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Lee MK, Kim N, Cho H, Bang JH, Park SW, Lee E. Risk of microbial transmission by reusing gloves after alcohol-based hand hygiene. J Hosp Infect 2023; 135:171-178. [PMID: 36934790 DOI: 10.1016/j.jhin.2023.01.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Revised: 12/27/2022] [Accepted: 01/15/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Disinfection of gloves might reduce the the workload of healthcare workers, protect the environment, and bring economic benefits. Thus, the safety of hand hygiene of gloved hands is an important issue. AIM We aimed to evaluate the risk of microbial transmission by comparing residual microorganisms after multiple patient contacts, with or without gloves, in clinical practice. METHODS Researchers, two with gloved hands (single or double gloves) and one with bare hands, made rounds of patients, followed by alcohol-based hand rub. Hand imprints were obtained before and after the rounds and cultured. The number of colony-forming units (CFUs) of gloved and bare hands was compared, and the colony distribution was evaluated semi-quantitatively by hand region. FINDINGS AND CONCLUSION A total of 108 imprints were obtained after 10 rounds. The median CFU counts were significantly higher in the gloved hands (single and double) than in the bare hands (9.00 vs. 3.50, p=0.028). The CFU counts of single- and double-gloved hands were higher after than before contact (p=0.044 and p=0.001, respectively). Carbapenem-resistant Acinetobacter baumannii was identified in a pair of double gloves after a round, which included patients with the same organism with identical antibiotic susceptibility results. The mean percentage of colony-growing compartments from gloved hands was significantly higher than that of bare hands in the finger and wrist regions (p=0.019 and p=0.049, respectively). Compared to bare hands, reuse of gloves increased residual microbial colonies and potential for transmission of multidrug-resistant organisms, even after using alcohol-based hand rub.
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Affiliation(s)
- Min Kyeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
| | - Namhee Kim
- Department of Laboratory Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Centre and Seoul National University College of Medicine, Seoul, Korea
| | - Hyunjae Cho
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ji Hwan Bang
- Department of Internal Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Centre and Seoul National University College of Medicine, Seoul, Korea
| | - Sang-Won Park
- Department of Internal Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Centre and Seoul National University College of Medicine, Seoul, Korea
| | - Eunyoung Lee
- Department of Internal Medicine, Seoul Metropolitan Government - Seoul National University Boramae Medical Centre and Seoul National University College of Medicine, Seoul, Korea
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Abolmaaty A, Amin DH, Abd El-Kader RMM, ELsayed AF, Soliman BSM, Elbahnasawy AS, Sitohy M. Consolidating food safety measures against COVID-19. J Egypt Public Health Assoc 2022; 97:21. [PMID: 36319882 PMCID: PMC9626693 DOI: 10.1186/s42506-022-00112-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/08/2022] [Indexed: 11/05/2022]
Abstract
Background The world is facing an extraordinarily unprecedented threat from the COVID-19 pandemic triggered by the SARS-CoV-2 virus. Global life has turned upside down, and that several countries closed their borders, simultaneously with the blockage of life cycle as a result of the shutdown of the majority of workplaces except the food stores and some few industries. Main body In this review, we are casting light on the nature of COVID-19 infection and spread, the persistence of SARS-CoV-2 virus in food products, and revealing the threats arising from the transmission of COVID-19 in food environment between stakeholders and even customers. Furthermore, we are exploring and identifying some practical aspects that must be followed to minimize infection and maintain a safe food environment. We also present and discuss some World Health Organization (WHO) guidelines-based regulations in food safety codes, destined to sustain the health safety of all professionals working in the food industry under this current pandemic. Conclusion The information compiled in this manuscript is supporting and consolidating the safety attributes in food environment, for a prospective positive impact on consumer confidence in food safety and the citizens’ public health in society. Some research is suggested on evaluating the use and potentiality of native and chemical modified basic proteins as possible practices aiming at protecting food from bacterial and viral contamination including COVID-19.
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Affiliation(s)
- Assem Abolmaaty
- Department of Food Science, Faculty of Agriculture, Ain Shams University, Cairo, Egypt
| | - Dina H Amin
- Department of Microbiology, Faculty of Science, Ain Shams University, Cairo, 1566, Egypt.
| | - Reham M M Abd El-Kader
- Radiation Microbiology Department, National Center for Radiation Research and Technology, Egyptian Atomic Energy Authority, Cairo, Egypt.
| | - Alaa F ELsayed
- Department of Microbiology, Faculty of Science, Ain Shams University, Cairo, 1566, Egypt
| | - Basma S M Soliman
- Department of Biochemistry and Nutrition, National Food Safety Authority, Cairo, Egypt
| | - Amr S Elbahnasawy
- Department of Bioecology, Hygiene and Public Health, Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Russia.,Department of Nutrition and Food Sciences, National Research Centre, Giza, Egypt
| | - Mahmoud Sitohy
- Department of Biochemistry, Faculty of Agriculture, Zagazig University, Zagazig, 44511, Egypt
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Singh M, Agrawal A, Sisodia D, Kasar PK, Kaur A, Datta V, Savanna RS, Singh M, Livesley N. Supplementing hand washing with proper use of alcoholic hand rub in a special neonatal care unit in a large academic public health institute at Jabalpur, Madhya Pradesh, India. BMJ Open Qual 2021; 10:bmjoq-2020-001131. [PMID: 34759034 PMCID: PMC8587682 DOI: 10.1136/bmjoq-2020-001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/25/2021] [Indexed: 11/29/2022] Open
Abstract
Objective The purpose was to increase use of alcoholic hand rub (AHR) in specialised newborn care unit (SNCU) to improve hand hygiene in order to reduce neonatal sepsis and mortality at Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur. Design A prospective interventional and observational study. Methodology We formed a quality improvement (QI) team in our SNCU consisting of doctors, nurses, auxiliary staff and parents (a floating member) to improve proper use of AHR. To identify the barriers to the problem, we used fishbone analysis tool. The barriers which were not allowing the health providers to use AHR properly identified were amount of AHR in millilitres to be used per day per baby, how much and when the amount of AHR to be indented from the main store and what is the proper site to place the bottle. We used plan–do–study–act cycles to test and adapt solutions to these problems. Within 5–6 weeks of starting our project, AHR use increased from 44 mL to 92 mL per baby per day and this is sustained around 100 mL per baby per day for over 2 years now. Results Significant decrease in neonatal mortality was observed (reduced from median of 41.0 between August 2016 and April 2018 to 24.0 between May 2018 and December 2019). The neonates discharged alive improved from 41.2 to 52.3 as a median percentage value. The percentage of babies who were referred out and went Left Against Medical Advice (LAMA) deceased too. Conclusion Multiple factors can lead to neonatal deaths, but the important factors are always contextual to facilities. QI methodology provides health workers with the skills to identify the major factors contributing to mortality and develop strategies to deal with them. Improving processes of care can lead to improved hand hygiene and saves lives.
