• Archives of Plastic Surgery
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• v.38 no.5
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• pp.590-593
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• 2011

Purpose: Surgical site infections (SSIs) are the third most frequently reported nosocomial infection. Of these SSIs, mostly were confined to the incision associated with underlying disease as diabetes, cigarette smoking, systemic steroid use, obesity, operating room environment, suture and surgical technique. This study has been planned to reduce the SSIs by using Vicryl $plus^{(R)}$ (Ethicon, USA) which contains triclosan, a broad-spectrum antibacterial agent, into the infected wound to evaluate whether or not Vicryl $plus^{(R)}$ (Ethicon, USA) is effective to nosocomial bacteria using a zone of inhibition assay. Methods: We did a comparison of Vicryl $plus^{(R)}$ suture (with triclosan) size 2-0, 5-0 with $Vicryl^{(R)}$ suture (without triclosan) size 4-0 each as treatment and control group, applied in Mueller-Hinton agar infected by following mircroorganisms: Methicillin-sensitive $Staphylococcus$ $aureus$ (MSSA), Methicillin-resistant $Staphylococcus$ $aureus$ (MRSA), Acinetobacter baumanii, $Escherichia$ $coli$, Enterobacter faecalis, Pseudomonas aeruginosa, Candida albicans. Cultures were made of the selected mircroorganisms, seeding the study strain in agar plates for 24 and 48-hour period in an oven at $37^{\circ}C$ followed by zone of inhibition assay. Results: Vicryl $plus^{(R)}$ group has demonstrated to create a zone of inhibition against MRSA, MSSA and $A.$ $baumanii$, but no effect on $E.$ $faecalis$, $P.$ $aeruginosa$, $C.$ $albicans$. Vicryl $plus^{(R)}$ suture size 2-0 also had antibactericidal effect while Vicryl $plus^{(R)}$ suture size 5-0 did not. $Vicryl^{(R)}$ group had no zones of inhibition showing colonization at all mircroorganisms. Conclusion: Our results seem to warrant the use of Vicryl $plus^{(R)}$ as absorbable buried suture when concerning SSIs as a prophylaxis against surgical nosocomial infection.

• Journal of Yeungnam Medical Science
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• v.16 no.2
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• pp.347-356
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• 1999

Background: Exit site/tunnel infection causes considerable morbidity and technique failure in CAPD patients. We presently use a unique revision method for the treatment of refractory ESI/TI in CAPD patients and mupirocin prophylaxis for high risk patients. Materials and Methods: We reviewed 139 CAPD patients about the ESI/TI from October 1993 to February 1999 at Yeungnam University Hospital. At the beginning of the ESI. we usually started medications with rifampicin and ciprofloxacin and then changed the antibiotics according to the sensitivity test. If the ESI had persisted and there were TI symptoms (purulent discharge, abscess lesion around exit site). we performed catheter revision(external cuff shaving, disinfection around tunnel and new exit site on opposit direction) with a combination of proper antibiotics. We applied local mupirocin ointment at the exit site three times per week to the 34 patients who had the risk of ESI starting from October 1998. Results: The total follow-up was 2401 patient months(pt. mon). ESI occurred on 105 occasions in 36 out of 139 patients, and peritonitis occurred on 112 occasions in 67 out of 139 patients. The total number of incidences of ESI and peritonitis was 1 per 23.0 pt. mon and 1 per 2l.6 pt.mon. The most common organism responsible for ESI was Staphylococcus aureus (26 of 54 isolated cases, 48%), followed by the Methicillin resistant S. aureus(MRSA) (13 cases, 24%). Seven patients(5: MRSA. 2: Pseudomonas) had to be treated with a revision to control infection. Three patients experienced ESI relapse after revision. One of them improved with antibiotics, while another needed a second revision and the remaining required catheter removal due to persistent MRSA infection with re-insertion at the same time. But, there was no more ESI in these 3 patients who were received management to relapse (The mean duration: 14.0 months). The rates of ESI were significantly reduced after using mupirocin than before(1 per 12.7 vs 34.0 pt.mon, P<0.01). Conclusions: In summary, revision technique can be regarded as an effective method for refractory ESI/TI before catheter removal. Also local mupirocin ointment can play a significant role in the prevention of ESI.

