A simple protocol for quality assessment.

This is a retrospective analysis of the 2000 and 2001 editions of the Agency for Healthcare Research and Quality’s Nationwide Inpatient Sample database, to determine the association of S aureus infections with length of stay, total charges, and in-hospital mortality.

Johns Hopkins Hospital researchers and colleagues reported in the journal Critical Care Medicine that bathing critically ill hospital patients with a 4 percent solution of chlorhexidine daily may potentially reduce bloodstream infections by as much as 73 percent. The program compared 2,650 chlorhexidine-bathed patients with 2,670 patients who bathed with soap and water. The study found 32 percent fewer cases of methicillin-resistant Staphylococcus aureus infections and 50 percent fewer cases of vancomycin-resistant Enterococci in the patients who bathed using chlorhexidine in six different hospitals

Brendan Wren of the London School of Hygiene and Tropical Medicine and colleagues have found that the recent rise in Clostridium difficile infections is the result of genetic changes that have caused strains to become more virulent, rather than due to dirty hospitals. The PCR-ribotype 027 strain has emerged in the past five years, and the highly virulent strain causes more severe diarrhea and a higher death rate. A comparison of the "hyper-virulent" strains with an older strain has shown that the bacteria have acquired genes enabling them to survive better in the environment, spread more easily and make patients more severely ill. Their findings were reported in the journal Genome Biology.

Dr. Michael Millar, a microbiologist from Barts and The London NHS Trust, wrote in BMJ that screening all hospital patients for MRSA in England has produced too many false results. All hospitals in England have had to screen patients admitted for non-emergency surgery since April 2009. "The problem with screening everyone is that in low risk groups you get as many false positives as positives, if not more," Millar said.

Laura Temime of the Conservatoire des Arts et Metiers in Paris and colleagues used a mathematical model to determine that "peripatetic" health care workers such as therapists are most likely to spread pathogens if they neglect hand hygiene, while "assigned" workers such as nurses and doctors are less likely to spread pathogens. Researchers used modeling techniques to pinpoint "superspreaders" among three types of health care workers. The three groups were those with frequent contact with a few patients, those with less frequent contact and more patients, and those who typically see patients once a day. They tracked what would happen over a month using the model if a single colonized patient was introduced into an 18-bed ward, relating to several scenarios about hand hygiene rule noncompliance. Findings were published in the Proceedings of the National Academy of Sciences.

An article published in the journal Emerging Infectious Diseases examines the cost of preventing the spread of SARS, swine flu and the Spanish flu within the hospital setting. According to researchers in Singapore, who conducted the study, the severity of the virus and high case-fatality rates were factors that affected cost-effectiveness the most. The study concludes that a calibrated approach based on the severity of the virus and community risks may be the most effective response to future epidemics.

Cuff pressures for endotracheal tubes may be too high during surgery, according to a new study by British investigators who are calling for routine monitoring of the devices in the operating room.

The study, by anesthesiologists at University College London, found that endotracheal tube (ETT) cuff pressures averaged 41 cm H₂O—16 cm H₂O greater than the recommended maximum level of 25 cm H₂O in the United Kingdom. Pressures that high could increase patients’ risk for sore throat, hoarseness and difficulty swallowing.

A new study published in Emerging Infectious Diseases finds that outpatients are a “major reservoir” of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), helping drive MRSA incidence at hospitals even as providers attempt to prevent and contain such infections

Researchers from Christian-Albrechts-University and the University Medical Center Schleswig-Holstein in Germany reported in the journal Antimicrobial Agents and Chemotherapy on their study that identified a new antimicrobial peptide that demonstrates activity against a variety of bacteria, including methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. The researchers identified the antimicrobial peptide arminin 1a from the ancient metazoan organism Hydra magnipapillata and found that it exhibited wide-spread activity against various bacteria. "Our data suggest that ancient metazoan organisms such as Hydra hold promise for the detection of novel antimicrobial molecules and the treatment of infections caused by the multiresistant bacteria," said the researchers.

Preoperative cleansing of the patient's skin with chlorhexidine–alcohol is superior to cleansing with povidone–iodine for preventing surgical-site infection after clean-contaminated surgery.

The number of surgical-site S. aureus infections acquired in the hospital can be reduced by rapid screening and decolonizing of nasal carriers of S. aureus on admission.

Methicillin-resistant Staphylococcus aureus is spread by patients who are transferred or move between hospitals. Researchers from the University Medical Center in Groningen, the Netherlands, and colleagues said screening people who are repeatedly admitted to different hospitals could help significantly curb the transmission rate of the drug-resistant bug.

 Preventing catheter-associated bloodstream infections in pediatric intensive care units requires a focus on daily maintenance, rather than maximizing insertion-bundle compliance alone. U.S. researchers used historical control data and an interrupted time-series design to lead a multi-institutional study involving 29 PICUs from 27 hospitals. The average baseline catheter-associated blood stream infection rate was 5.4 per 1,000 central-line days at the start of the study, dropping to 4.3 per 1,000 central-line days during the program’s first three months. Overall, there was a 43 percent decrease in catheter-associated blood stream infection rates over the course of the study

The attributable impact of S. aureus and methicillin-resistance on outcomes of surgical patients is substantial. Preventing a single case of SSI due to MRSA can save hospitals as much as $60,000.

Use of a new genetic profiling tool that was able to distinguish closely related strains of methicillin-resistant Staphylococcus aureus and shed light on how the bacteria spread. Researchers from the University of Cambridge, the Wellcome Trust Sanger Institute and colleagues said having the ability to track how MRSA mutates should help spark novel infection control strategies that can be applied to other emerging superbugs. The researchers used high-throughput DNA sequencing technologies to analyze a common strain of the bacteria known as ST239, and said the technology allowed them to construct a rough genetic evolutionary tree for the strain.

A recent review of 1,096 adult patients who had a central line in place concluded that the use of closed infusion containers resulted in a significantly reduced rate of central line-associated bloodstream infections when they were compared with open infusion containers. This article noted that open infusion containers are commonly used throughout the world. The open-label, prospective cohort study was conducted in four intensive care units in Mexico and published in the Annals of Clinical Microbiology and Antimicrobials.

ICU catheter-related infections can be prevented, a Keystone ICU initiative that kept rates at nearly zero for three years in Michigan hospitals showed. By implementing low-tech measures such as removing unnecessary catheters and handwashing, the hospitals saw no rebound in catheter-related infections, Peter J. Pronovost of Johns Hopkins and colleagues reported online in British Medical Journal. The researchers found that in the first 18 months of their initiative, catheter-related infections dropped from an average of 7.7 per 1,000 catheter days to zero. Three years later, infection rates remained near zero, with an average of 1.1 per 1,000 catheter days. The results show that hospitals are mistaken in thinking these infections are inevitable, Pronovost said.

