PubMed Health⌕ Search

Biomedical subjects

P J van den Broek

Publications and source records attributed to P J van den Broek.

At least 19 recordsLinked to original sources
PubMed2006

How many infection control staff do we need in hospitals?

During a one-day workshop experienced infection control practitioners (ICPs) and medical microbiologists debated how much time was needed for the delivery of infection control activities in a model hospital. They agreed a standard of one full-time equivalent (FTE) ICP per 178 hospital beds and one FTE medical microbiologist per 806 hospital beds. This is 40% and 24% more than the usual standard, respectively. Now that official numbers of hospital beds have become an inadequate parameter for work delivered by hospitals, a new standard is proposed, with the number of admissions as the denominator. This is one FTE ICP per 5000 admissions and one medical microbiologist or epidemiologist per 25000 admissions.

Humans↗
PubMed2006

[Optimisation of the antibiotic policy in the Netherlands. X. The SWAB guideline for antimicrobial treatment of complicated urinary tract infections].

The 'Stichting Werkgroep Antibioticabeleid' (SWAB; Dutch Working Party on Antibiotic Policy) has developed an evidence-based guideline for the empirical antimicrobial treatment of complicated urinary tract infections (UTIs) in hospitalised adult patients. The choice of treatment is based on recent Dutch data on the resistance ofuropathogens to the most frequently used antibiotics. The first choice for empirical antibiotic treatment in a patient with a complicated UTI is a 2nd or 3rd generation cephalosporin or the combination of amoxicillin and gentamicin. Amoxicillin-clavulanic-acid intravenously is the second empirical choice. The treatment duration must be at least 10 days. The treatment must be adjusted after the results of the urine culture become known and made more specific if possible. Oral treatment can be given if the patient's clinical situation allows it. There are separate recommendations for the treatment ofUTIs in the following patient categories: men, pregnant women, patients with a urinary catheter, patients with diabetes mellitus and patients with renal diseases, congenital polycystic kidney disease or pyocystis.

Anti-Bacterial Agents↗
PubMed2006

Is there evidence for recommending needleless closed catheter access systems in guidelines? A systematic review of randomized controlled trials.

A systematic review was conducted to determine whether certain vascular access policies are better than others in terms of prevention of catheter-related infections. Publications were retrieved by a search of Medline, the Cochrane Library and Embase up to May 2005. All randomized trials and systematic reviews/meta-analyses of randomized trials evaluating the effect of vascular access policies (i.e. needleless closed systems, conventional closed systems or conventional open systems) on catheter-related infection in hospitalized patients with intravascular catheters in situ were selected. Two reviewers independently assessed trial quality and extracted data. Data from the original publications were used to calculate the relative risk or the incidence-density relative rate of catheter-related infection. Data for similar outcomes were combined in the analysis where appropriate using a random-effects model. Of the six studies reviewed, one was excluded. Five randomized controlled trials were included in the review. The quality of the trials and the way they were reported were generally unsatisfactory. Four trials compared needleless closed systems with conventional open systems. There was a trend for an advantage of the needleless closed devices in terms of less catheter-associated bloodstream infection, less catheter tip colonization and less hub inlet colonization. There were no possibilities for combining data because of clinical heterogeneity. One trial compared needleless closed systems with conventional closed systems and the evidence was inconclusive. From the point of view of infection prevention, there are no objections to use these new systems. However, there is insufficient evidence at this stage to recommend the needleless closed vascular devices.

Catheterization↗
PubMed2006

Status of infection control policies and organisation in European hospitals, 2001: the ARPAC study.

