During the second half of the 19th century many operations were developed after anesthesia was introduced but advances were limited for many years because of the high rate of infection and the high mortality rate that followed infections. After the introduction of the principle of antisepsis, postoperative infectious morbidity decreased substantially. With the introduction of antibiotic therapy in the middle of the 20th century, a new adjunctive method to treat and prevent surgical infections was discovered. However, not only have postoperative wound and hospital required infections continued, but widespread antibiotic therapy has often made prevention and control of surgical infections more difficult. Based on National Nosocomial Infection Surveillance (NNIS) system reports, SSIs (Surgical Site Infections) are the third most common nosocomial infection, accounting for 14% to 16% of all nosocomial infections among hospitalized patients. It is also a significant source of postoperative morbidity, resulting in increased hospital length of stay and increased cost. Determination of risk factors for the development of SSI has been a major focus of surgical research. To reduce the rate of SSIs we have to eliminate risk factors of SSIs and keep a continuous surveillance with feedback of information to surgeons and other relevant staff. A successful SSI surveillance program includes standardized definition of infection, effective surveillance method, and stratification of the SSIs rates according to risk factors. Because SSIs may be the most preventable of nosocomial infections, health care facilities should make special efforts to reduce the risk of development of these surgical complications. The evaluation of infection control programs and the development of more effective infection control strategies should be established and surgeons should be more concern about SSI control.
Anesthesia ; Antisepsis ; Cross Infection ; Delivery of Health Care ; Humans ; Infection Control ; Length of Stay ; Mortality ; Risk Factors ; Wounds and Injuries

Clostridium difficile-associated diarrhea (CDAD) is common among hospital-acquired bacterial diarrhea, its mortality and morbidity show an increasing trend in recent years. Improper antimicrobial drug use is one of the key reasons. Adequate hand hygiene of healthcare workers, thorough disinfection of hospital environment, and appropriate isolation of patients are effective measures to prevent the outbreak of hospital-aquired CDAD.
Clostridium difficile ; physiology ; Cross Infection ; microbiology ; mortality ; prevention & control ; Diarrhea ; microbiology ; mortality ; prevention & control ; Enterocolitis, Pseudomembranous ; microbiology ; mortality ; prevention & control ; Humans ; Infection Control

BACKGROUND: Healthcare-associated infection (HAI) affects the morbidity and mortality of inpatients worldwide. Nepal is a developing country in which HAIs pose a major problem in terms of patient safety. Therefore, this study was designed to assess the level of knowledge and attitude toward HAIs and compliance for infection control among nurses. METHODS: A cross-sectional survey was conducted using a self-administered questionnaire including general characteristics, and knowledge of, attitude toward, and compliance with HAI control practices, on a sample of 259 nurses from 11 hospitals in 3 cities in Nepal, from July 17 to August 5, 2014. RESULTS: The average score on knowledge of HAI was 6.56, on a 13-point scale. In total, 59 nurses had undergone HAI control training and 211 nurses reported that they were governed by some guidelines, but there were no significant differences. The overall level of compliance with HAI control guidelines was 79.2 points based on a 100-point scale, which did not differ in terms of age, exposure to infection control training, and the presence of any guidelines. CONCLUSION: The level of knowledge of HAI control among nurses was very low and a majority had never undergone any HAI control training. Evidently, there is an urgent need to provide HAI control training to nurses, and to develop infrastructure to provide training for them.
Compliance* ; Cross-Sectional Studies ; Developing Countries ; Humans ; Infection Control* ; Inpatients ; Mortality ; Nepal* ; Patient Safety

PURPOSE: Neonates in neonatal intensive care units(NICU) have a high risk of acquiring nosocomial infection because of their impaired host defence mechanism and invasive procedures. Nosocomial infection result in considerable morbidity and mortality among neonates. This study was carried out to survey both the epidemiology of nosocomial infection in our NICU and the annual trends of pathogens. METHODS: We retrospectively reviewed culture proven nosocomial infection which occurred in our NICU from January 1995 to December 1999. The data included clinical characteristics, site of infection, pathogens, and mortality. RESULTS: Nosocomial infection rates was 9.0 per 100 NICU admissions during the five-year period. Major sites of infection were bloodstream(32.3%), skin(18.4%), endotracheal tube(17.2%), and catheter(10.6%). The most common pathogen was S. aureus(29.9%). and the others were coagulase-negative staphylococci(CONS)(14.8%), Enterobacter(12.4%), and Candida(9.0%). During the five-year period, nosocomial infection rates increased from 9.5 to 11.6 per 100 admissions with the increase of CONS, Candida, Klebsiella, and Acinetobacter baumannii. The infection rate of S. aureus decreased. Multiple episodes of nosocomial infection occurred in 26.1% of all nosocomial infections. Overall bloodstream infection rates were 3.6 per 100 NICU admissions during five years. CONS(29.1%) and S. aureus(27.1%) were the two most common pathogens. Increasing rates of bloodstream infection by CONS, Candida, Klebsiella, and Acinetobacter baumannii were observed. Bloodstream infection related mortality was 11.9%. CONCLUSION: The predominant pathogens of nosocomial infection in NICU were S. aureus and CONS. Bloodstream infection, the most frequent nosocomial infection, should be a major focus of surveillance and prevention efforts in NICU.
Acinetobacter baumannii ; Candida ; Cross Infection* ; Epidemiology ; Humans ; Infant, Newborn ; Intensive Care, Neonatal* ; Klebsiella ; Mortality ; Retrospective Studies