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Affiliation(s)
- Mahtab Singh
- Department of Quality Improvement, Nationwide Quality of Care Network, New Delhi, Delhi, India
| | - Avyact Agrawal
- Department of Pediatrics, Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, India
| | - Deepti Sisodia
- Department of Pediatrics, Netaji Subhash Chandra Bose Medical College and Hospital, Jabalpur, India
| | | | - Arvinder Kaur
- Nationwide Quality of Care Network, New Delhi, Delhi, India
| | - Vikram Datta
- Department of Neonatology, Kalawati Saran Children's Hospital, New Delhi, Delhi, India.,Department of Neonatology, Lady Hardinge Medical College, New Delhi, Delhi, India
| | - Ravi Shankar Savanna
- Faculty of Medicine, University of Kuala Lumpur Royal College of Medicine Perak, Ipoh, Malaysia
| | - Manish Singh
- National Health Mission, Government of Madhya Pradesh, Bhopal, India
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Takoi H, Fujita K, Hyodo H, Matsumoto M, Otani S, Gorai M, Mano Y, Saito Y, Seike M, Furuya N, Gemma A. Acinetobacter baumannii can be transferred from contaminated nitrile examination gloves to polypropylene plastic surfaces. Am J Infect Control 2019; 47:1171-1175. [PMID: 31153711 DOI: 10.1016/j.ajic.2019.04.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/03/2019] [Accepted: 04/05/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND Several observational studies suggest that gloves of health care workers are major routes of multidrug-resistant Acinetobacter baumannii transmission. However, limited experimental data are available assessing Acinetobacter transmission from gloves to environmental surfaces. This study determined whether A baumannii was easily transferred from nitrile gloves to polypropylene plastic compared with other gram-negative bacteria that cause health care-associated infections in laboratory-controlled experiments. METHODS Gloved fingerpad-to-fomite transfer efficiency was determined for drug-resistant and -sensitive strains of A baumannii, Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, and Pseudomonas aeruginosa. RESULTS Only A baumannii transferred from gloves to fomites 3 minutes after the bacterial transfer event. Transfer efficiency of A baumannii was 0.1%-33% at that time point. DISCUSSION Bacterial transfer from contaminated gloves to the hospital environment may be related to the type of contaminating bacteria, inoculated bacterial level, fomites, and glove materials. Therefore, it is important to need a comprehensive assessment of the transfer efficiency. CONCLUSIONS A baumannii can transfer easily from nitrile gloves to fomite compared with other gram-negative bacteria that cause health care-associated infections. These findings support data from previous observational studies that gloves of health care workers can be major routes of A baumannii transmission in clinical settings.
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Affiliation(s)
- Hiroyuki Takoi
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Kazue Fujita
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan.
| | - Hiroka Hyodo
- Department of Clinical Laboratory Medicine, Faculty of Health Science Technology, Bunkyo Gakuin University, Tokyo, Japan
| | - Miki Matsumoto
- Department of Clinical Laboratory Medicine, Faculty of Health Science Technology, Bunkyo Gakuin University, Tokyo, Japan
| | - Sae Otani
- Department of Clinical Laboratory Medicine, Faculty of Health Science Technology, Bunkyo Gakuin University, Tokyo, Japan
| | - Misato Gorai
- Department of Clinical Laboratory Medicine, Faculty of Health Science Technology, Bunkyo Gakuin University, Tokyo, Japan
| | - Yoko Mano
- Department of Clinical Laboratory Medicine, Faculty of Health Science Technology, Bunkyo Gakuin University, Tokyo, Japan
| | - Yoshinobu Saito
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Masahiro Seike
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
| | - Nobuhiko Furuya
- Department of Clinical Laboratory Medicine, Faculty of Health Science Technology, Bunkyo Gakuin University, Tokyo, Japan
| | - Akihiko Gemma
- Department of Pulmonary Medicine and Oncology, Graduate School of Medicine, Nippon Medical School, Tokyo, Japan
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Effectiveness of healthcare worker screening in hospital outbreaks with gram-negative pathogens: a systematic review. Antimicrob Resist Infect Control 2018; 7:36. [PMID: 29556377 PMCID: PMC5845297 DOI: 10.1186/s13756-018-0330-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/25/2018] [Indexed: 01/26/2023] Open
Abstract
Background Identifying the source of an outbreak is the most crucial aspect of any outbreak investigation. In this review, we address the frequently discussed question of whether (rectal) screening of health care workers (HCWs) should be carried out when dealing with outbreaks caused by gram negative bacteria (GNB). A systematic search of the medical literature was performed, including the Worldwide Outbreak Database and PubMed. Outbreaks got included if a HCW was the source of the outbreak and the causative pathogen was an Escherichia coli, Klebsiella spp., Enterobacter spp., Serratia spp., Pseudomonas aeruginosa, or Acinetobacter baumannii. This was true for 25 articles in which there were 1196 (2.1%) outbreaks due to GNB, thereof 14 HCWs who were permanently colonized by the outbreak strain. Rectal screening of HCWs was helpful in only 2 of the 1196 (0.2%) outbreaks. Instead, the hands of HCWs served as a reservoir for the outbreak strain in at least 7 articles – especially when they suffered from onychomycosis or used artificial fingernails or rings. Conclusion Due to very weak evidence, we do not recommend rectal screening of HCWs in an outbreak situation with GNB. However, besides a critical review of hand hygiene habits, it might be useful to examine the hands of staff carefully. This measure is cheap, quick to perform, and seems to be quite effective. Electronic supplementary material The online version of this article (10.1186/s13756-018-0330-4) contains supplementary material, which is available to authorized users.
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Jain S, Clezy K, McLaws ML. Glove: Use for safety or overuse? Am J Infect Control 2017; 45:1407-1410. [PMID: 29046216 DOI: 10.1016/j.ajic.2017.08.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Revised: 08/22/2017] [Accepted: 08/24/2017] [Indexed: 10/18/2022]
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Rosales-Reyes R, Gayosso-Vázquez C, Fernández-Vázquez JL, Jarillo-Quijada MD, Rivera-Benítez C, Santos-Preciado JI, Alcántar-Curiel MD. Virulence profiles and innate immune responses against highly lethal, multidrug-resistant nosocomial isolates of Acinetobacter baumannii from a tertiary care hospital in Mexico. PLoS One 2017; 12:e0182899. [PMID: 28797068 PMCID: PMC5552319 DOI: 10.1371/journal.pone.0182899] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 07/26/2017] [Indexed: 11/18/2022] Open
Abstract
Virulence profiles and innate immune responses were studied in Acinetobacter baumannii from nosocomial infections collected over one year in a tertiary care hospital in Mexico. A. baumannii were identified by VITEK 2 System followed by susceptibility tests. Carbapenemase genes, active efflux mechanism to imipenem and meropenem and outer membrane proteins profile were analyzed to evaluate their role on the activity of carbapenem resistance. All isolates were genotyped by pulsed field gel electrophoresis. The ability to form biofilm was determined on a polystyrene surface. The resistance to complement was determined with a pooled human normal serum and TNFα release by infected macrophages was determined by ELISA. The 112 isolates from this study were associated with a 52% of mortality. All were resistance to β-lactams, fluoroquinolones, and trimethroprim-sulfamethoxal, 96 and 90% were resistant to meropenem and imipenem, respectively, but with high susceptibility to polymyxin B, colistin and tigecyclin. Isolates were classified in 11 different clones. Most isolates, 88% (99/112), were metallo-β-lactamases and carbapenemases producers, associated in 95% with the presence of blaOXA-72 gene. Only 4/99 and 1/99 of the carbapenem-resistant isolates were related to efflux mechanism to meropenem or imipenem resistance, respectively. The loss of expression of 22, 29, and/or 33-36-kDa proteins was detected in 8/11 of the clinical isolates with resistance to carbapenem. More than 96% (108/112) of the isolates were high producers of biofilms on biotic surfaces. Finally, all isolates showed variable resistance to normal human serum activity and were high inductors of TNFα release by macrophages. In summary, these results suggest that multidrug-resistant A. baumannii can persist in the hospital environment through its ability to form biofilms. The high mortality observed was due to their ability to survive normal human serum activity and capability to induce potent inflammatory immune response making this nosocomial pathogen a serious threat to hospitalized patients.