Patient safety in hospital care depends on effective infection control (IC) programmes. The Antimicrobial Resistance Prevention and Control (ARPAC) study assessed the organisation, components and human resources of IC programmes in European hospitals. A questionnaire survey of policies and procedures implemented in 2001 for the surveillance and control of nosocomial infection and antibiotic resistance was completed by 169 acute-care hospitals from 32 European countries, categorised by five geographical regions. A formal IC programme existed in 72% of hospitals, and a multidisciplinary IC committee was operational in 90%. Trained IC nurses (ICNs) were present in 80% of hospitals (ranging from 54% in south-east and central-eastern Europe, to 100% in northern Europe), whereas 74% had one or more trained IC doctors (ICDs) (ranging from 46% in south-east Europe to 84% in western Europe). Median staffing levels were 2.33 ICNs/1,000 beds and 0.94 ICDs/1,000 beds. The intensity of IC programmes scored higher in centres from northern and western Europe than from other European regions. Written guidelines promoted hand hygiene for healthcare workers in 89% of hospitals, education in 85%, and audit in 46%. Guidelines recommended use of alcohol-based solutions (70%) and/or medicated/antiseptic soap (43%) for decontamination of non-soiled hands. Use of alcohol-based solutions varied according to region, from 41% in southern Europe to 100% in northern Europe, compared with use of medicated soap from 77% in southern Europe to 11% in northern Europe (p < 0.01). These findings showed that IC programmes in European hospitals suffer from major deficiencies in human resources and policies. Staffing levels for ICNs were below recommended standards in the majority of hospitals. Education programmes were incomplete and often not supported by audit of performance. Hand hygiene procedures were sub-standard in one-third of centres. Strengthening of IC policies in European hospitals should be a public health priority.

Cross Infection↗
PubMed2006

Epidemiology of multiple Acinetobacter outbreaks in The Netherlands during the period 1999-2001.

An increase in the number of outbreaks of Acinetobacter infection was notified in The Netherlands during 1999-2001. The present study compared the outbreaks at the species and strain levels, and analysed the epidemiology and control measures at the different locations. For each institute, three representative isolates from three patients were identified to the species and strain levels by genotyping methods. A questionnaire investigated the impact of the outbreak, the control measures that were taken, and the possible effects of the measures. Seven outbreaks were associated with Acinetobacter baumannii (three outbreaks with a strain designated strain A, two outbreaks with a strain designated strain B, and one outbreak each with strains designated C and D). An additional outbreak was caused by genomic species 13TU, which is related closely to A. baumannii. Strains B and D were identified as European clones III and II, respectively. Except for two hospitals with outbreaks caused by strain A, there was no known epidemiological link between the participating hospitals. In all hospitals the outbreak occurred on one or several intensive care units, and spread to other departments was noted in two hospitals. The number of patients affected ranged from six to 66 over a period of 2-22 months. In most outbreaks, patients were the likely reservoir from which spread occurred. In all hospitals, a large panel of measures was required to bring the outbreak to an end. Extensive environmental sampling yielded numerous positive samples in most but not all hospitals.

Acinetobacter↗
PubMed2006

Genotypic diversity and antibiotic susceptibility of Acinetobacter baumannii isolates in a Bulgarian hospital.

A set of 18 Acinetobacter baumannii isolates, collected prospectively in a Bulgarian hospital during episodes of increased A. baumannii occurrence during 2000-2002, was investigated for genotypic diversity and antibiotic susceptibility. Four genotypes were identified by amplified fragment length polymorphism genomic fingerprinting, one of which (type 1) accounted for 13 isolates, indicating that a specific strain was predominant. The single isolate allocated to type 2 was identified to European clone I. All isolates were resistant to multiple antibiotics, but most retained susceptibility to tobramycin and colistin, and all except one were susceptible to imipenem.

Acinetobacter Infections↗
PubMed2005

[Meningococci infection by a bacteriophage with a virulence factor].

Meningococci are bacteria dreaded for their ability to kill young people. However, meningococci and humans usually live together peacefully. In a minority of cases, the co-existence results in disease. Recently, whole genome comparisons between hyperinvasive clones and clones not associated with disease revealed that a chromosomally integrated bacteriophage was related to invasiveness. Many examples of bacteriophage-encoded virulence factors are known--as such, this finding is not remarkable. However, the way this virulence factor was found is a nice example of unravelling the pathogenesis of infectious diseases in the genomic era.

Bacteriophages↗
PubMed2005

[Two guidelines on community-acquired pneumonia: both an important basis for individual policies].

Recently, two Dutch guidelines were published regarding the management of patients with community-acquired pneumonia. In the Dutch Working Party on Antibiotic Policy (SWAB) guideline, the choice of antibiotic is based primarily on the severity of illness. In the Dutch Thoracic Society (NVALT) guideline, patients are differentiated for empiric therapy based on clinical and rapidly-available laboratory information, placing severely-ill patients in a separate category. Rapid tests for detection of Legionella pneumophila antigen have a prominent place in both guidelines. Contrary to the NVALT guideline, the SWAB guideline does not value Gram staining of sputum when selecting an initial therapeutic choice. The antibiotics recommended in the guidelines differ. Clinicians should take notice of both guidelines and take the best from each to formulate their own personal approach to patients with community-acquired pneumonia.

