Journal of Nosocomial Infection

[Expand] Volume 1 (2014)

Journal of Nosocomial Infection

Volume 1 ,Number 2 (2014) Articles 1 - 8
Page(s) 1-8
Hamid Lavakhamseh, Pegah Shakib, Samaneh Rouhi, Bahman Mohammadi, Rashid Ramazanzadeh
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Background and Objective: Nosocomial infections are the most significant problems in hospitals. The aim of this study was to investigate the prevalence of nosocomial infections and antibiotic resistance of bacteria isolated from patients. Methods: This cross-sectional study was conducted in the Besat Hospital, Sanandaj, Iran from late March 2012 to early April 2013 on 32,400 hospitalized patients. Bacteria were isolated from the patients and identified through routine bacteriological methods. Then, the antibiotic susceptibility testing was performed using the disc diffusion method. For data analysis, SPSS 16 and t-tests were applied (p< 0.05). Results: Of the 32,400 patients that were hospitalized for more than 48 h, 327 (1%) were diagnosed with nosocomial infections according to the Centers for Disease Control and Prevention criteria. The nosocomial infections were related to UTIs (47.09%), blood infections (27.82%), wound infections (0.30%), and RTIs (16.81%). The most common bacterium was E. coli (68.51%) in the women’s ward and in urine samples (82.22%).The highest resistance was found for Co-trimoxazole (57.47%). Statistically significant differences were not observed between the female and male groups with nosocomial infections (p>0.05). Conclusion: Our research shows the existence of nosocomial infections in patients and antibiotic resistance in bacteria isolated from them. According to our results, appropriate programs for management of nosocomial infections and antibiotic resistance are necessary.
Page(s) 9-14
Mary-Louise McLaws, Mohsen Momeni, Mahbobeh Oroei, Mina Danaei, Mehrdad Askarian, Charles John Palenik, Hourvash Akbari Haghighi Nejad
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Background and Objective: We conducted a qualitative study to evaluate oncology and chemotherapy ward nurses’ perspectives concerning cytotoxic waste collection and disposal in Shiraz Medical University Hospitals and Clinics. Methods: Thematic analysis using the Grounded Theory approach was used on qualitative data collected during individual semi-structured interviews. Sixteen nursing staff experienced in chemotherapy services was each interviewed for 30–45 minutes. Interviews covered items from participant experiences and perceptions concerning obstacles to correct collection and disposal. Results: Two main barriers, individual and organizational, were identified. Conclusion: We found barriers to proper management of cytotoxic waste were a combination of individual and organizational factors. We propose the creation of a comprehensive training program coveringthe management and handling of cytotoxic waste for all healthcare workers and managers and development of a compliance surveillance scheme.
Page(s) 15-20
Alisha Akya, Keyghobad Ghadiri, Lida khodadadi, Lealy Nategh, Maryam Amighi, Amin Jalilian
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Background and Objective: Nosocomial infections are infections that develop 48 or 72 hours after the patient's admission to the hospital or during the specified period of 10 to 30 days after discharge. These infections should be non-existent at the time of the patient's admission and should not be at their incubation period either. The present study was conducted with the purpose of investigating the incidence rate of nosocomial infections and the associated factors at the Gynecology ward of Imam Reza Hospital of Kermanshah in 2012-13. Methods: The present cross-sectional study was conducted on cases of nosocomial infection in the gynecology ward of Imam Reza Hospital of Kermanshah in 2012-13. Data regarding the patients’ demographic information, the type of bacteria isolated from the culture and the antibiotics taken were collected using a questionnaire designed based on the National Monitoring System of Nosocomial Infections and according to the Diagnosis Algorithm for Nosocomial Infections provided in the National Nosocomial Infections Surveillance System's guidelines. Data were then analyzed using SPSS-19.Results: In 2012, 6244 women, and in 2013, 6855 women were admitted to the hospital, making a total of 13099 cases. In 2012, 0.44%, and in 2013, 0.99% of the admitted patients developed nosocomial infections, making the incidence of nosocomial infections in 2012 and 2013 at estimated rates of 44.8 and 99.1 in every 10,000 patients, in respective order; and the majority of patients were over the age of 20 (P<0.05). The most common nosocomial infections were included the surgical wound, urinary, blood and pulmonary secretion infections. The most commonly isolated organisms included Staphylococcus aureus, Candida albicans and Citrobacter. The antibiotics used included ampicillin, cefixime, gentamicin and metronidazole. Conclusion: Due to the increasing rate of nosocomial infections in gynecology ward and given their devastating effects on women health, hospitals should take extra care to report these cases, and as surgical site infections are more prevalent, pre and post operative care should be provided with the highest degree of precision.
