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BACKGROUND: In general, higher resistance rates are observed among intensive care unit (ICU) isolates than non-ICU isolates. In this study, resistance rates of isolates from ICUs and non-ICUs were compared using the data generated from 20 hospitals in Korea. METHODS: Susceptibility data were collected from 20 hospitals participating in the Korean Nationwide Surveillance of Antimicrobial Resistance (KONSAR) program. Duplicate isolates were excluded from the analysis. The resistance rates did not include intermediate susceptibility. RESULTS: The most prevalent bacteria in the ICUs were Staphylococcus aureus (21%) and Acinetobacter spp. (19%), and those in non-ICU were Escherichia coli (27%) and S. aureus (14%). The resistance rates were higher in ICUs than in non-ICUs at 84% and 58% for methicillin-resistant S. aureus, 86% and 70% for methicillin-resistant coagulase-negative Staphylcoccus (CNS), 34% and 19% for vancomycin-resistant Enterococcus faecium, 38% and 19% for cefotaxime-resistant E. coli, 45% and 25% for cefotaxime-resistant Klebsiella pneumoniae, 42% and 24% for ceftazidime-resistant Enterobacter cloacae, 29% and 11% for ceftazidime-resistant Serattia marcescens, 83% and 44% for imipenem-resistant Acinetobacter spp., and 32% and 17% for imipenem-resistant Pseudomonas aeruginosa, respectively. CONCLUSION: The most prevalent bacteria in ICUs were S. aureus, CNS, and Acinetobacter spp., and high multi-drug resistance rates were observed in the Acinetobacter isolates. Therefore, infection control should be practiced in ICUs to prevent infections caused by multi-drug resistant bacteria.
Acinetobacter ; Bacteria ; Drug Resistance, Multiple ; Enterobacter cloacae ; Enterococcus faecium ; Escherichia coli ; Infection Control ; Intensive Care Units* ; Klebsiella pneumoniae ; Korea ; Methicillin Resistance ; Pseudomonas aeruginosa ; Staphylococcus aureus

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The Hawthorne Effect between Covert and Overt Observations in the Monitoring of Hand Hygiene Adherence among Healthcare Personnel at Coronary Care Unit and Cardiac Surgery Intensive Care Unit.

Jeong Hyun KIM ; Jae Sim JEONG ; Mi Na KIM ; Jeong Yun PARK ; Hye Ran CHOI

Korean Journal of Nosocomial Infection Control.2014;19(1):20-28. doi:10.14192/kjnic.2014.19.1.20

BACKGROUND: Direct observation of healthcare workers is commonly used in hospitals to investigate hand hygiene compliance. However, the hand hygiene compliance rate may increase due to the Hawthorne effect, which is the modification of behavior simply because subjects become aware that they are being observed. The objective of this study was to investigate the occurrence of the Hawthorne effect when directly observing hand hygiene compliance in intensive care unit (ICU) healthcare personnel. METHODS: A total of 87 staff members from the coronary care unit and cardiac surgery ICU of a general hospital in Seoul were included in this study: 24 residents and interns, 55 nurses, and 8 nursing assistants. Both covert and overt observations, where subjects were either unaware or aware of any direct observation, were performed on separate occasions. RESULTS: A total of 1,052 covert and 1,336 overt observations were documented over 30 and 34 occasions, respectively. Overall hand hygiene compliance was significantly higher with overt observation than with covert observation (1,041/1,336, 77.9% vs. 659/1,052, 62.6%, P<0.001). The Hawthorne effect was present in all professions and behaviors, with the exception of nursing assistants, and prior to touching a patient. CONCLUSION: Direct observation of hand hygiene compliance was associated with the Hawthorne effect when observations were made overtly and this was likely to contribute to an overestimation of compliance rate.
Compliance ; Coronary Care Units* ; Delivery of Health Care* ; Effect Modifier, Epidemiologic* ; Hand Hygiene* ; Health Personnel ; Hospitals, General ; Humans ; Intensive Care Units* ; Nursing ; Seoul ; Thoracic Surgery*

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Trends of HIV-infected Patients Operated at Single Hospital.

