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Biomedical subjects

H Sax

Publications and source records attributed to H Sax.

At least 19 recordsLinked to original sources
PubMed2006

Behavioural considerations for hand hygiene practices: the basic building blocks.

Hand hygiene is considered to be the most effective measure to prevent microbial pathogen cross-transmission and healthcare-associated infections. In October 2005, the World Health Organization (WHO) World Alliance for Patient Safety launched the first Global Patient Safety Challenge 2005-2006, 'Clean Care is Safer Care', to tackle healthcare-associated infection on a large scale. Within the Challenge framework, international infection control experts and consultative taskforces met to develop new WHO Guidelines on Hand Hygiene in Healthcare. The taskforce was asked to explore aspects underlying hand hygiene behaviour that may influence its promotion among healthcare workers. The dynamics of behavioural change are complex and multi-faceted, but are of vital importance when designing a strategy to improve hand hygiene compliance. A reflection on challenges to be met and areas for future research are also proposed.

Attitude of Health Personnel↗
PubMed2006

Control of a cluster of community-associated, methicillin-resistant Staphylococcus aureus in neonatology.

To control an outbreak of community-associated MRSA (CA-MRSA) in a neonatology unit, an investigation was conducted that involved screening neonates and parents, molecular analysis of MRSA isolates and long-term follow-up of cases. During a two-month period in the summer of 2000, Panton-Valentine leukocidin (PVL)-producing CA-MRSA (strain ST5-MRSA-IV) was detected in five neonates. The mother of the index caseshowed signs of mastitis and wound infection and consequently tested positive for CA-MRSA. A small cluster of endemic, PVL-negative MRSA strains (ST228-MRSA-I) occurred in parallel. Enhanced hygiene measures, barrier precautions, topical decolonization of carriers, and cohorting of new admissions terminated the outbreak. Four months after the outbreak, the mother of another neonate developed furunculosis with the epidemic CA-MRSA strain. One infant had persistent CA-MRSA carriage resulting in skin infection in a sibling four years after the outbreak. In conclusion, an epidemic CA-MRSA strain was introduced by the mother of the index case. This spread among neonates and was subsequently transmitted to another mother and a sibling. This is the first report of a successfully controlled neonatology outbreak of genetically distinct PVL-producing CA-MRSA in Europe.

Adult↗
PubMed2005

[Consequences of an unsufficient range of immunity in "pediatric" infectious diseases--example with measles].

From January to February 2005, the healthcare authorities of the Canton of Geneva were alerted to 15 cases of measles, in contrast to one single case in 2004. The adult status (17-44 years) of the affected persons years was unusual. Four were health care workers at the same hospital who were infected after contact with a 44-year-old patient in a single night during his stay in the emergency room. The presumption that measles are only a paediatric disease had made the diagnosis difficult. None of all these adults was immune according to the actual recommendations. Despite a federal vaccine policy, repetition of recommendations, good results of available vaccines and reimbursement of the cost by health insurance companies, voluntary vaccination prevalence is too small in Switzerland to prevent the outbreak of epidemics. In contrast to the goals of the World Health Organization (WHO) and the Swiss Federal Office of Public Health, the country is unfortunately far from displaying a sufficiently high herd immunity to prevent health care-associated and economic damage by sporadic epidemics.

Communicable Disease Control↗
PubMed2004

[Nationwide surveillance of nosocomial infections in Switzerland--methods and results of the Swiss Nosocomial Infection Prevalence Studies (SNIP) in 1999 and 2002].

The first multi-center prevalence study of nosocomial infections in Switzerland took place in 1996. Since then, the number of participating hospitals has steadily increased. Today, 72 hospitals of various sizes are part of the Swiss-NOSO surveillance network and represent 30% of all Swiss acute care hospitals, which include approximately 10,000 acute care beds. This article describes the methodology of the national prevalence studies and the results of the 1999 and 2002 surveys. The proportion of infected patients was 10.1% and 8.1% in 1999 and 2002, respectively. The highest prevalence occurred in intensive care units. The most prevalent nosocomial infections were surgical site infections, urinary tract infections, pneumonia, and bloodstream infections. Increasingly, crude rates of nosocomial infections serve as a quality indicator and are used for interhospital comparison and benchmarking. This may be misleading due to differences in case-mix between hospitals as shown in the 1999 study. Using a coordinated approach within a national network, surveillance of nosocomial infections has established itself as an indispensible part of infection control and prevention in Swiss hospitals.