Anti-Bacterial Agents↗
PubMed2005

[Clostridium difficile ribotype 027, toxinotype III in The Netherlands].

Recently, two Dutch hospitals reported outbreaks of Clostridium difficile ribotype 027, toxinotype III. This strain, which was seen earlier in the United States, Canada and the United Kingdom, produces large amounts of toxins due to a defect in the toxin-regulating gene and causes severe diarrhoea. Antibiotic use, especially use of fluoroquinolones, is a risk factor. Control of outbreaks is hampered by the fact that Clostridium forms spores that can survive for a very long time in the environment and are resistant to the usual surface disinfectants. Protocols for diagnostic investigations, prevention and control of outbreaks are available.

Bacterial Toxins↗
PubMed2005

Urinary catheter policies for short-term bladder drainage in adults.

BACKGROUND: Indwelling urinary catheters are often used for bladder drainage during hospital care. Urinary tract infection is a common complication. Other issues that should be considered when choosing an approach to catheterisation are patients' comfort, other complications/adverse effects, and costs. OBJECTIVES: To determine the advantages and disadvantages of alternative approaches to catheterisation for short-term bladder drainage in adults. SEARCH STRATEGY: We searched the Cochrane Incontinence Group Specialised Register (searched 20 December 2004). Additionally, we examined all reference lists of identified trials. SELECTION CRITERIA: All randomised and quasi-randomised trials comparing catheter route of insertion for adults catheterised for up to 14 days. DATA COLLECTION AND ANALYSIS: Data were extracted by both reviewers independently and compared. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. If the data in trials had not been fully reported, clarification was sought directly from the authors. MAIN RESULTS: Seventeen parallel-group randomised controlled trials met the inclusion criteria. Fourteen trials compared indwelling urethral catheterisation with suprapubic catheterisation. Groups managed with an indwelling catheter had more cases of bacteriuria (RR 2.60; 95%CI 2.12 to 3.18), more frequent recatheterisation (RR 4.12; 95%CI 2.94 to 7.56), and more people with discomfort (RR 2.98; 95%CI 2.31 to 3.85). There were no reports of complications during insertion, although not all trials stated this explicitly. Three trials compared indwelling urethral catheterisation with intermittent catheterisation. In the two trials with data, there were fewer cases of bacteriuria in the intermittent catheterisation group (RR 2.90; 95%CI 1.44 to 5.84). Costs analyses reported in two trials favoured the indwelling group. AUTHORS' CONCLUSIONS: There was evidence that suprapubic catheters have advantages over indwelling catheters in respect of bacteriuria, recatheterisation and discomfort. The clinical significance of bacteriuria was uncertain, however, and there was no information about possible complications or adverse effects during catheter insertion. There was more limited evidence that the use of intermittent catheterisation was also associated with a lower risk of bacteriuria than indwelling urethral catheterisation, but might be more costly. Using intermittent catheterisation postoperatively limits catheterisation to those people who definitely need it.

Adult↗
PubMed2005

Antibiotic policies for short-term catheter bladder drainage in adults.