An Expert Panel of the Infectious Diseases Society of America released new guidelines on how to diagnose, prevent and treat catheter-associated urinary tract infection in adults. The guidelines, published in Clinical Infectious Diseases, are targeted at doctors in all medical specialties who perform direct patient care. The panel said that there are many holes in the knowledge about catheter-associated infections, partly due to the poor quality of many clinical trials, and its new guidelines aim to fill those holes.

In 2006, hospital-acquired pneumonia and sepsis took 48,000 lives in the U.S. and cost $8.1 billion. Patients who contracted sepsis following surgery were about 20 percent likely to die; stayed in the hospital an average 11 days longer; and cost $32,900 per patient. Hospital-acquired pneumonia patients, meanwhile, were about 11 percent likely to die; stayed in the hospital an average 14 days longer; and cost $46,400 per patient 

The overall incidence of both MRSA colonization and MRSA infection increased 17-fold in Canadian hospitals from 1995 to 2007. There has also been a dramatic increase in cases of community-associated MRSA infection due to the CMRSA-10 (USA300) clone. Continued surveillance is needed to monitor the ongoing evolution of MRSA colonization or infection in Canada and globally.

Aaron Milstone of Johns Hopkins Children’s Center and colleagues have discovered hospitals may cut the risk of life-threatening bloodstream infections in newborns with peripherally inserted central venous catheters if they replace the device about every 30 days. Researchers reported in the journal Pediatrics that the daily risk of falling ill with a dangerous bacterial infection rose by 33 percent day at about day 35 and continued to be elevated thereafter in babies needing the device over the long term.

Seriously injured intensive care patients can reduce their risk of developing certain types of infections by bathing with antiseptic-soaked washcloths, according to a new study by Heather L. Evans of the Harborview Medical Center in Seattle and colleagues. In the study, published in the Archives of Surgery, the researchers used antiseptic-free disposable cloths to bathe ICU patients daily for six months, and then used the antiseptic, or chlorhexidine, cloths for another six months. They found that antiseptic bathing reduced the patients’ chances of developing catheter-related bloodstream infections as well as the risk of ventilator-associated pneumonia caused by MRSA.

Nearly 40 percent of reported gastrointestinal infections are Clostridium difficile infections, which is rapidly becoming a critical issue in health care, according to preliminary data collected from nursing homes. Researchers at the Pennsylvania Patient Safety Authority and colleagues looked at infection data submitted from state nursing homes and found that from 1993 to 2001, hospital discharges with CDI increased by 74 percent, while cases nearly doubled from 2001 to 2005 with a 102 percent increase in patients discharged with CDI.

Researchers from Johns Hopkins Children’s Center recently reported in the journal Emerging Infectious Diseases that community-acquired methicillin-resistant Staphylococcus aureus is increasingly turning up in children hospitalized in the intensive care unit. Six percent of patients admitted to the pediatric intensive care unit between 2007 and 2008 were colonized with MRSA. Sixty percent of the 72 children who tested positive for MRSA were found the have the community-acquired strain.

The Association for the Advancement of Medical Instrumentation’s Sterility Assurance Levels Working Group, WG 90, presented a poster on acceptable sterilization assurance levels for new products at the U.S. Centers for Disease Control Decennial meeting on March 19.  The poster presentation concluded that new and emerging health care products need to incorporate a variety of SALs in order to be terminally sterilized, labeled as sterile and still function as intended.

Article on a new antibacterial wound dressing developed by researchers from the University of Bath in England. The new dressing contains tiny vesicles that appear to be similar to cells that bacteria would infect. This statement noted that when bacteria attack the vesicles, an antibacterial agent is released that kills them. The dressing has been shown to be effective against a species of Staphylococcus and a member of the Pseudomonas group.

The Centers for Disease Control and Prevention said Thursday that health care workers are at risk from the chemicals used in hospitals and other facilities to prevent microbial colonization and infections. However, the risk is low and the side effects that were observed were both mild and temporary, the agency added in its Morbidity and Mortality Weekly Report. The data came from a recent analysis of information from California, Louisiana, Michigan and Texas from 2002 through 2007. The CDC during the period noted 401 cases of work-related illness associated with antimicrobial pesticide exposures in health care settings, and 61 percent were identified through workers’ compensation systems.

The New England Journal of Medicine published findings from researchers at Massachusetts General Hospital that suggested gram-negative bacteria play a significant role in about 30 percent of hospital-acquired infections in the U.S. The findings showed that such bacteria were the predominant players in 47 percent of ventilator-associated pneumonia cases and 45 percent of urinary tract infections. The researchers noted that almost any gram-negative bacteria can cause bloodstream infection if an adequate portal of entry is present.

Clostridium difficile, a germ that causes terminal intestinal infections in hospital patients and was thought to spread only by contact with contaminated surfaces, can also travel through the air, according to a study by British researchers published in Clinical Infectious Diseases. Mark H. Wilcox of the University of Leeds and colleagues repeatedly tested 10 patients with symptomatic illness over a 10-hour period, and the air nearby seven of them was positive for C. difficile, generally during visiting hours or when there was activity in patient rooms, such as food delivery or bedding changes. Surfaces around 90 percent of the patients were also contaminated. The scientists stressed, however, that there is no evidence that C. difficile can be contracted through inhalation; the germs just float on the air, landing in places where more people can touch them.

Hospitals across the country are experiencing a decline in infections from central line catheters, according to a report by the CDC. In 2009, the Department of Health and Human Services initiated a program aimed at reducing health care-related infections, with one of the goals being to reduce central line infections by 50 percent by 2013. The study was conducted to track the progress of this program, and it found an 18 percent dip in central line-associated bloodstream infections across 17 states during the first half of 2009, compared with the three previous years

Researchers from Duke University and Tumaini University in Tanzania have found that community-acquired bloodstream infections may be linked to high rates of in-hospital fatality in African settings. A meta-analysis of 22 studies involving nearly 58,300 patients - 15,200 adults and 43,100 children - found that 13.5 percent of adults and 8.2 percent of adults had bloodstream infections. There was an overall in-hospital case-fatality rate of 18.1 percent in those with bloodstream infections.

Denise M. Korniewicz of the University of Miami and Maher El-Masri of the University of Windsor in Canada have found that nurses and other health care providers often do not comply with hand hygiene guidelines prior to and after procedures. They noted in the journal Applied Nursing Research that compliance was higher with high-risk procedures and when health care providers were exposed to blood. Korniewicz and El-Masri evaluated hand hygiene practices observed during 612 procedures performed by 67 health care professionals at an oncology hospital.