Benchmarking↗
PubMed2004

Impact of positive legionella urinary antigen test on patient management and improvement of antibiotic use.

AIM: To assess the incidence of legionella infection over a 27 month period at a large university hospital. MATERIAL AND METHODS: The present retrospective cohort study enrolled patients with legionellosis, defined as those presenting a positive urinary antigen for legionella together with a medical history, clinical findings, and radiological findings consistent with pneumonia. These patients were evaluated to determine the relation between their test results and changes in treatment modalities. A control group of patients with pneumonia but a negative urinary antigen test for legionella were also analysed. RESULTS: Twenty seven of 792 assessed patients tested positive for legionella. In 22 of these patients, legionella active antibiotics were administered empirically. In seven patients, the test results prompted a legionella specific treatment, whereas in 12 cases, non-specific antibiotics were stopped within 24 hours. Overall, treatment was altered in more than half of the patients as a result of the test results. CONCLUSIONS: The urinary antigen may have a direct impact on clinical management of pulmonary legionellosis. However, patient comorbidities and individual clinical judgment are still important for determining the best treatment to be given in each individual case.

Adult↗
PubMed2003

The preventable proportion of nosocomial infections: an overview of published reports.

The proportion of nosocomial infections potentially preventable under routine working conditions remains unclear. We performed a systematic review to describe multi-modal intervention studies, as well as studies assessing exogenous cross-infection published during the last decade, in order to give a crude estimate of the proportion of potentially preventable nosocomial infections. The evaluation of 30 reports suggests that great potential exists to decrease nosocomial infection rates, from a minimum reduction effect of 10% to a maximum effect of 70%, depending on the setting, study design, baseline infection rates and type of infection. The most important reduction effect was identified for catheter-related bacteraemia, whereas a smaller, but still substantial potential for prevention seems to exist for other types of infections. Based on these estimates, we consider at least 20% of all nosocomial infections as probably preventable, and hope that this overview will stimulate further research on feasible and cost-effective prevention of nosocomial infections for daily practice.

Bacteremia↗
PubMed2002

[Successful strategies against increasing antibiotic resistance].

The development of antibiotic resistance, known since the early days of antibiotic therapy, has accelerated in recent years and makes a postantibiotic era a realistic future scenario. The battle against increasingly resistant strains has become a major concern for infectious disease and infection control specialists worldwide. The issue has now gained heightened awareness among physicians in all specialties and the public, and has become a challenge to hospital leadership. Detailed evidence about the causes and conditions of antibiotic resistance is accumulating, but the main axes have been known for some time: overuse and misuse of antibiotic therapy and transmission of multiresistant pathogens or genetic material between humans. Selection pressure by the systematic use of antibiotics as growth promoters in animal husbandry and the resulting transmission by the food chain is an additional important cause. This overview presents the most promising strategies to contain further resistance spread and hopefully inverse the current trend.

Animal Husbandry↗
PubMed2001

Pilot study of interferon-alpha with and without amantadine for the treatment of hepatitis C in HIV coinfected individuals on antiretroviral therapy.

