BACKGROUND: The aim of this study was to evaluate the influence of an improved method of endotracheal suction on nosocomial pneumonia (NP) and tracheal colonization by Pseudomonas aeruginosa and Acinetobacter baumannii in intensive care units (ICUs). METHODS: The study was carried out in both the medical and surgical ICUs of a tertiary-care university hospital; 2,347 patients were admitted in the ICUs from January 2003 to December 2004. The method of endotracheal suction to remove secretions was improved by using a sterile, individually packed catheter and sterile fluid filled in a small container for a single use instead of sterile catheters and fluid packed or filled in large containers for a multiple use. Then, we compared the incidence of NP, the colonization rates of P. aeruginosa and A. baumanni in the respiratory tract, and their carbapenem resistance before and after the intervention. RESULTS: The incidence of NP (1,000 patient-day rate) was decreased from 4.08 to 2.46 in the SICU and from 1.4 to 0.8 in the MICU after the intervention, but the differences were not significant. The colonization rate by A. baumannii was decreased significantly from 35.7% to 4.6% in the SICU (P<0.001) and from 12.7% to 7.6% in the MICU (P<0.001). The colonization rate by P. aeruginosa was decreased significantly from 17.7% to 7.4% in the SICU (P<0.001), but not in the MICU. There was also a marked decrease in carbapenem resistance, 21% to 8% in P. aeruginosa and 70% to 16% in A. baumannii. CONCLUSION: Endotracheal suction with a sterile catheter and sterile fluid is important in preventing respiratory infections and colonization by P. aeruginosa and A. baumannii in the ICU.
Acinetobacter baumannii* ; Acinetobacter* ; Catheters ; Colon* ; Drug Resistance, Bacterial ; Humans ; Incidence ; Intensive Care Units* ; Critical Care* ; Pneumonia* ; Pseudomonas aeruginosa* ; Pseudomonas* ; Respiratory System ; Respiratory Tract Infections ; Suction*

Infection control is an essential factor for improving the quality of acute and long-term care facilities, including patient safety. Infection control should be implemented in all medical facility sectors, and participation of all healthcare workers is required. For efficient infection control, securing and maintaining professionals with sufficient experience and training to establish and implement infection control plans focusing the infection control unit is imperative. Moreover, there should be no shortage of infection control supplies, including consumables and disposables necessary for hand hygiene, personal protective equipment, and isolation. The fee for infection prevention and control should be resourced as necessary funding to establish such infection control infrastructure. Moreover, re-evaluating whether the standard for the fee for infection prevention and control is appropriate, improving the current payment mode, and monitoring whether the fee used is executed as infection control costs are necessary.

No abstract available.
Humans ; Outpatients*

Recent changes in the Korean government's strategies for resident quotas and training condition results is creating a gap in the treatment of inpatients and threatening patient safety. The hospitalist system, which has been established and operates in the United States, has also been suggested as an alternative in Korea. In 2015, a pilot project for the implementation of a hospitalist system was successfully executed in three teaching hospitals. The most important factors for the successful implementation of a hospitalist system are to establish the job description and security of the hospitalist. In addition, securing finances and making medical insurance fee-for-service, a certification system for hospitalists, an education program, and proper salaries are needed. The introduction and management of a hospitalist system may be seen as necessary for the times, considering changing resident strategies and the reinforcement of responsibility for patient safety. The hospitalist system is a solution for the gap in the treatment of inpatients and is predicted to improve patient safety.
Certification ; Education ; Hospitalists* ; Hospitals, Teaching ; Humans ; Inpatients ; Insurance ; Job Description ; Korea ; Patient Safety ; Pilot Projects ; Salaries and Fringe Benefits ; United States

BACKGROUND: Infections are usually related to the surgical patients prognosis. Therefore consultations from surgical departments to division of infectious diseases are considered very important in the aspect of improvement of surgical outcomes and control of hospital infection. This study was conducted to analyze the results of infectious disease consultation from surgical departments. MATERIALS AND METHODS: We retrospectively reviewed 624 cases of consultation to division of infectious diseases from surgical departments from March to August in the year of 2002. RESULTS: Among 624 cases, 610 were included; 292 cases (47.9%) were new and 318 cases (52.1%) were follow-up requests. More than 50% of consultations were from the department of neurosurgery and orthopedics. Overall, 558 cases (91.4%) were about infection-related conditions, and among them, common causes were soft tissue infection, respiratory tract infection, and urinary tract infection. However, those results were remarkably variable according to each surgical department. The measures taken after consultations were change of antibiotics (35.6%), maintenance of antibiotics (18.4%), discontinuance of antibiotics (10%), start of antibiotics (9.2%), and observation without antibiotics (4.3%). CONCLUSION: This is the report on analysis of infectious disease consultation from surgical departments. Through the analysis of consultations we expect to enable more efficient care of patients and infection control.
Anti-Bacterial Agents ; Communicable Diseases* ; Cross Infection ; Follow-Up Studies ; Humans ; Infection Control ; Neurosurgery ; Orthopedics ; Prognosis ; Referral and Consultation* ; Respiratory Tract Infections ; Retrospective Studies ; Soft Tissue Infections ; Urinary Tract Infections

