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Petra Gastmeier

Publications and source records attributed to Petra Gastmeier.

34 records · Page 2Linked to original sources
PubMed2004

Surveillance of antimicrobial use and antimicrobial resistance in intensive care units (SARI): 1. Antimicrobial use in German intensive care units.

OBJECTIVE: To study antimicrobial use for benchmarking and ensuring quality of antimicrobial treatment and to identify risk factors associated with the high use of antimicrobials in German intensive care units (ICUs) through implementation of the SARI (Surveillance of Antimicrobial Use and Antimicrobial Resistance in ICUs) system. DESIGN: Prospective, unit-based surveillance on antimicrobial use from February, 2000, until June, 2002. The data are standardised by use of the defined daily dose (DDD) for each antimicrobial defined by the WHO and by calculating use per 1000 patient days. SETTING: The data were obtained from 35 German ICUs and stratified by type of ICU (medical, surgical, interdisciplinary). RESULTS: To date, the project covers a total of 266,013 patient days in 744 reported ICU months and 354,356 DDDs. Mean antimicrobial use density (AD) was 1,332 DDD/1000 patient days and was correlated with length of stay. Penicillins with beta-lactamase inhibitor (AD 338.3) and quinolones (155.5) were the antimicrobial group with the highest ADs. Comparison with US ICARE (Intensive Care Antimicrobial Resistance Epidemiology)/AUR (Antimicrobial Use and Resistance) data revealed a higher AD for glycopeptides and 3rd generation cephalosporins in ICARE/AUR ICUs, but a higher AD for carbapenems in German SARI ICUs regardless of the type of ICU. In the multivariate analysis, length of stay was an independent risk factor for an AD above the 75% percentile of the total amount of antimicrobials used (OR 1.96 per day); likewise, for the AD above the 75% percentile of carbapenems (OR 1.90 per day) and penicillins with extended spectrum (OR 2.01 per day). High use of glycopeptides and quinolones (AD >75% percentile) correlated with central venous catheter (CVC) rate (OR 1.14 per CVC day per 100 patient days and 1.16, respectively). CONCLUSION: The SARI data on antimicrobials serve ICUs as a benchmark by which to improve the quality of antimicrobial drug administration and for international comparison.

Anti-Bacterial Agents↗
PubMed2004

Bacterial contamination of multiple-dose vials: a prevalence study.

BACKGROUND: Two patients died of a meningitis caused by Pseudomonas aeruginosa in a hospital in Germany in July 2001, their infections having been caused by a contaminated contrast media (iomeprol [Imeron]) used as a multiple-dose vial (MDV) over 8 days. Therefore, a prevalence study was performed to investigate the use and contamination of multiple-use vials in a tertiary hospital. METHODS: In a 1300-bed hospital on a specific day in November 2001, all used MDVs were collected by the infection control nurses. Information was recorded about the medication, labeling of vials, storing temperature, wards, and dates of opening. Each vial was also tested for sterility. RESULTS: Opened vials were to be found in all wards. Of the 227 vials available, 1 vial and 1 spike were contaminated with Staphylococcus epidermidis (contamination rate 0.9%; 95% CI, 0.3-2.1). The opening dates were marked on only 114 (50%) MDVs, 15 (13%) of which had already expired. Only 44 (19%) MDVs had been stored in the refrigerator, whereas 109 MDVs contained medications without any preserving agent. CONCLUSION: Results revealed somewhat risky handling of MDVs. In light of a possible high risk in this hospital of about 1 contaminated MDV per day, and in view of many reported outbreaks induced by contaminated MDVs, the following infection control measures were encouraged: alcohol hand hygiene, the disinfection of gums, observance of the manufacturer's recommendations, appropriate storing temperatures, marking the opening time, and avoiding the multiple use of medications not containing preserving agents.

Bacterial Infections↗
PubMed2004

Should electronic faucets be recommended in hospitals?

Microbiological examinations of electronic faucets newly installed in a hospital kitchen revealed high bacteria counts and Pseudomonas aeruginosa during a 6-month period of observation. Our data suggest that the use of electronic faucets poses a potential risk for nosocomial infection in high-risk areas of hospitals.