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Affiliation(s)
- Roberto Rosales-Reyes
- Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México. Ciudad de México, México
- * E-mail: (MDAC); (RRR)
| | - Catalina Gayosso-Vázquez
- Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México. Ciudad de México, México
| | - José Luis Fernández-Vázquez
- Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México. Ciudad de México, México
| | - Ma Dolores Jarillo-Quijada
- Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México. Ciudad de México, México
| | | | - José Ignacio Santos-Preciado
- Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México. Ciudad de México, México
| | - María Dolores Alcántar-Curiel
- Unidad de Investigación en Medicina Experimental, Facultad de Medicina, Universidad Nacional Autónoma de México. Ciudad de México, México
- * E-mail: (MDAC); (RRR)
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García-Rada G, Damiani E, Copa H, Ruiz E, Santalla J, Revollo C, Mehlis A, Molina I, Mamani A. Huellas digitales de cepas de Acinetobacter baumannii procedentes de pacientes hospitalizados en la Caja Petrolera de Salud de Obrajes, mediante el método de Pulsed Field Gel Electrophoresis (PFGE), La Paz, Bolivia. Marzo 2015. JOURNAL OF THE SELVA ANDINA RESEARCH SOCIETY 2017. [DOI: 10.36610/j.jsars.2017.080100083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Poutanen SM, Vearncombe M, McGeer AJ, Gardam M, Large G, Simor AE. Nosocomial Acquisition of Methicillin-ResistantStaphylococcus aureusDuring an Outbreak of Severe Acute Respiratory Syndrome. Infect Control Hosp Epidemiol 2016; 26:134-7. [PMID: 15756882 DOI: 10.1086/502516] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AbstractObjective:The four hospitals assessed in this study use active surveillance cultures for methicillin-resistantStaphylococcus aureus(MRSA) and contact precautions for MRSA-positive patients as part of routine infection control practices. The objective of this study was to determine whether nosocomial acquisition of MRSA decreased in these hospitals during an outbreak of severe acute respiratory syndrome (SARS) when barrier precautions were routinely used for all patients.Design:Retrospective cohort study.Setting:Three tertiary-care hospitals (a 1,100-bed hospital; a 500-bed hospital; and an 823-bed hospital) and a 430-bed community hospital, each located in Toronto, Ontario, Canada.Patients:All admitted patients were included.Results:The nosocomial rate of MRSA in all four hospitals combined during the SARS outbreak (3.7 per 10,000 patient-days) was not significantly different from that before (4.7 per 10,000 patient-days) or after (3.4 per 10,000 patient-days) the outbreak (P= .30 andP= .76, respectively). The nosocomial rate of MRSA after the outbreak was significantly lower than that before the outbreak (P= .003). Inappropriate reuse of gloves and gowns and failure to wash hands between patients on non-SARS wards were observed during the outbreak. Increased attention was paid to infection control education following the outbreak.Conclusions:Inappropriate reuse of gloves and gowns and failure to wash hands between patients may have contributed to transmission of MRSA during the SARS outbreak. Attention should be paid to training healthcare workers regarding the appropriate use of precautions as a means to protect themselves and patients.
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Picheansathian W, Chotibang J. Glove utilization in the prevention of cross transmission: a systematic review. ACTA ACUST UNITED AC 2015. [DOI: 10.11124/01938924-201513040-00013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Wilson J, Prieto J, Singleton J, O'Connor V, Lynam S, Loveday H. The misuse and overuse of non-sterile gloves: application of an audit tool to define the problem. J Infect Prev 2015; 16:24-31. [PMID: 28989395 DOI: 10.1177/1757177414558673] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Accepted: 10/05/2014] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The use of non-sterile gloves (NSG) has become routine in the delivery of health care, often for procedures for which they are not required; their use may increase the risk of cross contamination and is generally not integrated into hand hygiene audit. This paper describes a small-scale application and validation of an observational audit tool devised to identify inappropriate use of NSG and potential for cross contamination. METHODS Two observers simultaneously observed the use of NSG during episodes of care in an acute hospital setting. The inter-rater reliability (IRR) of the audit tool was measured corrected for chance agreement using Kappa. RESULTS A total of 22 episodes of care using NSG were observed. In 68.6% (24/35) of procedures there was no contact with blood/body fluid; in 54.3% (19/35) NSG-use was inappropriate. The IRR was 100% for eight of 12 components of the tool. For hand hygiene before and after NSG removal it was 82% (Kappa = 0.72) and 95% (Kappa = 0.87). CONCLUSIONS In this small-scale application of a glove-use audit tool we demonstrated over-use and misuse of NSG and potential for cross transmission on gloved hands. The audit tool provides an effective mechanism for integrating glove use into the audit of hand hygiene behaviour.
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Affiliation(s)
- Jennie Wilson
- Richard Wells Research Centre, University of West London, London, UK
| | | | | | | | - Siobhan Lynam
- Richard Wells Research Centre, University of West London, London, UK
| | - Heather Loveday
- Richard Wells Research Centre, University of West London, London, UK
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Diaz MH, Silkaitis C, Malczynski M, Noskin GA, Warren JR, Zembower T. Contamination of Examination Gloves in patient Rooms and Implications for Transmission of Antimicrobial-Resistant Microorganisms. Infect Control Hosp Epidemiol 2015; 29:63-5. [DOI: 10.1086/524338] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
An assessment of bacterial contamination on examination gloves indicated that contaminated gloves may be a mechanism of indirect bacterial transmission from the hands of healthcare workers to patients. This mechanism is indicated by the recovery of identical Acinetobacter baumannii isolates from gloves and from the clinical cultures of a patient with invasive infection.
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Nosocomial Infection Caused by Antibiotic-Resistant Organisms in the Intensive-Care Unit. Infect Control Hosp Epidemiol 2015. [DOI: 10.1017/s0195941700003829] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractResistance to antimicrobial agents is an evolving process, driven by the selective pressure of heavy antibiotic use in individuals living in close proximity to others. The intensive care unit (ICU), crowded with debilitated patients who are receiving broad-spectrum antibiotics and being cared for by busy physicians, nurses, and technicians, serves as an ideal environment for the emergence of antibiotic resistance. Problem pathogens presently include multiply resistant gram-negative bacilli, methicillin-resistantStaphylococcus aureus, and the recently emerged vancomycin-resistant enterococci. The prevention of antimicrobial resistance in ICUs should focus on recognition via routine unit-based sur veillance, improved compliance with handwashing and barrier precautions, and antibiotic-use policies tailored to individual units within hospitals.
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Loveday HP, Lynam S, Singleton J, Wilson J. Clinical glove use: healthcare workers' actions and perceptions. J Hosp Infect 2013; 86:110-6. [PMID: 24412643 DOI: 10.1016/j.jhin.2013.11.003] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 11/04/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND The incorrect use of clinical gloves and the failure to change them between procedures increases the risk of cross-transmission. Much attention has been focused on compliance with hand hygiene. AIM To investigate the use of gloves, their potential for cross-contamination, and factors that influence the decision of healthcare workers (HCWs) to wear them. METHODS The use of gloves was observed in six wards in a single UK hospital trust. Risk of cross-contamination was defined as a violation of a 'moment of hand hygiene' during the glove-use episode. Twenty-five HCWs from the wards included in the observational audit were interviewed to identify the drivers for glove use. FINDINGS A total of 163 glove-use episodes were observed over a period of 13 h. Glove use was inappropriate in 69 out of 163 (42%) episodes, with gloves commonly used inappropriately for low-risk procedures (34/37; 92%). In 60 out of 163 (37%) episodes of glove use there was a risk of cross-contamination, most (48%) being associated with failure to remove gloves or with performing hand hygiene after use. HCW interviews indicated that the decision to wear gloves was influenced by both socialization and emotion. Key emotions were disgust and fear. Assumptions that patients preferred gloves to be used, confusion about when to wear them, and social norms and peer pressure were also important influences. CONCLUSION Glove use is associated with risk of cross-contamination and should be more explicitly integrated into hand hygiene policy. An understanding of the drivers of glove-use behaviour is required to design interventions to reduce misuse and overuse.
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Affiliation(s)
- H P Loveday
- Richard Wells Research Unit, University of West London, London, UK
| | - S Lynam
- Richard Wells Research Unit, University of West London, London, UK
| | - J Singleton
- Infection Prevention & Control Department, Imperial College Healthcare NHS Trust, London, UK
| | - J Wilson
- Institute of Practice, Interdisciplinary Research & Enterprise, University of West London, London, UK.
