledge and behaviour of adult patients with cystic fibrosis (CF) regarding cross-infection are ill understood. Methods A questionnaire was designed to investigate this at the West Midlands Adult CF Centre. Results 94 patients completed the questionnaire. 54%, 36% and 46% had "no idea" of the lifetime risk of contracting Burkholderia cepacia complex, epidemic strains of Pseudomonas aeruginosa , and MRSA, respectively. 25–33% did not know the consequences of infection with these bacteria. 35% mixed with other people with CF, 6.5% during physiotherapy or nebulizer use. Most respondents did not think quality of life was significantly linked with segregation from other patients with CF. Conclusions Adults with CF, at least in the West Midlands, have poor knowledge of the risk and consequences of cross-infection. A significant proportion ignored advice not to mix with other patients, although segregation was not thought to impact upon quality of life. This suggests that more education about the risks of cross-infection would be beneficial.

OBJETIVOS: Investigar la prevalencia y sensibilidad de gérmenes aislados en recién nacidos hospitalizados en un hospital de referencia de Bogotá. Proponer un esquema antibiótico inicial en infecciones neonatales. MÉTODOS: Se analizaron los cultivos para aerobios y aerobios facultativos practicados entre febrero y diciembre del 2002. Los hemocultivos se procesaron en BacT/ALERT (Dirham, NC); los urocultivos en UROCULT (Bio-Bacter) y las puntas de catéter en Tioglicolato. La identificación se hizo con BBL CRYSTAL (BD, Sparks, MD). La sensibilidad se determinó por difusión de disco. RESULTADOS: Fueron positivos 1 097 de 3 710 cultivos; se aislaron 64,3 % Gram-positivos, 30,6% Gram-negativos y 4,9% Candidas. Los Gram-positivos aislados fueron: estafilococos coagulasa negativa (64,2%); Enterococcus (13,8 %) y estafilococos coagulasa positiva (13,3%). Los Gram-negativos mas frecuentes fueron Klebsielas (45,2%); Escherichia coli (30,9%) y Serratias (10,1 %). El 64% de los estafilococos coagulasa negativos fueron Stafilococcus epidermidis. La sensibilidad del S. epidermidis y los estafilococos coagulasa positivos a la vancomicina fue del 100%. Hubo 86,4% (IC95%: 82,3-89,9) de resistencia de los estafilococos coagulasa negativos a los beta-lactámicos. La sensibilidad de los Gram-negativos fue del 98,1% (IC95%: 89,9-99,9) a imipenem, 78,1% (IC95%: 64,9-88,2) a gentamicina y 46,6% (IC95%: 28,3-65,7) a amikacina. CONCLUSIONES: Se encontró una alta prevalencia de estafilococos coagulasa negativos particularmente de S. epidermidis. No se observó resistencia de S. epidermidis ni estafilococos coagulasa positivos a vancomicina. Se observa resistencia creciente de los estafilcocos coagulasa negativos a oxacilina y de los Gram-negativos a amikacina. OBJECTIVES: Investigating the prevalence and sensitivity of germs isolated from newborn in a referral hospital in Bogotá. Suggesting an empirical antibiotic treatment for neonatal infection. METHODS: Cultures taken between February and December 2002 were analysed. Blood cultures were processed using BacT/ALERT (Durham, NC), urine cultures by UROCULT (Bio-Bacter) and catheter tips in thioglycollate. BBL CRYSTAL identification system (BD, Sparks, MD) was used for identifying germs. Antibiotic sensitivity was determined by disk diffusion. RESULTS: There were 1,097 positive aerobic and facultative aerobic germ cultures; 64,3% were Gram-positive, 30,6% Gram-negative and 4,9% were yeasts. Gram-positive germs consisted of coagulase-negative staphylococci (64,2%), enterococcus (13,8%) and coagulase-positive staphylococci (13,3%). The most frequent Gram-negatives were Klebsiella (45,2%), Eschericha coli (30,9%) and Serratia (10,1%). Staphylococcus epidermidis accounted for 64% of the coagulase-negative staphylococci. S. epidermidis susceptibility to vancomycin was 100%. Coagulase-negative staphylococci susceptibility to rifampin and amikacin was 59% and 67,4% (respectively). Coagulase-negative staphylococci resistance to beta-lactams was 86,4% (95% CI: 82,3-89,9). Coagulase-positive staphylococci sensitivity to vancomycin was 100%. Gram-negative susceptibility to imipenem was 98,1% (95% CI: 89,9-99,9), 78,1% to gentamicin (95% CI: 64,9-88,2) and 46,6% to amikacin (95% CI: 28,3-65,7). CONCLUSIONS: There was high coagulase-negative staphylococci prevalence in neonatal infection (particularly S. epidermidis). All S. epidermidis and coagulase-positive staphylococci were sensitive to vancomycin. There was increasing coagulase-negative staphylococci and Gram-negative resistance to oxacillin and amikacin, respectively.

