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H Rüden

Publications and source records attributed to H Rüden.

At least 19 recordsLinked to original sources
PubMed2000

[Reasonable and unreasonable hygiene measures in anesthesia in the intensive care unit].

The objective of this review is to describe which hygiene measures are appropriate and necessary in anaesthesia and the ICU and which are not, whereby unnecessary hygiene measures are those which are not substantiated by scientific data. The most effective single infection control measure is still hand disinfection between patient contacts. Unnecessary measures include routine sampling of environmental surfaces, disinfecting the floor in the ICU, protective gowns for visitors, so called in-line filters in the infusion system etc. Ventilator tubes only need to be exchanged once a week, even when no HMEs are used.

Anesthesia↗
PubMed2000

Repeated prevalence investigations on nosocomial infections for continuous surveillance.

In order to obtain an overview for the planning of further infection control activities, nine repeated prevalence studies were performed at monthly intervals. These occurred in the surgical units of eight medium-sized German hospitals. A total of 4984 surgical patients were investigated, the number of patients observed in each hospital varied from 365 to 913 patients, an average of 69.2 patients per prevalence study per hospital. A total of 212 nosocomial infections were found, the majority being surgical site (43.9%) and urinary tract infection (33.0%). The overall prevalence rate was 4.0%. More than four repeated investigations had only a minor influence on the 95% confidence intervals, and a follow-up of late microbiological reports increased the prevalence rate by only 7.5%. However, it was very useful to record the presence of urinary catheters on the prevalence day and also the preceding days; for instance, a device-associated prevalence of 7.8 urinary tract infections per 100 patients with urinary catheters was found on the day of investigation. In order to evaluate the situation in one's own surgical department by prevalence studies and for reasons of cost-effectiveness, the workload can be limited to four repeated studies in most hospitals. A further follow-up of later microbiological reports is not recommended, and it seems useful to concentrate on patients with indwelling devices.

Cross Infection↗
PubMed2000

Identifying outliers of antibiotic usage in prevalence studies on nosocomial infections.

OBJECTIVE: To investigate whether the correlation between patients' antibiotic treatment (yes/no) and patients' infections (yes/no) in each hospital department, described by Pearson's correlation coefficient (p) for binary data as a measure for adequate use of antibiotics, is an appropriate quality indicator. DESIGN: Comparison of the results of repeated prevalence studies in different hospitals with the data of a national prevalence study, comparing the hospital (p) and reference (pNIDEP[Nosokomiale Infektionen in Deutschland: Erfassung und Pravention]) correlation coefficients for "use of antibiotics/ presence of infections." SETTING: The data of 5,377 surgical patients were separated from the total data of a national prevalence study in 72 representative hospitals to create a reference correlation coefficient (rhoNIDEP) with a reference range. Nine additional prevalence studies, involving a total of 4,984 patients, were repeatedly performed in the surgical departments of 8 other hospitals during a 12-month period, whereby the correlation coefficients rho(n) for every prevalence investigation were determined. RESULTS: In the national prevalence study, 15.3% of the surgical patients received antibiotics on the study day. Surgical patients had a 3.8% prevalence of nosocomial infections and a 7.0% prevalence of community-acquired infections. Pearson's correlation coefficient rhoNIDEP for correlation between patients' binary data use of antibiotics and presence of infection was 0.62. To compare the correlation coefficient of each department with the appropriate reference range, the coefficients of the single departments were plotted against the number of patients; in these plots, three lines indicated the value rhoNIDEP and the upper and lower reference ranges, depending on the number of patients. Seven of eight surgical departments investigated during the repeated prevalence studies were found to be within the reference range, near the reference value, in the majority of prevalence studies; only one of the departments was identified as an outlier as regards antibiotic use. CONCLUSION: The correlation between patients' antibiotic treatment (yes/no) and patients' infections (yes/no) in hospitals or departments, as described by Pearson's correlation coefficient p for binary data with a definitive reference range depending on the number of patients, is useful for quality management in identifying the overall necessity for evaluating the indications for antibiotic use in one's own hospital.

Anti-Bacterial Agents↗
PubMed2000

How to survey nosocomial infections.

Many surveillance methods for nosocomial infections (NIs) have been put forward in the literature, and all have their advantages and disadvantages. Different surveillance methods are useful, depending on whether the objective of surveillance is only to increase sensitivity to infection control problems and to identify areas with possible infection control problems; to confirm a possible infection control problem through comparison with other units or departments; or to use surveillance data for identifying the sources of infections. Furthermore, time effectiveness is a major point in selecting the most appropriate method, particularly the method for case identification. In units or departments with a high level of NI, even highly time-consuming surveillance methods may be ultimately time-effective; in units or departments with a lower level of NI, the time-effectiveness depends on the time necessary for case identification. Close liaison with staff in the units is a sine qua non for the success of all surveillance activities.