Patients who have had major chest or head operations are at an increased risk of developing post-surgical staphylococcus aureus infections. The findings are based on a review of 81,267 patients who underwent 96,455 orthopedic, cardiothoracic, plastic surgery or neurosurgery procedures at nine locations between 2003 and 2006. There were 454 staph infections among the patients, with the highest rates of bloodstream infections occurring in patients who had chest surgery, while the highest rates of surgical site infections occurred in patients who had brain operations. Deverick Anderson, lead author from Duke University Medical Center, said additional preventions for cardiovascular or neurosurgical procedures may be needed.

Overall, 46 of 68 ASCs (67.6%; 95% confidence interval [CI], 55.9%-77.9%) had at least 1 lapse in infection control; 12 of 68 ASCs (17.6%; 95% CI, 9.9%-28.1%) had lapses identified in 3 or more of the 5 infection control categories. Common lapses included using single-dose medication vials for more than 1 patient (18/64; 28.1%; 95% CI, 18.2%-40.0%), failing to adhere to recommended practices regarding reprocessing of equipment (19/67; 28.4%; 95% CI, 18.6%-40.0%), and lapses in handling of blood glucose monitoring equipment (25/54; 46.3%; 95% CI, 33.4%-59.6%).

Conclusion  Among a sample of US ASCs in 3 states, lapses in infection control were common.

Lee E. Morrow of Creighton University and colleagues have discovered that cases of ventilator-associated pneumonia in critically ill patients in hospitals were cut in half after patients were given probiotic bacteria. The study involved 138 critically ill patients from a single hospital, who were either given placebo or the probiotic Lactobacillus rhamnosus. Donald Craven of the Lahey Clinic Medical Center in Burlington, Mass., said the results "hold promise for trying to prevent an infection that has serious morbidity, mortality and is a major factor for hospital costs that we’re trying to contain."

Among hospitals in the Premier Inc Perspective Database reporting SCIP performance, adherence measured through a global all-or-none composite infection-prevention score was associated with a lower probability of developing a postoperative infection. However, adherence reported on individual SCIP measures, which is the only form in which performance is publicly reported, was not associated with a significantly lower probability of infection.

Racial differences in severe sepsis are explained by both a higher infection rate and a higher risk of acute organ dysfunction in black than in white individuals.

Methicllin-resistant Staphylococcus aureus infections in children have spiked from two to 21 cases per 1,000 hospital admissions between 1999 and 2008. The findings, based on a review of more than 64,000 children treated for a staph infection in 25 U.S. children’s hospitals, showed that the rate of staph infections has more than doubled in the time period. However, the findings indicated that most of the infections were acquired at schools, locker rooms and gyms, and not health care settings. The study also showed that the use of the antibiotic clindamycin increased threefold, with 63 percent of such infections being treated with the drug in 2008.

Scientists at the National Institute of Allergy and Infectious Diseases have identified and isolated a new toxin called LukGH that laboratory studies indicate is a potent killer of human immune cells and could be a key factor in the severity of MRSA infections in otherwise healthy people. The research project was intended to identify all the surface proteins of USA300, the most common community-associated strain of MRSA. The scientists said they are not sure of the full contribution of LukGH to the severity of MRSA infection, but LukGH is the only MRSA toxin currently known to promote the destruction of human neutrophils after the bacteria have been ingested by the immune cells designed to destroy them.

J. Hsu from the University of Wisconsin School of Medicine and Public Health at Madison and colleagues reported  that antimicrobial stewardship, glove use, hand hygiene and disposable thermometers should be used routinely to prevent Clostridium difficile infection. However, they reported that environmental disinfection and probiotics should be studied further. To make their recommendations, the investigators searched multiple computerized databases and performed manual searches to retrieve relevant articles.

Interfering with the function of the cell membrane protein called programmed death 1 improved survival in a clinically relevant model of severe infection, a discovery that could pave the way for new drugs that reduce the severity of blood infections leading to sepsis. Researchers at the Washington University School of Medicine in St. Louis and colleagues said a study of mice showed that PD-1 inhibits the ability of the immune system to fight infection by suppressing the function of immune cells, and therefore blocking PD-1 can restore the ability of the host to combat infections and also help improve chances for survival.

The National Conference of State Legislatures has released a new report that offers lessons on infection-reporting data from nine of the states that first required medical facilities to report health care-associated infections. The NCSL looked at state laws passed from 2005 to 2009 and interviewed state lawmakers, health care providers and other related groups in Alabama, Colorado, Delaware, Illinois, Massachusetts, New Hampshire, Oregon, Pennsylvania and Washington. Since 2005, the number of states that require health care facilities to report HAIs has jumped from six to 27.

Rates of invasive methicillin-resistant Staphylococcus aureus infection in U.S. hospitals have fallen over the past few years. In the Journal of the American Medical Association, this study showed that the number of cases of MRSA in nine metro areas declined 16 percent between 2005 and 2008; however, the rates of skin and soft tissue infections remained largely unchanged. The researchers said their findings suggest that efforts aimed at preventing MRSA, such as promoting better hand-washing among health care workers and testing for MRSA when patients are admitted to the hospital, are paying off.

A study examined 7,000 patients undergoing elective, inpatient orthopedic procedures at New England Baptist Hospital in Boston who were screened for methicillin-sensitive Staphlylococcus aureus and MRSA. Patients who tested positive were instructed via pre-op phone calls to apply mupiricin ointment to the interior of each naris, and patients who still carried MRSA after the application of the ointment were treated with standard MRSA isolation precautions in addition to pre-op antibiotics. The study showed that the surgical site infection rate dropped 59 percent when the prescreening program was in place. The researchers suggested the drop in SSIs was likely due to the ability of clinicians to switch preoperative antibiotic prophylaxis to vancomycin, as well as the treatments with the ointment. The researchers concluded that prescreening programs are "feasible and can lead to significant reductions in postoperative rates of surgical site infection."

Differences in reported hand hygiene compliance rates were assessed on the basis of the unit affiliation of observers. In 2 hospitals, unit-based observers more often reported higher compliance rates than did non–unit-based observers (79% vs 58.6%; difference, 20.4%; P<.001). Nonstandardized data collection methods contribute to the variability in hand hygiene compliance rates.

Direct observation cannot be considered the gold standard for assessing hand hygiene, because there was no relationship between the observed adherence and the number of dispensing episodes or the volume of product used. Other means to monitor hand hygiene adherence, such as electronic devices and measurement of product usage, should be considered.

