Guideline for the management of nosocomial infections in South Africa

Brink, AJ; Feldman, Charles; Dusé, Adriano; Gopalan, Dean; Grolman, D C; Mer, M; Naicker, Saraladevi; Paget, Graham; Perovic, Olga; Richards, G. K.

doi:10.1080/10158782.2006.11441269

Cited by 13 publications

(18 citation statements)

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“…Overall the most prevalent organisms responsible for community-acquired (S. pneumoniae, E. coli, S. aureus and K. pneumoniae) and healthcareacquired (Acinetobacter spp., Klebsiella spp., S. aureus, E. coli, enterococci, Enterobacter spp., P. aeruginosa, and coagulase-negative staphylococci) BSIs in our study were generally consistent with other recent studies. [18,19] Klebsiella spp., S. aureus and E. coli were the commonest causes of healthcare-acquired infections in all areas outside the ICUs, whereas Acinetobacter was common in the ICUs and rare in all other areas.…”

Section: Discussionmentioning

confidence: 99%

Community- versus healthcare-acquired bloodstream infections at Groote Schuur Hospital, Cape Town, South Africa

McKay

Bamford

2015

S Afr Med J

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Groote Schuur Hospital (GSH) is a large tertiary academic and teaching hospital in Cape Town, SA. In this hospital, blood cultures are generally collected when a patient has clinical features of sepsis, Background. Bloodstream infections (BSIs) cause considerable morbidity and mortality. The epidemiology of bacterial infections differs in community and hospital settings. Regular surveillance and reporting of pathogens and antimicrobial susceptibility can assist in appropriate management of BSIs. Objectives. To describe the distribution of organisms and of antibiotic susceptibility among isolates from blood cultures at a tertiary academic hospital during a 1-year period, stratifying by place of infection acquisition. Methods. This was a retrospective descriptive study of bloodstream isolates from cultures from adults (>13 years of age) routinely submitted between 1 October 2011 and 30 September 2012 to the clinical laboratory at Groote Schuur Hospital, Cape Town, South Africa. Community-acquired infections were compared with healthcare-acquired infections, defined as infections developing at least 48 hours after admission or within 3 months of admission to a healthcare facility. Frequencies and proportions of infecting organisms are presented, along with susceptibility results for selected pathogens. The hospital-acquired isolates were stratified by ward (emergency, general medical or general surgical ward or intensive care unit (ICU)) to determine organism frequency and susceptibility patterns by hospital ward. Results. Among adults, 740 non-duplicate pathogens were isolated from BSIs. Nearly three-quarters of infections were healthcare acquired. Enterobacteriaceae and non-fermentative Gram-negative bacilli were predominant among healthcare-acquired pathogens (39.2% and 28.5%, respectively), while Enterobacteriaceae and Gram-positive organisms were the most common among community-acquired pathogens (39.2% and 54.3%, respectively). The majority of community-acquired Enterobacteriaceae were highly susceptible to antibiotics (gentamicin 95.6%, ceftriaxone 96.1% and ciprofloxacin 92.2%), whereas 64.6% of healthcare-associated isolates were susceptible to gentamicin, 58.5% to ceftriaxone and 70% to ciprofloxacin. All community-acquired Staphylococcus aureus isolates v. 52.4% of healthcare-acquired isolates were susceptible to cloxacillin. The susceptibility of healthcare-acquired Pseudomonas aeruginosa and Acinetobacter baumanii complex isolates was <80% to all antibiotics with the exception of colistin. Klebsiella spp., S. aureus and Escherichia coli were the commonest causes of healthcareacquired infections in all areas outside of the ICUs, whereas Acinetobacter was common in the ICUs and rare in all other areas. Conclusion. The distinction between community-and healthcare-acquired infections is critical in antibiotic selection because narrowspectrum agents can be utilised for community-acquired infections. The considerable antibiotic resistance of healthcare-acquired pathogens highlights the importance of infectio...

