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Biomedical subjects

H Rüden

Publications and source records attributed to H Rüden.

At least 37 records · Page 2Linked to original sources
PubMed2005

Effectiveness of a hospital-wide selective screening programme for methicillin-resistant Staphylococcus aureus (MRSA) carriers at hospital admission to prevent hospital-acquired MRSA infections.

Screening of potential MRSA-positive patients at hospital admission is recommended in German and international guidelines. This policy has been shown to be effective in reducing the frequency of nosocomial MRSA transmissions in the event of an outbreak, but the influence of screening on reducing hospital-acquired MRSA infections in a hospital setting where MRSA is endemic is not yet well-documented. This study describes the effect of hospital-wide screening of defined risk groups in a 700-bed acute care hospital during a period of 19 months. In a cohort study with a 19-month control period, the frequencies of hospital-acquired MRSA infections were compared with and without screening. In the control period, there were 119 MRSA-positive patients, of whom 48 had a hospital-acquired MRSA infection. On the basis of this frequency, a predicted total of 73.2 hospital-acquired MRSA infections was calculated for the screening period, but only 52% of the expected number (38 hospital-acquired MRSA infections) were observed, i.e., 48% of the predicted number of hospital-acquired MRSA infections were prevented by the screening programme. The screening programme was performed with minimal effort and can therefore be recommended as an effective measure to help prevent hospital-acquired MRSA infections.

Aged↗
PubMed2005

Elemental carbon and respirable particulate matter in the indoor air of apartments and nursery schools and ambient air in Berlin (Germany).

UNLABELLED: This study was performed to examine exposure to typical carcinogenic traffic air pollutants in the city center of an urban area. In all, 123 apartments and 74 nursery schools were analyzed with and without tobacco smoke interference and the households in two measuring periods. Simultaneously, the air outside 61 apartment windows as well as the average daily traffic volume were measured. Elemental carbon (EC), the marker for particulate diesel exhaust and respirable particulate matter (RPM) were determined. The thermographic EC analysis was conducted with and without prior solvent extraction of the soluble carbon fraction. Comparison of these two thermographic EC measurements clearly showed that method-related differences in the results, especially for indoor measurements, when high background loads of organic material were present (e.g. tobacco smoke), existed. Solvent extraction prior to EC determination was therefore appropriate. For the first winter measuring period, the EC concentration levels without solvent extraction in the indoor air were about 50% higher than those measured in the spring/summer period. In the second measuring period (i.e. spring/summer), the median EC concentrations after solvent extraction were 1.9 microg/m3 for smokers' apartments and 2.1 microg/m3 for non-smokers' apartments, with RPM concentrations of 57 and 27 microg/m3, respectively. Nursery schools showed high concentrations with median values of 53 microg/m3 for RPM and 2.9 microg/m3 for EC after solvent extraction. A significant correlation between the fine dust and EC concentrations (after solvent extraction) in the indoor and ambient air was determined. Outdoor EC values were also correlated with the average daily traffic volume. The EC ratios between indoor and ambient concentration showed a median of 0.8 (range: 0.3-4.2) in non-smoker households and 0.9 (range: 0.4-1.5) in smoker apartments. Furthermore, the EC/RPM ratio in indoor and ambient air was 0.01-0.15 (median 0.06) and 0.04-0.37 (median 0.09), respectively. PRACTICAL IMPLICATIONS: In the absence of indoor sources a significant correlation with regard to respirable particulate matter (RPM) and elemental carbon concentrations between the indoor and ambient air of apartments was observed. The high degree of certainty resulting from this correlation underscores the importance of ambient air concentrations for indoor air quality. In nursery schools we found higher concentrations of RPM. An explanation of these results could be the high number of occupants in the room, their activity and the cleaning intensity.

Adult↗
PubMed2004

Polycyclic aromatic hydrocarbons inside and outside of apartments in an urban area.