BACKGROUND: Infections are usually related to the surgical patients prognosis. Therefore consultations from surgical departments to division of infectious diseases are considered very important in the aspect of improvement of surgical outcomes and control of hospital infection. This study was conducted to analyze the results of infectious disease consultation from surgical departments. MATERIALS AND METHODS: We retrospectively reviewed 624 cases of consultation to division of infectious diseases from surgical departments from March to August in the year of 2002. RESULTS: Among 624 cases, 610 were included; 292 cases (47.9%) were new and 318 cases (52.1%) were follow-up requests. More than 50% of consultations were from the department of neurosurgery and orthopedics. Overall, 558 cases (91.4%) were about infection-related conditions, and among them, common causes were soft tissue infection, respiratory tract infection, and urinary tract infection. However, those results were remarkably variable according to each surgical department. The measures taken after consultations were change of antibiotics (35.6%), maintenance of antibiotics (18.4%), discontinuance of antibiotics (10%), start of antibiotics (9.2%), and observation without antibiotics (4.3%). CONCLUSION: This is the report on analysis of infectious disease consultation from surgical departments. Through the analysis of consultations we expect to enable more efficient care of patients and infection control.
Anti-Bacterial Agents ; Communicable Diseases* ; Cross Infection ; Follow-Up Studies ; Humans ; Infection Control ; Neurosurgery ; Orthopedics ; Prognosis ; Referral and Consultation* ; Respiratory Tract Infections ; Retrospective Studies ; Soft Tissue Infections ; Urinary Tract Infections

No abstract available.
Hospitals, Teaching* ; Internal Medicine* ; Internship and Residency*

Background: Since the global coronavirus disease 2019 (COVID-19) pandemic, nonpharmacological interventions (NPIs) such as extensive and comprehensive hand hygiene, mask-wearing, and social distancing have been implemented globally. This study aimed to investigate changes in respiratory viruses other than severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that occurred following the implementation of these NPIs. Methods: From January 2018 to December 2021, influenza-like illness patient specimens and specimens from the Korea Influenza and Respiratory Viruses Surveillance System were analyzed at the Incheon Metropolitan City Institute of Public Health and Environment.Oropharyngeal or nasopharyngeal swab samples from respiratory infection patients were transferred in a virus transport medium at 4°C. After RNA or DNA extraction, respiratory virus-specific genes for human influenza virus (IFV), adenovirus (ADV), parainfluenza virus (PIV), respiratory syncytial virus (RSV), human rhinovirus (hRV), human coronavirus, human bocavirus, and human metapneumovirus were detected by individual real-time reverse transcription polymerase chain reaction. Results: A total 3,334 samples were collected. After NPI was implemented, the detection of respiratory viruses other than SARS-CoV-2 decreased overall. The yearly detection rate of respiratory viruses was decreased from 69.5% (399/574) in 2018 and 73.3% (505/689) in 2019 to 19.8% (206/1,043) in 2020 and 34.9% (365/1,028) in 2021. The epidemic was more prominent in respiratory viruses such as IFV and RSV, which were considered dominant viruses, especially those with viral envelopes. Among viruses that were not considered dominant, hRV showed no clear change before and after NPI, while PIV showed a rapid increase compared to the existing dominant viruses between October–December 2021, after the increase in the number of gatherings started at the end of September and the “Relaxing COVID19 and mitigation policy,” which was implemented on November 1. Conclusion NPI seems to have influenced the isolation and transmission of respiratory viruses in South Korea. In the future, additional studies focusing on the isolation and transmission patterns of respiratory viruses following NPI are needed.

