Antimicrobial resistance in the hospital is the most important challenging issue in the field of nosocomial infection control. Several nationwide surveys performed so far revealed that various profiles of resistance were already stablished in Korea: the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was more than 70%; vancomycin-resistant Enterococcus was around 15%; resistance to third generation cephalosporins and aminoglycosides were around 30%, and so on. Although there remains some controversy, association between the development of antimicrobial resistance and the adverse clinical outcome does exist as supported by many studies worldwide. Therefore, combating and overcoming the antimicrobial resistance in the hospital is the most urgent task to solve. For the purpose of eradicating the antimicrobial resistance, we should use a two-edged sword: antimicrobial stewardship and hospital infection control. Regulation of antimicrobials could prevent the emergence of resistance, While infection control and precaution could contain the further spread of resistant organisms. In addition to these, futher aggressive strategy could be used for some species, e.g., active surveillance and \lquote search and destroy\rquote decolonization for MRSA. In conclusion, continuous education of appropriate antimicrobial prescription, implementation of proper precautions, and systematic approach to the infection control via organization of specialized personnel are sine qua non in overcoming the antimicrobial resistance in the hospital.
Aminoglycosides ; Cephalosporins ; Cross Infection ; Education ; Enterococcus ; Infection Control ; Korea ; Methicillin-Resistant Staphylococcus aureus ; Prescriptions ; Prevalence

BACKGROUND: Extended-spectrum beta-lactamase-producing (ESBL) Klebsiella pneumoniae is an important cause of nosocomial infections in neonatal intensive care units (NICUs). This study aimed to reduce ESBL-producing K. pneumoniae in the NICU by using infection control measures. METHODS: We performed prospective surveillance cultures, monitoring, and education for infection control in the NICU between May and August 2011. Specimens were collected from all infants and the environment including stethoscopes, thermometers, ventilators, incubators, etc. The anterior nares and hands of healthcare workers were also screened. We inspected infection control practices and provided feedback. The level of infection control awareness was measured using a questionnaire. RESULTS: The level of awareness and performance of hand washing increased significantly after intervention (both P<0.001). The environmental management of healthcare providers also improved significantly (P=0.001). The yield of ESBL-producing K. pneumoniae from clinical specimens decreased gradually throughout the study period (30.4% in May to 12.6% in August). Central catheter-related K. pneumoniae bacteremia decreased from 1.3/1000 to 0/1000 catheter-days. CONCLUSION: Infection control measures including education, monitoring, and surveillance can lower the incidence of ESBL-producing K. pneumoniae in the NICU.
Bacteremia ; beta-Lactamases ; Cross Infection ; Delivery of Health Care ; Hand ; Hand Disinfection ; Health Personnel ; Humans ; Incidence ; Incubators ; Infant ; Infant, Newborn ; Infection Control ; Intensive Care Units ; Intensive Care Units, Neonatal ; Intensive Care, Neonatal ; Klebsiella ; Klebsiella pneumoniae ; Pneumonia ; Prospective Studies ; Stethoscopes ; Thermometers ; Ventilators, Mechanical

BACKGROUND: This study aimed to identify the effects of a multifaceted needlestick injury (NSI) prevention program on changes in knowledge about bloodborne infectious diseases and postexposure coping, attitudes toward postexposure reporting, preventive measures, the number of NSIs, and postexposure reporting pre- and post-intervention among nurses. METHODS: A total of 429 and 420 nurses participated in the pre- and post-intervention periods, respectively. The intervention was performed from April to September 2007, comprising NSI guideline education, the use of containers with enhanced engineering, and the supply of safety devices. RESULTS: The average score of knowledge about bloodborne infectious diseases increased significantly from 8.3 to 8.9 out of 14 points (P<0.001), but the change in score of knowledge about postexposure coping was insignificant. The average score of attitude toward postexposure reporting increased significantly from 8.9 to 9.6 out of 12 points (P<0.001). Preventive measures such as "gloves are provided whenever needed" (P<0.001), "use one-hand technique" (P<0.001), and "needle containers are provided whenever needed" (P=0.031) increased significantly. The number of NSIs decreased by 40.4%, and the postexposure reporting rate increased by 552.8%. CONCLUSION: The multifaceted NSI prevention program positively affected knowledge about infectious diseases and postexposure coping, attitudes toward postexposure reporting, preventive measures, the number of NSIs, and postexposure reporting after intervention. Therefore, we recommend that this program be applied to various healthcare workers in hospitals.
Communicable Diseases ; Delivery of Health Care ; Incidence ; Needlestick Injuries ; Post-Exposure Prophylaxis