A report from New Hampshire health officials showed that patients developed 134 infections in 2009 from central lines, as well as from heart, colon and knee surgeries. Officials said the number of infections was 26 percent lower than expected based on national data. Portsmouth Regional Hospital, however, reported 16 infections related to coronary artery bypass graft surgery, which is nearly twice the amount of infections expected for a hospital of its size. Martha Wassel, infection control director for the hospital, said the facility has created a task force to promote and ensure the use of best practices for hand hygiene, the timing of antibiotic use, operating room procedures and patient education. Jose Montero, director of public health at the Department of Health and Human Services, said the state could also improve its rate of influenza vaccinations among health care workers, noting that overall state vaccination rate among health care workers was 70 percent, but 10 hospitals had rates significantly lower than the national average.

Jonathan S. Dordick of the Rensselaer Polytechnic Institute and colleagues have developed a nanoscale coating for surgical equipment, hospital walls and other surfaces that safely rids the surface of MRSA.  100 percent of MRSA in solution was killed within 20 minutes of contact with a surface painted with latex paint laced with the coating. The coating is toxic only to MRSA. It does not rely on antibiotics, nor does it leach chemicals into the environment.

Researchers discovered that systems that remind hospital staff to remove catheters can reduce the rate of catheter-associated urinary tract infections by 52 percent. In a meta-analysis of interventional studies that used reminders to indicate that a urinary catheter was in use or stop orders to prompt catheter removal in patients, the researchers found no evidence that the reminders would lead to catheters being removed too early. The researchers said that hospitals should consider "nurse-empowered" catheter stop orders, which allow nurses to remove urinary catheters based upon set criteria and without a direct order from a physician.

A study led by researchers at the Institute of Hygiene and Environmental Medicine at Ernst-Moritz-Arndt University in Greifswald, Germany, has confirmed previous research that asserted bacterial migration through unnoticed microperforations in surgical gloves occurs in surgery, adding that it occurs frequently. The researchers used an established design to measure bacterial migration from the operating site through a punctured glove, and they reported that in a consecutive series of 20 procedures, microperforations were discovered on the outer surgical glove 10 percent of the time in a median wearing duration of 100 minutes, and perforations were found in 81 percent of cases on the nondominant hand.

Duke University Medical Center researchers said they found that surgically implanted antibiotic-infused sponges do not reduce the rate of sternal wound infections in patients who have had heart surgery. Gentamicin-collagen sponges, approved in 54 countries, not including the U.S., are used in more than 1 million people. The study of 1,502 heart surgery patients found there was no significant difference in the overall rates of sternal wound infections between people who received sponges and those who did not.

Research led by investigators at the University of Illinois at Chicago has found that the standards for detecting and treating drug-resistant staph infections varies from hospital to hospital, but the majority comply with national guideline recommendations. The study, which was funded by a grant from the Agency for Healthcare Research and Quality and published in the American Journal of Health-System Pharmacist, employed a 61-question survey that was sent to pharmacy directors at 263 acute care hospitals in the U.S. to discover policies and practices in regards to methicillin-resistant Staphylococcus aureus. Of the 102 that responded, 43 percent reported a standard procedure for screening patients for the bacteria.

A study  by Clive Beggs from the University of Bradford and colleagues found that under normal circumstances the risk of acquiring a pulmonary tuberculosis infection during a visit to a hospital waiting area is minimal, the risks associated with the transmission of influenza are an order of magnitude greater than for TB yet still relatively small and the risks associated with acquiring measles are high. The researchers analyzed the transmission of airborne infections in a hypothetical hospital waiting area in which occupancy levels, waiting times and ventilation rates were varied. They concluded that while the installation of air disinfection may be beneficial, it was more important to minimize waiting times and the number of susceptible individuals present to reduce infection rates

Emory University School of Medicine researchers reported in the journal Infection Control and Hospital Epidemiology that using an alcohol-based hand sanitizer to clean hands as well as stethoscopes between patients could become an accepted bedside practice. The researchers said cleaning the stethoscope with an alcohol wipe is more effective, but most clinicians consider such a move impractical and are unlikely to reliably take such precautions. A review of 84 stethoscopes showed that the median bacteria colony count dropped to 4 CFU from 34.5 CFU prior to being cleaned with the hand sanitizer. After cleaning with the alcohol wipe, the median colony count was zero CFU.

Researchers in the journal Clinical Infectious Diseases reported that vancomycin-resistant enterococci of genotype vanC appear not to be associated with outbreaks. The researchers estimated the risk of bloodstream infections in patients colonized with VRE of genotype vanC who received care from a bone marrow transplant unit for patients with leukemia. They found that infection control policy required contact isolation for patients infected with VRE of genotype vanA or vanB, but only standard precautions for patients infected with VRE of genotype vanC. The scientists concluded that carriers of VRE of genotype vanC do not require contact isolation, which could save resources and improve patient care.

A promising treatment that reduced the severity of skin and soft-tissue damage caused by USA300, the leading cause of the Staphylococcus aureus infections in the U.S., in laboratory mice has been discovered by scientists at the National Institutes of Health and the University of Chicago. The investigators accomplished the reductions by neutralizing a toxin known as alpha-hemolysin, or Hla, that is associated with S. aureus.

Fred Gordin of the Infectious Diseases Section of the Veterans Affairs Medical Center in Washington, D.C., reported in a commentary in Infection Control and Hospital Epidemiology on the evolving epidemiology of MRSA. His research team reviewed infection control data from clinical MRSA isolates during a period from 2001 to 2007. The researchers found that the number of new clinical MRSA isolates increased during the study period, from 129 to 221, and the number of HA-MRSA isolates decreased from 78 isolates to 46. Gordin said there needs to be a better understanding of the risk factors contributing to the increase in the incidence of MRSA infection, and that approaches to prevention, screening and treatment need to reflect the changing epidemiology of MRSA.

The Agency for Healthcare Research and Quality reported that the rate of hospital-acquired infections among adults declined to 2.03 per 1,000 after peaking at 2.3 per 1,000 in 2004 and 2005. The agency determined that HAIs were recorded in 0.2 percent of hospital stays in 2007. Claudia Steiner of AHRQ, who led the research, did not offer reasons for the decline, but other researchers have speculated that improved adherence to treatment guidelines and better management of risk factors for HAIs have played a factor.

Michigan-based researchers revealed that leadership plays a vital role in hospital infection prevention and control programs. Sanjay Saint of the University of Michigan and colleagues conducted a three-phase study involving the lead infection preventionists at several hospitals. The preventionists first completed a quantitative survey about health care-associated infection prevention; the second stage of the study was data collection; and the third phase was on-site interviews. The team of investigators found that successful leaders created a culture of clinical excellence and communicated it effectively to staff, and the scientists concluded that hospital epidemiologists and infection preventionists play bigger leadership roles in their facility’s patient safety activities than senior executives.