In the context of environmental monitoring in Berlin polycyclic aromatic hydrocarbon (PAH) concentrations in air and household dust were measured inside 123 residences (and simultaneously in a sub group in the air outside the windows). The aim of this study was to determine exposure to PAHs in the environment influencing by several factors, for instance, motor vehicle traffic in a populous urban area. Indoor air samplings were carried out in two periods (winter and spring/summer) in smokers and non-smokers apartments. Benzo(a)pyrene (BaP) median values were 0.65 ng m(-3) (winter) and 0.27 ng m(-3) (spring/summer) in smokers' apartments and 0.25 ng m(-3) (winter) and 0.09 ng m(-3) (spring/summer) in the apartments of non-smokers. The median BaP content in ambient air was 0.10 ng m(-3) (maximum: 1.1 ng/m(-3)) with an indoor-outdoor mean concentration ratio of 0.9 in non-smoker households and 5.4 in smoker apartments. In household dust we obtained median values of 0.3 mg kg(-1) (range: 0.1-1.4 mg kg(-1)). We found a significant relation between indoor and outdoor values. Approximately 75% of the variance of indoor air values was caused by the corresponding BaP concentrations in the air outside the apartment windows. Otherwise a significant correlation between indoor air and household dust values cannot be found. Therefore, according to our results, it is suggested that the indoor PAH concentration in non-smoker apartments could be attributed mainly to vehicular emissions.

Air Pollutants↗
PubMed2004

[Quality assurance in intensive care medicine. SARI-surveillance on antibiotic use and bacterial resistance in intensive care units].

Intensive care units (ICUs) are high risk areas for emergence and spread of multiresistant bacterial pathogens. In Germany, there are no representative epidemiological data on antibiotic resistance, prophylactic or therapeutic use of antibiotics in ICUs, or on the correlation between antibiotic use and emergence of resistance. Supported by the German Ministry of Science and Education, project SARI (Surveillance on antibiotic use and bacterial resistance in ICUs) started in 02/2000 and now includes data on antibiotic use and resistance rates in 35 medical, surgical and interdisciplinary ICUs. To date (2/2000-12/2002), a total of 939 participant months, 339,461 patient days and 452,282 defined daily doses (DDD) have been covered with a mean antibiotic usage density (AD) of 1,332 DDDs/1,000 patient days and resistance data on 31,189 isolates from ICUs. The design of the project and first results of SARI are presented. The epidemiological data of SARI form a basis for improved antibiotic and infection control management in ICUs (http://www.sari-antibiotika.de).

Anti-Bacterial Agents↗
PubMed2004

[SARI: surveillance of antibiotic use and bacterial resistance in German intensive care units. Correlation between antibiotic use and the emergence of resistance].

Intensive care units (ICUs) are considered to be high-risk areas for the emergence and spread of multiresistant bacterial pathogens. In Germany, there are no representative epidemiological data on antibiotic resistance, on the use of antibiotics in ICUs, or on the correlation between antibiotic use and the emergence of resistance. Project SARI (surveillance of antibiotic use and bacterial resistance in ICUs), which as a part of the epidemiological network Spread of Nosocomial Infections and Resistant Pathogens (SIR) is supported by the German Ministry of Science and Education, started in February 2000 and meanwhile includes data on antibiotic use and resistance rates in 38 medical, surgical, and interdisciplinary ICUs. To date (February 2000-June 2003), a total of 1142 months, 413,065 patient days, and 550,288 defined daily doses (DDDs in accordance with the WHO) have been covered with a mean antibiotic usage density (AD) of 1335 DDDs/1000 patient days and resistance data on 37,612 isolates from ICUs. Ciprofloxacin use and MRSA correlate significantly, as do imipenem use and the rate of imipenemresistant P. aeruginosa. The genodiversity of P. aeruginosa is lower in ICUs with high resistance rates and low use of imipenem than in ICUs with high resistance rates and high use. This is an indirect parameter of transmission of identical strains. The epidemiological data of SARI form a basis for improved antibiotic and infection control management in ICUs (http://www.sari-antibiotika.de).

Anti-Bacterial Agents↗
PubMed2004

[Surgical site infections in hospitals and outpatient settings. Results of the German nosocomial infection surveillance system (KISS)].

About 1,000,000 hospital days attributable to surgical site infections can be expected per year in German hospitals. Among the various measures for prevention, surveillance of surgical site infections is strongly recommended. Therefore, beginning in 1997 the National Reference Center for Surveillance of Nosocomial Infections began to establish a hospital infection surveillance system in order to provide data for prevention and control of these infections. The surveillance system (called KISS) documents postoperative surgical site infections in patients undergoing selected indicator procedures. Today we have an overview of 274,050 procedures for a total of 20 operative indicator procedures. A further surveillance component focussing on surgical site infections in outpatient settings has recently been developed (AMBU-KISS). The participating hospitals and outpatient settings regularly receive their infection rates as well as the equivalent data of all hospitals involved in order to assess the position of their own hospital. However, competent and meaningful interpretation of these data is necessary for internal quality management in order to avoid wrong conclusions. The available results demonstrate that this approach can lead to a substantial reduction of surgical site infections.

Cross Infection↗
PubMed2004

[Use of information on nosocomial outbreaks for infection control].