Cross Infection↗
PubMed1999

Catheter-associated primary bloodstream infections: epidemiology and preventive methods.

The incidence of catheter-associated primary bloodstream infections (BSIs) in Germany as defined by the CDC (Centers for Disease Control) has been determined on the basis of (a) a national prevalence study in a representative sample of 72 hospitals (NIDEP), and (b) an incidence study in which data about the use and duration of insertion of central venous catheters (CVC) and of catheter-associated BSI were collected from 25 intensive-care units (ICUs) participating in the hospital infection surveillance system (KISS+) and analyzed. The first study showed primary bloodstream infection to be the fourth most frequent nosocomial infection at 8.3% of all nosocomial infections. With an ICU prevalence of 2.1%, primary BSI comprises 12.8% of all nosocomial infections observed in ICU patients. The second study showed a 60.4% prevalence of CVC use in German ICUs. An analysis of 55,400 CVC days in 14,988 ICU patients in the KISS hospitals yielded 2.2 CVC-associated BSIs per 1,000 CVC days (CI95 1.8-2.6). The rates of CVC-associated BSI on individual hospital wards were very variable and indicates a reduction potential. A reduction in the number of infections of about one-third would prevent 1,000-1,400 deaths due to CVC-associated BSI annually as well as about 40,000 to 60,000 extra days of hospital stay and the associated costs.

Catheterization, Central Venous↗
PubMed1999

Neonatal nosocomial infection surveillance: incidences by site and a cluster of necrotizing enterocolitis.

Nosocomial infection (NI) was prospectively studied in hospitalized neonates during a 10-month period. The Centers for Disease Control (CDC) criteria (some specified for neonates) were used for surveillance. Forty-nine of 677 infants experienced 73 episodes of NI. The overall incidence was 10.8 NI/100 patients and 6.5 NI/1,000 patient days. The average monthly NI number did not correlate with patient load. Very low birth weight (VLBW) infants showed a higher NI incidence (81.8 NI/100 patients and 11.1 NI/1,000 patient days), also elevated if adjusted for their inherently longer neonatal intensive care unit (NICU) stay. The most common NI sites in the VLBW stratum were sepsis and necrotizing enterocolitis (NEC), the latter occurring in a seasonal cluster. It can be concluded that surveillance for NIs should focus on VLBW infants and include the evaluation of NEC, as it behaves like a nosocomial disease.

Anti-Bacterial Agents↗
PubMed1999

Guidelines for infection prevention and control in Germany: evidence- or expert-based?

Nosocomial infections (NI) are a major problem, and numerous measures are being recommended for preventing NIs in Germany. However, the evidence for the efficacy of many currently recommended measures is incomplete or has been established for certain sub-groups of patients or specific conditions only. In view of this situation, it is necessary to improve the established measures for preventing NIs. Since many procedures and components of infection control involve additional expenditure, their deployment can only be justified if their efficiency has been demonstrated or is highly likely on the basis of rational considerations.

Cross Infection↗
PubMed1999

How many nosocomial infections are missed if identification is restricted to patients with either microbiology reports or antibiotic administration?

OBJECTIVE: To investigate how many nosocomial infections would be missed if surveillance activities were restricted to patients having either microbiology reports or antibiotic administration. DESIGN: Analysis of data from a large prevalence study on nosocomial infections (Nosocomial Infections in Germany-Surveillance and Prevention). SETTING: A total of 14,966 patients were investigated in medical, surgical, obstetric-gynecologic, and intensive-care units of 72 German hospitals representatively selected according to size. Five hundred eighteen patients (3.5%) had at least one nosocomial infection. Microbiology reports were available for 56.6% of these patients on the prevalence day, and 86.3% received antibiotics. RESULTS: Only 31 nosocomially infected patients (6%) would have been missed by using either microbiology reports or antibiotic treatment as an indicator. These indicators of nosocomial infections had a high diagnostic sensitivity for nosocomial pneumonia (98.8%), urinary tract infections (96.3%), and primary bloodstream infections (95.3%), but a lower sensitivity for wound infections (85.4%). Thus, 97.4% of all nosocomial infections were found with this method in intensive-care units and 96.1% in medicine units, but only 89.7% in surgical departments. In 9 (12.5%) of 72 hospitals, the overall sensitivity would have been <80% using a combination of the two indicators. For this reason, the situation in one's own hospital should be checked before using this method. CONCLUSIONS: After checking the situation in one's own hospital, the "either-or" approach using the two indicators "microbiology report" and "antibiotic administration" can be recommended as a time-saving measure to diagnose pneumonia, urinary tract, and primary bloodstream infections. For wound infections, additional information obtained by changing dressings or participating in ward rounds is necessary to achieve satisfactory sensitivity in the surveillance of nosocomial infections. Of course, it is necessary that the surveillance staff discard all false positives to ensure a satisfactory specificity.

