D Pittet

..Indiscriminate application of these guidelines can result in a large number of unnecessary screening tests...

..There is growing evidence that low nurse staffing jeopardizes quality of patient care. The objective of the study was to determine whether low staffing level increases the infection risk in critical care...

..Alcohol-based handrub is the new standard for hand hygiene action worldwide and usually requires a system change for its successful introduction in routine care. Product acceptability by HCWs is a crucial step in this process...

..We conducted the present study to determine whether low nurse-to-patient ratio increases the risk for VAP and whether this effect is similar for early-onset and late-onset VAP...

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..We review the evidence supporting each of these steps and propose a dynamic model for hand hygiene research and education strategies, together with corresponding indications for hand hygiene during patient care...

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..The Challenge addresses health care-associated infection, a major, patient safety problem affecting hundreds of millions of people worldwide...

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..To review the most recently published literature on hand hygiene practices in healthcare settings...

..The strategies proposed in this review target both the appropriate use of antimicrobials in order to decrease resistance acquisition, and improvements in health care practices to reduce cross-transmission...

..The authors assessed the compliance rate with hand-cleansing practices in the postanesthesia care unit and investigated factors associated with noncompliance...

..An update on HAI activities and related networks throughout Europe, together with the outcome of the meeting, are presented, with special emphasis on future considerations for a European WHO strategy on HAI prevention...

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..To compare healthcare workers' skin tolerance for and acceptance of 3 alcohol-based hand rub formulations...

..Until such data are obtained, clinical judgement is still the best tool in decision-making regarding the individual patient...

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..Transmission of microorganisms from the hands of health care workers is the main source of cross-infection in hospitals and can be prevented by handwashing...

..However, further work is required to refute the myth among HCWs that patient involvement undermines the doctor- or HCW-patient relationship...

..Diabetic foot lesion is associated with increased morbidity and high resource use. Although early amputation has been advocated in case of osteomyelitis, conservative treatment is a more attractive alternative...

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..We attempted to promote hand hygiene by implementing a hospital-wide programme, with special emphasis on bedside, alcohol-based hand disinfection. We measured nosocomial infections in parallel...

..It is important to note that the First Global Patient Safety Challenge has mobilized an unprecedented number of countries over a short timeframe to commit to take action on HAI...

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..This article reviews barriers to appropriate hand hygiene and risk factors for noncompliance and proposes strategies for promoting hand hygiene...

..Patient participation in hand hygiene promotion is under testing. Early results of the strategy tested in a large number of healthcare settings in both limited- and high-resource countries are extremely encouraging...

..This paper reviews barriers to appropriate hand hygiene and describes the results of the first successful experience of sustained hand hygiene promotion and its effectiveness on hospital-acquired infection...

..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...

..Further studies are needed to elucidate the role of migration as a factor contributing to the emergence of CA-MRSA in Europe...

..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...

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..While this is important for sustainability, further action is required to initiate coordinated activities across the world, including countries with limited resources...

..00; 95% CI: 0.93, 1.07). Multistate modelling is a promising statistical method to evaluate the health-economic impact of nosocomial antibiotic-resistant infections...

..Cross-transmission of microorganisms by the hands of health care workers is considered the main route of spread of nosocomial infections...

..However, local epidemiology plays a critical role. Settings with a higher prevalence of MRSA colonization may find universal screening cost-effective and, in some cases, cost-saving...

..The most efficacious strategy to detect occult MRSA carriage is via the screening of high-risk patients on admission to the hospital which has proven to be cost-effective in varied acute-care endemic settings...

..Several key elements for a successful educational programme are also identified. A particular emphasis is placed on concepts included in the tools developed by WHO for education, monitoring and performance feedback...

..The total cost of the hand hygiene promotion corresponded to less than 1% of the costs associated with nosocomial infections. Successful hand hygiene promotion is probably cost-saving...

..ICU catheters have a short dwell time but are utilised more often, whereas catheters in non-ICU settings show a reverse characteristic. Prevention measures targeting catheter care are more likely to be successful in non-ICU settings...

..Accordingly, clinicians and hospital management in charge of patient-care policies should be aware of how to read and compare nosocomial infection rates...

..The aim of this study was to determine the temporal relation between the use of antibiotics and alcohol-based hand rubs (ABHRs) and the incidence of methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile...

..My five moments for hand hygiene' bridges the gap between scientific evidence and daily health practice and provides a solid basis to understand, teach, monitor and report hand hygiene practices...

..The proportion of meticillin resistance among CoNS has remained stable over the last decade with a favourable clinical outcome...

..14). Elevated PCT concentrations appear to be a promising indicator of sepsis in newly admitted, critically ill patients capable of complementing clinical signs and routine laboratory parameters suggestive of severe infection...

..New evidence of the effectiveness of basic infection control measures that have been regarded of little importance during the last two decades by the exponential progress of technologically sophisticated medicine, is discussed...

..To assess the feasibility and effectiveness of the World Health Organization hand hygiene improvement strategy in a low-income African country...

..Once validated in a clinical trial, our risk score may be used as a tool to optimise MRSA control...

..We demonstrated strain diversity, including clones rarely found in Europe. Local epidemiology of community-associated MRSA is diverse and is evolving by importation and transmission of new strains...