Outbreaks of nosocomial infections can be associated with significant morbidity in the patients involved and require time, effort, and resources. In addition, they may lead to panic reactions among health care workers and patients as well as the community. However, their systematic analysis can contribute to knowledge about the sources and transmission of nosocomial infections and the best methods for prevention. Furthermore, the results of outbreak investigations may serve as a valuable tool for education. That is why a systematic register of nosocomial outbreaks would be a very useful instrument for people working in the field of nosocomial infection control. This article describes the need for a systematic collection of outbreaks published in the literature and an available possibility for filling this gap.

Adult↗
PubMed2004

[Role and responsibilities of infection control practitioners and hospital epidemiologists in the context of cost effectiveness].

In the past it was a guiding principle of hospital epidemiologists and infection control practitioners to compare the particular standards prevailing in their hospitals with the regulations, directives, and guidelines laid down by law and then to aim for some change. However, if we are to ever really achieve a reduction in nosocomial infections, it will be necessary to sensitize all hospital personnel to the problems associated with such infections and to convince them of the unavoidability of having to introduce specific new measures. Accordingly, surveillance of nosocomial infections and multiresistant pathogens, analysis of possible infection-associated problems, and initiating appropriate intervention procedures are indispensable goals for hospital hygiene if a decrease in nosocomial infections is to be realized. It would be possible to thus reduce expenditures representing more than the present costs for the hygiene staff. On the strength of their thorough specialist knowledge of the spread of nosocomial infections, it is also part of the responsibilities of infection control practitioners and hospital epidemiologists to question and to do away with senseless preventive measures and thereby contribute to reducing hospital expenditures.

Cost Control↗
PubMed2004

Development of a surveillance system for nosocomial infections: the component for neonatal intensive care units in Germany.

Neonates are at high risk of nosocomial infections and surveillance has been shown to be valuable for the reduction of nosocomial infections. The National Nosocomial Infections Surveillance (NNIS) system established in the US has a special surveillance component for neonatal intensive care units (NICUs) with some fairly specific methods. However, there are no specific definitions of nosocomial infections in this patient group. When creating a surveillance component for NICUs in Germany we therefore decided not to adopt merely all Centers for Disease Control and Prevention definitions and NNIS methods, but also to develop our own surveillance methods for this patient group. For this process four steps became necessary: (1)development of modified definitions for nosocomial infections and their evaluation; (2)testing the NNIS method in three NICUs with infection control nurses; (3)a pilot project for a surveillance component within the national surveillance system in Germany; and (4)establishment of a surveillance component within our national surveillance system. The system is now established in 33 hospital departments and 66 NICUs participate in the surveillance system. We have an overview of 3357 neonates in three birthweight groups. This article explains the reasons for the various steps, and the advantages and disadvantages of modification of the original NNIS methods and definitions.

Clinical Protocols↗
PubMed2004

[Recommendations for personal respiratory protection in tuberculosis].

These recommendations of the German Central Committee against Tuberculosis give an overview of the current scientific knowledge on the tuberculosis risk of health service employees and on the risk of infection in individual areas of work. The efficacy of face masks and their benefit in tuberculosis control is discussed. There are no reliable data on the efficacy of face masks in preventing infection with M. tuberculosis, nor can such data be expected in the near future, due to the complex interaction of infection-preventing measures. As rapid case finding, isolation, and immediate, effective treatment of infected patients already greatly diminish the risk of transmission, we consider face masks to be of limited use in reducing this risk. However, they may be beneficial in certain areas of work and in certain situations, particularly in the presence of elevated aerosol concentrations. The benefit of face masks depends largely on their correct application. The choice of a particular type of mask requires knowledge of the current epidemiological situation, and a competent assessment of the risk in the area of work for which it is chosen, taking into account the closeness of contact with potentially infectious tuberculosis patients.

Germany↗
PubMed2004

[Microbiological isolates associated with nosocomial infections in intensive care units: data of 274 intensive care units participating in the German Nosocomial Infections Surveillance System (KISS)].