BACKGROUND: Concurrent potent therapy of hepatitis C (HCV) and HIV includes at least five antiviral drugs. Drug interactions, toxicity, tolerance and acceptance by patients of such treatment regimens are unknown. STUDY DESIGN: A prospective open randomized pilot trial was conducted to test interferon-alpha (6 million units/day for the 1st month followed by 6 million thrice weekly) and amantadine versus interferon-alpha monotherapy for tolerability and feasibility among HIV and HCV co-infected patients on stable antiretroviral combination therapy. RESULTS: 1,013 HIV-infected patients were consecutively evaluated. 314 were anti-HCV antibody positive; only eight (2.4%) were eligible. Major reasons for exclusion were: normal transaminase levels (34%), ongoing intravenous drug use (33%), or recent change in antiretroviral therapy (31%). Study drugs were stopped in all of the seven patients enrolled because of side effects and/or failure of anti-HCV therapy. CD4 lymphocyte counts and HIV-1 RNA remained stable. CONCLUSION: Among patients on highly active antiretroviral therapy, the addition of interferon-alpha with or without amantadine was inefficient and poorly tolerated, but had no negative influence on HIV infection. Eligibility for the study was unexpectedly low.

Adult↗
PubMed2001

Variation in nosocomial infection prevalence according to patient care setting:a hospital-wide survey.

A study was performed to estimate the prevalence of nosocomial infections (NI) and assess differences between medical care settings in one hospital complex. A seven-day period-prevalence survey was conducted in May 1998 in a large primary and tertiary healthcare centre in Geneva, Switzerland, that included all patients in acute, sub-acute and chronic care settings. Variables included demography, exposure to invasive devices and antibiotics, surgical history, and patients' localization. Overall prevalence of NI was 11.3% (acute, 8.4%; sub-acute, 11.4%; chronic care setting, 16.4%) in the 1928 patients studied, and ranged from 0% in ophthalmology to 23% in critical care units. Odds of infection in sub-acute and chronic care settings were significantly higher than in the acute care setting even after adjustment for case-mix [OR, 2.59; 95% confidence interval (CI(95)) 1.53-4.41; and OR, 2.34; Cl(95)1.38-3.95, respectively]. As a distinct group, patients in the geriatric location (belonging to the sub-acute care setting) showed a significant proportion of urinary (39%) and respiratory (21%) tract infections, contrasting with a relatively low exposure to urinary catheters (6.1%) and orotracheal intubation (0%). In conclusion, sub-acute and chronic care settings are associated with high infection prevalence even after case-mix adjustment. Prevalence studies are an easy surveillance tool that can be exploited further by analysing data according to hospital care settings to identify high-risk areas.

Acute Disease↗
PubMed2000

Clinical impact of an infectious disease service on the management of bloodstream infection.

The impact of an infectious disease (ID) service on the optimal antibiotic management of 103 patients with bloodstream infections, defined as bacteremia and systemic inflammatory response syndrome, was evaluated. The optimal antibiotic management was defined according to the Sanford Guide to Antimicrobial Therapy (1996) or written internal guidelines. The judgment on optimal antibiotic management was made at the time of reporting the positive blood culture results. Switching from a broad-spectrum to a narrow-spectrum agent was carried out significantly more often by the ID service than by the attending physicians (25 of 25 vs. 20 of 40; P<0.001). In patients without empirical therapy, the ID service initiated optimal antimicrobial therapy significantly more often than physicians without training in infectious diseases (12 of 12 vs. 4 of 10, P=0.0028). Three of 12 patients in whom the attending physician misinterpreted the positive blood culture result needed 8 days to 4 months of additional hospitalization. In summary, patients for whom an ID service was provided received appropriate treatment more often and experienced significantly fewer complications.

Adult↗
PubMed1999

[Quality standards for hospital hygiene in intermediate and large hospitals in Switzerland: a recommended concept].

The incidence of nosocomial infections is one of the most important quality indicators in health care. It increases the economical burden, augments morbidity, lengthens hospital stay, and is associated with a high mortality rate. Infection control programs are designed to minimize such adverse events. An effective infection control program can reduce the incidence of nosocomial infections by over 30%. It is regarded as among the most cost-efficient medical interventions available in modern public health. The national law for health insurance (KVG) makes quality in health care also a legal issue. This law enforces quality assurance on a scientific basis. In Switzerland there are no national guidelines to define the nature and extent of infection control in health care institutions as in many other European countries. In the United States quality standards are part of accreditation of any health care institution. Evaluating scientific evidence and international experience this article provides the rationale for a quality standard for infection control in Swiss hospitals. It features three general rules and five elements of structural quality. The recommendations are: (1) Every hospital must have a system to control nosocomial infection in patients, care givers and visitors. (2) This program consists of defined elements of structural quality. (3) The program is permanently being improved in its quality. The basic elements are: (1) infection control committee, (2) infection control team, (3) guidelines, (4) surveillance, (5) infrastructure. The feasability and impact of this standard has to be evaluated.