Mi Young KWON ; Mi Rum KIM ; Jieun KIM ; Gunn Hee KIM

Korean Journal of Nosocomial Infection Control.2014;19(1):15-19. doi:10.14192/kjnic.2014.19.1.15

BACKGROUND: As anti-retroviral therapy has improved and the life expectancy of patients' with HIV in Korea has increased, an increased number of surgical procedures have been performed in this population. Therefore, in the current study, we investigated the trend in surgery conducted on patients with HIV in our hospital over the last 5 years. METHODS: We retrospectively reviewed the medical records of HIV-infected patients who underwent surgery under general or local anesthesia at our hospital between 2005 and 2010. RESULTS: The total number of surgeries performed in HIV-infected patients in the 5-year period was 95. Of these, 23 (24%) were performed under general anesthesia and 72 (76%) under spinal anesthesia. Anorectal surgery was the most commonly performed surgery (71 cases, 76%). The postoperative complication rate was 5.3% (3 cases of pneumonia and 2 of wound infection), with general anesthesia and time to discharge being identified as contributory factors. Preoperative CD4+ T cell count was not significantly associated with complications. CONCLUSION: This study was the first to analyze the trends in surgical procedures performed in HIV-infected patients in Korea. Our study may be beneficial as a reference for clinicians who manage patients with HIV.
Acquired Immunodeficiency Syndrome ; Anesthesia, General ; Anesthesia, Local ; Anesthesia, Spinal ; Cell Count ; HIV ; Humans ; Korea ; Life Expectancy ; Medical Records ; Pneumonia ; Postoperative Complications ; Retrospective Studies ; Wounds and Injuries

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Hand Hygiene Promotion in a Hospital Setting through the WHO Multimodal Hand Hygiene Improvement Strategy.

Hee Kyung CHUN ; Mee La KIM ; Jee In HWANG

Korean Journal of Nosocomial Infection Control.2014;19(1):1-14. doi:10.14192/kjnic.2014.19.1.1

BACKGROUND: This study evaluated the frequency and types of hand hygiene practices among healthcare workers directed by the WHO multimodal hand hygiene improvement strategy, and investigated the effect of hand hygiene practice on methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) isolation and MRSA acquisition rate and colonization pressure. METHODS: A quasi-experimental study was performed at a tertiary care university hospital with 850 beds from January to September 2012. We assessed the hospital hand hygiene program using the WHO hand hygiene self-assessment framework. The WHO multimodal strategy was used for healthcare workers with low indexes, and the subjects were reassessed. RESULTS: Hand hygiene compliance increased significantly from a pre-intervention rate of 58.7% to 72.6% post-intervention. MRSA and VRE isolation rates decreased from 1.69 per 1000 patient days to 1.41 and from 0.17 to 0.11, respectively. In intensive care units (ICUs), hand hygiene compliance rate rose to 77.9%, with a total score of 4.16 points out of 5 being awarded for the hand hygiene method, which was higher than that for the other care units. The pre-intervention MRSA acquisition rate in the ICU decreased from 7.47% to 4.30% post-intervention. This was associated with a decrease in the MRSA colonization pressure over the intervention period (26.2% to 16.9%). CONCLUSION: The utilization of the WHO multimodal strategy for improvement of hand hygiene increased the hand hygiene compliance rate and was effective in predicting a decreased rate of cross-infection, MRSA acquisition, and colonization pressure. We conclude that the implementation of such improvement strategies is crucial to maintaining hygiene standards and reducing infection within healthcare facilities.
Awards and Prizes ; Colon ; Compliance ; Delivery of Health Care ; Hand Hygiene* ; Humans ; Hygiene ; Intensive Care Units ; Methicillin-Resistant Staphylococcus aureus ; Self-Assessment ; Tertiary Healthcare