On January 1, 1999, all adult critically ill patients were moved to new and larger SICU and MICU facilities. The rate of nosocomial infections was calculated before and after the introduction of the AIC as an intervention for the time periods that preceded the move. On August 1, 1998, the AICs were introduced to the MICU and SICU. In the old unit, the rate of nosocomial BSIs decreased from 6.8 per 1,000 patient-days prior to the introduction of the AICs (ie, September 1, 1997, to July 31, 1998) to 1.9 per 1,000 patient-days after their introduction (ie, August 1 to December 31, 1998) [p < 0.001]. Similarly, the rate of documented catheter-related infections decreased from 3.4 per 1,000 patient days to 0.2 per 1,000 patient-days (p = 0.003) during the two time periods described above. In addition, the rate of nosocomial Gram-positive BSIs significantly decreased during the same time periods (p < 0.01) and tended to decrease for nosocomial Gram-negative BSIs (p = 0.06).
Most of the nosocomial primary BSIs were caused by Gram-positive organisms. When calculated in terms of 1,000 patient-days, there was a significant decrease in nosocomial Gram-positive BSIs from FY 1998 to FY 1999. For specific Gram-positive organisms, there was a significant decrease in the rate of nosocomial BSIs independently for VRE infections, coagulase-negative staphylococci, and vancomycin-sensitive enterococci (p < 0.05). In addition, the rate of nosocomial BSIs caused by Gram-negative bacillary organisms tended to decrease from 1 per 1,000 patient-days in FY 1998 to 0.2 per 1,000 patient-days in FY 1999 (p = 0 0.06). Within the limitations of small numbers, there was no significant decrease in the frequency of Pseudomonas aeruginosa infections or Candida infections for the two time periods. In three of eight (38%) of the nosocomial VRE bacteremias diagnosed in FY 1998, the catheter was documented as the source of the BSI.
Seven of the eight VRE isolates were available for susceptibility testing. Five of the seven isolates were susceptible to minocycline (MIC, < 2 g/mL). There were two additional VRE bacteremic isolates, one of which was resistant to minocycline (MIC, 8 g/mL) but was highly susceptible to rifampin (MIC, < 0.06 g/mL). The other VRE bacteremic isolate had intermediate susceptibility to minocycline (MIC, 4 g/mL) but was highly resistant to rifampin (MIC, > 128 g/mL) Tretinoin cream Canada. Hence, six of the seven isolates were susceptible either to minocycline or rifampin, and therefore, the catheters impregnated with minocycline and rifampin had a zone of inhibition of > 11 mm against these same isolates.