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Alves PGV, Menezes RDP, Silva NBS, Faria GDO, Bessa MADS, de Araújo LB, Aguiar PADF, Penatti MPA, Pedroso RDS, Röder DVDDB. Virulence factors, antifungal susceptibility and molecular profile in Candida species isolated from the hands of health professionals before and after cleaning with 70% ethyl alcohol-based gel. J Mycol Med 2024; 34:101482. [PMID: 38763122 DOI: 10.1016/j.mycmed.2024.101482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 02/10/2024] [Accepted: 05/06/2024] [Indexed: 05/21/2024]
Abstract
Fungal infections in neonatal intensive care units (NICU) are mainly related to Candida species, with high mortality rates. They are predominantly of endogenous origin, however, cross-infection transmitted by healthcare professionals' hands has occurred. The aim of this study was to identify Candida species isolated from the hands of healthcare professionals in a NICU before and after hygiene with 70% ethanol-based gel and evaluate virulence factors DNase, phospholipase, proteinase, hemolysin, biofilm biomass production, and metabolic activity. In vitro antifungal susceptibility testing and similarity by random amplified polymorphic DNA (RAPD) were also performed. C. parapsilosis complex was the most frequent species (57.1%); all isolates presented at least one virulence factor; three isolates (Candida parapsilosis complex) were resistant to amphotericin B, two (Candida famata [currently Debaryomyces hansenii] and Candida guilliermondii [currently Meyerozyma guilliermondii]) was resistant to micafungin, and six (Candida parapsilosis complex, Candida guilliermondii [=Meyerozyma guilliermondii], Candida viswanathi, Candida catenulata [currently Diutina catenulata] and Candida lusitaniae [currently Clavispora lusitaniae]) were resistant to fluconazole. Molecular analysis by RAPD revealed two clusters of identical strains that were in the hands of distinct professionals. Candida spp. were isolated even after hygiene with 70% ethanol-based gel, highlighting the importance of stricter basic measures for hospital infection control to prevent nosocomial transmission.
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Affiliation(s)
- Priscila Guerino Vilela Alves
- Postgraduate Program in Health Sciences, Medicine, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
| | - Ralciane de Paula Menezes
- Technical School of Health, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
| | - Nagela Bernadelli Sousa Silva
- Postgraduate Program in Applied Immunology and Parasitology, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
| | | | | | - Lúcio Borges de Araújo
- Clinical Hospital, Federal University of Uberlândia (UFU), Uberlândia, Minas Gerais, Brazil
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SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent healthcare-associated infections through hand hygiene: 2022 Update. Infect Control Hosp Epidemiol 2023; 44:355-376. [PMID: 36751708 PMCID: PMC10015275 DOI: 10.1017/ice.2022.304] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
The purpose of this document is to highlight practical recommendations to assist acute-care hospitals in prioritization and implementation of strategies to prevent healthcare-associated infections through hand hygiene. This document updates the Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals through Hand Hygiene, published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.
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Bredin D, O'Doherty D, Hannigan A, Kingston L. Hand hygiene compliance by direct observation in physicians and nurses: a systematic review and meta-analysis. J Hosp Infect 2022; 130:20-33. [PMID: 36089071 DOI: 10.1016/j.jhin.2022.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 08/05/2022] [Accepted: 08/29/2022] [Indexed: 11/20/2022]
Abstract
BACKGROUND Direct observation of hand hygiene compliance is the "gold standard" despite limitations and potential for bias. Previous literature highlights poorer hand hygiene compliance amongst physicians than nurses and suggests that covert monitoring may give better compliance estimates than overt monitoring. AIM This review aimed to explore differences in compliance between physicians and nurses further, and to analyse if compliance estimates differed when observations were covert rather than overt. METHODS A systematic search of databases PubMed, EMBASE, CENTRAL and CINAHL was performed. Experimental or observational studies in hospital settings in high-income countries published in English from 2010 onwards were included if estimates for both physicians and nurses using direct observation were reported. The search yielded 4814 studies, of which 105 were included. FINDINGS The weighted pooled compliance rate for nurses was 52% (95% CI 47% to 57%) and for doctors was 45% (95% CI 40% to 49%). Heterogeneity was considerable (I2=99%). The majority of studies were at moderate or high risk of bias. Random-effects meta-analysis of low risk of bias studies suggests higher compliance for nurses than physicians for both overt (difference of 7%, 95% CI for the difference 0.8% to 13.5%, p=0.027) and covert (difference of 7%, 95% CI 3% to 11%, p=0.0002) observation. Considerable heterogeneity was found in all analyses. CONCLUSION Wide variability in compliance estimates and differences in the methodological quality of hand hygiene studies were identified. Further research with meta-regression should explore sources of heterogeneity and improve the conduct and reporting of hand hygiene studies.