A study led by Vincent C.C. Cheng from Queen Mary Hospital in China found that compliance with infection control measures relies significantly on a personal commitment by health care workers. In the study,  Cheng and colleagues monitored the incidence of MRSA infection in a hospital’s newly renovated intensive care unit during three phases: the baseline period, after ICU renovation and after implementing a hand hygiene campaign. The researchers found that while they observed a reduction in ICU-onset MRSA infection, a significant improvement was only seen in comparisons done before and after the SARS epidemic. These findings suggest that health care workers are more likely to comply with infection control measures when they feel their personal safety is threatened, the researchers said.

David Holyoake of the University of Wolverhampton recently wrote about how a group of nursing students explored whether perceiving hand washing as a social behavior rather than merely an act of hygiene might influence how often health care workers wash their hands. The students focused on how health care centers allow cross-contamination and infections to persist and whether "shaming and blaming" could be used to encourage greater rates of hand washing. The students created a series of posters related to the concept.

The Methodist Hospital in Texas found that sepsis is 10 times more common and more deadly than other surgical complications, such as heart attacks and blood clots. The number of people who have died from sepsis has nearly doubled in the last 20 years in the U.S., the report found. Sepsis is the No. 1 cause of organ failure and mortality in general surgery units, and about 934,000 people in the U.S. will be afflicted with sepsis by the end of the year. The study reviewed 363,897 general surgical patients in the American College of Surgeons National Surgical Quality Improvement Program database

Residential addresses could be useful for differentiating health care-acquired from community-acquired MRSA infections, although methods for categorizing residence type based on electronic medical records have not been widely documented. In this study, researchers were seeking to establish a process to aid in distinguishing health care-associated from community-associated MRSA infections by analyzing patient addresses to identify if residence noted at the time of positive culture was linked to a health care facility or other institutional location.

Postoperative high blood sugar levels may increase the risk for infection at the surgical site in patients having general surgery. The study examined 1,561 patients, including 559 who had vascular surgery, 226 who had colorectal surgery and 776 who had a type of general surgery other than colorectal. Age, emergency status, physical status as classified by the American Society of Anesthesiologists, time in surgery, diabetes and high postoperative blood glucose were all factors that appeared to be associated with surgical site infections, but factors other than postoperative blood glucose level were not significant predictors of infection. "In conclusion, we found postoperative hyperglycemia to be the most important risk factor for surgical site infection in general and colorectal cancer surgery patients, and serum glucose levels higher than 110 milligrams per deciliter were associated with increasingly higher rates of post-surgical infection," the researchers wrote.

A new study by the Centers for Disease Control and Prevention’s Prevention Epicenter Program found that growing rates of Clostridium difficile infection could indicate a regional problem, rather than an issue at a single health care institution. In the study, the researchers compared CDI incidence rates from 2000 to 2006 among five U.S. academic medical centers. They found that during the period, overall incidence rates of CDI increased, whether the infections were health care facility-onset, community-onset or health care facility-associated. Additionally, the researchers discovered significant differences in the total incidence rate among health care institutions for each surveillance definition of CDI.

A group of infectious-disease organizations is urging the health care industry to adopt a new prevention framework that it says can eliminate health care-associated infections.  The group outlined the key elements of the framework. These include data collection, evidence-based practices, systemwide infection prevention strategies and enhanced medical knowledge, the paper’s authors said, among whom are representatives from the CDC and the Society for Healthcare Epidemiology of America.

Yale University researchers reported that they were able to introduce foreign small molecules into the cell wall of Staphylococcus aureus bacteria. The researchers focused on introducing biotin, fluorescein and azide into the bacteria, and they noted that the procedure could be applied to naturally occurring bacteria in the human body. The researchers said the findings could lead to better approaches for fighting drug-resistant bacteria or allow for the observation of the progression of disease in the human body in real time.

New government data show MRSA to be more prevalent in the U.S. than in the UK, and that Americans are more than six times as likely as Britons to contract the superbug in their communities, although rates of hospital infections are about equal.  The government statistics found that about 29 per 100,000 people in the U.S. contract a MRSA bloodstream infection every year, compared with 11 Britons.

This paper was written to help preventionists explain inherent constraints in using administrative data to identify such infections. Specifically, the paper said the exclusive use of administrative data is not exact and does not facilitate real-time implementation of useful prevention methods. Moreover, the paper calls for the adoption of the CDC/National Healthcare Safety Network's standardized definitions.

The rate of adherence to hand hygiene practices among health care workers increased 6 percent following the institution of a multifaceted intervention, However, the incidence of MRSA colonization did not fall. Researchers conducted their study in three tertiary care hospitals in Ontario, Canada. Of the 30 total hospital units studied, 15 were randomly assigned to the intervention technique, which included performance feedback, small-group teaching seminars and posters, and the other 15 were assigned usual practice. Hand hygiene adherence in the intervention group was 48.2 percent, compared with 42.6 percent in the control group.

A study has been launched by researchers at the Medical College of Georgia to identify how to optimize communications in health care settings to avert fatal catheter-related bloodstream infections. According to the CDC, such infections, which annually cause 28,000 deaths and generate $9 billion in health care costs, are preventable if correct practices are adhered to. However, "while some hospitals have succeeded in implementing these standards, many have not," said Pavani Rangachari, the principal investigator on the study. Therefore, Rangachari and her team have been given a two-year, $100,000 grant from the Department of Health and Human Services’ Agency for Healthcare Research and Quality to analyze hospital communication logs in an attempt to pinpoint why some protocols are more successful than others at preventing infections.

Erik Dubberke of the Division of Infectious Diseases in the Department of Medicine at Washington University School of Medicine in St. Louis said that the wearing of gloves when caring for a patient with a Clostridium difficile infection is the single recommended practice graded "A-I." As evidence, Dubberke pointed to a 1990 study performed prior to the introduction of universal and standard precautions that randomized four wards with similar baseline rates of CDI. Some of the wards continued with standard of care, while others implemented an education campaign instructing nurses to wear gloves. The study showed a statistically significant decrease in CDI incidence in the intervention wards.

Canadian researchers have discovered in the country an infectious superbug that is deadly to people with cystic fibrosis. In a 446-patient study, researchers found about 15 percent of the subjects to be infected with the bacteria, an A strain of the P aeruginosa bug, which doubled or tripled the risk of death or the need for a lung transplant during the three-year period. Resistant to most antibiotics, the strain first was identified in Liverpool in 1996. The study said that the superbug, commonly found in showers, bathtubs and hot tubs, attacks seven out of every 1,000 cystic fibrosis patients each year.