• Child Health Nursing Research
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• v.22 no.4
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• pp.379-389
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• 2016

Purpose: A longitudinal study was conducted to explore flora colonization and oral glucose high-risk newborns during the first 7 days after birth. Methods: Oral secretions of hospitalized newborns were obtained for microbial cultures and glucose test at days 1-7 after birth. Results: Among the total 112 newborns, 40% were girls and 73% were premature. Mean gestational age was $34.4{\pm}3.2$ weeks and weight was $2,266{\pm}697.5$ grams. The most common flora included Streptococcus (28.2%), Methicillin-resistant Staphylococcus aureus (MRSA, 10.9%), Staphylococcus (6.0%) and Coagulase-Negative Staphylococcus (CNS, 4.0%). The average oral glucose level was $29.2{\pm}23.0mg/dL{\sim}58.2{\pm}39.5mg/dL$. Newborns with higher oral glucose than serum (crude odds ratio [ORc] =1.75; 95% confidence interval [CI] =1.03-2.97), phototherapy (ORc=3.30; 95% CI=2.29-4.76) and prone position (ORc= 2.04; 95% CI=1.13-3.69) were more likely to be colonized. Having oral tubes (ORc=0.42; 95% CI=0.29-0.59), parental nutrition (ORc=0.21; 95% CI=0.13-0.32) and antibiotics (ORc=0.51; 95% CI=0.36-0.73) had protective effects. For oral glucose statistical significances existed on time effect among newborns with Streptococcus (F=9.78, p=.024), MRSA (F=7.60, p=.037) or CNS (F=11.15, p=.019) and interaction between time and colonization among newborns with all of four flora (F=2.73, p=.029) or colonization with only Staphylococcus (F=2.91, p=.034). Conclusion: High-risk newborns develop flora colonization at an early period of life. Their clinical features were associated with types and time of oral flora colonization. They need close monitoring and multifaceted intervention to improve oral environment and infection control.

• Journal of Society of Preventive Korean Medicine
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• v.23 no.1
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• pp.27-47
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• 2019

Purpose : This study was designed to identify the perception and practice level of infection control among korean medical doctors and to identify factors that may influence the performance and practice level. Methods : Data were collected using the on­line survey method. Seven hundred and eighty four Korean medical doctors(KMD) participated the survey. The study was conducted from December 2018 to January 2019. Results : The results of this study are as follows. 1. Participants who experienced infection risk by needles or sharp instruments were 596(76%). and participants who had experienced blood or body fluid contact with the mucous membrane or skin of the patient during treatment were 226(28.8%) of them. 2. The degree of perception and practice of the infectious guideline was higher in the group over 50 years, in the doctor group, in the group with more than 6 years experience in clinic and in the group who work in the hospital. (p < 0.05) 3. In the performance of the infection control management related to the Korean medical treatment, the practice level of the article 'Discard the remaining needle that used for one patient' was the lowest at 4.02, 'Identify the patient and check the validity period of sterilization of medicines or instruments' was the second lowest in 4.16. 4. Among the contents of "Prevention of Nosocomial infection and Sanitary Safety Guidelines" issued by the Korean Medical Association in 2008, the guideline "Prevention of infection by pathogens such as HIV, MRSA, SARS" were lowest article in the perception and practice level of participants. 5. Regression analysis was performed to find out the factors affecting perception and performance of the participants. The regression model showed significant difference in the regression model of the working years. (p < 0.05) 6. In order to examine the effect of the variables on the perception and practice of the infectious guideline, the mediated effect of the knowledge and education level according to the years of working, age, education degree was found to be significant only in the education degree variable. (p < 0.05) In conclusion : in order to improve the perception and practice of infectious control of Korean medicine doctors, it is necessary to include the contents of infection management as essential education during the continuing education of Korean medicine association.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.14
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• pp.5787-5791
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• 2014

Background: With increasing survival periods and diversification of treatment methods, treatment of critically ill cancer patients has become an important factor influencing patient prognosis. Patients with cancer are at high risk of infections and subsequent complications. This study investigated the incidence and factors contributing to the development of ventilator-associated pneumonia (VAP). Materials and Methods: This retrospective study investigated the incidence of VAP and factors leading to infection in patients admitted to the intensive care unit (ICU) of a cancer center from January 1, 2012 to December 31, 2013. Results: The incidence of VAP was 2.13 cases per 1,000 days of intubation, and 13 of 288 patients (4.5%) developed VAP. Lung cancer was the most common cancer associated with VAP (N=7, 53.9%), and longer hospital stays and intubation were associated with increased VAP incidence. In the group using a "ventilator bundle," the incidence was 1.14 cases per 1,000 days compared to 2.89 cases per 1,000 days without its use; however, this difference was not statistically significant (p=0.158). Age (${\geq}65$, OR=5.56, 95% confidence interval [CI]=1.29-23.95), surgery (OR=3.78, 95%CI=1.05-13.78), and tracheotomy (OR=4.46, 95%CI=1.00-19.85) were significant VAP risk factors. The most common causative organisms were methicillin-resistant Staphylococcus aureus (MRSA) and Pseudomonas aeruginosa (N=4, 30.8% each), followed by Acinetobacter baumannii and Candida albicans (N=2, 15.4% each). Conclusions: The incidence of pneumonia among critically ill cancer patients is highest in those with lung cancer, but lower than among non-cancer patients. The length of hospital stay and time on mechanical ventilation are important risk factors for development of VAP. Although not statistically significant, "ventilator bundle" care is an effective intervention that delays or reduces incidence of VAP. Major risk factors for VAP include age (${\geq}65$ years), surgery, and tracheostomy, while fungi, gram-negative bacteria, and multidrug-resistant organisms were identified as the major causative pathogens of VAP in this study.

