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Biomedical subjects

R P Wenzel

Publications and source records attributed to R P Wenzel.

At least 19 recordsLinked to original sources
PubMed1992

Comparative efficacy of alternative hand-washing agents in reducing nosocomial infections in intensive care units.

BACKGROUND: Effective hand-washing can prevent nosocomial infections, particularly in high-risk areas of the hospital. There are few clinical studies of the efficacy of specific hand-cleansing agents in preventing the transmission of pathogens from health care workers to patients. METHODS: For eight months, we conducted a prospective multiple-crossover trial involving 1894 adult patients in three intensive care units (ICUs). In a given month, the ICU used a hand-washing system involving either chlorhexidine, a broad-spectrum antimicrobial agent, or 60 percent isopropyl alcohol with the optional use of a nonmedicated soap; in alternate months the other system was used. Rates of nosocomial infection and hand-washing compliance were monitored prospectively. RESULTS: When chlorhexidine was used, there were 152 nosocomial infections, as compared with 202 when the combination of alcohol and soap was used (adjusted incidence-density ratio [IDR], 0.73; 95 percent confidence interval, 0.59 to 0.90). The largest reduction with chlorhexidine was in gastrointestinal infections (IDR, 0.19; 95 percent confidence interval, 0.05 to 0.64). When chlorhexidine was available, the rates of nosocomial infection declined in each of the ICUs, and health care workers washed their hands more often than when alcohol and soap were used (relative risk, 1.28; 95 percent confidence interval, 1.02 to 1.60). The total volume of alcohol and soap used was 46 percent that of chlorhexidine (P less than 0.001). CONCLUSIONS: A hand-disinfection system using an antimicrobial agent (chlorhexidine) reduces the rate of nosocomial infections more effectively than one using alcohol and soap. The improvement may be explained at least in part by better compliance with hand-washing instructions when chlorhexidine was used.

1-Propanol↗
PubMed1992

Nosocomial pneumonia in patients having bone marrow transplant. Attributable mortality and risk factors.

The authors performed a matched historic cohort study to determine the attributable mortality and risk factors for nosocomial pneumonia in bone marrow transplant (BMT) recipients. All patients with nosocomial pneumonia at a university tertiary care center were identified by a prospective surveillance system between 1980 and 1988. Control patients were selected from the population of BMT patients. The crude mortality for 55 patients with nosocomial pneumonia was 74.5% (95% confidence interval [CI95], 63% to 86%). The excess or attributable mortality was 61.8% (CI95, 43.7% to 80%). Aspergillus species represented the most frequent etiologic agent in this series, causing 20 of the 55 (36%) episodes. The attributable mortality of Aspergillus species pneumonia alone was 85% (CI95, 58.6% to 100%). For death in the hospital, the risk ratio for all 55 case patients relative to control patients was 9.5 (CI95, 4.1 to 22.1). To evaluate several risk factors simultaneously, a multiple logistic regression analysis using a conditional likelihood method was performed. A mathematical model with three variables best predicted nosocomial pneumonia in our patients: the occurrence of other nosocomial infections before the diagnosis of pneumonia, allogeneic BMT, and the use of methotrexate. The presence of other nosocomial infections before the diagnosis of pneumonia remained a significant independent risk factor, with an odds ratio of 13.27 (CI95, 2.51 to 70.2) after adjustment for the use of methotrexate and allogeneic BMT. Most importantly, effective methods for preventing nosocomial pneumonias in BMT recipients will have an enormous effect on crude mortality.

Bone Marrow Transplantation↗
PubMed1992

Restriction endonuclease analysis of Staphylococcus aureus plasmid DNA from three continents.

Staphylococcus aureus isolates (n = 1201) from 20 centers in Europe, the USA and Brazil were evaluated for the presence of epidemiologic markers. Plasmid typing and restriction endonuclease analysis of plasmid DNA confirmed the presence of an apparently identical plasmid in 13% of clinical isolates. The plasmid was recovered from all 20 hospitals studied, with an overall frequency of greater than 10% on each of the three continents. Since relatively few staphylococcal plasmids may be shared by epidemiologically unrelated strains, there are inherent limitations to this otherwise useful technique. Additionally, these data demonstrate the importance of including unrelated strains of Staphylococcus aureus from the local region as controls when molecular typing methods are performed.

Brazil↗
PubMed1992

A new standard for sterility testing for autoclaved surgical trays.

Sterility testing on autoclaved surgical trays provides scientific information on the duration for which an item can be safely stored. Previous studies were performed by sampling at various time-points after storage and did not take into account potential injuries (moving, lifting etc.) to these trays as they occur in a clinical setting. A standardized protocol was developed by an expert panel based on events which were frequently observed in the Central Sterilization area. We tested 600 samples in 100 surgical trays that were moved and transported according to the standardized protocol. Moved surgical trays were contaminated in 8.3% of tests, a figure much higher than that reported by previous studies. These data suggest that current standards for sterility testing of autoclaved surgical trays can be improved by the addition of event-related testing.

Central Supply, Hospital↗
PubMed1992

Postdischarge surveillance for nosocomial wound infection: a brief review and commentary.

