Assessment of minimally invasive surgical skills is a non-trivial task, usually requiring the presence and time of expert observers, including subjectivity and requiring special and expensive equipment and software. Although there are virtual simulators that provide self-assessment features, they are limited as the trainee loses the immediate feedback from realistic physical interaction. The physical training boxes, on the other hand, preserve the immediate physical feedback, but lack the automated self-assessment facilities. This study develops an algorithm for real-time tracking of laparoscopy instruments in the video cues of a standard physical laparoscopy training box with a single fisheye camera. The developed visual tracking algorithm recovers the 3D positions of the laparoscopic instrument tips, to which simple colored tapes (markers) are attached. With such system, the extracted instrument trajectories can be digitally processed, and automated self-assessment feedback can be provided. In this way, both the physical interaction feedback would be preserved and the need for the observance of an expert would be overcome. Real-time instrument tracking with a suitable assessment criterion would constitute a significant step towards provision of real-time (immediate) feedback to correct trainee actions and show them how the action should be performed. This study is a step towards achieving this with a low cost, automated, and widely applicable laparoscopy training and assessment system using a standard physical training box equipped with a fisheye camera.

The in vitro efficacy of temocillin in combination with ticarcillin and with gentamicin, tobramycin, amikacin and netilmicin against 80 Gram-negative and 20 Gram-positive bacterial strains was compared by use of the checkerboard agar dilution technique. No synergistic or additive effect was seen on the Gram-positive strains. Great variations occurred between the different bacterial species, and the temocillin-ticarcillin combination had only little effect against the Pseudomonas strains tested. On average, only 12% of all strains tested were inhibited synergistically by temocillin-gentamicin combinations, and only 7 to 10% by combinations of temocillin with the other aminoglycosides. However, 25% of Gram-negative strains were inhibited synergistically and 40% of Gram-negative strains were inhibited additively by the combination of temocillin-gentamicin.

Objective:To evaluate whether operating room (OR) ventilation with (vertical) laminar airflow impacts on surgical site infection (SSI) rates. Design:Retrospective cohort-study based on routine surveillance data. Patients and Methods:Sixty-three surgical departments participating voluntarily in the German national nosocomial infections surveillance system “KISS” were included (a total of 99,230 operations). Active SSI surveillance was performed according to the methods and definitions given by the US National Nosocomial Infection Surveillance system. Surgical departments were stratified according to type of OR ventilation used: (1) turbulent ventilation with high-efficiency particulate air-filtered air, and (2) HEPA-filtered (vertical) laminar airflow ventilation. Multivariate analyses were performed by the generalized estimating equations method to control for the following variables as possible confounders: (a) Patient-based: wound contamination class, ASA score, operation duration, patients’ age and gender, endoscopic operation; (b) Hospital-based: the number of beds in the hospital, its academic status, operation frequency, and long-term participation in KISS. Results:The risk for severe SSI after hip prosthesis implantation was significantly higher using laminar airflow OR ventilation (1.63 < 1.06; 2.52>), as compared with turbulent ventilation. The adjusted odds ratios for the other operative procedures analyzed were: knee prosthesis 1.76 < 0.80, 3.85>; appendectomy 1.52 < 0.91, 2.53>; cholecystectomy 1.37 < 0.63, 2.97>; colon surgery 0.85 < 0.49, 1.49>; and herniorrhaphy 1.48 < 0.67; 3.25>. Conclusions:Unexpectedly, in this analysis, which controlled for many patient and hospital-based confounders, OR ventilation with laminar airflow showed no benefit and was even associated with a significantly higher risk for severe SSI after hip prosthesis.

In a multi-center study 523 strains of H. influenzae and H. parainfluenzae isolated from patients in eight towns of the Federal Republic of Germany were tested for their sensitivity to 15 different chemotherapeutic agents. 1.7% of the strains were resistant to ampicillin, 1,5% to chloramphenicol and 2.5% to tetracycline. All ampicillin-resistant strains produced beta-lactamase. For the first time, multiple resistant strains were isolated: two against ampicillin, chloramphenicol and tetracycline; one in addition also against co-trimoxazole. It is likely that there will be a spread of such resistant strains.

Using a 1% aldehyde disinfectant the bacterial count was reduced by 84% by scrubbing the floor, by 60% with a wet mop and by 50% with a dry mop. However, two hours after floor disinfection the bacterial count was nearly back to pretreatment when walked on again. Disinfectant mats did not decrease bacterial count on the surface behind them. Plastic overshoes did not influence floor contamination. There was no significant difference regarding the infection rate, in an intensive care unit during a six-month period, between routine floor disinfection and cleaning without disinfectant. It is possible that by doing without routine floor disinfection something like 20 million DM can be saved per year. The World Health Organisation also recommends floor disinfection only immediately after contamination of the floor by infectious secretions.