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Strategies to minimize antibiotic resistance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2013; 10:4274-305. [PMID: 24036486 PMCID: PMC3799537 DOI: 10.3390/ijerph10094274] [Citation(s) in RCA: 221] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Revised: 09/02/2013] [Accepted: 09/03/2013] [Indexed: 02/07/2023]
Abstract
Antibiotic resistance can be reduced by using antibiotics prudently based on guidelines of antimicrobial stewardship programs (ASPs) and various data such as pharmacokinetic (PK) and pharmacodynamic (PD) properties of antibiotics, diagnostic testing, antimicrobial susceptibility testing (AST), clinical response, and effects on the microbiota, as well as by new antibiotic developments. The controlled use of antibiotics in food animals is another cornerstone among efforts to reduce antibiotic resistance. All major resistance-control strategies recommend education for patients, children (e.g., through schools and day care), the public, and relevant healthcare professionals (e.g., primary-care physicians, pharmacists, and medical students) regarding unique features of bacterial infections and antibiotics, prudent antibiotic prescribing as a positive construct, and personal hygiene (e.g., handwashing). The problem of antibiotic resistance can be minimized only by concerted efforts of all members of society for ensuring the continued efficiency of antibiotics.
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Moore G, Dunnill CW, Wilson APR. The effect of glove material upon the transfer of methicillin-resistant Staphylococcus aureus to and from a gloved hand. Am J Infect Control 2013; 41:19-23. [PMID: 22981164 DOI: 10.1016/j.ajic.2012.03.017] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 03/05/2012] [Accepted: 03/05/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Although disposable gloves can protect the hands of a health care worker from acquiring bacteria, during patient care the glove surface itself can become heavily contaminated making cross transmission via contaminated gloved hands likely. The aim of this study was to determine whether the type of glove worn by health care workers could influence the spread of methicillin-resistant Staphylococcus aureus (MRSA). METHODS Laboratory studies were conducted to assess the ease with which MRSA was transferred between different types of glove and surfaces likely to be found within the ward environment. RESULTS In the absence of simulated body fluid, mean bacterial transfer to and from the different gloves ranged from 0.1% to 16% and from 0.01% to 19.5%, respectively. Glove material and glove hydrophobicity were identified as the 2 most important factors influencing bacterial transfer. Nitrile gloves were associated with the lowest transfer rates. The highest numbers of bacteria were transferred to and from the most hydrophilic and most hydrophobic glove, respectively. The adsorption of simulated body fluids altered the physiochemical properties of the gloves. Bacterial transfer significantly increased and was similar to and from all glove types. CONCLUSION Disposable glove type can affect cross-contamination rates among patient, health care worker, and environment. Nonetheless, choice of glove should be considered less important than the correct use of gloves and proper hand hygiene.
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Affiliation(s)
- Ginny Moore
- Clinical Microbiology and Virology, University College London Hospitals NHS Foundation Trust, London, UK.
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Eijkelkamp BA, Hassan KA, Paulsen IT, Brown MH. Investigation of the human pathogen Acinetobacter baumannii under iron limiting conditions. BMC Genomics 2011; 12:126. [PMID: 21342532 PMCID: PMC3055841 DOI: 10.1186/1471-2164-12-126] [Citation(s) in RCA: 162] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2010] [Accepted: 02/23/2011] [Indexed: 02/06/2023] Open
Abstract
Background Iron acquisition systems are important virulence factors in pathogenic bacteria. To identify these systems in Acinetobacter baumannii, the transcriptomic response of the completely sequenced strain ATCC 17978 under iron limiting conditions was investigated using a genomic microarray that contained probes for all annotated open reading frames. Results Under low iron conditions, transcription levels were more than 2-fold up-regulated for 463 genes, including 95 genes that were up-regulated more than 4-fold. Of particular significance, three siderophore biosynthesis gene clusters, including one novel cluster, were highly up-regulated. Binding sites for the ferric uptake regulator were identified in the promoter regions of many up-regulated genes, suggesting a prominent role for this regulator in the Acinetobacter iron acquisition response. Down-regulation under iron limitation was less dramatic as the transcription of only 202 genes varied more than 2-fold. Various genes involved in motility featured prominently amongst the genes down-regulated when iron was less readily available. Motility assays confirmed that these transcriptional changes are manifested at the phenotypic level. The siderophore biosynthesis gene clusters were further investigated by means of comparative genomic analysis of 10 sequenced Acinetobacter isolates. These analyses revealed important roles for mobile genetic elements in shaping the siderophore meditated iron acquisition mechanisms between different Acinetobacter strains. Conclusions A. baumannii grown under iron limited conditions resulted in major transcriptional changes of not only many iron acquisition related genes, but also genes involved in other processes such as motility. Overall, this study showed that A. baumannii is well adaptable to growth in an environment which has limiting iron availability.
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Affiliation(s)
- Bart A Eijkelkamp
- School of Biological Sciences, Flinders University, Adelaide, SA 5001, Australia
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Hsu J, Abad C, Dinh M, Safdar N. Prevention of endemic healthcare-associated Clostridium difficile infection: reviewing the evidence. Am J Gastroenterol 2010; 105:2327-39; quiz 2340. [PMID: 20606676 DOI: 10.1038/ajg.2010.254] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Clostridium difficile is the most common infectious cause of healthcare-associated diarrhea. Because of the increasing incidence and severity of endemic C. difficile infection (CDI), interventions to prevent healthcare-associated CDI are essential. We undertook a systematic review of interventions to reduce healthcare-associated CDI. METHODS We searched multiple computerized databases, and manually searched for relevant articles to determine which interventions are useful in preventing CDI. Studies were required to be controlled in design and to report the incidence of endemic CDI as an outcome. Data on the patient population, intervention, study design, and outcomes were abstracted and reviewed using established criteria. RESULTS Few randomized controlled trials exist in the area of CDI prevention. The interventions with the greatest evidence for the prevention of CDI include antimicrobial stewardship, glove use, and disposable thermometers. Environmental decontamination also may decrease CDI rates, although the level of evidence is not as strong as for the other proven interventions. Treatment of asymptomatic carriage of C. difficile is not recommended. There is insufficient evidence to make a recommendation for or against the use of probiotics. In cases of known or suspected CDI, hand hygiene with soap and water is preferred over use of waterless alcohol hand rub. Many nonrandomized trials included in our analysis used multiple interventions concurrently, making the independent role of each preventive strategy difficult to determine. We chose to include only studies that focused on endemic CDI because studies of outbreaks have used multiple strategies, making it difficult to measure the relative efficacy of each strategy. Environmental disinfection and probiotics need to be studied further to evaluate their roles in the prevention of CDI. Although there have been no studies assessing the utility of isolation and cohorting for the prevention of endemic CDI specifically, it is a widely used intervention for containment of this and other similar multidrug-resistant pathogens. CONCLUSIONS Antimicrobial stewardship, glove use, hand hygiene, and disposable thermometers should be routinely used for the prevention of CDI. Environmental disinfection and probiotics should be studied further for their role in reducing CDI.
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Affiliation(s)
- J Hsu
- Section of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA
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Todd ECD, Michaels BS, Greig JD, Smith D, Bartleson CA. Outbreaks where food workers have been implicated in the spread of foodborne disease. Part 8. Gloves as barriers to prevent contamination of food by workers. J Food Prot 2010; 73:1762-73. [PMID: 20828485 DOI: 10.4315/0362-028x-73.9.1762] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The role played by food workers and other individuals in the contamination of food has been identified as an important contributing factor leading to foodborne outbreaks. To prevent direct bare hand contact with food and food surfaces, many jurisdictions have made glove use compulsory for food production and preparation. When properly used, gloves can substantially reduce opportunities for food contamination. However, gloves have limitations and may become a source of contamination if they are punctured or improperly used. Experiments conducted in clinical and dental settings have revealed pinhole leaks in gloves. Although such loss of glove integrity can lead to contamination of foods and surfaces, in the food industry improper use of gloves is more likely than leakage to lead to food contamination and outbreaks. Wearing jewelry (e.g., rings) and artificial nails is discouraged because these items can puncture gloves and allow accumulation of microbial populations under them. Occlusion of the skin during long-term glove use in food operations creates the warm, moist conditions necessary for microbial proliferation and can increase pathogen transfer onto foods through leaks or exposed skin or during glove removal. The most important issue is that glove use can create a false sense of security, resulting in more high-risk behaviors that can lead to cross-contamination when employees are not adequately trained.