BACKGROUND: Respiratory infection in pregnancy can cause various side effects and affect the fetus. Therefore, efforts to prevent infection during pregnancy are essential. This study investigated knowledge and compliance regarding the prevention of respiratory infection among pregnant women. METHODS: A survey was conducted on May 10, 2012 on 300 pregnant women who attended a maternity school education program in a tertiary care hospital. The responses of 259 women were collected and analyzed. RESULTS: Only 2 women (0.8%) had been educated about respiratory infection prevention methods, while 106 (40.9%) experienced respiratory infection during pregnancy. The mean score of respiratory infection prevention knowledge was 11.63 out of 15 points (percentage of correct answers: 77.5%). The mean score for compliance to respiratory infection prevention was 32.34 out of 52 points (percentage of practice: 62.19%). Knowledge and compliance were found to be positively correlated. CONCLUSION: Although many pregnant women experience respiratory infection during pregnancy, few have opportunities to be educated about prevention. Thus, the positive correlation between knowledge and compliance highlights the need for respiratory infection prevention education programs.
Compliance ; Female ; Fetus ; Humans ; Pregnancy ; Pregnant Women ; Tertiary Healthcare

BACKGROUND: We evaluated the effectiveness of isolation measures using cohorting rooms and antimicrobial use in reducing the isolation rate of methicillin-resistant Staphylococcus aureus (MRSA) and multidrug-resistant Acinetobacter baumannii (MDR-AB). METHODS: Four cohorting rooms (16 beds) for patients colonized or infected with multidrug-resistant organisms (MDRO) have been created in the general wards of our 894-bed hospital since October 2003. We prospectively evaluated the isolation rates of MRSA and MDR-AB, and amount of antimicrobial use during the 8-year study period. We also investigated the relationship between antimicrobial use density (AUD) and the isolation rates of MRSA and MDR-AB. RESULTS: After creating cohorting rooms, the isolation rates of MRSA decreased from 1.56 cases per 1,000 patient-days from 2004-2005 to 1.24 from 2006-2007 (P=0.57). The isolation rates of MDR-AB also decreased from 0.72 from 2004-2005 to 0.36 from 2010-2011 (P<0.01). The mean quarterly AUDs of glycopeptides and carbapenems were 30.17+/-6.80 and 19.5+/-7.10, respectively. There were no significant correlations between AUD values and the isolation rate of MRSA or MDR-AB. CONCLUSION: This study suggests that isolation measures using cohorting rooms to help limit the transmission of MDRO infection and colonization, especially MDR-AB, in resource-limited settings is feasible and efficacious.
Acinetobacter ; Acinetobacter baumannii ; Carbapenems ; Cohort Studies ; Colon ; Drug Resistance ; Glycopeptides ; Humans ; Methicillin Resistance ; Methicillin-Resistant Staphylococcus aureus ; Patient Isolation ; Patients' Rooms ; Prospective Studies

BACKGROUND: This study tested the efficacy of 0.12% chlorhexidine gluconate for improving oral hygiene in intubated intensive care patients. METHODS: In a group of 57 ventilated patients, 29 received normal saline (NS) for oral hygiene, and 28 were treated with chlorhexidine gluconate (CHG). Data on oral bacterial colonization was collected for 11 months from October 2005 to August 2006. Tests of oral hygiene and oral microorganism culture were performed on the day of the ventilation, and repeated on days 4, 8, and 12. RESULTS: Oral hygiene was significantly improved in the CHG group compared to that in the NS group (P<.001). Further, all patients (100%) in the NS group tested positive for Staphylococcus aureus on the 12th day after the endotracheal intubation, whereas only 42.9% (P=0.026) of the CHG group were positive. The NS group also had higher isolation rates of Pseudomonas aeruginosa at 66.7% on the 8th day after intubation and 87.5% on the 12th day. At these same intervals, the CHG group had isolation rates of 29.4% (P=.028) and 14.3% (P=.010) respectively. CONCLUSION: The longer the period of endotracheal intubation, the more effective the 0.12% CHG treatment was for improved oral hygiene and reduction of S. aureus and P. aeruginosa colonization when compared to treatment with NS.
Chlorhexidine ; Colon ; Humans ; Critical Care ; Intensive Care Units ; Intubation ; Intubation, Intratracheal ; Oral Hygiene ; Pseudomonas aeruginosa ; Sodium Chloride ; Staphylococcus aureus ; Ventilation