OBJECTIVE: To describe the frequency and distribution of microbiological isolates in association with nosocomial infections (NI) in intensive care units (ICUs) in Germany. METHODS: The hospital infection surveillance system (KISS = Krankenhaus-Infektions-Surveillance-System) started in Germany in January 1997 as a nationwide surveillance project for the voluntary registration of nosocomial infections. For ICUs reporting focuses on device-associated primary bloodstream infections, urinary tract infections, as well as on pneumonia and bronchitis. The data collected for each patient who acquires a nosocomial infection include the site of infection and patient demographics. Up to 4 pathogens can be recorded for each infection. RESULTS: From 1997 until 2002 274 ICUs were participating. The data of 590 695 patients with 18 073 device associated infections (ventilator-associated pneumonia and bronchitis, central line-associated bloodstream infection (BSI) and urinary catheter-associated urinary tract infection (UTI)) were analyzed. In the group of device-associated NI S. aureus was most frequently isolated (16.5/100NI) followed by Ps. aeruginosa (14.2/100NI), E. coli (13.9/100NI), enterococci (13.4/100NI) and C. albicans (11.2/100NI). Of all S. aureus isolates 20.0 % were MRSA. There was an increase of the MRSA rate from 8 % in 1997 to 26.9 % in 2002. The most frequent pathogen in BSI was coagulase-negative staphylococcus (31.0/100NI). In ventilator-associated pneumonia and bronchitis S. aureus was the most frequent pathogen (24.2 and 24.9/100NI). In more than half of all catheter-associated UTI E. coli (25.7/100NI) and enterococci (25.4/100NI) were found. After stratification for the type of ICU differences in the distribution of pathogens could be shown. CONCLUSIONS: The KISS data give an overview of the most important pathogens associated with nosocomial infections on ICUs in Germany.

Cross Infection↗
PubMed2004

Occurrence of phthalates and musk fragrances in indoor air and dust from apartments and kindergartens in Berlin (Germany).

UNLABELLED: In this study, the occurrence of persistent environmental contaminants room air samples from 59 apartments and 74 kindergartens in Berlin were tested in 2000 and 2001 for the presence of phthalates and musk fragrances (polycyclic musks in particular). These substances were also measured in household dust from 30 apartments. The aim of the study was to measure exposure levels in typical central borough apartments, kindergartens and estimate their effects on health. Of phthalates, dibutyl phthalate had the highest concentrations in room air, with median values of 1083 ng/m(3) in apartments and 1188 ng/m(3) in kindergartens. With around 80% of all values, the main phthalate in house dust was diethylhexyl phthalate, with median values of 703 mg/kg (range: 231-1763 mg/kg). No statistically significant correlation could be found between air and dust concentration. Musk compounds were detected in the indoor air of kindergartens with median values of 101 ng/m(3) [1,3,4,6,7,8-hexahydro-4,6,6,7,8,8- hexamethylcyclopenta-(g) 2-benzopyrane (HHCB)] and 44 ng/m(3) [7-acetyl-1,1,3,4,4,6-hexamethyl-tetraline (AHTN)] and maximum concentrations of up to 299 and 107 ng/m(3) respectively. In household dust HHCB and AHTN were detected in 63 and 83% of the samples with median values of 0.7 and 0.9 mg/kg (Maximum: 11.4 and 3.1 mg/kg) each. On comparing the above phthalate concentrations with presently acceptable tolerable daily intake values (TDI), we are talking about only a small average intake [di(2-ethylhexyl) phthalate and diethyl phthalate less than 1 and 8% of the TDI] by indoor air for children. The dominant intake path was the ingestion of foodstuffs. For certain subsets of the population, notably premature infants (through migration from soft polyvinyl chloride products), children and other patients undergoing medical treatment like dialysis, exchange transfusion, an important additional intake of phthalates must taken into account. PRACTICAL IMPLICATIONS: The phthalate and musk compounds load in a sample of apartments and kindergartens were low with a typical distribution pattern in air and household dust, but without a significant correlation between air and dust concentration. The largest source of general population exposure to phthalates is dietary. For certain subsets of the general population non-dietary ingestion (medical and occupational) is important.

Air Pollution, Indoor↗
PubMed2003

[Proven and unproven hygiene measures in urology].

In urology, catheter-associated urinary tract infections are most common, and postoperative wound infections the second most common nosocomial infections. This article gives an overview of standard hygiene measures, but focuses on proven and unproven hygiene measures for preventing catheter-associated urinary tract infections and postoperative wound infections. Consistent implementation of these measures contributes to minimizing infection rates and to establishing a quality standard, whereby surveillance of nosocomial infections contributes substantially to internal quality assurance.

Antibiotic Prophylaxis↗
PubMed2003

Inducibility and potential role of MecA-gene-positive oxacillin-susceptible Staphylococcus aureus from colonized healthcare workers as a source for nosocomial infections.