Colony Count, Microbial↗
PubMed2004

To isolate or not to isolate? Analysis of data from the German Nosocomial Infection Surveillance System regarding the placement of patients with methicillin-resistant Staphylococcus aureus in private rooms in intensive care units.

OBJECTIVE: To investigate whether isolating patients with MRSA in private rooms in ICUs (or cohorting) is a protective factor for nosocomial MRSA infection. DESIGN: Association between nosocomial MRSA infection rates and ICU structure and process parameters in the German Nosocomial Infection Surveillance System (KISS). SETTING: Two hundred twelve ICUs participating in KISS in 2001. METHODS: In June 2001, a structured questionnaire was sent to the participating ICUs regarding their preventive measures, their type and size, their patient-to-personnel ratios, and routine cultures. Univariate and multivariate analyses were conducted to identify risk factors for nosocomial MRSA infection. RESULTS: The questionnaire was completed by 164 (77.4%) of the ICUs. These ICUs had 325 nosocomial MRSA infections in a 5-year period (1997 to 2001). The mean incidence density of nosocomial MRSA infections was 0.3/1,000 patient-days. Ninety-one ICUs (55.5%) did not register any nosocomial MRSA infections during the observation period. Forty-two ICUs had an incidence density of at least 0.3/1,000 patient-days (75th percentile). Surgical ICUs were found to be a risk factor for a nosocomial MRSA infection rate above this threshold. Multivariate analysis found surgical ICUs to be an independent predictor and isolation in private rooms (or cohorts) to be a protective factor (OR, 0.36; CI95, 0.17-0.79). CONCLUSION: Many (34.4%) of the German ICUs have not isolated MRSA patients in private rooms or cohorts, a procedure associated with lower MRSA infection rates in this study.

Cross Infection↗
PubMed2004

Finding a method for optimizing risk adjustment when comparing surgical-site infection rates.

OBJECTIVE: To investigate whether stratification of the risk of developing a surgical-site infection (SSI) is improved when a logistic regression model is used to weight the risk factors for each procedure category individually instead of the modified NNIS System risk index. DESIGN AND SETTING: The German Nosocomial Infection Surveillance System, based on NNIS System methodology, has 273 acute care surgical departments participating voluntarily. Data on 9 procedure categories were included (214,271 operations). METHODS: For each of the procedure categories, the significant risk factors from the available data (NNIS System risk index variables of ASA score, wound class, duration of operation, and endoscope use, as well as gender and age) were identified by multiple logistic regression analyses with stepwise variable selection. The area under the receiver operating characteristic (ROC) curve resulting from these analyses was used to evaluate the predictive power of logistic regression models. RESULTS: For most procedures, at least two of the three variables contributing to the NNIS System risk index were shown to be independent risk factors (appendectomy, knee arthroscopy, cholecystectomy, colon surgery, herniorrhaphy, hip prosthesis, knee prosthesis, and vascular surgery). The predictive power of logistic regression models (including age and gender, when appropriate) was low (between 0.55 and 0.71) and for most procedures only slightly better than that of the NNIS System risk index. CONCLUSION: Without the inclusion of additional procedure-specific variables, logistic regression models do not improve the comparison of SSI rates from various hospitals.

Adult↗
PubMed2004

Nosocomial infection surveillance and control policies.

PURPOSE OF REVIEW: In the majority of countries costs for health care are increasing and strategies to reduce adverse events in medical treatment have an increasing importance. Nosocomial infection remains the most common type of complication affecting hospitalized patients. As preventive strategies have indeed become more important they now have to show not only that they are effective in reducing nosocomial infections but also that they are cost effective. This paper investigates the contribution made by articles published in the last year to the development of nosocomial-infection surveillance and control policies. RECENT FINDINGS: At least 15 randomized controlled studies and six meta-analyses investigating various infection-control policies were published last year. They did not lead to any changes in present guidelines, but rather endorsed existing recommendations. At least nine studies were found reporting a substantial reduction in nosocomial infections by the introduction of quality management principles under routine working conditions. Furthermore there were a lot of studies published which focused on optimizing surveillance measures and investigating the use of reference data for reducing infection rates. Only seven studies estimating the burden of disease were found in the literature of the past year. SUMMARY: The predominant opinion voiced in the studies was that in many medical institutions some 30% or more of nosocomial infections could be prevented.