BACKGROUND: The hospital-acquired pneumonia is the most common nosocomial infection. Recently, the Acinetobacter baummannii infections are rapidly increasing, especially the frequency of Multi-drug resistant A. baumannii. Therefore we assessed clinical features and prognosis of patients in the ICU with Multi-drug resistant A. baumannii from the sputum culture using the Clinical Pulmonary Infection Score(CPIS). METHODS: The medical records of 43 patients with Multi-drug resistant A. baumannii from sputum culture who were suspected had clinically pneumonia and admitted to the ICU from January 2000 to July 2002 were retrospectively analyzed. RESULT: 19 patients were CPIS greater than 6 and 24 patients were CPIS less than or equal to 6. Mean age for the former was 71+/-11 years old, and the latter was 61+/-19 years old. The mean APACHE II score on admission and on sputum study was not different between two groups(17.4+/-5.7 vs 18.5+/-6.1, p=0.553, 20+/-6 vs 17+/-8, p=0.078). But the mortality rate was 73.7% for the former, and 16.7% for the latter(p<0.001). CONCLUSION: In ICU patients who had clinically suspected pneumonia with sputum culture positive for Multi-drug resistant A. baumannii, the mortality was significantly higher if CPIS was greater than 6.
Acinetobacter baumannii* ; Acinetobacter* ; APACHE ; Cross Infection ; Humans ; Medical Records ; Mortality ; Pneumonia ; Prognosis ; Retrospective Studies ; Sputum*

The concepts of systemic inflammatory response syndrome (SIRS) and scoring system were defined by the journal of Bone in 1992. SIRS was described as occurrence of two or more clinical criteria in four ones (fever or hypothermia, tachypnea, tachycardia, and leukocytosis). An early diagnosis and estimation of systemic inflammation in patients is helpful for treatment selection. This paper reviews the application of SIRS scoring system, which has been extensively validated for large groups of critical care patients with severe injury and critical surgical diseases. Recent studies have documented SIRS score as a significant predictive parameter of adverse outcome in critical care patients. Furthermore, some studies also give us a suggestion on how to reduce the overload systemic response.
Cross Infection ; complications ; Humans ; Length of Stay ; Systemic Inflammatory Response Syndrome ; diagnosis ; mortality ; prevention & control

BACKGROUND: Adequate nutrition support reduces infectious complications, mortality and length of hospitalizationin intensive care unit. However, there are multi factors like frequent null per os (NPO) due to examination, intolerance to tube feeding, complication of TPN (total parenteral nutrition) and ineffective recognition by medical staff. The purpose of this study is to identify detrimental effects of cumulative energy deficiency in critically ill patients. METHODS: The patients who were received tube feeding or total parenteral nutrition for more than 5 days were investigated. Daily and cumulative energy deficiency was tabulated until oral intake was achieved or until they discharged or died. Patients were divided into two groups, severe energy deficient group (>10, 000 kcal) or mild energy deficient group (<5, 000 kcal). Then we compared clinical outcomes between two groups. RESULTS: Total 150 patients were studied. 48 (32%) patients were severe energy deficient group and 42 (28%) patients were mild energy deficient group. Mortality and nosocomial infection were significantly higher in severe energy deficient group than in mild group. Hospital day and ICU day were significantly higher in severe energy deficient group than in mild group. CONCLUSIONS: Severe energy deficiency was very common in critically ill patients and it deteriorated the clinical outcomes such as mortality, nosocomial infection, hospital day and ICU day.
Critical Illness* ; Cross Infection ; Enteral Nutrition ; Humans ; Intensive Care Units ; Medical Staff ; Mortality ; Parenteral Nutrition, Total