Page(s) 21-30
Zhaleh Dezfoolimanesh, Nasrollah Sohrabi, Mohammad Rasoul Tohidnia
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Background and Objective: Production of extended-spectrum ß-lactamases (ESBLs) is the major cause of resistance to β-lactam antibiotics in Escherichia coli. In this study, the antibiotic susceptibility pattern and the prevalence of ESBL-producing E. coli isolates were studied in a hospital in Kermanshah, western Iran. Methods: E. coli isolates were identified using microbiological and biochemical standard tests. Antibiotic susceptibility testing and the detection of ESBL-producing E. coli isolates were done according to Clinical and Laboratory Standards Institute (CLSI) criteria. Results: The most frequent isolation source of E. coli clinical isolates was urine (94.1%). Most of the isolates were resistant against ampicillin (88.2%). Imipenem and amikacin were the most active antibiotics having 81.2% and 78.8% activity, respectively. Results of antimicrobial susceptibility showed that 57.6% of isolates were multidrug resistant (MDR). Results of Combined Disk Test (CDT) showed that 56.5% of isolates were ESBL positive, and among MDR isolates, 79.6% were ESBL producers. There was a significant difference in ESBL MDR patterns between ESBL producers and non-producer ESBL E.coli isolates (p<0.05). Conclusion: Results of this study showed that most isolates were MDR and pose problems for therapeutics. Prevention and control of antibiotics resistance requires efforts at increasing surveillance and infection control and limitation of unnecessary antibiotic use.
Page(s) 31-37
Alisha Akya, Mansour Aletaha, KeyghobadGhadiri, Mansour Rezaee
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Background and Objective: Sexually transmitted diseases (STDs) are common infectious diseases in communities. Mycoplasma hominis, Mycoplasma genitalium, and Ureaplasma urealyticum are the smallest bacteria without cell walls and can cause various STDs. This study aimed to investigate the prevalence of these bacterial infections in women with cervicitisin Kermanshah. Methods: Two hundred and thirty-five married women with cervicitis were included, cervical samples were collected using Dacronswabs, and demographic and other crelevant data of the women were recorded. Bacterial DNA was extracted for Polymerase Chain Reaction (PCR) analysis with specific primers for the detection of M. hominis, M. Genitalium and U. urealyticum. Results: Of the 235womenwith an averageageof32.5 years, 82 (34.9%) were infected, and 12 (5.1%), 14(6%) and 61(26%) had M. hominis, M. genitalium, and U. urealyticum infection, respectively. Two hundred and twenty-one patients (94%) had clinical symptoms and vaginal discharge was the most common symptom among women with cervicitis. Conclusion: Theoverall prevalence rate of mycoplasma infection in Kermanshahissimilartothat in other parts oftheworld. The frequency of infection by this bacterium is higher among age groups with more sexual activity. The use of condom reducesmycoplasma infections, indicating the significant role that men play in the transmissionofthese bacteria. Mycoplasma infection needs to be considered and assessed among women with cervicitis.