Critically ill patients with bloodstream infections and pneumonia face a significantly higher risk of dying, but resistance to common antimicrobial agents has a small additional effect on patient outcomes. Researcher Marie-Laurence Lambert from the Scientific Institute of Public Health in Belgium and colleague examined data for 119,699 patients staying for more than two days in 537 intensive care units across Europe. Measuring the correlations among infection sites, microorganisms, resistance status, risk of death and extended length of stay, they found that infection with pneumonia doubles the likelihood of death, while bloodstream infections triple the risk. However, resistance to common antimicrobial agents increased the chance of death by only 20 percent.

Scientists at the National Institute of Allergy and Infectious Diseases have uncovered a molecular mechanism involved in the development of catheter-related bacterial infection with Staphylococcus epidermidis in mice implanted with catheters. Their findings may have broader implications for understanding several types of bacterial biofilm infections, including MRSA. In the Journal of Clinical Investigation, they showed that a specific S. epidermidis protein, phenol-soluble modulin beta, was employed by biofilms for multiple purposes, including to grow and to disseminate infection. The spread of the bacteria was slowed by antibodies against PSM-beta, suggesting that interfering with biofilm development could help prevent the spread of biofilm-associated infection. Similar proteins also known to exist in S. aureus.

The Public Health Agency of Canada  released a new guidance to provide instruction in the management of patients colonized or infected with carbapenem-resistant Gram-negative bacilli, including the New Delhi metallo beta-lactamase. Recent events suggest an increasing occurrence of antimicrobial resistance in Gram-negative bacteria, the agency noted.

A new paper released by the Association for Professionals in Infection Control, the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America and the CDC has suggested that addressing gaps in knowledge is a critical step in the process of eliminating health care-acquired infections. The authors wrote that in order to create and evaluate prevention strategies for such infections, an understanding of how and why they occur must first be grasped and disseminated among those in the medical field. Meanwhile, the website Infection Control Today found in its inaugural "State of the Industry Report" that approximately a third of survey respondents said lack of education was one of the biggest barriers to health care workers’ compliance with infection prevention practices.

Scientists have discovered that a taste for human blood could help explain why the MRSA superbug is such a threat, according to a study published in the journal Cell Host & Microbe. The researchers, led by Eric Skaar of Vanderbilt University Medical Center, said the reason why the microbe that lives harmlessly in the noses of nearly a third of the population causes serious infections in others could be individual differences in the blood protein hemoglobin. The team of investigators revealed that the "vampire" bug favors human hemoglobin over that of other animals. Therefore, the scientists hypothesized that people who are resistant to the bacteria might have genetic variations that tweak the hemoglobin regions the bug seeks, making them impervious to the attack.

A new study led by Todd Vogel of the University of Medicine and Dentistry of New Jersey found that delaying elective surgical procedures after a patient has been admitted to a hospital significantly increased the risk of infectious complications and raised hospital costs. For the study, the authors queried a U.S. sample of 163,006 patients, aged 40 and older, from 2003 to 2007, and evaluated patients who developed postoperative complications following elective procedures. They found that infection rates increased significantly from those performed on the day of admission to those performed one, two to five, and six to 10 days later

An essay by Robert Moellering of Harvard Medical School cautions that the New Delhi metallobeta-lactamase 1, or NDM-1, an enzyme found in a wide variety of bacterial types that is thought to make them resistant to antibiotics, will pose significant health challenges in the coming years. "What makes this enzyme so frightening is not only its intrinsic ability to destroy most known beta-lactam antibiotics but also the company it keeps," Moellering wrote. He cautioned that NDM-1 and similar genes could disable much of the available arsenal of antibiotics. Moellering said there are 890 known enzymes that pose drug-resistance threats, which far outnumbers the amount of antibiotics developed to combat them.

Researchers led by Amy Ray of the division of infectious diseases and HIV medicine at the University Hospitals Case Medical Center in Cleveland have shown that environmental decontamination with vaporized hydrogen peroxide, in combination with comprehensive infection prevention and control efforts, interrupted nosocomial transmission of multidrug-resistant Acinetobacter baumannii in a long-term acute care hospital. The researchers, who noted that the approach tested needed further investigation, identified 13 patients infected or colonized with MDR A. baumannii between January 2008 and June 2008. They reported that environmental cultures appeared negative immediately after decontamination with VHP, as well as 24 hours and one week after VHP decontamination.

Contaminating bacteria are commonly present on the hands of anesthesia providers and found high rates of transmission to the surgical field during operations. Led by Randy Loftus of Dartmouth-Hitchcock Medical Center, researchers conducted a study to pinpoint the origin of bacteria transmitted to the surgical field in 164 operating room procedures using general anesthesia. Loftus and colleagues used culture tests to determine that bacteria were transmitted to the stopcock valves of the intravenous lines in 11.5 percent of procedures. In almost half of those instances, the bacteria discovered in the intravenous lines were the same as those found on the hands of anesthesia providers, including attending anesthesiologists, residents and nurse-anesthetists

 Cade M. Nylund of Maryland's Uniformed Services University of the Health Sciences and colleagues used a national database to assess records of hospitalized children who were discharged from the hospital in 1997, 2000, 2003 and 2006. The database consisted of approximately 10.5 million patients, about 0.2 percent of whom had C. difficile infection. However, the scientists discovered that the number of infections increased about 15 percent each year, from 3,565 in 1997 to 7,779 in 2006. According to the study, the risk of infection was higher for white children than black or Hispanic children.

Researchers from Rhode Island Hospital and colleagues discovered that culturing the nose is a more effective way to reveal MRSA than culturing under the arms, groin or perineum, according to a study published in the Journal of Clinical Microbiology. Led by Leonard Mermel, the scientists also found that when patients had a large quantity of MRSA in their nose, they were also likely to have a large quantity of it in those other areas as well. "This study shows us that the quantities of MRSA at different body sites are highly correlated," Mermel said. The investigators did add that they were unable to find a correlation between the number of body sites with MRSA and the chances of having an active MRSA infection.

Placing intensive care unit patients in private rooms may help lower the risk of infection. In the study, Teltsch and colleagues analyzed data from 19,343 ICU admissions between 2000 and 2005 at two Montreal hospital centers, one of which switched to only private ICU rooms in March 2002. They found that the combined risk of a patient acquiring an infection such as MRSA, vancomycin-resistant Enterococcus species and Clostridium difficile dropped by 54 percent after the transition to private rooms. Additionally, the researchers found that the average patient in a private room stayed in the ICU 10 percent fewer days after the conversion.