Direct person-to-person transmission of periodontal bacteria through saliva has recently been widely reported and dental units have been demonstrated to retract saliva from patients under treatment and to release it into the mouths of subjects undergoing the next operation. In this study the presence of a group of periodontal pathogenic bacteria inside waterlines in dental units was investigated using polymerase chain reaction (PCR) based methods. Briefly, 18 dental units of three different manufacturers were studied. Dental units were divided into two groups according to their prevalent use in routine practice. The first group consisted of nine dental units characterized by the frequent use of high-speed dental hand-pieces directly inside the mouth and in contact with patients' saliva. The second group, as a control, consisted of nine dental units where high-speed dental hand-pieces were not in use. A one cm section of the waterline tubing connected to the high-speed hand-piece was removed from each dental unit to evaluate the presence of DNA of Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis, Prevotella intermedia, Bacteroides forsythus, Treponema denticola. Two specimens were positive for Prevotella intermedia DNA. All the positive results were from samples obtained from dental units categorised in the first group. These findings clearly suggest that dental units have the potential to transmit periodontal pathogens. Manufacturers should be invited to design dental units that incorporate automated devices to disinfect DUWLs between patients with minimal effort by dental staff.

Clusters of nosocomial infection often occur undetected, at substantial cost to the medical system and individual patients. We evaluated binary cumulative sum (CUSUM) and moving average (MA) control charts for automated detection of nosocomial clusters. We selected two outbreaks with genotyped strains and used resistance as inputs to the control charts. We identified design parameters for the CUSUM and MA (window size, k, alpha, Beta, p(0), p(1)) that detected both outbreaks, then calculated an associated positive predictive value (PPV) and time until detection (TUD) for sensitive charts. For CUSUM, optimal performance (high PPV, low TUD, fully sensitive) was for 0.1or = alphaor = 0.25 and 0.2or = Betaor = 0.25, with p(0) = 0.05, with a mean TUD of 20 (range 8-43) isolates. Mean PPV was 96.5% (relaxed criteria) to 82.6% (strict criteria). MAs had a mean PPV of 88.5% (relaxed criteria) to 46.1% (strict criteria). CUSUM and MA may be useful techniques for automated surveillance of resistant infections.

Despite their high bacterial load, bacteraemia is rare in patients with cystic fibrosis (CF). We report an adult with CF who developed Pseudomonas aeruginosa bacteraemia during an episode of acute appendicitis. The Pseudomonas aeruginosa isolated from the blood culture was confirmed by molecular typing to be the same transmissible strain responsible for the patient's chronic pulmonary infection. We hypothesise that this patient's bacteraemia was caused by Pseudomonas aerunginosa in swallowed sputum, crossing the inflamed appendiceal wall and entering the blood stream.

Evidence-based reasons for segregation of patients colonized with Pseudomonas aerugionsa in the outpatient setting are unclear. To clarify local decisions, Pseudomonas genotyping of the local environment, patients and patient contacts was undertaken in 1993. The hospital environment was re-swabbed in 1997. Pseudomonas genotyping of old and new patients attending the North Staffordshire cystic fibrosis clinic has subsequently been undertaken and more recently been repeated on an annual basis to assess whether the same Pseudomonas genotypes can be found in both the environment and in patients, and whether the same Pseudomonas genotype can be transferred from one patient to another.NoPseudomonas genotype found in the local environment in 1993 or in 1997 has been found in any of our patients. Nine children attending the same special school for many years and sharing the same physiotherapy facilities showed no evidence of cross-infectivity. Except for siblings living in the same household our cross-infectivity rate is very low and where cross-infection has potentially occurred the level of contact between these patients has been minimal. This study does not support the suggestion that patients with cystic fibrosis attending the North Staffordshire clinic and colonized with Pseudomonas aeruginosa should be segregated from non-colonized patients.