Page(s) 39-47
Maria Rangelova Todorova-Christova, Damyan Nikolov Damyanov, Rossitza Stefanova Vatcheva-Dobrevska, Nasya Spartakova Hadzhieva, Anna Bozhidarova Kirtcheva, Peter Parvanov Parvanov
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background and Objective: Surgical site infections (SSIs) have an enormous impact over the operative intervention outcome. In the last 20 years the use of antibiotic prophylaxis (ABP) has been greatly improved as regards appropriate choice of antibacterial drugs, timing of initial dose and precised duration of the administration scheme. Methods: The study should be considered a compiling work (references review), reviewing some latest original statements on antibitic prophylaxis in surgery of experienced centers and a society of anesthesiology and reanimation. The recommendations discussed were selected with the presumption of demonstrating practical guidelines of highly interested in antibiotic prophylaxis institutions. The analysis takes into consideration the specific definitions and risk-related factors for SSI. Thus the recommended new (2010) algorithms of the strategy for antibiotic prophylaxis are presented in the context of, and in compliance with the classification systems of wounds, and with respect to the majorsurgical clinical specialities. Results The study presents some new recommended regimens (2010) for antibitic prophylaxis administration considering surgical wounds classifications (by anatomical location, class of the wound), and major surgical specialities practice, substantiated by the practical experience of leading medical centers and a society of anesthesiology and reanimation. Conclusion: These guidelines should be treated as general statements regarding the appropriate practices for ABP, based on the current available medical references and the clinical experience in the course of time of their development. They could be considered a guidance applying to the elaboration of antibiotic policy for surgical wards and critical care units as resuscitation, intensive care units, in particular the responsible original decisions for the individual patients considering their general health and surgical status.
Page(s) 48-55
Orhnan Nadhm Mawlood, Ibrahim Khasraw Ghafoor, Adnan Muhammad Hasan
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Background and Objective: Thalassemia, one of the most dangerous diseases, is an inherited impairment of hemoglobin production, in which there is partial or complete failure of the globin chain synthesis. To evaluate the prevalence of hepatitis C in multi-transfused children with thalassemia major. Materials and methods: From February 2014 to September 2014, 200 patients with thalassemia major were studied retrospectively. Data regarding their age, sex, number of blood transfusions, use of chelating agents, and history of splenectomy were obtained. Serum was used for detection of antibodies against HCV, HBsAg and HIV. In addition, the liver enzymes AST and ALT were checked. Results: Eighty-eight (44%) patients were found to be HCV seropositive. The prevalence correlated with gender, history of splenectomy, and number of blood transfusions. No significant differences were found between age groups or chelating agents. Liver enzymes were significantly higher in seropositive patients. Conclusion: Multi-transfused patients with thalassemia have a high risk of HCV infection, and more accurate techniques of blood screening are recommended.
Page(s) 56-64
Haider AliGhashghaee, Bigan Saboor, Ehsan Malekianzadeh, Maryam ChalehChaleh, Kamran Vafaee-Dehbaghi
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Background and Objective: Nosocomial infections are a major health issue in health care system, where pneumonia is the most common infection in the intensive care unit. This study aims to assess the effect of oral suctioning before position change on incidence of ventilator-associated pneumonia in patients undergoing mechanical ventilation in intensive care unit at Imam Reza Hospital in 2012. Methods: In a clinical trial with control group, 60 patients with less than 6 hours of intubationwere randomly divided into intervention and control groups 48 hours after mechanical ventilation. In the intervention group, oral secretions were suctioned before position change, and in the control group, suctioning was performed as required. After 72 hours, patients were assessed for incidence of pneumonia. Data were analyzed in SPSS-16 using descriptive and inferential statistical tests. Results: According to the results, incidence of pneumonia was 10% in the intervention group and 33.33% in the control group, with a significant difference between the two (P=0.029). Conclusion: Performing suction before position change can reduce ventilator-associated pneumonia. Thus, this technique is recommended to prevent pneumonia.
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