• Journal of Korean Biological Nursing Science
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• v.5 no.2
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• pp.21-30
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• 2003

The effect of hand hygiene was measured by hand culture before and after hand hygiene for 86 nurses, doctors, and nurses aide/housekeepers in Surgical Intensive Care Unit. The subjects were asked to press their dominant hand in hand-shaped Mannitol salt agar immediately after patient contact and then washed their hand by preferred hand hygiene agents [soap and water, waterless alcohol gel, or 4% chlorhexidine gluconate detergent (CHG)], and cultured one hand again Amount of isolated microorganism was calculated by counting the number of divided areas ($1{\times}1cm$) which is culture positive in hand culture plate. The amount of microorganisms were significantly reduced from 58.1(${\pm}38.59$) to 27.4(${\pm}30.4$) cells after hand hygiene. The staff nurse's hand hygiene was more effective compared to medical doctors and nurses aide/housekeepers. Methicillin-resistant Staphylococcus aureus(MRSA) was isolated in 41(47.1%) subjects ; but only removed 100% in 28(32.2%) subjects. When the amount of hand microorganisms was compared by subject's preferred hand hygiene agents, it was decreased in order of 4% CHG, waterless alcohol solution, soap and water, and water. The hand hygiene practice was inadequate to reduce hand microorganisms and significantly different by occupations. Further research and development of hand hygiene improvement program which emphasize the quality of hand hygiene is recommended.

• Biomedical Science Letters
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• v.20 no.2
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• pp.77-84
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• 2014

Periodic analysis of local epidemiologic data of prevalent pathogens of blood culture can provide clinicians with relevant information to guide empirical antibiotic therapy. In this study, we analyzed a pattern of change of causative microorganisms and antimicrobial resistance at a tertiary medical center in Chungcheong province from 2003 to 2012, retrospectively. Of 70,258 blood specimens cultured, 6,063 (8.6%) were positive. Among the positive isolates, 95.9% were aerobic or facultative anaerobic bacteria, 0.1% were anaerobes, and 3.9% were fungi. Coagulase-negative Staphylococci (CoNS) (32.9%), Escherichia coli (16.7%), Staphylococcus aureus (9.1%), Klebsiella pneumoniae (6.4%), and ${\alpha}$-hemolytic Streptococcus (5.9%) were commonly isolated bacteria, and Candida albicans (1.4%) was the most commonly isolated fungi. Enterococcus faecium progressively increased but Streptococcus pneumoniae, Acinetobacter baumannii and Proteus species gradually decreased over a period of 10 years. The multidrug-resistant microorganisms such as methicillin-resistant S. aureus (MRSA), vancomycin-resistant enterococci (VRE), cefotaxime-resistant E. coli, imipenem-resistant Pseudomonas aeruginosa (IRPA) and imipenem-resistant A. baumannii (IRAB), were significantly increased. Therefore, there is a need for a more strict control of antibiotics and a more updated guideline for the treatment of bloodstream infection.

• Archives of Plastic Surgery
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• v.35 no.4
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• pp.393-399
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• 2008

Purpose: Chronic infected wounds sustained over 4 weeks with exposed tendon or bone are difficult challenges to plastic surgeons. Vacuum assisted closure (VAC) device has been well used for the management of chronic wounds diminishing wound edema, reducing bacterial colonization, promoting formation of granulation tissue and local blood flow by negative pressure to wounds. But Commercial ready-made VAC device might have some difficulties to use because of its high expenses and heavy weight. So we modified traditional VAC device with silver dressing materials as topical therapeutic agents for control of superimposed bacterial wound infection such as MRSA, MRSE and peudomonas. Methods: We designed the modified VAC device using wall suction, 400 cc Hemovac and combined slow release silver dressing materials. We compared 5 consecutive patients' data treated by commercial ready-made VAC device(Group A) with 11 consecutive patients' data treated by modified VAC device combined with silver dressing materials(group B) from September 2004 to June 2007. Granulation tissue growth, wound discharge, wound culture and wound dressing expenses were compared between the two groups. Results: In comparison of results, no statistical differences were identified in reducing rate of wound size between group A and B. Wound discharge was significantly decreased in both groups. Modified VAC device with silver dressing materials showed advantages of convenience, cost effectiveness and bacterial reversion. Conclusion: In combination of modified VAC device and silver dressing materials, our results demonstrated the usefulness of managing chronic open wounds superimposed bacterial infection, cost effectiveness compared with traditional VAC device and improvement of patient mobility.