Cross Infection↗
PubMed2003

[Surveillance of nosocomial infections in intensive care units. Current data and interpretations].

The German nosocomial infections surveillance system KISS was established in 1996 using a surveillance protocol based on the National Nosocomial Infections Surveillance (NNIS) System. Meanwhile data from a total of 274 intensive care units (ICU) are available, among them 134 interdisciplinary, 71 surgical, 55 medical, 9 neurosurgical and 5 paediatric ICUs. The data comprise about 6,966 surveillance months with more than 500,000 intensive care patients and more than 1.8 million patient days. A total of 6,888 cases of pneumonia and 2,357 cases of central venous catheter (CVC) associated primary bloodstream infections (BSI) were recorded. Ventilator associated pneumonia rates and CVC associated primary BSI rates are presented, stratified according to the type of the ICU and affiliation to a university, a teaching hospital or another type of hospital. The most frequent pathogens associated with ventilator associated pneumonia were S. aureus (24.1%), followed by P. aeruginosa (16.8%) and Klebsiella spp. (12.1%). In the case of CVC associated primary BSI coagulase negative staphylococci dominated (30.9%) followed by S. aureus (15.4%) and Enterococci spp. (11.6%). A remarkable increase of Methicillin Resistant Staphylococcus aureus (MRSA) infections was observed during the period from 1997 to 2002. 19.2% of S. aureus associated pneumonia cases and 25.5% of S. aureus associated primary BSI were due to MRSA. KISS data are useful benchmarks for internal quality management, however a careful interpretation is necessary to stimulate infection control efforts.

Adult↗
PubMed2003

The relationship between methodological trial quality and the effects of impregnated central venous catheters.

OBJECTIVE: We assessed the methodological trial quality of individual randomized controlled studies on chlorhexidine silver sulfadiazine impregnated catheters and the effect on catheter-related infection (CRI). DESIGN: Only the studies identified in the Medline database from 1966 to December 2001 were considered, abstracts being excluded. The outcome of this investigation centered on bloodstream CRI. The trial quality of the 11 studies identified and published (total 3,131 catheters) was assessed using a scoring system based on allocation, patient selection, patient characteristics, blinding of the intervention and the diagnosis of CRI (range 0-2 points, 10 points maximum). RESULTS: The mean methodological quality score was 7.1 (range 5-9). The relative risk reduction for bloodstream CRI ranged from -0.14 to 1.0. No association between trial quality and the impact of chlorhexidine silver sulfadiazine impregnated catheters on CRI was found. The summary odds ratio for CRI was 0.69 (95% CI 0.46-1.03). Taking only those studies with 2 points for diagnosis of CRI a summary odds ratio of 0.87 (95% CI 0.44-1.72) resulted, whereas studies with a diagnosis score of only 1 point led to a summary odds ratio of 0.60 (95% CI 0.35-1.02). CONCLUSIONS: The quality of the studies seems to have had no influence on the outcome, according to the results of this investigation, but the use of only a single quality score may not be sufficient to investigate the prevention effect of impregnated catheters.

Anti-Infective Agents, Local↗
PubMed2003

Clinical or epidemiologic diagnosis of nosocomial pneumonia: is there any difference?

OBJECTIVE: To evaluate the draft Centers for Disease Control and Prevention definitions of nosocomial pneumonia in comparison with current CDC definitions to increase acceptance by intensive care specialists. SETTING: A 12-bed medical intensive care unit in a German teaching hospital. METHOD: Clinicians were asked to retrospectively assess all patients of the year 1999 according to 3 different definitions of pneumonia: the current CDC definitions, the draft CDC definitions, and their own clinical criteria for diagnosing and treating. To test the agreement observed between the different sets of criteria, the kappa method described by Fleiss was used; for evaluating the strength of agreement between various categories, the recommendations of Landis and Koch were applied. RESULTS: One thousand eight hundred forty-two patients were assessed. According to the clinical criteria, 31 patients developed nosocomial pneumonia during their stay in the intensive care unit. The number of pneumonia cases according to the current CDC definitions was 30 and according to the draft definitions, 32. However, agreement with the clinical definitions was intermediate for the current definitions kappa = 0.62 (95% CI, 0.47-0.76) but excellent for the draft definitions kappa = 0.98 (95% CI, 0.95-1.02). CONCLUSION: Even though the current definitions are useful, agreement with the clinical assessment was greater for the draft definitions and might lead to improved acceptance of surveillance data by intensive care specialists.