BACKGROUND: Over the past several years, Clostridium difficile has become a major healthcare-associated pathogen. Fecal bacteriotherapy has been reported as an effective intervention for treating recurrent C. difficile infection by restoring the normal intestinal microbiota. METHODS: Articles on fecal bacteriotherapy were collected through PubMed, CINAHL, Cochrane Library, and Web of Science databases using the keywords "Clostridium difficile," "feces," "fecal transplantation," "fecal microbiota transplantation," and "fecal bacteriotherapy." Using a systematic literature review, variables of interest from articles that met the inclusion criteria were extracted and summarized. RESULTS: Among 141 articles that were published in English from January 1, 2000 to August 31, 2012, 8 studies were selected for analysis after assessing the titles, abstracts, and full contents. Fecal bacteriotherapy procedures varied with respect to donor selection, screening, infusion route, and preparation of the suspension. Donors were mostly family members or relatives, and donor screening included tests for blood borne and stool pathogens. Selected infusion routes were colonoscopy (62.5%), nasogastric tube (25%), and enema (12.5%). The success rate was reported to be 73-100%. There was a lack of a standard procedure for fecal bacteriotherapy in all of the selected studies. CONCLUSION: Fecal bacteriotherapy is an effective intervention for combating C. difficile infection that has a high success rate and no adverse effects. This therapy would be helpful for infection control in hospital settings by facilitating early eradication of C. difficile infection.
Clostridium ; Clostridium difficile ; Colonoscopy ; Donor Selection ; Enema ; Feces ; Humans ; Infection Control ; Mass Screening ; Metagenome ; Tissue Donors

BACKGROUND: This study aims to examine the knowledge of nursing and allied health-college students on cough etiquette and their actual compliance to it. METHODS: For data collection, a structured questionnaire was created and handed out to students from 3 colleges from November 9 to November 18, 2011. The questionnaires were distributed to 300 students, and responses from 253 students were used for data analysis. RESULTS: In total, 54.85% students provided correct answers to questions regarding their knowledge on cough etiquette. The compliance score was 34.39 (compliance rate: 61.41%). There was a positive association between knowledge of proper cough etiquette and compliance with those procedures. CONCLUSION: It can be concluded that college student's knowledge of cough etiquette is low, and subsequently that their compliance with the proper procedures of cough etiquette was low. Therefore, it is necessary to develop a program to build knowledge of proper cough etiquette amongst these students.
Compliance ; Cough ; Data Collection ; Hand ; Humans ; Surveys and Questionnaires

BACKGROUND: Compliance with hand hygiene protocols is one of the simplest ways to prevent healthcare-associated infections (HAIs). Hand hygiene is influenced by individual habits and beliefs, as well as by local organizational culture practices. This study was performed in order to increase the rate of compliance to hand hygiene through changes in the organizational culture. METHODS: From 2009 through 2011, this study was performed in a 2,000-bed tertiary-care university hospital with more than 6,000 employees. The program was implemented mainly by team activities, and the leadership and hand hygiene steering committee members supported them. Goals for planning, intervention, and evaluation of the compliance rate for hand hygiene were made annually in the hospital. RESULTS: The rate of compliance to hand hygiene increased significantly each year (43.8% in 2008, 75.3% in 2009, 80.7% in 2010, and 83.2% in 2011). The detection rate of vancomycin-resistant Enterococcus (VRE) and the incidence of healthcare-associated Staphylococcus aureus bacteremia decreased. CONCLUSION: The rate of compliance to hand hygiene was remarkably improved, and it continuously increased through systematic and continuous changes in the organizational culture. In addition, the detection rate of VRE and incidence of S. aureus bacteremia decreased. These results show that hand hygiene is an important factor for preventing HAIs.
Bacteremia ; Committee Membership ; Compliance ; Enterococcus ; Hand Hygiene ; Incidence ; Organizational Culture ; Staphylococcus aureus

No Abstract available.
Chungcheongnam-do* ; Infection Control*