• Journal of Korean Foot and Ankle Society
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• v.22 no.1
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• pp.38-43
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• 2018

Purpose: Treatment of diabetic foot infection due to methicillin-resistant Staphylococcus aureus (MRSA) remains challenging. Applying vancomycin-impregnated cement is one of the best methods of treatment. Vancomycin-impregnated cement has been used worldwide; however, to date, there is a limited number of studies regarding its use. We evaluated the duration of antimicrobial activity of vancomycin-impregnated cement stored at room temperature after manufacturing. Materials and Methods: The vancomycin-impregnated cement was manufactured by mixing 1 g of vancomycin with 40 g of polymer and adding 17.90 g of liquid monomer. The cement dough was shaped into flat cylinders with diameter and height of 6 mm and 2 mm, respectively. Another cement of the same shape without mixing vancomycin was prepared as the negative control. All manufactured cements were sterilized with ethylene oxide gas and stored at room temperature. Each cement was placed on Mueller Hinton agar plate lawned with standard MRSA strain. Standard vancomycin disk and gentamicin disk were placed together. After 24 hours, the diameter of inhibition zone was measured, and if the diameter was less than 15 mm, vancomycin-impregnated cement was regarded as a loss of antimicrobial activity. The study was repeated every 2 weeks until vancomycin-impregnated cements lost their antimicrobial activity. Results: Vancomycin-impregnated cement stored for a duration of 16 weeks created a 14 mm inhibition zone, while vancomycin disk created a 15 mm inhibition zone. Vancomycin-impregnated cement stored for a duration of 17 weeks created 7 mm and 9 mm inhibition zones, while vancomycin disk created 16 mm and 15 mm inhibition zones, respectively. Conclusion: We found a decrease of antimicrobial activity in vancomycin-impregnated cements after 16 weeks. After 17 weeks, they showed definite loss of antimicrobial activity. Therefore, we recommend not using vancomycin-impregnated cement spacers that has been stored for more than 16 weeks at room temperature.

• Clinical and Experimental Pediatrics
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• v.46 no.1
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• pp.24-32
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• 2003

Purpose : Nosocomial infection with Staphylococcus aureus, especially methicillin resistant S. aureus, has become a serious concern in the neonatal intensive care unit. The aim of this study is to investigate the virulence factors, and the relationship between the antibiotic resistance and the associated genes of Staphylococcus aureus isolated from nasal cavity of neonates. Methods : Fifty one isolates of S. aureus were obtained from nasal swab taken in 28 neonates in the NICU and nursery of Pusan National University Hospital between February and May, 2001. They were tested in regard to antibiotic susceptibility, coagulase test and typing, plasmid DNA profile, as well as reactivity to enterotoxin A-E(sea, seb, sec, sed, see) genes and toxic shock syndrome toxin-1(tst) gene by polymerase chain reaction(PCR). Associated genes such as mecA, mecR1, mecI, and femA were also determined by PCR. The origin of MRSA strains was assessed using DNA fingerprinting by arbitrarily-primed polymerase chain reaction(AP-PCR). Results : Twenty three(45.1%) and six(11.8%) isolates were resistant to oxacillin and vancomycin respectively. Multidrug resistance to three or more of the antibiotics tested was observed in 51.0% of the isolates. Forty two isolates were coagulase positive and twenty two isolates had mecA gene. Sixteen isolates had both mecA and femA genes and had type I-III plasmids. 64.7% of isolates carried sec gene, and 80.4% carried tst gene. DNA fingerprinting by AP-PCR for 12 MRSA strains showed 10 distinct patterns, suggesting different origins. Conclusion : We confirmed that the prevalence of nasal carriage of S. aureus and the incidence of antimicrobial-resistant S. aureus, especially vancomycin resistance, is very high in neonates who were admitted in NICU and nursery. It is possible that these pathogens are responsible for serious nosocomial infections in neonates. The need for improved surveillance and continuous control of pathogens is emphasized.