Anti-Bacterial Agents↗
PubMed2003

Five years working with the German nosocomial infection surveillance system (Krankenhaus Infektions Surveillance System).

A national surveillance system for nosocomial infections, Krankenhaus Infektions Surveillance System (KISS), was established in Germany as a joint effort by the National Reference Center for Hospital Epidemiology (currently called the National Reference Center for the Surveillance of Nosocomial Infections) and the Robert Koch Institute. To begin with a well-accepted and proven method, surveillance protocols were developed on the basis of the National Nosocomial Infections Surveillance system. Hospitals from all parts of Germany took part voluntarily. There were 4 surveillance components: intensive care departments (227), patients undergoing operation (231 departments), neonatal intensive care departments (23 hospitals), and patients undergoing bone marrow and peripheral blood stem cell transplants (10 hospitals). Five years after the introduction of KISS many hospitals have introduced continuous surveillance activities whereby the various definitions and methods have attained wide acceptance. This has lead to much better understanding and cooperation between clinicians and infection control personnel in preventing nosocomial infections. KISS is considered the national reference database, but continuous evaluation and development of KISS are necessary to react adequately.

Cross Infection↗
PubMed2003

A cluster of nosocomial Klebsiella pneumoniae bloodstream infections in a neonatal intensive care department: Identification of transmission and intervention.

OBJECTIVE: We sought to determine the cause and mode of transmission of a cluster of bloodstream infections as a result of Klebsiella pneumoniae. DESIGN AND SETTING: We conducted a prospective cohort study in a neonatal intensive care department from May 1999 to December 2000. METHODS: We performed surveillance of nosocomial infections, and clinical and environmental investigations. RESULTS: During an 8-week period, 5 cases of K pneumoniae bloodstream infections were observed, at least 3 of them belonging to the same genotype. Before the second case developed any symptoms of infection, the same strain had also been found in the patient environment. Intervention measures were, therefore, immediately introduced. Further cases, however, occurred in the following weeks. Even after further intervention activities and the end of the outbreak, the same strain was discovered in environmental samples from a stethoscope and a nurse's hand. CONCLUSIONS: Even where there is acute awareness of the problem and a generally high infection control level in a department, it is difficult to change behavior in such a way that further nosocomial infections can be totally excluded.

Bacteremia↗
PubMed2003

Reducing central venous catheter-associated primary bloodstream infections in intensive care units is possible: data from the German nosocomial infection surveillance system.

BACKGROUND AND OBJECTIVE: The German Nosocomial Infection Surveillance System (KISS) began in 1997 as a nationwide surveillance project for voluntary registration of nosocomial infections in intensive care units (ICUs). This study investigates trends in the rates of central venous catheter (CVC)-associated primary bloodstream infections (BSIs) in ICUs since participation in KISS. METHODS: Eighty-four ICUs that had participated in KISS for at least 24 months were considered for more detailed analysis. Monthly rates of primary BSI for the 84 ICUs were pooled for the 24 months. The best model for describing the curve of reduction was sought. Additionally, incidence densities were compared using the z test. RESULTS: For the 212 ICUs participating, a relative 25.7% decrease (from 2.1 to 1.6 primary BSIs per 1,000 CVC-days) was observed from January 1997 to June 2001. The 84 ICUs that participated in KISS for a minimum of 24 months accumulated 552,359 patient-days and 404,897 CVC-days during their 24 months. A linear regression model was selected to explain the curve of primary BSI reduction in the 84 ICUs. It showed a decrease from 2.1 to 1.5 primary BSIs per 1,000 CVC-days, meaning an overall relative reduction of 28.6% during the 2-year observation period. These results were significant (Student's t test for the monthly reduction coefficient; P = .04). The reduction of primary BSIs was shown for both clinical sepsis and laboratory-confirmed, CVC-associated primary BSIs. CONCLUSION: Performing surveillance with KISS was associated with a reduction of the rates of CVC-associated primary BSIs in ICU patients.