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Affiliation(s)
- Ewen C D Todd
- Department of Advertising Public Relations and Retailing, Michigan State University, East Lansing, Michigan 48824, USA.
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Matsumoto T, Fujita M, Yoshimura C, Toyoshima H, Kitamura T, Ishikura H, Watanabe K. [A case of hospital-acquired pneumonia caused by intermediately susceptible carbapenem Acinetobacter baumannii]. KANSENSHOGAKU ZASSHI. THE JOURNAL OF THE JAPANESE ASSOCIATION FOR INFECTIOUS DISEASES 2010; 84:305-308. [PMID: 20560423 DOI: 10.11150/kansenshogakuzasshi.84.305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
The incidence of Acinetobacter baumannii pneumonia in hospital-acquired pneumonia in Japan is rare. We report a case of ventilator-associated A. baumanii pneumonia. A 69-year-old man admitted for fever was diagnosed with Streptococcus pneumoniae pneumonia based on chest radiography, urine antigen, and sputum examination. Despite appropriate antibiotics, the pneumonia progressed, necessitating intensive respiratory management. Ten days there after, he suffered sudden septic shock and superimposed pneumonia despite both carbapenem and fluoroquinolone administration. A. baumanii was detected from blood and sputum. Piperacilline/tazobactam, amikacin, and intensive care saved his life.
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Kurcik-Trajkovska B. Acinetobacter spp. - A Serious Enemy Threatening Hospitals Worldwide. ACTA ACUST UNITED AC 2010. [DOI: 10.3889/mjms.1857-5773.2009.0043] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Pittet D, Allegranzi B, Boyce J. The World Health Organization Guidelines on Hand Hygiene in Health Care and their consensus recommendations. Infect Control Hosp Epidemiol 2009; 30:611-22. [PMID: 19508124 DOI: 10.1086/600379] [Citation(s) in RCA: 434] [Impact Index Per Article: 28.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
The World Health Organization's Guidelines on Hand Hygiene in Health Care have been issued by WHO Patient Safety on 5 May 2009 on the occasion of the launch of the Save Lives: Clean Your Hands initiative. The Guidelines represent the contribution of more than 100 international experts and provide a comprehensive overview of essential aspects of hand hygiene in health care, evidence- and consensus-based recommendations, and lessons learned from testing their Advanced Draft and related implementation tools.
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Affiliation(s)
- Didier Pittet
- Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.
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[Evaluation of the effect of a cleaning/disinfection intervention on the rate of multiresistant microorganism infections in the Intensive Care Unit]. ENFERMERIA INTENSIVA 2009; 20:27-34. [PMID: 19401090 DOI: 10.1016/s1130-2399(09)70664-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
AIM Evaluate the effect of an intervention on the rate of nosocomial infections (NI) produced by multiresistant microorganisms in the Intensive Care Units. MATERIAL AND METHODS A study was conducted before and after an intervention in two ICUs to control an outbreak of multiresistant Acinetobacter baumanii (MRAB). During the outbreak (from 22-12-06 to 12-2-07) the wards were closed and both the wards and the equipment of both ICUs were cleaned and disinfected. A microbiological sampling was also made. The nosocomial infection rate density of the multiresistant microorganisms was compared between hospitalized patients: preintervention (1-3-2006 to 15-12-2006) and postintervention (1-3-2007 to 15-12-2007). To certify if there were any statistically significant differences between them, a rate ratio (RT) was calculated with a 95% confidence interval. The level of statistical significance was established at p < 0.05. We stratified per unit, per type of microorganism and location of the infection. RESULTS The global NI incidence rate for multiresistant microorganisms significantly declined after the interventions in both units (RT: 1.83, 95% CI: 1.34-2.50), p < 0.005. A significant decrease was also observed on the NI incidence rate for the following microorganisms: P. aeruginosa (RT: 2.36, 95% CI: 1.41-3.96), Enterobacter BLEE (RT: 2.31, 95% CI: 1.11-4.82) and S. maltophilia (RT: 2.77, 95% CI: 1.10-6.99). In regards to the infection location, a significant decrease in respiratory infection rates was observed (RT: 1.96, 95% CI: 1.29-2.99). CONCLUSION The intervention conducted to control the MRAB outbreak was effective in reducing the NI incidence of multiresistant microorganisms.
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25
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Endemic carbapenem-resistant Acinetobacter baumannii in a Brazilian intensive care unit. J Hosp Infect 2009; 72:365-8. [DOI: 10.1016/j.jhin.2009.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2009] [Accepted: 04/09/2009] [Indexed: 11/18/2022]
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Institutional Outbreak and Control of a Multidrug-Resistant Clone of Acinetobacter baumannii. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2009. [DOI: 10.1097/ipc.0b013e31819e308f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Siegel JD, Rhinehart E, Jackson M, Chiarello L. 2007 Guideline for Isolation Precautions: Preventing Transmission of Infectious Agents in Health Care Settings. Am J Infect Control 2007; 35:S65-164. [PMID: 18068815 PMCID: PMC7119119 DOI: 10.1016/j.ajic.2007.10.007] [Citation(s) in RCA: 1629] [Impact Index Per Article: 95.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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Kenneley IL. Infection control and prevention in home healthcare: prevention activities are the key to desired patient outcomes. ACTA ACUST UNITED AC 2007; 25:459-67; quiz 468-9. [PMID: 17667005 DOI: 10.1097/01.nhh.0000281613.89047.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Irena L Kenneley
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106-4904, USA
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Woodward KN. Veterinary pharmacovigilance. Part 6. Predictability of adverse reactions in animals from laboratory toxicology studies. J Vet Pharmacol Ther 2005; 28:213-31. [PMID: 15842309 DOI: 10.1111/j.1365-2885.2005.00650.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Toxicological studies are conducted on constituents of veterinary medicinal products for a number of reasons. Aside from being a requirement of legislation, they are carried out for predictive purposes in the assessment of user safety or for the determination of consumer safety, for example, in the elaboration of maximum residue limits or tolerances. Alternatively, the results of toxicology studies may be available as they have been generated for registration of the drug for human medicinal purposes. This paper examines if the results of such studies have any predictive value for adverse reactions, which might occur during clinical use in animals. A number of adverse reactions, notably the Type A (toxicology or pharmacology dependent) should be predictable from these laboratory studies. However, as with human pharmaceutical products, they have less utility in predicting Type-B reactions (idiosyncratic in nature).
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Jumaa PA. Hand hygiene: simple and complex. Int J Infect Dis 2005; 9:3-14. [PMID: 15603990 DOI: 10.1016/j.ijid.2004.05.005] [Citation(s) in RCA: 129] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2004] [Revised: 05/22/2004] [Accepted: 05/24/2004] [Indexed: 11/26/2022] Open
Abstract
This review gives an overview of hand hygiene in healthcare and in the community, including some aspects which have attracted little attention, such as hand drying and cultural issues determining hand hygiene behaviour. Hand hygiene is the most effective measure for interrupting the transmission of microorganisms which cause infection both in the community and in the healthcare setting. Using hand hygiene as a sole measure to reduce infection is unlikely to be successful when other factors in infection control, such as environmental hygiene, crowding, staffing levels and education are inadequate. Hand hygiene must be part of an integrated approach to infection control. Compliance with hand hygiene recommendations is poor worldwide. While the techniques involved in hand hygiene are simple, the complex interdependence of factors which determine hand hygiene behaviour makes the study of hand hygiene complex. It is now recognised that improving compliance with hand hygiene recommendations depends on altering human behaviour. Input from behavioural and social sciences is essential when designing studies to investigate compliance. Interventions to increase compliance with hand hygiene practices must be appropriate for different cultural and social needs. New strategies to promote hand hygiene worldwide include the formation of public-private partnerships.