Cross Infection↗
PubMed1999

Impact of drug resistance mutations on virologic response to salvage therapy. Swiss HIV Cohort Study.

OBJECTIVE: To assess the prognostic significance of drug-associated mutations in the protease and reverse transcriptase (RT) genes on virological response to salvage therapy. PATIENTS: All patients from four centres of the Swiss HIV Cohort Study who were switched, between February and October 1997, to nelfinavir plus other antiretroviral drugs following failure of highly active antiretroviral therapy (HIV-1 RNA >1000 copies/ml after > 3 months). METHODS: Direct sequencing of RT and protease genes derived from plasma RNA was performed in 62 patients before salvage therapy. Baseline predictors (drug-resistance mutations, drug exposure, clinical and biological parameters) of virological response after 4-12 weeks of therapy were assessed by linear regression analyses. RESULTS: Patients had been treated with RT inhibitors and protease inhibitors for a median duration of 35.6 and 12.2 months, respectively. Baseline median CD4 cell count was 113 x 10(6)/l and HIV-1 RNA 5.16 log10 copies/ml. The median decrease of HIV-1 RNA was 0.38 log10; 32% of the patients showed > 1 log10 decrease. At baseline, 90% of the patients had RT inhibitor-resistance mutations with a median number per patient of four (range, 0-7). Primary and secondary protease inhibitor-resistance mutations were detected in 69% and 89% of the patients, respectively. The median number of total protease inhibitor-resistance mutations per patient was four (range, 0-9). In univariate analysis, virological response to salvage therapy was associated with number of RT inhibitors, primary and secondary protease inhibitor-resistance mutations, history of protease inhibitor use (duration and number), but not with clinical stage, HIV-1 RNA level or CD4 cell count. After adjustment for all variables, the number of RT inhibitor plus protease inhibitor-resistance mutations was the only independent predictor. CONCLUSIONS: In patients with advanced HIV infection, the virological response to salvage therapy containing nelfinavir is best predicted by the number of baseline RT inhibitor plus protease inhibitor-resistance mutations.

Anti-HIV Agents↗
PubMed1999

Osteomyelitis.

Despite significant progress in antibiotic therapy and orthopedic surgery, osteomyelitis remains a difficult-to-treat infection that is often associated with recurrence. In this paper we summarize the most recent developments in understanding the pathogenesis of this complex disease, as well as novel means for its diagnosis and treatment.

Journal Article↗
PubMed1998

Antibodies against platelet glycoproteins and antiphospholipid antibodies in autoimmune thrombocytopenia.

Autoantibodies against platelet glycoproteins (anti-GP) are found in the majority of patients with autoimmune thrombocytopenia (AITP) as well as in thrombocytopenia associated with systemic lupus erythematosus (SLE). Some of these patients may have anti-phospholipid antibodies (anti-PL). To evaluate the pathogenetic significance of anti-PL and anti-GP antibodies in AITP and SLE patients, we investigated anti-cardiolipin (anti-CL), anti-phosphatidylserine (anti-PS) and anti-GP antibodies (anti-GPIIb-IIIa and anti-GPIb-IX) in 71 patients with AITP and 3 thrombocytopenic patients with SLE. Anti-GP antibodies were detected in 52 (70%) patients. Fifty-six (73%) patients showed anti-PL antibodies. Seven patients (6 AITP, 1 SLE) with both anti-GPIIb-IIIa and IgG anti-PL antibodies were followed during treatment with corticosteroids. Antibodies were measured before treatment and at the time of platelet-peak. Anti-GPIIb-IIIa antibodies decreased in all or became undetectable in five. In contrast, IgG anti-PS and IgG anti-CL antibodies decreased only moderately or remained positive. Adsorption experiments, using gelfiltered platelets, erythrocyte (Ec)-inside-out-vesicles and purified GPIIb-IIIa, showed that anti-GP and anti-PL antibodies have distinct specificities and do not crossreact. We conclude that anti-PL and anti-GP antibodies may be present simultaneously in some patients with immune mediated thrombocytopenia. Although anti-PS as well as anti-CL antibodies may be responsible for thrombocytopenia, we speculate that anti-GPIIb-IIIa antibodies are more related to the severity of thrombocytopenia.

