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The results could be used to inform local practice and stimulate debate on measures to prevent ventilator-associated pneumonia. Education, guidelines as well as ventilator bundles and instruments should be developed and updated to improve infection control.

The type of pneumonia (i.e. SCAP, HAP or VAP) had no significant association with hospital mortality, whereas the SCAP patients had the lowest 1-year mortality.

Background: Endotracheal-suctioning (ETS) is a procedure that may constitute a risk factor for ventilator-associated pneumonia (VAP) by increasing microbial colonization of the lower airway. Unsafe ETS practices have been observed worldwide during recent years. Because of adverse reactions, practioners need to take all necessary precautions to ensure patient safety and a high quality of nursing care. The aim of the present study was to evaluate critical-care nurses' performance in relation to current recommendations in their daily practice prior to, during and post ETS events. Methods:A structured, non-participatory, observational study (n=40) was conducted using a 25-item best-practice information sheet to assess critical-care nurses' ETS practices in a mixed medical-surgical intensive-care unit. Onesample-and independent-samples t-tests were used to compare critical-care nurses' ETS performance against current recommendations within different ICU experience groups.Results: The quality of observed ETS practices was significantly lower than the required quality of care (p<0.001). The most significant discrepancies were observed in ETS practices related to infection-control practices. Conclusion:Critical-care nurses are currently not following current ETS recommendations. Significant discrepancies, which may constitute a risk factor for VAP by increasing microbial colonization of the lower airway, were identified. Unsafe ETS practices may jeopardize patient safety, and thus the quality of nursing care. Educational interventions, clinical guidelines and adequate support need to be provided to critical-care nurses to assess and improve their professional capabilities and current practice. Regular auditing and prompt feedback would be beneficial.

IntroductionThe aim of this study was to elucidate the impact of intensive care unit (ICU)-acquired infection on hospital mortality.MethodsPatients with a longer than 48 hour stay in a mixed 10 bed ICU in a tertiary-level teaching hospital were prospectively enrolled between May 2002 and June 2003. Risk factors for hospital mortality were analyzed with a logistic regression model.ResultsOf 335 patients, 80 developed ICU-acquired infection. Among the patients with ICU-acquired infections, hospital mortality was always higher, regardless of whether or not the patients had had infection on admission (infection on admission group (IAG), 35.6% versus 17%, p = 0.008; and no-IAG, 25.7% versus 6.1%, p = 0.023). In IAG (n = 251), hospital stay was also longer in the presence of ICU-acquired infection (median 31 versus 16 days, p < 0.001), whereas in no-IAG (n = 84), hospital stay was almost identical with and without the presence of ICU-acquired infection (18 versus 17 days). In univariate analysis, the significant risk factors for hospital mortality were: Acute Physiology and Chronic Health Evaluation (APACHE) II score >20, sequential organ failure assessment (SOFA) score >8, ICU-acquired infection, age ≥ 65, community-acquired pneumonia, malignancy or immunosuppressive medication, and ICU length of stay >5 days. In multivariate logistic regression analysis, ICU-acquired infection remained an independent risk factor for hospital mortality after adjustment for APACHE II score and age (odds ratio (OR) 4.0 (95% confidence interval (CI): 2.0–7.9)) and SOFA score and age (OR 2.7 (95% CI: 2.9–7.6)).ConclusionICU-acquired infection was an independent risk factor for hospital mortality even after adjustment for the APACHE II or SOFA scores and age.

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The rates of urinary tract infections and bloodstream infections were lower than reported previously, differentiating our results from the classic pattern of ICU-acquired infections, with the exception of the predominance of VAP.

c Coxsackievirus A6 (CV-A6) caused hand, foot, and mouth disease (HFMD) with a unique manifestation of epididymitis. The patient underwent operation due to suspicion of testicular torsion. Epididymitis was diagnosed by ultrasound examination. Enterovirus was detected from epididymal fluid by PCR and typed by partial sequencing of viral protein 1 as CV-A6. CASE REPORT The case patient was a 17-year-old male who had previously been in good health. He was not on any regular medication. He sought medical care at the emergency department of the Oulu University Hospital due to an intense pain in his left testis. He was admitted to the surgical ward with suspicion of a testicular torsion. On admission, his general condition was good. He had mild fever and swelling in the left side of the scrotum, and that area was painful in palpation. Vesicular exanthema had appeared on his palms during the week before admission to the hospital.Due to the suspicion of testicular torsion, an ultrasound examination was performed, which revealed epididymo-orchitis. The right testicle was normal when examined by ultrasound. Because the possibility of torsion could not be excluded, an exploratory operation was performed. The left testis and epididymis were found to be swollen and irritated. There was no pus in the scrotal area, but under the tunica vaginalis there was a small amount of fluid, which was aspirated and sent for the microbiological analysis. Antimicrobial treatment was started with cefuroxime and ciprofloxacin. After the operation, the patient remained on the ward for 3 days, and on discharge, he was recovering; he was afebrile and did not have any pain or swollenness in the scrotal area.Laboratory analysis showed an increased blood C-reactive protein (CRP) level of 105 mg/ml (normal level, Ͻ10 mg/liter). On discharge, the CRP level was 30 mg/ml. The white blood cell count was normal (6.2 to 7.8 ϫ 10 9 /liter). A bacterial culture from the epididymal fluid gave a negative result, as did a urine culture. Chlamydia trachomatis and Neisseria gonorrhoeae PCR test results from epididymal fluid were negative.