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Affiliation(s)
- P A Jumaa
- Department of Medical Microbiology, Faculty of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 17666, Al Ain, United Arab Emirates.
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31
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Girou E, Chai SHT, Oppein F, Legrand P, Ducellier D, Cizeau F, Brun-Buisson C. Misuse of gloves: the foundation for poor compliance with hand hygiene and potential for microbial transmission? J Hosp Infect 2004; 57:162-9. [PMID: 15183248 DOI: 10.1016/j.jhin.2004.03.010] [Citation(s) in RCA: 117] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2003] [Accepted: 03/04/2004] [Indexed: 11/17/2022]
Abstract
Improvement in hand hygiene compliance is important for reducing cross-infection by micro-organisms. The objective of this prospective observational study was to measure how the improper use of gloves limits compliance to hand hygiene and exposes patient's to infection. The study was conducted in five wards (three intensive care units and two medical wards) in a French university hospital. Staff-patient and staff-environment contacts were observed in 120 healthcare workers caring for patients colonized or infected with pathogenic bacteria. Hand hygiene was not undertaken due to improper gloving in 64.4% (95%CI, 64.1% to 65.1%) of instances. Possible microbial transmission might have occurred in 18.3% (95%CI, 17.8% to 18.8%) of all contacts because used gloves were not removed before performing care activities that necessitated strict aseptic precautions. Failure to change or remove contaminated gloves was a major component in the poor compliance with hand hygiene and carried a high-risk of microbial transmission. Improving hand hygiene compliance will require changing healthcare workers behaviour towards glove use.
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Affiliation(s)
- E Girou
- Infection Control Unit, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Créteil, France.
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Lam BCC, Lee J, Lau YL. Hand hygiene practices in a neonatal intensive care unit: a multimodal intervention and impact on nosocomial infection. Pediatrics 2004; 114:e565-71. [PMID: 15492360 DOI: 10.1542/peds.2004-1107] [Citation(s) in RCA: 236] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE Health care-associated infections persist as a major problem in most neonatal intensive care units. Hand hygiene has been singled out as the most important measure in preventing hospital-acquired infection. However, hand hygiene compliance among health care workers (HCWs) remains low. The objective of this study was to assess the frequency and nature of patient contacts in neonatal intensive care units and observe the compliance and technique of hand hygiene among HCWs before and after the implementation of a multimodal intervention program. METHODS The nature and frequency of patient contacts, the hand hygiene compliance, and hand-washing techniques of HCWs were observed unobtrusively to reflect the baseline compliance and to investigate factors for noncompliance. The intervention consisted of problem-based and task-orientated hand hygiene education, enhancement of minimal handling protocol and clustering of nursing care, liberal provision of alcohol-based hand antiseptic, improvement in hand hygiene facilities, ongoing regular hand hygiene audit, and implementation of health care-associated infection surveillance. The observational study was repeated 6 months after the completion of the intervention program, which extended over 1-year period. RESULTS Overall hand hygiene compliance increased from 40% to 53% before patient contact and 39% to 59% after patient contact. More marked improvement was observed for high-risk procedures (35%-60%). The average number of patient contacts also decreased from 2.8 to 1.8 per patient per hour. There was improvement in most aspects of hand-washing technique in the postintervention stage. The health care-associated infection rate decreased from 11.3 to 6.2 per 1000 patient-days. CONCLUSION A problem-based and task-orientated education program can improve hand hygiene compliance. Enhancement of minimal handling and clustering of nursing procedures reduced the total patient contact episodes, which could help to overcome the major barrier of time constraints. A concurrent decrease in health care-associated infection rate and increase in hand hygiene compliance was observed in this study. The observational study could form part of an ongoing audit to provide regular feedback to HCWs to sustain the compliance.
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Affiliation(s)
- Barbara C C Lam
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, 102 Pokfulam Rd, Hong Kong, China.
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Pessoa-Silva CL, Dharan S, Hugonnet S, Touveneau S, Posfay-Barbe K, Pfister R, Pittet D. Dynamics of bacterial hand contamination during routine neonatal care. Infect Control Hosp Epidemiol 2004; 25:192-7. [PMID: 15061408 DOI: 10.1086/502376] [Citation(s) in RCA: 102] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To evaluate the dynamics of bacterial contamination of healthcare workers' (HCWs) hands during neonatal care. SETTING The 20-bed neonatal unit of a large acute care teaching hospital in Geneva, Switzerland. METHODS Structured observation sessions were conducted. A sequence of care began when the HCW performed hand hygiene and ended when the activity changed or hand hygiene was performed again. Alcohol-based handrub was the standard procedure for hand hygiene. An imprint of the five fingertips of the dominant hand was obtained before and after hand hygiene and at the end of a sequence of care. Regression methods were used to model the final bacterial count according to the type and duration of care and the use of gloves. RESULTS One hundred forty-nine sequences of care were observed. Commensal skin flora comprised 72.4% of all culture-positive specimens (n = 360). Other microorganisms identified were Enterobacteriaceae (n = 55, 13.8%); Staphylococcus aureus (n = 10, 2.5%); and fungi (n = 7, 1.8%). Skin contact, respiratory care, and diaper change were independently associated with an increased bacterial count; the use of gloves did not fully protect HCWs' hands from bacterial contamination. CONCLUSIONS These data confirm that hands become progressively contaminated with commensal flora and potential pathogens during neonatal care, and identify activities at higher risk for hand contamination. They also reinforce the need for hand hygiene after a sequence of care, before starting a different task, and after glove removal.
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Affiliation(s)
- Carmem Lúcia Pessoa-Silva
- Infection Control Program, Department of Internal, University of Geneva Hospitals, Geneva, Switzerland
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Michaels B, Keller C, Blevins M, Paoli G, Ruthman T, Todd E, Griffith CJ. Prevention of food worker transmission of foodborne pathogens: risk assessment and evaluation of effective hygiene intervention strategies. ACTA ACUST UNITED AC 2004. [DOI: 10.1111/j.1471-5740.2004.00088.x] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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LaBan MM, Singh J, Moll V, Zervos MJ. Pertinacious habit on a rehabilitation unit: repetitive finger licking while paging through the clinical chart. Am J Phys Med Rehabil 2004; 83:75-8. [PMID: 14709979 DOI: 10.1097/01.phm.0000078187.72286.49] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A survey was performed to determine the frequency of unrecognized repetitive licking of fingers while reviewing hospital charts by various healthcare professionals who, by this habit, may be putting themselves at risk of acquiring a nosocomial infection. Nine of 14 charts demonstrated the presence of Staphylococci aureus, cultures obtained from three of nine charts grew methicillin-resistant S. aureus, and six grew methicillin-susceptible S. aureus. Of the 50 healthcare professionals surveyed, five (10%) admitted to habitual repetitive licking of fingers while reviewing charts. In addition, 30 (60%) of those surveyed had observed other professionals doing so. Forty-seven (94%) acknowledged that they did not routinely wash their hands after reviewing the charts, potentially placing themselves at risk of acquiring a nosocomial infection. As an immediate consequence of this study, staff members have been encouraged to wash their hands before and after reviewing a patient's chart.