Adolescent↗
PubMed1997

Creatine kinase MB during myocardial infarction: relationship to preexisting coronary heart disease and medication.

Creatine kinase (CK) and its isoenzyme CK-MB are important tools for the diagnosis of acute myocardial infarction. The content of CK-MB relative to total CK in myocardial cells is variable; it is low in normal myocardium and increased several-fold in hypoxic myocardium. We tested the hypothesis that CK-MB mass (CK-MBm) could be related to cardiovascular history, preinfarctional medication and clinical course during myocardial infarction. In a prospective study CK and CK-MBm were measured 0, 6, 12, 18, 24, 36, 48 and 72 h after the admission to the coronary care unit. Peak values and areas under the curve (AUC) were determined and normalized for total CK activity (CK-MBm/CK). Of 185 patients with acute chest pain, 70 patients had 71 acute myocardial infarctions and were enrolled in the study. A history of chronic angina pectoris or hypertension had no influence on CK-MBm/CK levels. In contrast, treatment with beta-blockers before infarction resulted in a lower relative CK-MBm peak value (CK-MBm/CK 6.0 (median value), range 3.1-15.3, versus 7.0, range 0.5-17.3: p < 0.05). Other drugs had no influence. Patients with persistent pain on admission tended to have higher relative CK-MBm values (peak CK-MBm/CK: 6.8, range 0.5-17.3, versus 5.3, range 1.4-7.9, p = 0.08; AUC CK-MBm/CK: 0.05, range 0.01-0.10, versus 0.03, range 0.01-0.06, p < 0.05). Three vessel disease on coronary angiography was associated with higher peak CK-MBm/CK values during the acute phase of myocardial infarction than those with 1-2 vessel disease (Peak CK-MBm/CK: 7.9, range 5.5-17.3, versus 6.4, range 3.1-10.2, p < 0.05; AUC CK-MBm/CK: 0.06, range 0.02-0.11, versus 0.04, range 0.02-0.07, p < 0.05). We conclude that relative CK-MBm/CK levels reflect to a certain degree the extent of the coronary disease and that preinfarctional beta-blockade may result in lower CK-MBm levels.

Adrenergic beta-Antagonists↗
PubMed1989

A new model for studying nutrition in peritonitis. The adverse effect of overfeeding.

In guinea pigs fed ad libitum, controlled intraperitoneal infusion of bacteria by an implanted 7-day osmotic pump resulted in peritonitis or abscess formation with a 50% survival 14-18 days after pump implantation. Administration of 125 kcal/kg/day of a diet found to be optimal for burned guinea pigs by continuous pump controlled feedings via a previously placed gastrostomy was well-tolerated, with a 62.5% mortality by Day 17. Administration of only 100 kcal/kg/day caused weight loss of approximately 17% after 16 days, but fewer animals died (42.8%, p = NS). Feeding either 150 kcal/kg/day or 175 kcal/kg/day caused death in all 25 animals (p less than 0.001) and their survival time was slightly shortened (p = NS) when compared with animals receiving 100 or 125 kcal/kg/day. This is the first animal model of peritonitis that permits incisive dissection of the relative influences of dietary composition on outcome, because survival can be extended to 2 weeks or more in the presence of continuing sepsis.

Animals↗