Cefotaxim was administered to ten children with purulent meningitis. All isolated micro-organisms were highly sensitive to it in serial dilution, except for one case, and were quickly removed from blood and CSF by the administration of cefotaxim alone. Blood and CSF concentrations measured in eight children were much above the minimal inhibitory concentration for the particular micro-organism. Thus cefotaxim has a high antibacterial activity and satisfactory CSF passage in purulent meningitis caused by sensitive, especially gram-negative, bacteria and is well suitable for therapy, if penicillins alone or combined are not applicable or effective.

Grundproblematik und Fragestellung: Patienten und Methodik: Ergebnisse: Folgerung: Objective: Patients and methods: Results: Conclusion:

According to the German Law on Infectious Diseases (Infektionsschutzgesetz or IfSG) German outpatient centres must provide evidence of maintaining certain standards of hygiene and record their nosocomial infection rates. To fulfill their legal obligations, the Commission for Hospital Hygiene and the Prevention of Infection recommends surveillance modules such as that known as AMBU-KISS.The AMBU-KISS project centre implemented a survey to evaluate all procedures relevant to hygiene, surveillance of surgical site infections, and facilities available at centres participating in the AMBU-KISS surveillance programme. The questionnaire was returned by 99 of 110 participants.All the centres possess cleaning and disinfection schemes, and practically all of them use written instructions on the processing of instruments and surgical hand disinfection procedure. Many of the participants spend too much time on surgical hand disinfection and presurgical skin disinfection.The survey demonstrates that hygienic conditions at centres participating in AMBU-KISS are largely satisfactory. However, there is nevertheless a need to optimise infection control measures.

The purpose of this study was to analyse risk factors for blood stream infection (BSI) and pneumonia in neutropenic patients who have undergone peripheral blood stem-cell transplantation (PBSCT). Data were taken from the ONKO-KISS multicenter surveillance project. Infections were identified using CDC definitions (laboratory-confirmed BSI) and modified criteria for pneumonia in neutropenic patients. The multivariate analysis was performed using the Fine-Gray regression model for the cumulative incidences of the competing events 'infection', 'death' and 'end of neutropenia'. The risk factors investigated were: sex, age, underlying disease and type of transplant. From January 2000 to June 2004, a total of 1699 patients in 20 hospitals were investigated. In the multivariate analysis, male patients had a significantly higher risk of acquiring BSI than female patients (P=0.002). The risk of acquiring BSI is highest in patients with advanced acute myeloid leukaemia (AML). In the univariate and multivariate analysis, unrelated donor allogeneic transplantation constituted a risk factor for pneumonia (P=0.012). ONKO-KISS provides reference data on the incidence of pneumonia and BSI. The increased risk for BSI in males and patients with advanced AML, and the increased risk for pneumonia in unrelated donor allogeneic PBSCT patients should be targeted to prevent infections in these higher risk groups.

Vor dem Hintergrund des Infektionsschutzgesetzes müssen auch ambulante Zentren nachweisen, dass sie hygienisch arbeiten, und die Rate ihrer nosokomialen Infektionen aufzeichnen. Für diese gesetzlichen Regelungen empfiehlt die Kommission für Krankenhaushygiene und Infektionsprävention Surveillance-Module wie AMBU-KISS (ambulantes Krankenhaus-Infektions-Surveillance-System).

OBJECTIVES To evaluate the impact of an intervention to reduce the duration of antibiotic treatment for pneumonia in a neurosurgical intensive care unit (ICU). The usage of antibiotics and the resultant costs were examined using interrupted time series analysis while resistance and device-associated infection rates are also described. METHODS In January 2004, revised guidelines for the use of antibiotics were implemented. As a consequence of this, the duration of antibiotic therapy for nosocomial pneumonia was reduced from 14 to 7 days, while for community-acquired pneumonia the period fell from 10 to 5 days. The effect on the antibiotic use density [AD; expressed as defined daily doses (DDD) per 1000 patient days (pd)] was calculated by segmented regression analysis of interrupted time series for the 24 months prior to (2002 and 2003) and after the intervention (2004 and 2005). RESULTS The intervention was associated with a significant decrease in total AD from 949.8 to 626.7 DDD/1000 pd after the intervention. This was mainly due to reduced consumption of second-generation cephalosporins (-100.6 DDD/1000 pd), imidazoles (- 100.3 DDD/1000 pd), carbapenems (-33.3 DDD/1000 pd), penicillins with beta-lactamase inhibitor (-33.5 DDD/1000 pd) and glycopeptides (-30.2 DDD/1000 pd). Glycopeptide reduction might be associated with a significant decrease in the proportion of methicillin-resistant Staphylococcus aureus (8.4% before and 2.9% after the intervention). Similarly, total antibiotic costs/pd (Euro) showed a significant decrease from 13.16 Euro/pd before to 7.31 euro/pd after the intervention. This is a saving of 5.85 Euro/pd. The incidence of patients dying with pneumonia did not change significantly. CONCLUSIONS The most conservative estimate of segmented regression analysis over a 48 month period showed that halving the duration of treatment for pneumonia results in a reduction of over 30% in antibiotic consumption and costs. Because respiratory infections are most common in ICU patients, interventions targeting a reduction in the duration of treatment of pneumonia might be extremely worthwhile.