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Affiliation(s)
- Myron M LaBan
- Department of Physical Medicine and Rehabilitation, William Beaumont Hospital, 3601 W. Thirteen Mile Road, Royal Oak, MI 48073, USA
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Girou E. Prévention des risques d’infection urinaire nosocomiale dans les collectivités (hospitalières et extra-hospitalières) : l’isolement. Med Mal Infect 2003. [DOI: 10.1016/s0399-077x(03)00158-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Turner PJ, Greenhalgh JM. The activity of meropenem and comparators against Acinetobacter strains isolated from European hospitals, 1997-2000. Clin Microbiol Infect 2003; 9:563-7. [PMID: 12848736 DOI: 10.1046/j.1469-0691.2003.00591.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
In vitro susceptibilities to meropenem and comparators of Acinetobacter strains isolated from serious infections in 37 European hospital centers participating in the Meropenem Yearly Susceptibility Test Information Collection (MYSTIC) Program (1997-2000) were tested. There were 635 Acinetobacter strains collected: 490 A. baumannii; 51 A. calcoaceticus var. lwoffii; and 94 other Acinetobacter strains. Overall, meropenem and imipenem were the most effective agents tested. Resistance to the antimicrobials was: 14%, meropenem; 16%, imipenem; 39%, piperacillin-tazobactam; 41%, tobramycin; 45%, ceftazidime; and 53%, ciprofloxacin. Thus, the carbapenems have useful activity against Acinetobacter spp. and represent a viable choice for treating infections caused by these organisms.
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Affiliation(s)
- P J Turner
- Antibiotic Development and Technical Support Group, AstraZeneca, Alderley House, Alderley Park, Macclesfield, Cheshire, SK10 4TF, UK.
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Saiman L, Siegel J. Infection control recommendations for patients with cystic fibrosis: microbiology, important pathogens, and infection control practices to prevent patient-to-patient transmission. Infect Control Hosp Epidemiol 2003; 24:S6-52. [PMID: 12789902 DOI: 10.1086/503485] [Citation(s) in RCA: 178] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Infection Control Recommendations for Patients With Cystic Fibrosis: Microbiology, Important Pathogens, and Infection Control Practices to Prevent Patient-to-Patient Transmissionupdates, expands, and replaces the consensus statement,Microbiology and Infectious Disease in Cystic Fibrosispublished in 1994. This consensus document presents background data and evidence-based recommendations for practices that are intended to decrease the risk of transmission of respiratory pathogens among CF patients from contaminated respiratory therapy equipment or the contaminated environment and thereby reduce the burden of respiratory illness. Included are recommendations applicable in the acute care hospital, ambulatory, home care, and selected non-healthcare settings. The target audience includes all healthcare workers who provide care to CF patients. Antimicrobial management is beyond the scope of this document.
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Affiliation(s)
- Lisa Saiman
- Department of Pediatrics, Columbia University, New York, New York, USA
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Zeana C, Larson E, Sahni J, Bayuga SJ, Wu F, Della-Latta P. The epidemiology of multidrug-resistant Acinetobacter baumannii: does the community represent a reservoir? Infect Control Hosp Epidemiol 2003; 24:275-9. [PMID: 12725357 DOI: 10.1086/502209] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the role of the community as a potential reservoir for Acinetobacter baumannii. DESIGN Antimicrobial resistance patterns and genotypes of A. baumannii isolates from patients in two Manhattan hospitals were compared with those of A. baumannii isolates from the hands of community members. RESULTS A total of 103 isolates from two hospitals (hospital A, 81; hospital B, 22) and 23 isolates from community residents were studied. Of the hospital isolates, 36.6% were multidrug resistant (hospital A, 68.2%; hospital B, 27.8%). In contrast, there were no multidrug-resistant isolates from the community (P < .005 between hospital and community). The prevalence of A. baumannii on the hands of community residents was 10.4% (23 of 222). By molecular typing, 42 strains of A. baumannii were identified. Of the isolates from hospital A and hospital B, 55.6% (45 of 81) and 68.2% (15 of 22), respectively, were indistinguishable or closely related. In contrast, most community (83.3%) isolates were unrelated (P = .001 between hospital and community). CONCLUSION Acinetobacter isolates from the community, characterized by a large variety of unrelated strains (83.3%), were distinct from the hospital isolates, of which 58.3% were closely related. The absence of multidrug-resistant strains in the community compared with 36.8% prevalence among hospital isolates suggests that the reservoir for epidemic strains resides in the hospital environment itself. To our knowledge, this is the first study to examine the community as a potential reservoir for hospital strains of A. baumannii.
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Affiliation(s)
- Cosmina Zeana
- Columbia University College of Physicians & Surgeons, New York, New York, USA
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Schultz M, Gill J, Zubairi S, Huber R, Gordin F. Bacterial contamination of computer keyboards in a teaching hospital. Infect Control Hosp Epidemiol 2003; 24:302-3. [PMID: 12725363 DOI: 10.1086/502200] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
We tested 100 keyboards in 29 clinical areas for bacterial contamination. Ninety five were positive for microorganisms. Streptococcus, Clostridium perfringens, Enterococcus (including one vancomycin-resistant Enterococcus), Staphylococcus aureus, fungi, and gram-negative organisms were isolated. Computer equipment must be kept clean so it does not become another vehicle for transmission of pathogens to patients.
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Abstract
This review of Acinetobacter outbreaks summarizes factors related to the presence and recognition of organism transmission and describes the implementation of control and prevention measures directed at limiting spread. Exogenous transmission of Acinetobacter should be considered when infections are endemic and when case rates increase. Increasing or new antimicrobial resistances in a collection of isolates also suggest transmission, and transmission can be definitively confirmed when isolates are found to be indistinguishable from or related to one another by a discriminatory genotyping test. An investigation for a common source should be conducted. When a common source cannot be found and eliminated, or once an endemically transmitted organism is established, containment or prevention efforts may require aggressive interventions, complex interventions, or both. Colonization at multiple sites, the relative ease of induction of antibiotic resistance in the organism following patient exposure to multiple drugs, and long-term environmental survival provide enhanced opportunities for the transmission of Acinetobacter between and among patients. New approaches and interventional trials are needed to define effective measures for the prevention and control of Acinobacter infections.
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Wang SH, Sheng WH, Chang YY, Wang LH, Lin HC, Chen ML, Pan HJ, Ko WJ, Chang SC, Lin FY. Healthcare-associated outbreak due to pan-drug resistant Acinetobacter baumannii in a surgical intensive care unit. J Hosp Infect 2003; 53:97-102. [PMID: 12586567 DOI: 10.1053/jhin.2002.1348] [Citation(s) in RCA: 103] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Acinetobacter baumannii is ubiquitous and has recently become one of the most important healthcare-associated (HA) pathogens in hospitals. Infection caused by this organism often leads to significant morbidity and mortality. Outbreaks of pan-drug resistant Acinetobacter baumannii (PDRAB) have rarely been reported. During a two-month period, an outbreak of PDRAB colonization and infection affecting 7 patients occurred in our surgical intensive care unit (SICU). The colonized sites were respiratory tract (N = 7) and central venous catheter (N = 2). One of the patients had a surgical wound infection. Extensive environmental contamination was identified, including sites such as bed rails, bedside tables, surface of ventilators and infusion pump, water for nasogastric feeding and ventilator rinsing and sinks. All of the isolates were analysed by pulsed-field gel electrophoresis (PFGE) and showed an identical pattern. After use of strict cohort nursing, hand hygiene environmental cleaning, and replacement of a dysfunctional high-efficiency particulate air filter (HEPA), the outbreak was controlled.
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Affiliation(s)
- S H Wang
- Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan
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45
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Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HIPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Am J Infect Control 2002; 30:S1-46. [PMID: 12461507 DOI: 10.1067/mic.2002.130391] [Citation(s) in RCA: 453] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.
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Boyce JM, Pittet D. Guideline for Hand Hygiene in Health-Care Settings: recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. Infect Control Hosp Epidemiol 2002; 23:S3-40. [PMID: 12515399 DOI: 10.1086/503164] [Citation(s) in RCA: 628] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The Guideline for Hand Hygiene in Health-Care Settings provides health-care workers (HCWs) with a review of data regarding handwashing and hand antisepsis in health-care settings. In addition, it provides specific recommendations to promote improved hand-hygiene practices and reduce transmission of pathogenic microorganisms to patients and personnel in health-care settings. This report reviews studies published since the 1985 CDC guideline (Garner JS, Favero MS. CDC guideline for handwashing and hospital environmental control, 1985. Infect Control 1986;7:231-43) and the 1995 APIC guideline (Larson EL, APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251-69) were issued and provides an in-depth review of hand-hygiene practices of HCWs, levels of adherence of personnel to recommended handwashing practices, and factors adversely affecting adherence. New studies of the in vivo efficacy of alcohol-based hand rubs and the low incidence of dermatitis associated with their use are reviewed. Recent studies demonstrating the value of multidisciplinary hand-hygiene promotion programs and the potential role of alcohol-based hand rubs in improving hand-hygiene practices are summarized. Recommendations concerning related issues (e.g., the use of surgical hand antiseptics, hand lotions or creams, and wearing of artificial fingernails) are also included.