Anti-Bacterial Agents↗
PubMed1999

Evaluation of the BBL Crystal MRSA ID System for detection of oxacillin resistance in Staphylococcus aureus.

AIMS: To evaluate the BBL Crystal MRSA ID System for detection of oxacillin resistance in Staphylococcus aureus. METHODS: 52 methicillin resistant S aureus (MRSA) from five different countries and 85 methicillin susceptible S aureus (MSSA) were included. The species was confirmed by tube coagulation and detection of the clumping factor using the Staphaurex Plus. Clonal non-identity of the MRSA isolates was shown by pulsed field gel electrophoresis. MIC values (oxacillin) were determined using the Etest. Polymerase chain reaction was carried out to detect the mecA gene. The BBL Crystal MRSA ID System was carried out according to the manufacturer's instructions. RESULTS: The BBL Crystal MRSA ID System showed fluorescence in 45 of 52 MRSA (sensitivity 86.5%; negative predicitive value 92.2%), and the specificity was 97.6% (positive predicitive value 95.7%). Two of seven MRSA that failed to show fluorescence had MIC values (oxacillin) of 4 mg/litre. CONCLUSIONS: The BBL Crystal MRSA ID System is a valuable test for detecting oxacillin resistance in S aureus. Its major advantage is the short time (4-5 hours) required to perform the test when organisms are grown on tryptic soy agar or sheep blood agar. Difficulties may arise in borderline resistant isolates.

Evaluation Studies as Topic↗
PubMed1998

[Requirements of mandatory accident insurance for hospitals, which participate in inpatient treatment of occupational accident patients: position of the National Reference Center for Hospital Hygiene].

Aseptic operations as well as operations on infected sites can be done in the same operating room. Two or more theatres can share common facilities such as X-ray equipment, scrub-up or anaesthesia areas. Sophisticated air locks with double doors, which separate the protective zone from the operating room are not necessary to maintain a good hygienic standard. Nevertheless the new requirements for theatre design by the German "Gesetzliche Unfallversicherungen" are much higher. In this commentary we try to summarize scientific evidence regarding design of a theatre and infection control.

Accidents, Occupational↗
PubMed1998

Limited effectiveness of chlorhexidine based hand disinfectants against methicillin-resistant Staphylococcus aureus (MRSA).

Hand disinfectants containing chlorhexidine are thought to be less bactericidal against methicillin-resistant Staphylococcus aureus (MRSA) than methicillin-susceptible Staphylococcus aureus (MSSA). We report an in vitro comparison between three distinct MRSA strains and three MSSA strains. The bactericidal efficacy of chlorhexidine digluconate, 'Hibiscrub' and 'Hibisol' against Staphylococcus aureus was determined in a quantitative suspension test. Logarithmic reduction factors (RF) were calculated for each of six parallel experiments. Chlorhexidine digluconate and 'Hibisol' showed RF > 5 at most concentrations and reaction times but 'Hibiscrub' did not. MRSA was found to be significantly less susceptible than MSSA to chlorhexidine digluconate, 'Hibiscrub' and 'Hibisol' (P < 0.05; two-tailed t-test for independent samples). 'Hibisol' was significantly more effective against MRSA than 'Hibiscrub' (P < 0.05). Hand disinfectants containing both alcohol and chlorhexidine (e.g., 'Hibisol') are more effective against MRSA than scrubs based only on chlorhexidine ('Hibiscrub') and should be used in clinical practice.

Chlorhexidine↗
PubMed1998

Prevalence of nosocomial infections in representative German hospitals.

The nosocomial infection (NI) rate in German hospitals was studied in order to create reference data for comparison in hospitals where ongoing surveillance is impossible. The study was designed as a one-day prevalence study. Patients in 72 selected hospitals (inclusion criteria: acute care hospitals with departments for general medicine, surgery, obstetrics/gynaecology) were examined by four external investigators (physicians trained and validated in the diagnosis of NI). A total of 14,996 patients were studied. The overall prevalence rate was 3.5% (CI 3.1-3.9) with a variation of 0-8.9% between hospitals. The commonest NI were: urinary tract infection (42.1%), lower respiratory tract infection (20.6%), surgical site infections (15.8%) and primary sepsis (8.3%). The highest prevalence rate (15.3%) was found in intensive care ward patients, followed by surgery (3.8%), general medicine (3.0%) and gynaecology/obstetrics (1.4%). The infection rate varied significantly with hospital size. A microbiology laboratory report was only available for 56.5% of patients thought to have an NI, and there were remarkable differences between hospitals with and without an on-site microbiology laboratory. Because of this and other methodological reasons the NI prevalence rates reported here may represent the absolute minimum of nosocomially infected patients in Germany.

Cross Infection↗