Researchers led by Andrew Barron and Qilin Li of Rice University have developed a new technique to make titanium dioxide, a common disinfectant, more effective. In their research, the scientists found that adding silicone to the disinfectant significantly increased its ability to degrade aerosol- and waterborne viruses. Using a very simple treatment, "we've improved [titanium dioxide's] performance by more than three times without any real cost," Barron said.

A report released by the Centers for Disease Control and Prevention has validated efforts by the Centers for Medicare and Medicaid Services to reduce hospital-acquired infections, improve patient outcomes and increase transparency in provider performance, all while containing the cost of care, according to Dark Daily. The report evaluated the progress achieved in a program where multiple hospitals reported a major decrease in the number of HAIs in 2009. The report was generated from data collected from hospitals in states that require their hospitals to report patient outcome data to the National Healthcare Safety Network. These facilities experienced an 18 percent reduction in central line-associated bloodstream infections in the first six months of 2009, compared with the prior three years.

In order to find out the effects electronic surveillance systems have on infection prevention and control programs in health care institutions, Patti G. Grota of the Texas Health Science Center San Antonio and colleagues surveyed 207 hospitals in California. The team found that just 23 percent of the participating hospital infection prevention and control programs had an ESS, even though one study suggested that using one decreased the time spent conducting surveillance by as much as 61 percent. That study also found that an ESS could improve efficiency of data collection and patient outcomes. The respondents with an ESS said the system was used mainly to create reports and data summaries from built-in templates.

A U.S. program for reducing catheter-related bloodstream infections, known as Matching Michigan, is being implemented throughout the UK’s National Health Service. The initiative relies on "significant nursing leadership," as well as data collection and checklists, to slash rates of infection. A study led by Christine Goeschel of Johns Hopkins University, which was published in the journal Nursing in Critical Care, showed the approach reduced median infection rates per 1,000 catheter-days from 2.7 to zero in three months at 103 intensive care units in the U.S.

Hypothermia does not increase the risk of infection in patients treated with selective decontamination of the digestive tract and could improve patients’ outcomes following traumatic brain injuries, particularly when it is maintained for more than 48 hours, according to a study published in Critical Care. Researcher Marlijn Kamps from the Radboud University Nijmegen Medical Center in the Netherlands and colleagues examined data on 35 patients treated with prolonged hypothermia as well as a control group of 169 patients with severe brain injury. They found the overall risk of infection during ICU stay to be 20 percent in the hypothermia groups, compared with 34.4 percent in the normothermia group. Additionally, the study found that the incidence of meningitis, wound infection, bacteremi and urinary tract infection was low and similar between the groups

Pascale Hancart-Petitet of the Institut Pasteur du Cambodge in Phnom Penh, Cambodia, and colleagues reported in BMC Public Health on the social and cultural factors shaping hygiene practices in Cambodian health care settings. According to the researchers, the frequency of bloodborne pathogen-related infections is thought to be high in developing Southeast Asian countries, but the social-cultural logics contributing to the risks of transmission are rarely studied. The researchers conducted qualitative surveys of 319 participants and found that hygiene practices were burdened in part by a lack of adequate materials and equipment.

The Association for Professionals in Infection Control and Epidemiology has published a second edition of its "Guide to the Elimination of Methicillin-Resistant Staphylococcus aureus Transmission in Hospital Settings," updating the guidance with the most current evidence-based practice information available to prevent health care-associated infections. The revised guide updates and enhances the original APIC guide, which was published in 2007, adding references, resources, research findings and new guidance.

Researchers have shown that stopping MRSA’s ability to degrade RNA can inhibit its spread, both in the laboratory and in infected mice, according to a report published in PLoS Pathogens. Scientists led by Paul Dunman of the University of Rochester Medical Center especially focused on RnpA, a molecule they found to be involved in the RNA degradation process. Specifically, the team isolated RNPA1000, and in tests on mice, 50 percent of those treated with a large dose of the molecule survived while all of the mice in the control group died. The scientists said inhibiting degradation might cause the bacteria to be overcome by an onslaught of confusing instructions that should have been turned off.

Chlorhexidine gluconate baths were more effective in reducing hospital-acquired infections than soap-and-water baths, according to a new study from Rhode Island Hospital. Researchers looked at a group of 7,699 adult patients who were bathed daily with CHG cloths, comparing the outcomes with those of a control group of 7,102 patients who were bathed with soap and water. Senior investigator Leonard Mermel said the results indicated a significant reduction in patients’ risk of developing an infection related to methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus.

Researchers from the University of Chicago and colleagues concluded that many steps hospitals take to minimize the number of methicillin-resistant Staphylococcus aureus infections, including engaging in surveillance for MRSA colonization, are costly and can result in false-positive test results. According to the scientists, whose work was published in Infection Control and Hospital Epidemiology, the performance of this technique would be enhanced if patients who are at high risk for colonization could be easily targeted. The investigators studied 23,314 patients and came up with five MRSA prediction rules that could be used to identify the 30 percent of patients who account for approximately 70 percent of all MRSA-associated patient-days.

Researchers found that electronic laboratory data sent to the BioSense surveillance system could be used to produce disease rates of C. difficile infection comparable with those of other studies, showing the feasibility of using such data to track a disease that has implications for public health. For a study published in Infection Control & Hospital Epidemiology, Stephen R. Benoit from the National Center for Public Health Informatics and colleagues conducted a retrospective study of 34 hospitals sending inpatient, emergency department or outpatient data to BioSensemore. They found more than 4,500 patients in 12 states who had C. difficile-positive assay results, with more than half of the cases classified as community-onset. Additionally, they found that 30.8 percent of community-onset cases occurred in patients who were recently hospitalized. Overall, the rate of health care-onset CDI was 7.8 cases per 10,000 patient-days.

A report  by the Pennsylvania Health Care Cost Containment Council found that 30 percent of Pennsylvania patients who acquired a health-care associated infection in 2009 had to be readmitted to the hospital within 30 days for an infection or complication. Moreover, the study revealed that among patients who did not contract an HAI, just 6.2 percent were readmitted within 30 days for an infection or complication. "The data suggest that if you contract an infection in the hospital, you are more likely to be rehospitalized," said Joe Martin, executive director of PHC4. He added it is unknown why that initial infection leads to high readmission rates, but "it may present opportunities for quality improvement and cost containment."

Research published in Deutsches Arzteblatt International said infections are among the most frequent complications of a stay in a hospital in Germany, and they raise complication and mortality rates. Based on data from the Hospital Infection Surveillance System, the study showed an incidence of almost 60,000 newly acquired infections annually in Germany’s intensive care units. Christine Geffers of the Institut fur Hygiene und Umweltmedizin and co-author Petra Gastmeier also found that while the percentage of patients in intensive care who have methicillin-resistant Staphylococcus aureus species has been stable for years, the number with extended-spectrum beta-lactamase-producing E. coli and Klebsiella pneumoniae is increasing.