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Affiliation(s)
- John M Boyce
- Hospital of Saint Raphael, New Haven, Connecticut, USA
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47
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Bayuga S, Zeana C, Sahni J, Della-Latta P, el-Sadr W, Larson E. Prevalence and antimicrobial patterns of Acinetobacter baumannii on hands and nares of hospital personnel and patients: the iceberg phenomenon again. Heart Lung 2002; 31:382-90. [PMID: 12487017 DOI: 10.1067/mhl.2002.126103] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the prevalence and antimicrobial susceptibility patterns of Acinetobacter baumannii on the hands and nares of health care workers and patients from intensive care and rehabilitation units at two hospitals in northern Manhattan, New York. DESIGN Prevalence survey of Acinetobacter on the hands and anterior nares of staff (n = 184) and patients (n = 98) in rehabilitation and intensive care units of two hospitals. RESULTS Twenty subjects (7.1%) had positive test results for A baumannii (6 staff [3.3%] and 14 patients [14.3%]). Five patients had positive test results at both sites, four in the nares only, and 11 on hands only. Among patients, four significant predictors of A baumannii were days on unit (P = .003), location (hospital A or B) (P = .01), surgery (P = .04), and receiving an antifungal agent (P = .02; OR, 5.6; 95% CI, 1.25-24.52). Among staff, predictors were skin damage (P = .02) and employment in hospital B (P = .03). Nine of the 20 subjects (45%) had positive test results for multiresistant strains, one from a staff member and eight from patients. CONCLUSION Patients whose conditions are not clinically symptomatic for A baumannii, as well as staff, are often colonized. Staff with damaged skin are more likely to be colonized. Control of this organism will only be possible when the principle of the iceberg phenomenon--all patients (and staff) treated with standard, Universal Precautions--is strictly followed. Further, the endemic prevalence of multiresistant strains may be higher than previously appreciated.
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Affiliation(s)
- Sharon Bayuga
- Joseph L. Mailman School of Public Health, New York, NY, USA
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48
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Simor AE, Lee M, Vearncombe M, Jones-Paul L, Barry C, Gomez M, Fish JS, Cartotto RC, Palmer R, Louie M. An outbreak due to multiresistant Acinetobacter baumannii in a burn unit: risk factors for acquisition and management. Infect Control Hosp Epidemiol 2002; 23:261-7. [PMID: 12026151 DOI: 10.1086/502046] [Citation(s) in RCA: 137] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES To describe the investigation and management of an outbreak due to multiresistant Acinetobacter baumannii and to determine risk factors for acquisition of the organism. SETTING A 14-bed regional burn unit in a Canadian tertiary-care teaching hospital. DESIGN Case-control study with multivariate analysis of potential risk factors using logistic regression analysis. Surveillance cultures were obtained from the hospital environment, from noninfected patients, and from healthcare providers. RESULTS A total of 31 (13%) of 247 patients with acute burn injuries acquired multiresistant A. baumannii between December 1998 and March 2000; 18 (58%) of the patients were infected. The organism was recovered from the hospital environment and the hands of healthcare providers. Significant risk factors for acquisition of multiresistant A. baumannii were receipt of blood products (odds ratio [OR], 10.8; 95% confidence interval [CI95], 3.4 to 34.4; P < .001); procedures performed in the hydrotherapy room (OR, 4.1; CI95, 1.3 to 13.1; P = .02); and increased duration of mechanical ventilation (OR, 1.1 per day; CI95, 1.0 to 1.1; P= .02). INTERVENTIONS Improved compliance with hand hygiene, strict patient isolation, meticulous environmental cleaning, and temporary closure of the unit to new admissions. CONCLUSIONS Acquisition of multiresistant A. baumannii was likely multifactorial, related to environmental contamination and contact with transiently colonized healthcare providers. Control measures addressing these potential sources of multiresistant A. baumannii were successful in terminating the outbreak. Ongoing surveillance and continued attention to hand hygiene and adequate environmental cleaning are essential to prevent recurrent outbreaks due to antibiotic-resistant bacteria in burn units.
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Affiliation(s)
- Andrew E Simor
- Department of Microbiology, Sunnybrook and Women's College Health Sciences Centre, North York, Ontario, Canada
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Martínez-Pellús A, Ruiz Gómez J, Jaime Sánchez F, Simarro Córdoba E, Fernández Lozano JA. [Incidence of colonization and infection by Acinetobacter baumannii in an endemic seting (ICU). Analysis of risk factors by means of a surveillance study]. Enferm Infecc Microbiol Clin 2002; 20:194-9. [PMID: 12006255 DOI: 10.1016/s0213-005x(02)72788-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Our ICU has witnessed a gradual increase in infections due to Acinetobacter baumannii complex that has reached a level of stable endemia since 1995. This situation, aggravated by a high degree of resistance, has led to the present prospective study, designed to establish the incidence of Acinetobacter colonization and to investigate the role of risk factors and their relation to environmental colonization. METHODS Serial sampling of all patients from the time of ICU admission to discharge. Sample collection from the environment and from hospital personnel. Monitorization of pre-established risk factors and detection of episodes of infection. RESULTS One-third of patients were colonized during their stay, with the trachea (43%), rectum (31%), and skin (35%) being the most frequent sites. In 92% of cases, colonization was established within the first 9 days after admission. Significant risk factors included mechanical ventilation (p < 0.01) and previous use of antibiotics (p < 0.007). Acinetobacter was recovered from thermometers (35%), respirator switches (43%), and damp surfaces (54%). Infection developed in 8% of patients; all had been previously colonized. CONCLUSIONS In an endemic setting, Acinetobacter colonization can occur in a third of ICU patients. This event is relatively early and often precedes infection. Duration of mechanical ventilation and previous use of antibiotics are the main risk factors. Environmental elements are frequent bacterial reservoirs, but the main reservoir is the colonized patient.
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Affiliation(s)
- Antonio Martínez-Pellús
- Servicios de UCI y Microbiología. Hospital Universitario Virgen de la Arrixaca. Murcia. Spain
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50
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García-Garmendia JL, Ortiz-Leyba C, Garnacho-Montero J, Jiménez-Jiménez FJ, Pérez-Paredes C, Barrero-Almodóvar AE, Gili-Miner M. Risk factors for Acinetobacter baumannii nosocomial bacteremia in critically ill patients: a cohort study. Clin Infect Dis 2001; 33:939-46. [PMID: 11528563 DOI: 10.1086/322584] [Citation(s) in RCA: 141] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2000] [Revised: 02/12/2001] [Indexed: 01/07/2023] Open
Abstract
Nosocomial bacteremia caused by Acinetobacter baumannii (AB) is of increasing concern in critically ill patients, and the risk factors for this infection are not well established. An inception cohort study in a 40-bed medical and surgical intensive care unit (ICU) at a single institution was conducted during a 2-year period to determine the risk factors for AB nosocomial bacteremia. Risk factors related to the underlying diseases, the clinical picture at admission, and those acquired during the stay in the ICU were recorded upon admission and daily throughout the ICU stay. We defined an "invasive procedures index" as the number of invasive procedures performed every day during the ICU stay before the onset of AB bacteremia divided by the number of days in the ICU before the onset of AB bacteremia. Risk factors that were independently associated with AB bacteremia were immunosuppression, unscheduled admission to the hospital, respiratory failure at ICU admission, previous antimicrobial therapy, previous sepsis in the ICU, and the invasive procedures index.
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