BACKGROUND: The emergence of multidrug-resistant, Gram-negative bacteria has resulted in reconsideration of colistimethate sodium (CMS) as a last resort for treatment of such infections. However, acute kidney injury (AKI) may represent a major limiting adverse effect of use of CMS. Early AKI detection in CMS-treated patients can help prevent progression to acute failure and reduce the need of renal replacement therapy. We hypothesized that plasma neutrophil gelatinase-associated lipocalin (NGAL) may be an early biomarker of AKI in CMS-treated patients. MATERIALS AND METHODS: This prospective cohort study included patients aged ≥20 years who received intravenous CMS between March 2014 and November 2015. AKI was defined according to Kidney Disease: Improving Global Outcomes criteria. The primary endpoint was the difference between the average time to AKI onset based on serum creatinine and empirically derived plasma NGAL levels. RESULTS: Among 109 CMS-treated patients, 23 patients (mean age, 61.3 ± 16.1 years; men, 65.2%) were evaluated. Thirteen (56.5%) patients fulfilled the AKI criteria. The mean time to AKI onset based on serum creatinine after CMS initiation was 78.15 ± 30.49 hours. AKI was detected approximately 22 hours earlier using plasma NGAL than when using serum creatinine as an indicator of AKI (P = 0.035). The baseline plasma NGAL level was 264.0 ± 167.3 ng/mL and 192.7 ± 65.3 ng/mL in patients with and without AKI, respectively (P = 0.218). The area under the curve for plasma NGAL level at 56 hours was 0.796 (95% confidence interval, 0.609–0.983; P = 0.017), with a sensitivity and specificity of 69.2% and 90.0%, respectively (cutoff value, 285 ng/mL). CONCLUSION: NGAL level was found to be a strong predictor of AKI. This study provides additional evidence of the utility of NGAL for AKI in patients with treated CMS. Plasma NGAL represent sensitive and specific predictive early biomarkers for AKI in patient treated CMS.
Acute Kidney Injury* ; Biomarkers ; Cohort Studies ; Creatinine ; Gram-Negative Bacteria ; Health Resorts ; Humans ; Kidney Diseases ; Lipocalins* ; Male ; Neutrophils* ; Plasma ; Prospective Studies ; Renal Replacement Therapy ; Sensitivity and Specificity ; Sodium*

BACKGROUND: The emergence of multidrug-resistant, Gram-negative bacteria has resulted in reconsideration of colistimethate sodium (CMS) as a last resort for treatment of such infections. However, acute kidney injury (AKI) may represent a major limiting adverse effect of use of CMS. Early AKI detection in CMS-treated patients can help prevent progression to acute failure and reduce the need of renal replacement therapy. We hypothesized that plasma neutrophil gelatinase-associated lipocalin (NGAL) may be an early biomarker of AKI in CMS-treated patients. MATERIALS AND METHODS: This prospective cohort study included patients aged ≥20 years who received intravenous CMS between March 2014 and November 2015. AKI was defined according to Kidney Disease: Improving Global Outcomes criteria. The primary endpoint was the difference between the average time to AKI onset based on serum creatinine and empirically derived plasma NGAL levels. RESULTS: Among 109 CMS-treated patients, 23 patients (mean age, 61.3 ± 16.1 years; men, 65.2%) were evaluated. Thirteen (56.5%) patients fulfilled the AKI criteria. The mean time to AKI onset based on serum creatinine after CMS initiation was 78.15 ± 30.49 hours. AKI was detected approximately 22 hours earlier using plasma NGAL than when using serum creatinine as an indicator of AKI (P = 0.035). The baseline plasma NGAL level was 264.0 ± 167.3 ng/mL and 192.7 ± 65.3 ng/mL in patients with and without AKI, respectively (P = 0.218). The area under the curve for plasma NGAL level at 56 hours was 0.796 (95% confidence interval, 0.609–0.983; P = 0.017), with a sensitivity and specificity of 69.2% and 90.0%, respectively (cutoff value, 285 ng/mL). CONCLUSION: NGAL level was found to be a strong predictor of AKI. This study provides additional evidence of the utility of NGAL for AKI in patients with treated CMS. Plasma NGAL represent sensitive and specific predictive early biomarkers for AKI in patient treated CMS.
Acute Kidney Injury* ; Biomarkers ; Cohort Studies ; Creatinine ; Gram-Negative Bacteria ; Health Resorts ; Humans ; Kidney Diseases ; Lipocalins* ; Male ; Neutrophils* ; Plasma ; Prospective Studies ; Renal Replacement Therapy ; Sensitivity and Specificity ; Sodium*