BACKGROUND: Urinary tract infections account for about 40% of hospital-acquired (nosocomial) infections, and about 80% of urinary tract infections acquired in hospital are associated with urinary catheters. OBJECTIVES: To determine if certain antibiotic policies are better than others in terms of prevention of urinary tract infections, complications, quality of life and cost-effectiveness in short-term catheterised adults. SEARCH STRATEGY: We searched the Cochrane Incontinence Group Specialised Register (searched 20 December 2004). Additionally, we examined all reference lists of identified trials. SELECTION CRITERIA: All randomised and quasi-randomised trials comparing antibiotic policies for short-term (up to and including 14 days) catheterization in adults. DATA COLLECTION AND ANALYSIS: Data were extracted by both reviewers independently and compared. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. If data had not been fully reported, clarification was sought directly from the authors of the trial. MAIN RESULTS: Six parallel-group randomised controlled trials met the inclusion criteria. In one trial comparing antibiotic prophylaxis with giving antibiotics when clinically indicated amongst female surgical patients who had a urethral catheter for more than 24 hours, symptomatic urinary tract infection was less common in the prophylaxis group (RR 0.20, 95% CI 0.06 to 0.66). Five trials compared antibiotic prophylaxis with giving antibiotics when microbiologically indicated, bacteriuria, pyuria and gram-negative isolates in patients' urine were less common in the prophylaxis group amongst surgical patients with bladder drainage for at least 24 hours postoperatively. Bacteriuria rates were also about five-fold lower in the prophylaxis group in trials involving urological surgery patients and non-surgical patients. No trial compared giving antibiotics when microbiologically indicated with giving antibiotics when clinically indicated. AUTHORS' CONCLUSIONS: There was weak evidence that antibiotic prophylaxis compared to giving antibiotics when clinically indicated reduced the rate of symptomatic urinary tract infection in female patients with abdominal surgery and a urethral catheter for 24 hours. The limited evidence indicated that receiving antibiotics during the first three postoperative days or from postoperative day two until catheter removal reduced the rate of bacteriuria and other signs of infection such as pyuria and gram-negative isolates in patients urine in surgical patients with bladder drainage for at least 24 hours postoperatively. There was also limited evidence that prophylactic antibiotics reduced bacteriuria in non-surgical patients.

Adult↗
PubMed2005

[Optimising patient isolation due to methicllin-resistant Staphylococcus aureus].

Isolation of patients is used to control the spread of certain microorganisms in the hospital, e.g. meticillin-resistant Staphylococcus aureus (MRSA). Recent investigations have shown that the quality of care for patients in isolation is affected significantly. However, this is not accompanied by an effect on the morbidity or mortality. The successful Dutch policy on MRSA is based largely on strict isolation of patients colonised with MRSA. If MRSA becomes endemic, this is accompanied by increases in morbidity and mortality as well as costs. The disadvantages of isolation are recognised and should be prevented as far as possible. New diagnostic and therapeutic developments can shorten the duration of isolation significantly, which will further improve the quality of care.

Cross Infection↗
PubMed2005

Urinary catheter policies for long-term bladder drainage.

BACKGROUND: People requiring long-term bladder draining commonly experience catheter-associated urinary tract infection and other problems. OBJECTIVES: To determine if certain catheter policies are better than others in terms of effectiveness, complications, quality of life and cost-effectiveness in long-term catheterised adults and children. SEARCH STRATEGY: We searched the Cochrane Incontinence Group specialised trials register (searched 9 June 2003). Additionally, we examined all reference lists of identified trials. SELECTION CRITERIA: All randomised and quasi-randomised trials comparing catheter policies (route of insertion and use of antibiotics) for long-term (more than 14 days) catheterisation in adults and children. DATA COLLECTION AND ANALYSIS: Data were extracted by both reviewers independently and compared. Disagreements were resolved by discussion. Data were processed as described in the Cochrane Handbook. If the data in trials have not been fully reported, clarification were sought from the authors. When necessary, the incidence-density rates (IDR) and/or the incidence-density differences (IDD) within a certain time period were calculated. MAIN RESULTS: Seven trials met the inclusion criteria involving 328 patients in four crossover and three parallel-group randomised controlled trials. Only two of the pre-stated six comparisons were addressed in these trials. Three trials compared antibiotic prophylaxis with antibiotics when clinically indicated. For patients using intermittent catheterisation, there were inconsistent findings about the effect of antibiotic prophylaxis on symptomatic urinary tract infection. For patients using indwelling urethral catheterisation, one small trial reported fewer episodes of symptomatic UTI in the prophylaxis group.Four trials compared antibiotic prophylaxis with giving antibiotics when microbiologically indicated. For patients using intermittent catheterisation, there was limited evidence that receiving antibiotics reduced the rate of bacteriuria (asymptomatic and symptomatic). There was weak evidence that prophylactic antibiotics were better in terms of fewer symptomatic bacteriuria. AUTHORS' CONCLUSIONS: No eligible trials were identified that compared alternative routes of catheter insertion. The data from seven trials comparing differing antibiotic policies were sparse, particularly when intermittent catheterisation was considered separately from in-dwelling catheterisation. Possible benefits of antibiotic prophylaxis must be balanced against possible adverse effects, such as development of antibiotic resistant bacteria; these cannot be reliably estimated from currently available trials.