BACKGROUND: Lymphocytopenia is a common finding in critically ill patients while lymphocyte depletion in critically ill patients is presumed to have little clinical significance. However, a total lymphocyte count has been reported to provide prognostic information in surgical patients. The aim of this study was to evaluate the association of a total lymphocyte count (TLC) with a prognostic criterion in critically ill patients. METHODS: The patients were divided into three groups according to their TLC on admission to intensive care unit (ICU) (Group 1: TLC > 1.0 x 10(9)/L, Group 2: 0.7 x 10(9)/L < TLC < 1.0 x 10(9)/L, and Group 3: TLC <0.7 x 10(9)/L). Outcomes examined were patients' in-hospital mortality, length of hospital stay and incidence of infection. RESULTS: Patients with a TLC less than 0.7 x 10(9)/L (Group 3) had an infection twice (32% VS 15%) as often as those with a TLC more than 0.7 109/L (Group 1 2). But, in the hospital stay and mortality, there was no significant difference among the groups. CONCLUSIONS: TLC is very useful indicator in critically ill patients with a high risk of hospital infection on ICU admission.
Critical Illness* ; Cross Infection* ; Hospital Mortality ; Humans ; Incidence ; Intensive Care Units ; Length of Stay ; Lymphocyte Count* ; Lymphocyte Depletion ; Lymphopenia ; Mortality

PURPOSE: Despite advances in infection control practices, Surgical Site Infections (SSIs) remain a substantial cause of morbidity and mortality among hospitalized patients. This study was undertaken to determine prospectively the incidence of postoperative wound infections in surgical patients and to identify the risk factors associated with the development of wound infections. METHODS: Prospective data on 761 surgical operation patients in the department of surgery at Ewha Womans University Mokdong Hospital were collected over a 7 month-period from May 1, to December 31, 2001. The Centers for Disease Control and Prevention (CDC)'s definitions of surgical wound infections were used. RESULTS: A total of 761 patients were observed over 30 days. The overall incidence of wound infection was 2%. SSIs were significantly associated with the degree of wound contamination (P=0.0004). The infection rate increased as the degree of wound contamination increased from clean (1.4%) through clean-contaminated (1.8%) and contaminated (1.8%), to dirty- infected wound (12.7%). The infection rate was related with the American Society of Anesthesiologists (ASA) preoperative assessment score (P=0.00153). There were no SSIs from laparoscopic surgery. The duration of operation was not associated with an increase in wound infections. Enterococcus faecium and Staphylococcus aureus were the most frequently isolated organisms. Three out of the five (60%) cases of E. faecium were vancomycin-resistant enterococci (VRE) and all of three cases of S. aureus were methicillin- resistant Staphylococcus aureus (MRSA). CONCLUSION: This study confirms that the degree of wound contamination is a significant preoperative risk factor for SSI. Many antibiotic-resistant bacteria such as MRSA and VRE were isolated. Accordingly, infection control practitioners need to consider this risk factor in the design of effective infection control strategies. There should be another safe and feasible option available for the treatment of selective patients.
Bacteria ; Centers for Disease Control and Prevention (U.S.) ; Cross Infection ; Enterococcus faecium ; Female ; Humans ; Incidence ; Infection Control ; Infection Control Practitioners ; Laparoscopy ; Methicillin-Resistant Staphylococcus aureus ; Mortality ; Prospective Studies* ; Risk Factors ; Staphylococcus aureus ; Surgical Wound Infection* ; Wound Infection ; Wounds and Injuries

BACKGROUNDPrevious studies have different viewpoints about the clinical impact of methicillin resistance on mortality of hospital-acquired bloodstream infection (BSI) patients with Staphylococcus aureus (S. aureus). The objective of this study was to investigate the mortality of hospital-acquired BSI with S. aureus in a military hospital and analyze the risk factors for the hospital mortality.

METHODSA retrospective cohort study was performed in patients admitted to the biggest military tertiary teaching hospital in China between January 2006 and May 2011. All included patients had clinically significant nosocomial BSI with S. aureus. Multivariate Logistic regression analysis was used to identify the risk factors for hospital mortality of patients with S. aureus BSI.

RESULTSOne hundred and eighteen patients of more than one year old were identified as clinically and microbiologically confirmed nosocomial bacteraemia due to S. aureus, and 75 out of 118 patients were infected with methicillin-resistant S. aureus (MRSA). The overall mortality of nosocomial S. aureus BSI was 28.0%. Methicillin resistance in S. aureus bacteremia was associated with significant increase in the length of hospitalization and high proportion of inappropriate empirical antibiotic treatment. After Logistic regression analysis, the severity of clinical manifestations (APACHE II score) (odds ratio (OR) 1.22, 95% confidence interval (CI) 1.12 - 1.34) and inadequacy of empirical antimicrobial therapy (OR 0.25, 95%CI 0.09 - 0.69) remained as risk factors for hospital mortality.

CONCLUSIONSNosocomial S. aureus BSI was associated with high in-hospital mortality. Methicillin resistance in S. aureus has no significant impact on the outcome of patients with staphylococcal bacteremia. Proper empirical antimicrobial therapy is very important to the prognosis.

Adult ; Aged ; Cross Infection ; drug therapy ; mortality ; Female ; Hospital Mortality ; Humans ; Male ; Methicillin-Resistant Staphylococcus aureus ; pathogenicity ; Middle Aged ; Retrospective Studies ; Risk Factors ; Staphylococcal Infections ; drug therapy ; mortality