Current methods for diagnosis of catheter-related infection (CRI) are cumbersome and may require removal of the central venous catheter (CVC). A prospective study was conducted to validate the difference in time to detection (DTD) of cultures of blood samples obtained simultaneously from a peripheral vein (PV) and from the CVC for differentiation of CRI and non-CRI. During a 15-month period, 9 episodes were categorized as CRI and 24 as non-CRI. The median DTD for patients with CRI was significantly higher than that for patients with non-CRI (457 vs. -4 min; P<.001). The optimum cutoff point for diagnosis of CRI was a DTD of > or =120 min (sensitivity, 88.9%; specificity, 100%). With pretest probability of CRI ranging from 28% to 54%, the positive predictive value of a DTD of > or =120 min for the diagnosis of CRI was 100%; the negative predictive value was 89%-96%. On the basis of findings from this study, which is the largest, to date, to involve pediatric patients with tunneled CVCs and the first to use paired quantitative blood cultures as a "criterion standard," DTD was found to be a simple, reliable tool for diagnosis of CRI in hospitals that use continuously read blood culture systems.
Within the context of its limitations, this novel method provides an alternative for diagnosing catheter-related bloodstream infections among patients with a CVC, without PV cultures.
Optimal yield of blood cultures in immunocompromised pediatric patients included the use of BAC with a weight-based, graduated volume of culture inoculation and routine use of both AF and MFL.
We studied the bacterial burden on toilet seats in a children's cancer hospital to validate a policy requesting that immunocompromised children use alcohol wipes on the seats prior to use of the toilets. Methicillin resistant Staphylococcus aureus (MRSA) was recovered from 3.3% of hospital toilets when wipes were not in use. Use of wipes resulted in a 50-fold reduction in mean daily bacterial counts and eliminated MRSA.
Keywords
MRSA; Staphylococcus aureus; toilet; infection control; immunocompromisedAntibiotic resistant bacteria are an increasing problem for infection control. Since the emergence of community-acquired forms of methicillin-resistant Staphylococcus aureus the problem has become even more acute. These strains are associated with higher virulence than traditional hospital-acquired MRSA, and are not only entering the healthcare system from the community but are becoming established in hospitals. 1 Similarly, vancomycin-resistant enterococci (VRE) have become increasingly prevalent in hospitals and represent a severe threat to immunocompromised or critically ill patients as few antibiotic choices are available for treatment of these pathogens. 2 Potential modes of acquisition of these gram-positive bacteria are of keen interest to infection control programs because this knowledge might lead to effective means of preventing transmission or acquisition.St. Jude Children's Research Hospital is a children's cancer hospital and research institute dedicated to prevention and treatment of catastrophic illnesses of childhood. Because all of our patients are immunocompromised, infection control is of prime importance. The St. Jude Infection Control Program conducts daily whole house surveillance to monitor for hospitalacquired infections. In addition, culture-based surveillance of inpatient populations that varies in intensity by risk factors is conducted, focusing on epidemiologically important pathogens including MRSA and VRE. Increases in the prevalence of MRSA and VRE in 2006-2007 led us to review our Policies and Procedures. One area of potential concern identified was shared use of objects that could potentially provide a source of fomite transmission. It was recognized Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
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NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript that outpatients were sharing toilet facilities with other patients, and potentially staff and visitors, in some parts of the hospital. This raised the possibility that fomite transmission could occur by contact with toilet seats. A policy was put i...
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