Antibiotic Prophylaxis↗
PubMed2005

Hair removal policies in clean surgery: systematic review of randomized, controlled trials.

OBJECTIVE: To determine whether certain hair removal policies are better than others to prevent surgical-site infections in patients undergoing clean surgery. METHODS: Publications were retrieved by a systematic search of Medline, the Cochrane Library, and EMBASE up to February 2005. Additionally, the reference lists of all identified trials were examined. All randomized trials, quasi-randomized trials, and systematic reviews or meta-analyses of randomized or quasi-randomized trials comparing hair removal policies in clean surgery were selected. Trials involving patients undergoing cranial neurosurgery were excluded. Two reviewers independently assessed trial quality and extracted data. Disagreements were resolved by discussion with a third reviewer. Data from the original publications were used to calculate the relative risk or risk difference of surgical-site infection. Data for similar outcomes were combined in the analysis, where appropriate, with the use of a random effects model. RESULTS: Four trials were included in the review. No eligible systematic review or meta-analysis of randomized or quasi-randomized trials was found. The quality of the trials and how they were reported were generally unsatisfactory. Evidence regarding whether preoperative hair removal has any effect was inconclusive. When hair removal was considered necessary, evidence about the best time for removal was inconclusive. There was some evidence that hair removal by clipper is superior to removal by razor. CONCLUSIONS: Because of insufficient evidence as a basis for recommendations, the practical consequences for ward management were essential when the Dutch Working Party on Infection Prevention formulated its recommendations for hair removal policies. Large randomized, controlled trials are needed to determine the optimal policy for preoperative hair removal.

Hair Removal↗
PubMed2004

Outbreak of nosocomial meningitis caused by Acinetobacter baumannii in neurosurgical patients.

An outbreak of nosocomial meningitis caused by Acinetobacter baumannii, which developed postoperatively in seven neurosurgical patients is described. The clinical isolates of A. baumannii were typed by biochemical profiles and antibiogram patterns, and by random amplified polymorphic DNA polymerase chain reaction (RAPD-PCR) and amplified fragment length polymorphism (AFLP) fingerprinting. The implicated strain was multi-drug resistant, however, susceptibility to imipenem and netilmicin was detected. An extensive search for the environmental source of the epidemic strain was carried out. Two of several isolates from hospital environment, corresponded to the A. baumannii outbreak strain, one being cultured from the suctioning equipment used in the care of these patients. The introduction of multiresistant epidemic A. baumannii into a neurosurgical unit is a severe risk factor for patients undergoing neurosurgical procedures. Genotypic typing methods are important for definitive identification of these strains in patients and their environment.

Acinetobacter Infections↗
PubMed2004

Persistent Acinetobacter baumannii? Look inside your medical equipment.

Two outbreaks of multidrug-resistant Acinetobacter baumannii occurred in our hospital. The outbreak strains were eventually isolated from respiratory ventilators, an apparatus used to cool or warm patients, and four continuous veno-venous hemofiltration machines. Removing dust from the machines and replacing all dust filters brought the outbreaks to an end.

Acinetobacter Infections↗
PubMed2003

[Staphylococcus aureus, a successful pathogen].

Staphylococcus aureus is a dreadful pathogen for mankind, causing boils, abscesses, wound infections, osteomyelitis, septicaemia, endocarditis, pneumonia, toxic shock syndrome, scalded skin syndrome, and food poisoning. The development of penicillin-, methicillin-, and vancomycin-resistant strains shows that S. aureus has an enormous adaptive power. Most methicillin-resistant strains of S. aureus (MRSA) are hospital-acquired, although an increasing number are reported to be community-acquired. A limited number of clones of MRSA have spread all over the world. Since most community-acquired MRSA can be traced back to some contact with health care, MRSA can still best be combatted by control measures in health care institutions. In this respect, the Netherlands and Scandinavian countries have been very successful so far. S. aureus has many virulence factors at its disposal: structural components, enzymes and three types of toxins. Panton-Valentine leukocidin (PVL) has received attention as a factor causing severe pneumonia with high mortality. A strain combining methicillin resistance and PVL has spread through France. Recently, the genome of an MRSA strain has been unravelled. Its structure illustrates how well S. aureus can adapt itself and acquire properties of other microorganisms. This genetic knowledge may lead to new strategies to combat S. aureus.

Adaptation, Physiological↗