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Section: Discussionmentioning

confidence: 99%

Community- versus healthcare-acquired bloodstream infections at Groote Schuur Hospital, Cape Town, South Africa

McKay

Bamford

2015

S Afr Med J

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“…This results in significant morbidity and mortality, pressures on the need for intensive care beds, and the direct and indirect costs of these infections. [2] Factors contributing to this risk include indiscriminate use of antibiotics over the years, resulting in drugresistant organisms and more recently multidrug-resistant organisms. Patients may be discharged by the time the infection presents and it can then also spread in the community, making it difficult to distinguish between community-acquired and hospital-acquired infections.…”

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confidence: 99%

“…This can be through skin-to-skin contact, direct spread for droplets >5 microns in size and airborne spread for droplets <5 microns in size. [2] Besides general safety precautions, hand hygiene has been recommended as the single most important measure in preventing hospital-acquired infections. The Centers for Disease Control (CDC) guidelines suggest hand washing with antimicrobial soap between every patient contact and before and after performing invasive procedures.…”

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confidence: 99%

A multifaceted hospital-wide intervention increases hand hygiene compliance

et al. 2016

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Background. Hand hygiene is an important and basic practice that should be used by all healthcare staff to protect both themselves and their patients against infection. Unfortunately hand hygiene compliance remains poor. Objective. To show an improvement in hand hygiene compliance using a multifaceted approach. Methods. This was a quasiexperimental pre-post intervention study design with a number of standardised interventions to promote hand hygiene. The World Health Organization hand hygiene multimodal (five-step) intervention approach was used. The study ran from June 2015 to August 2015 in 11 selected wards of a 975-bed tertiary and quaternary care public hospital (Groote Schuur Hospital, Cape Town, South Africa). The outcome was to assess improvement in hand hygiene compliance monthly over the 3 months, compared with nonintervention wards and compared with the wards' own performance measured in 2014. The study included both descriptive and analytical components. Results. Post intervention, hand hygiene compliance showed a statistically significant improvement for before patient contact from 34% in 2014 to 76% in 2015 (p<0.05) and for after patient contact from 47% in 2014 to 82% in 2015 (p<0.05). Conclusion. The intervention improved hand hygiene compliance and can easily be replicated in other wards, resulting in sustaining a culture of hand hygiene improvement and behavioural change throughout the hospital.

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“…These results were further filtered to identify guidelines published by a national professional society or professional medical association. Guidelines by the following organizations were identified: American Thoracic Society and Infectious Diseases Society of America [1], Latin American Thoracic Society [2], South African Thoracic Society [3], Japanese Respiratory Society [4], Portuguese Society of Pulmonology and Portuguese Intensive Care Society [5], Society Brasieira de Pulmonlogia [6], Association of Medical Microbiology and Infectious Diseases of Canada [7], and British Society for Antimicrobial Chemotherapy [8]. Only articles that were published in an English version [1,3,5,7,8] are included in this review.…”

Section: Methodsmentioning

confidence: 99%

Recommendations for Treatment of Hospital‐Acquired and Ventilator‐Associated Pneumonia: Review of Recent International Guidelines

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2010

CLIN INFECT DIS

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Recently published guidelines for the management of hospital-acquired pneumonia and ventilator-associated pneumonia are reviewed for recommendations regarding diagnosis and antimicrobial therapy to assess the implications for development of future clinical trials. Despite some differences (mostly related to likely pathogens), there is a general agreement about the recommended approach to management. All of the reviewed guidelines invariably recommend early, appropriate antimicrobial therapy and avoidance of excessive antimicrobials by deescalation of therapy on the basis of microbiological culture results and the clinical response of the patient. Developers of future clinical trials will need to be mindful of these recommendations to maintain best practice care for each investigator.

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Guideline for the management of nosocomial infections in South Africa

Cited by 13 publications

References 0 publications

Community- versus healthcare-acquired bloodstream infections at Groote Schuur Hospital, Cape Town, South Africa

Community- versus healthcare-acquired bloodstream infections at Groote Schuur Hospital, Cape Town, South Africa

A multifaceted hospital-wide intervention increases hand hygiene compliance

Recommendations for Treatment of Hospital‐Acquired and Ventilator‐Associated Pneumonia: Review of Recent International Guidelines

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