Clinical data show that EPs (R) 7630, an aqueous ethanolic extract from the roots of Pelargonium sidoides, can be used for the treatment of upper respiratory tract infections (URTI). The biological effects of the preparation have not been fully investigated. The objective of this Study was to examine the impact of EPs (R) 7630 on the activity of human peripheral blood phagocytes (PBP).A whole blood-based, flow cytometric assay was used to simultaneously assess phagocytosis and oxidative burst. Calcein-AM stained Candida albicans (DSM 1386) were used as target organisms. Oxidative burst was measured by addition of dihydroethidum (DHE). Target organisms and whole blood were co-incubated and analyzed after 0, 2. 4 6. 10, and 30 min. Intracellular killing of the target organisms was evaluated by determining the number of surviving yeast cells after co-incubation of C albicans and human whole blood. EPs (R), 7630 was applied in therapeutically relevant concentrations between 0 and 30 mu h/ml.Compared with controls EPs (R), 7630 increased the number of phagocytosing PBP during the observed time points between 2 and 10 min in a concentration-dependent manner, with a maximum enhancement of 56% at 2 min (p = 0.002). The application of EPs (R) 7630 also led to a significant increase in the number of burst-active PBP for all time points observed beyond 2 min (p < 0.001). The maximum augmentation was 120% after application of 30 mu g/ml EPs (R) 7630 at 4 min. Using a microbiological assay, intracellular killing was also enhanced by EPs (R) 7630. This was expressed by a significant reduction in the number of surviving target organisms (p<0.001). The maximum reduction in viable yeast cells (-31%) was observed after co-incubation for 120 min with the highest concentration of EPs 7630 (30 mu g/ml).In conclusion, the positive effects of EPs (R) 7630 on phagocytosis, oxidative burst, and intracellular killing of yeast cells as test organisms are important components of the compound's biological activity. Our findings constitute a valuable contribution to understanding the clinical effects of EPs (R) 7630. (C) 2006 Elsevier GmbH. All rights reserved.

The study presented here was conducted over a period of 4 years (2001–2004) to investigate changes in the number of S. maltophilia isolates detected per 1,000 patient days and to look at the incidence density of nosocomial infections caused by S. maltophilia . The analysis was based on data provided by 34 German intensive care units participating continuously in the national project “Surveillance of Antimicrobial Use and Resistance in ICUs”; 31 of these ICUs reported nosocomial infections to the German infection surveillance system, KISS, during the study period.

OBJECTIVE:To evaluate whether surgical site infection (SSI) rates decrease in surgical departments as a result of performing active SSI surveillance.DESIGN:Retrospective multiple logistic regression analyses.SETTING:A group of 130 surgical departments of German hospitals participating in the Krankenhaus Infektions Surveillance System (KISS).METHODS:Data for 19 categories of operative procedures performed between January 1997 and June 2004 were included (119,114 operations). Active SSI surveillance was performed according to National Nosocomial Infections Surveillance system (NNIS) methods and definitions. Departments' SSI rates were calculated individually for each year of surveillance and for each operative procedure category, taking into account when the individual departments had begun their surveillance activities. Multiple logistic regression analyses on a single operation basis were carried out with stepwise variable selection to predict outcomes for patients with SSI. The variables included were as follows: the department's year of participation, NNIS risk index variables, patients' age and sex, and the hospitals' structural characteristics, such as yearly operation frequency, number of beds, and academic status.RESULTS:For 14 of 19 operative procedure categories analyzed, there was a tendency toward lower SSI rates that was associated with increasing duration of SSI surveillance. In multiple logistic regression analyses of pooled data for all operative procedures, the departments' participation in the surveillance system was a significant independent protective factor. Compared with the surveillance year 1, the SSI risk decreased in year 2 (odds ratio, 0.84; 95% confidence interval, 0.77-0.93) and in year 3 (odds ratio, 0.75; 95% confidence interval, 0.68-0.82), and there was no change in year 4.CONCLUSION:The SSI incidence was reduced by one quarter as a result of the surveillance-induced infection control efforts, which indicates the usefulness of a voluntary surveillance system.