Catheterization, Central Venous↗
PubMed2003

[Risk management from the hygienist's perspective].

Each year numerous patients acquire nosocomial infections in our hospitals, but the proportion of nosocomial infections that could potentially be prevented by infection control measures applied under routine working conditions remains unclear. Experts estimate that at least 20% of all nosocomial infections are likely to be avoidable. Various studies demonstrated that nosocomial infections can be significantly reduced by appropriate intervention methods in hospitals that are interested in quality management activities. However, continuous efforts are necessary to maintain these improvements. Also, hospitals must implement a wide range of policies designed to limit liability, some of which may only be marginally relevant to medical necessity. Persons working in the field of infection control therefore must have an understanding of both the medical and legal implications of their work, and those trained in the field of hospital epidemiology and infection control represent valuable support resources of today's hospitals.

Germany↗
PubMed2002

A quality management project in 8 selected hospitals to reduce nosocomial infections: a prospective, controlled study.

OBJECTIVE: To reduce the number of nosocomial infections (NIs) in surgical patients by a quality management approach. DESIGN: Prospective, controlled study in 8 medium-sized hospitals during a 26-month period. SETTING: Four study hospitals and 4 control hospitals. METHODS: In two 10-month intervention periods, 4 external physicians introduced quality circles and ongoing surveillance in the 4 study hospitals. There were three 8-week observation periods in all 8 hospitals with the same physicians before, during, and after the intervention periods. RESULTS: During the first observation period, almost identical overall incidence densities were found for the study hospitals and the control hospitals. During the course of the study, the overall incidence density decreased significantly in the study hospitals (risk ratio [RR], 0.74; 95% confidence interval [CI 95], 0.59 to 0.94) and nonsignificantly in the control hospitals (RR, 0.90; CI 95 0.70 to 1.16). With the use of a Cox regression model to evaluate the impact of the intervention periods while taking into account the distribution of risk factors for NI in both groups, a significant risk reduction (RR, 0.75; CI 95, 0.58 to 0.97) was observed after the first intervention period when comparing study and control hospitals. At the end of the study (ie, after the second intervention period), the difference between the study hospitals and the control hospitals was not significant (RR, 0.78; CI 95, 0.60 to 1.01). This was due to no further improvement at the end of the study in the study hospitals and a decrease in the control hospitals. CONCLUSION: This study demonstrates that NI rates can be significantly reduced by appropriate intervention methods in hospitals that are interested in quality management activities. However, continuous intense efforts are necessary to maintain these improvements.

Aged↗
PubMed2002

How many nosocomial infections are associated with cross-transmission? A prospective cohort study in a surgical intensive care unit.

OBJECTIVE: To determine the percentage of cross-transmissions in an intensive care unit (ICU) with high nosocomial infection (NI) rates according to the data of the German Nosocomial Infection Surveillance System. SETTING: A 14-bed surgical ICU of a 1,300-bed, tertiary-care teaching hospital. METHOD: Prospective surveillance of NIs during a period of 9 months. If an NI was present, the isolates of the following indicator pathogens were stored and typed by species: Staphylococcus aureus, Enterococcus species, Escherichia coli, Pseudomonas aeruginosa, Acinetobacter baumannii, and Enterobacter species. Pulsed-field gel electrophoresis was performed for typing of S. aureus strains and arbitrarily primed polymerase chain reaction was applied for the other pathogens. The presence of two indistinguishable strains in two patients was considered as one episode of cross-transmission. RESULTS: Two hundred sixty-two patients were observed during a period of 2,444 patient-days; 96 NIs were identified in 59 patients and the overall incidence density of NI was 39.3 per 1,000 patient-days. For 104 isolates, it was possible to consider typing results. Altogether, 36 cross-transmissions have lead to NIs in other patients. That means at least 37.5% of all NIs identified were due to cross-transmissions. CONCLUSION: Because of the method of this study, the percentage of NIs due to cross-transmission identified for this ICU is an "at least number." In reality, the number of cross-transmissions, and thus the number of avoidable infections, may have been even higher. However, it is difficult to assess whether the percentage of NIs due to cross-transmission determined for this ICU may be the crucial explanation for the relatively high infection rate in comparison to other surgical ICUs.

Bacteria↗