Escalating medical care costs during the last decade have resulted in shorter hospital stays and higher volumes of outpatients surgical procedures. As a result, the proportion of nosocomial surgical wound infections manifesting after discharge will increase. We performed a literature review to assess the current state of the art of postdischarge surveillance for nosocomial wound infection. From 20% to 70% of postoperative surgical site infections do not become apparent until after the patient's discharge, resulting in serious underreporting of true rates. Infections in outpatients are not being identified efficiently. Institutions using self-reporting methods report a low validity for these methods. The Centers for Disease Control and the Joint Commission for the Accreditation of Healthcare Organizations currently have no strong guidelines on the subject. Since valid postdischarge surveillance may become a necessity for a quality infection control program, new national recommendations are needed.

Ambulatory Surgical Procedures↗
PubMed1992

Methods for estimating days of hospitalization due to nosocomial infections.

While there is little agreement at the individual patient level of analysis, estimates of mean NI-attributed days of stay for the two methods were essentially the same. The lack of agreement at the individual patient level may reflect fundamental differences in the methods used to derive these estimates: incorporation of noninfected patient data versus exclusive reliance on data from infected patients; and, focus on length of stay rather than the actual care being received. The potential advantages of the AEP-based method include the following: 1) all patients with NI can be included in developing estimates; 2) estimates are based on the care provided rather than simple length of stay differences; 3) data on which to form the NI-day estimates are readily available in the medical record; 4) the AEP is a validated and commonly used utilization review instrument; 5) the AEP-based method has acceptable reliability; 6) this method is designed to provide individual and group estimates of NI-attributed days; 7) because every day of stay is reviewed, additional information is available, which results in greater precision of study of the development, diagnosis, and treatment of the NI relative to the other care that originally brought the patient into the hospital. The AEP-based method for estimating NI-days is a promising alternative to the historical cohort approach. Additional applications of this approach are encouraged to further assess its reliability,validity, and additional information yield.

Cohort Studies↗
PubMed1992

In vitro activity of decaplanin (M86-1410), a new glycopeptide antibiotic.

The in vitro activity of decaplanin (formerly M86-1410), a novel glycopeptide antimicrobial agent, was tested against 169 gram-positive bloodstream isolates from patients at the University of Iowa Hospitals and Clinics and 12 selected vancomycin-resistant strains. Enterococcus faecalis, E. faecium, Staphylococcus aureus, streptococci, bacilli, corynebacteria, and listeria were inhibited by decaplanin (MICs for 90% of the strains tested [MIC90s], 0.12 to 4 micrograms/ml). However, some rarely isolated and selected Enterococcus sp. populations had a MIC90 of 16 micrograms/ml, and S. haemolyticus strains had a MIC90 of 8 micrograms/ml. These in vitro results suggest that decaplanin may be useful against most gram-positive strains, even though some Enterococcus species and coagulase-negative staphylococci were potentially resistant (MICs, greater than or equal to 8 micrograms/ml).

Ampicillin↗
PubMed1992

The clinical impact of culturing central venous catheters. A prospective study.

The semiquantitative culture technique is a standard procedure for the laboratory diagnosis of catheter-associated infections and catheter-associated bacteremia. In a prospective observational study, we evaluated the clinical impact of the semiquantitative culture results on the treatment of the patient. Clinical impact was defined as a change in diagnosis or therapy on the basis of the semiquantitative culture result. One hundred fifty-seven catheters consecutively submitted from the surgical intensive care unit to the laboratory were studied. In 96% of the episodes, no clinical impact was observed. In the other 4%, clinical decisions were guided mainly by the concurrent positive blood cultures. Newer laboratory techniques that do not require removal of the catheter are needed to guide therapeutic decisions.

Anti-Bacterial Agents↗
PubMed1991

Infection control: the premier quality assessment program in United States hospitals.

The three decennial international meetings of the Centers for Disease Control have reaffirmed the national health priority for prevention of nosocomial infections. Moreover, the past 20 years have seen the institutionalization of the infection control practitioner and hospital epidemiologist. The epidemiologic activities of these two groups have included access to medical care, identification of risk factors, and both prevention and control of adverse nosocomial events. As such, they represent experience with issues commonly referred to as quality of care. It is argued that infection control not only is now but has been from its inception the premier quality assessment program in the United States. Moreover, it is the only activity in quality assessment that has been shown to be efficacious.

Cross Infection↗
PubMed1991

Methicillin-resistant Staphylococcus aureus: implications for the 1990s and effective control measures.

Data from around the world verify the escalating incidence of infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Since MRSA are spread primarily on the hands of health care workers, rates of infection are a function of infection control activities within institutions. Moreover, infections with MRSA are serious and often life-threatening. Thus, there are compelling medical and ethical reasons to invest in control measures. Currently available data suggest the efficacy of three measures: (a) identification of the entire patient reservoir (cases and carriers) for purposes of isolation; (b) strict handwashing between patients to prevent transmission; and (c) treatment of the carrier state in health care workers and patients during periods of high infection rates with safe and effective topical agents such as mupirocin.

Carrier State↗