To determine the carrier rate of methicillin-susceptible mecA-positive Staphylococcus aureus (dormant MRSA) among healthcare workers (HCWs), 447 nurses and physicians from 13 general wards and intensive care units were investigated for nasal or oropharyngeal S. aureus carriage during one year whenever an MRSA patient was treated. Induction of phenotypic resistance in all mecA-positive oxacillin-susceptible aureus was attempted by 24 h exposure to oxacillin and cefotaxime. Organisms from the broth tube with the highest antibiotic concentration and visible growth after incubation were re-exposed for a total of seven repetitive exposures. Two mecA-negative oxacillin-susceptible S. aureus served as negative control. A population analysis before and after antibiotic exposure was performed. A third of the HCWs were found to be S. aureus carriers. Only three nurses were MRSA positive (0.7%). Seven isolates of dormant MRSA were isolated in six nurses and one doctor (1.6%). After four days of repetitive antibiotic exposure six of seven dormant MRSA were highly resistant to oxacillin. Resistance of the two control S. aureus without the mecA gene was not changed by repetitive antibiotic exposure. Two of the seven dormant MRSA were clonally related as shown by pulsed-field gel electrophoresis (PFGE). The PFGE pattern of one dormant MRSA (HCW) was identical to an MRSA (HCW). The pattern of another dormant MRSA was indistinguishable from an MRSA isolated from a patient who was treated at the same time on the same ward suggesting transmission from the HCW to the patient. Dormant MRSA may be isolated twice as often as MRSA from HCWs. Transmission to patients is possible, which may lead to clinical infections. It might be useful to screen methicillin-susceptible S. aureus isolates from HCWs for the mecA gene when recurrent infections with MRSA occur on a ward and a source cannot be found.

Bacterial Proteins↗
PubMed2003

Surveillance of nosocomial infections in adult recipients of allogeneic and autologous bone marrow and peripheral blood stem-cell transplantation.

To identify overall and site-specific rates of nosocomial infections (NIs) during the neutropenic, as compared to the non-neutropenic stage of treatment in adult recipients of allogeneic and autologous bone marrow transplantation (BMT) and peripheral blood stem-cell transplantation (PBSCT), a prospective, 54-month study was started at the Haematological Stem Cell Transplantation Unit of the University Hospital of Freiburg, Germany. NI types were identified using modified CDC definitions. A total of 351 patients (14 256 in-patient days, 5026 neutropenic days) were investigated (316/90% allogeneic, 35/10% autologous; BMT: 119 patients, PBSCT: 234 patients). The mean length of neutropenia was 14.3 days (range: 0-66). Antimicrobial prophylaxis for allogeneic transplantation consisted of ciprofloxacin, trimethoprim/sulpha-methoxazole, fluconazole, and metronidazole. In total, 239 NIs were identified in 169 patients (48.1%), and of these 171 (71.5%) occurred during neutropenia (34.0 NIs per 1000 days at risk). The main pathogens were coagulase-negative staphylococci (36.3%), Clostridium difficile (20.4%), and enterococci (10.0%). Site-specific incidence densities during neutropenia vs non-neutropenia were: 13.9 vs 1.6 bloodstream infections (all central line-associated), 11.9 vs 1.8 pneumonias, 3.0 vs 2.9 gastroenteritis, and 1.6 vs 0.3 urinary tract infections. The greatest number of NI in BMT and PBSCT recipients is acquired during neutropenia, and multicentre surveillance programmes should focus on this.

Adult↗
PubMed2003

Surveillance of nosocomial infections in dermatology patients in a German university hospital.

BACKGROUND: Nosocomial infections (NIs) are a growing problem in healthcare today. Thus, surveillance of NIs is an important aspect of modern infection control, which aims to improve the quality of care. OBJECTIVES: To identify overall and site-specific NI rates in dermatology patients in a German university hospital. METHODS: In a prospective study, 1450 patients were surveyed for NIs according to criteria laid down by the Centers for Disease Control and Prevention. Case records were reviewed twice a week, microbiology reports were assessed and the ward staff was consulted. RESULTS: Altogether, 37 NIs were identified in 35 patients, of whom two had two NIs. The overall incidence was 2.5 NIs per 100 patients, and the incidence density was 1.9 NIs per 1000 patient days. Twenty-one patients developed superficial surgical site infections (SSIs). Thirteen of the 21 SSIs occurred after surgical removal of basal cell carcinoma (BCC; 172 in total). This represents an infection rate of 7.6% after surgery for BCC. CONCLUSIONS: Our data suggest that routine surveillance in dermatological wards is not accorded a high priority. However, surveillance of SSIs, especially following surgery for BCC, may be indicated.

Adolescent↗