..Accordingly, infection control measures are to be viewed as a priority and have to be integrated fully into the continuous process of improvement of the quality of care...

..Infections may also become manifest after several weeks of hospitalisation. In case of life-threatening infection, antibiotic therapy should cover non-fermenting pathogens...

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..Our results suggest that users of orfX-staphylococcal cassette chromosome mec-based assays should repeatedly monitor the local epidemiology to minimize the risks of detection bias and the omission of emerging MRSA clones...

..Factors independently associated with higher mortality were patient age greater than 65 years, intensive care unit admission, and underlying cancer...

..The latter are currently undergoing testing in several pilot sites to evaluate feasibility, acceptability and sustainability...

..CONCLUSION: Therapy with a high dose of vancomycin contributes to the sustained eradication of MRSA carriage without promoting the emergence of glycopeptide resistance...

..Management of invasive candidiasis in these patients will be addressed in the December issue of The Lancet Infectious Diseases...

..Here, we review the pathogenesis, prevention, and treatment of implant infections due to S. epidermidis and highlight some new compounds with already promising in vitro results...

..88 to 3.14 isolation-days) and related costs by 45% (from US dollars 113.2 to US dollars 62.1) for patients who test negative for MRSA...

..035). CONCLUSION: Our data highlight the importance of the opinions of superiors and a strong perceived controllability over the difficulty to perform hand hygiene as possible internal factors that may influence hand hygiene compliance...

..Our surveillance revealed similar CRBSI rates in both ICU and non-ICU departments, and when frequent ward transfers occurred. Hospital-wide CRBSI surveillance is advisable when a large proportion of CVC-days occur outside the ICU...

..Practical aspects regarding educational approaches will help clinicians to adapt and incorporate educational programs into clinical practice...

..Overall, in contrast to recently published reports, these results suggest that combination antibiotic therapy does not decrease mortality after severe pneumococcal sepsis...

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..krusei remained rare (2%). Fluconazole consumption increased significantly (P<.001). Despite increasing high-risk activities, the incidence of candidemia remained unchanged, and no shift to resistant species occurred...

..MRSA carriage on admission did not predict MRSA SSI...

..To assess the overall burden of healthcare-associated infections (HAIs) in patients exposed and nonexposed to surgery...

..It remains unclear whether PVC-BSI should be considered a serious healthcare problem or simply a very rare event. More research is needed both to capture the dimension of the problem and to provide efficient control measures...

..This type of rapid and high-throughput methodology opens the possibility to rapidly assess long-term nosocomial transmission or to characterize infecting strains in the general procedure of routine laboratories, in real-time...

..This short overview highlights recent advances and future priorities in infection prevention research, including methodological challenges to be addressed...

..Experts and policy makers have repeatedly called for universal screening at hospital admission to reduce nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection...

..Sample size estimates, survey analysis and report, and major bias and confounding factors associated with observation are discussed...

..All steps of this new procedure were developed to ensure a rapid turnaround time and moderate cost. The results obtained suggest that this rapid approach is a valuable tool for the genotyping of S. aureus isolates in real time...

..9/1,000 admissions. Although 5 CA-MRSA isolates contained Panton-Valentine leukocidin, only 1 patient had a previous skin infection. No easily modifiable risk factor for CA-MRSA was identified...

..The complete protocol may provide results in less than 6 h (while standard procedure needs 2 to 3 days), thus allowing prompt and cost-effective implementation of contact precautions...

..The present report describes the questions and student performance for this infection control exercise set and evaluates performance variability between countries...

..This paper reviews the epidemiology and impact of infections associated with the use of intravenous catheters. Principles of therapy are reviewed, as well as major aspects of prevention...

..There is growing concern that changes in nurse workforce and hospital-restructuring interventions negatively impact on patient outcomes. This review focuses on the association between understaffing and health-care-associated infections...

..This study tests the hypothesis that the incidence of fungal infections is lower in critically ill patients under mechanical ventilation receiving enteral rather than total parenteral nutrition...

..We determined the prevalence and risk profile of patients with previously unknown carriage of methicillin-resistant Staphylococcus aureus (MRSA) at hospital admission...

..Finally, better risk scores and laboratory tools are urgently needed to improve the adequacy of empirical antibiotic therapy and patient outcomes...

..Further studies are necessary to determine the in vivo efficacy of alcohol-based gels and whether they are as efficacious as alcohol-based rinses in reducing the transmission of nosocomial infections...

..The case-crossover methodology in hospital epidemiology is a promising alternative to traditional approaches, but selection of the referent periods is challenging...

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..CONCLUSIONS: The prognosis of postoperative PM endophthalmitis remains poor, despite adequate treatment of the infection. A history of recent pet exposure should alert physicians to this possible aetiological factor...

..By applying these restrictions, we could have saved at least $5,000 annually...

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..Systemic replacement of the intravenous lines every three to five days is common practice in the USA but not elsewhere in Europe. This issue should be studied, particularly in critically ill patients...

..We found that antimicrobial prophylaxis before dental interventions in patients with artificial joints lacks evidence-based information and thus cannot be universally recommended...

..Environmental bacterial sampling in operating theatres should be limited to investigation of epidemics, validation of protocols, or changes made in materials which could influence the microbial content...