Attributable mortality, excess length of hospitalization, and extra costs.

The Centers for Disease Control and Prevention (CDC) recommendations for the prevention of surgical site infections (SSIs), formerly called surgical wound infections.

The aim of this study was to identify intraoperative risk factors for surgical site infections (SSIs), which are accessible to interventions. We evaluated the effect of extensive intraoperative antiseptic measures and the impact of the behavior of members of the surgical team on SSIs.

Research led by Nick Daneman of the Sunnybrook Health Sciences Center in Toronto found that statin use was not linked with an elevated risk of surgical site infection in elderly patients. The study of 469,349 patients found an infection rate of 8.9 percent among statin patients, compared with 8.7 percent in non-statin patients

Preoperative cleansing of the patient's skin with chlorhexidine–alcohol is superior to cleansing with povidone–iodine for preventing surgical-site infection after clean-contaminated surgery.

The number of surgical-site S. aureus infections acquired in the hospital can be reduced by rapid screening and decolonizing of nasal carriers of S. aureus on admission.

The attributable impact of S. aureus and methicillin-resistance on outcomes of surgical patients is substantial. Preventing a single case of SSI due to MRSA can save hospitals as much as $60,000.

Patients might have a higher risk of developing invasive Staphylococcus aureus infections after cardiothoracic and neurosurgical procedures when compared with orthopedic or plastic surgical procedures, according to a study published in Infection Control and Hospital Epidemiology. Lead author Deverick Anderson and his team of researchers from Duke University Medical Center studied the postsurgical outcomes of 96,455 procedures from 11 hospitals. Included in the analysis were individuals who had undergone orthopedic, neurosurgical, cardiothoracic and plastic surgical procedures between 2003 and 2006. The breakdown of MRSA infections ranged from 62 percent following cardiothoracic surgery to 35 percent following plastic surgery, the investigators found.

Patients who have had major chest or head operations are at an increased risk of developing post-surgical staphylococcus aureus infections. The findings are based on a review of 81,267 patients who underwent 96,455 orthopedic, cardiothoracic, plastic surgery or neurosurgery procedures at nine locations between 2003 and 2006. There were 454 staph infections among the patients, with the highest rates of bloodstream infections occurring in patients who had chest surgery, while the highest rates of surgical site infections occurred in patients who had brain operations. Deverick Anderson, lead author from Duke University Medical Center, said additional preventions for cardiovascular or neurosurgical procedures may be needed.

Epidrual or spinal anesthesia may help curb the risk of surgical site infection when compared with the use of general anesthesia in patients undergoing total joint replacement surgery. In an editorial on the study, Daniel I. Sessler of the Cleveland Clinic Anesthesiology Institute’s Department of Outcomes Research, said the findings provide compelling epidemiologic evidence that neuraxial anesthesia reduces the risk of SSIs. The study examined 3,081 patients in Taiwan who underwent total knee and total hip replacement procedures, and it showed that SSI rates within 30 days of the procedure was 2.2 times greater in patients who had general anesthesia.

Leaving an antibiotic-soaked collagen sponge in the wound after colorectal surgery "paradoxically" seemed to cause an increase in surgical site infections. The findings of Elliott Bennett-Guerrero of Duke Clinical Research Institute in Durham, N.C., and colleagues opposed findings of an earlier study that identified a 70 percent decrease in such infections with the use of a gentamicin-collagen sponge. The study involved 602 patients undergoing open or laparoscopically assisted colorectal surgery at 39 U.S. sites.

The National Conference of State Legislatures has released a new report that offers lessons on infection-reporting data from nine of the states that first required medical facilities to report health care-associated infections. The NCSL looked at state laws passed from 2005 to 2009 and interviewed state lawmakers, health care providers and other related groups in Alabama, Colorado, Delaware, Illinois, Massachusetts, New Hampshire, Oregon, Pennsylvania and Washington. Since 2005, the number of states that require health care facilities to report HAIs has jumped from six to 27.

A study examined 7,000 patients undergoing elective, inpatient orthopedic procedures at New England Baptist Hospital in Boston who were screened for methicillin-sensitive Staphlylococcus aureus and MRSA. Patients who tested positive were instructed via pre-op phone calls to apply mupiricin ointment to the interior of each naris, and patients who still carried MRSA after the application of the ointment were treated with standard MRSA isolation precautions in addition to pre-op antibiotics. The study showed that the surgical site infection rate dropped 59 percent when the prescreening program was in place. The researchers suggested the drop in SSIs was likely due to the ability of clinicians to switch preoperative antibiotic prophylaxis to vancomycin, as well as the treatments with the ointment. The researchers concluded that prescreening programs are "feasible and can lead to significant reductions in postoperative rates of surgical site infection."

Duke University Medical Center researchers said they found that surgically implanted antibiotic-infused sponges do not reduce the rate of sternal wound infections in patients who have had heart surgery. Gentamicin-collagen sponges, approved in 54 countries, not including the U.S., are used in more than 1 million people. The study of 1,502 heart surgery patients found there was no significant difference in the overall rates of sternal wound infections between people who received sponges and those who did not.

Postoperative high blood sugar levels may increase the risk for infection at the surgical site in patients having general surgery. The study examined 1,561 patients, including 559 who had vascular surgery, 226 who had colorectal surgery and 776 who had a type of general surgery other than colorectal. Age, emergency status, physical status as classified by the American Society of Anesthesiologists, time in surgery, diabetes and high postoperative blood glucose were all factors that appeared to be associated with surgical site infections, but factors other than postoperative blood glucose level were not significant predictors of infection. "In conclusion, we found postoperative hyperglycemia to be the most important risk factor for surgical site infection in general and colorectal cancer surgery patients, and serum glucose levels higher than 110 milligrams per deciliter were associated with increasingly higher rates of post-surgical infection," the researchers wrote.

Contaminating bacteria are commonly present on the hands of anesthesia providers and found high rates of transmission to the surgical field during operations. Led by Randy Loftus of Dartmouth-Hitchcock Medical Center, researchers conducted a study to pinpoint the origin of bacteria transmitted to the surgical field in 164 operating room procedures using general anesthesia. Loftus and colleagues used culture tests to determine that bacteria were transmitted to the stopcock valves of the intravenous lines in 11.5 percent of procedures. In almost half of those instances, the bacteria discovered in the intravenous lines were the same as those found on the hands of anesthesia providers, including attending anesthesiologists, residents and nurse-anesthetists