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Affiliation(s)
- D Bredin
- School of Medicine, University of Limerick, Ireland
| | - D O'Doherty
- School of Medicine, University of Limerick, Ireland
| | - A Hannigan
- School of Medicine, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland
| | - L Kingston
- Department of Nursing and Midwifery, University of Limerick, Ireland; Health Research Institute, University of Limerick, Ireland.
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Ni L, Wang Q, Wang F, Ni Z, Zhang S, Zhong Z, Chen Z. An interventional implementation project: hand hygiene improvement. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:1149. [PMID: 33240998 PMCID: PMC7576019 DOI: 10.21037/atm-20-5480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Good hand hygiene is the most effective basic measure for preventing hospital-acquired infections. This research project, which originated from a project report on improving hand hygiene at a general hospital in Hangzhou, Zhejiang, China, aimed to investigate the effectiveness of hand hygiene improvement among the hospital staff. Methods Since 2017, a hand hygiene improvement project involving the staff of a 2,500-bed general teaching hospital in Zhejiang, China, has been carried out. This study summarized the implementation and effectiveness of the project, which is based on the five factors of systematic evaluation. The research summary was divided into three phases: phase I (December 2017 to August 2018), phase 2 (September 2018 to April 2019), and phase 3 (May 2019 to December 2019). The data of hand hygiene compliance rates of different groups of professionals in the different research periods were statistically analyzed. Results The results showed that continuous intervention led to a gradual increasing trend (Ptrend<0.001) in the hand hygiene implementation rate with as the intervention time and phases progressed. The hand hygiene compliance rates differed significantly during different phases (76.61%, 79.95%, and 83.34% in phases 1, 2, and 3, respectively, P<0.001). At the same time, the compliance rates of hand hygiene at each phase differed significantly between different professions (P<0.001, the compliance rate of hand hygiene among nurses was the highest and lowest among workers). The compliance rate of hand hygiene for different professions during the three phases were: nurses, 84.73%; doctors, 78.35%; interns, 77.62%; and other hospital workers, 72.79%. Conclusions The hand hygiene compliance rate was effectively improved among the hospital staff after the implementation of the hand hygiene improvement project. In this hospital, the project yielded remarkable results. Hand hygiene must be continuously practiced and improved to develop good habits. Effective and detailed planning as well as key factors, such as hand hygiene facilities, information monitoring, the active participation and response of employees, training and education, and supervision and feedback, could help to guarantee the effectiveness of the project.
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Affiliation(s)
- Lingmei Ni
- Infection Prevention and Control Department, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Qunmin Wang
- Anorectal Department, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Fang Wang
- Infection Prevention and Control Department, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zuowei Ni
- Infection Prevention and Control Department, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Sheng Zhang
- Infection Prevention and Control Department, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zifeng Zhong
- Infection Prevention and Control Department, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
| | - Zuobing Chen
- Department of Rehabilitation Medicine, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, China
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Rowley S, Clare S. How widely has ANTT been adopted in NHS hospitals and community care organisations in England and Scotland? ACTA ACUST UNITED AC 2020; 29:924-932. [DOI: 10.12968/bjon.2020.29.16.924] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background: To the detriment of patient safety, the important clinical competency of aseptic technique has been notoriously variable in practice, and described ambiguously in the literature, internationally. From a UK perspective, attempts have been made to improve patient safety by reducing variability and improving education and practice through standardisation. The Welsh Government mandated Aseptic Non Touch Technique (ANTT®) as a specific national standard in 2015. All healthcare organisations in England are required by the Health and Social Care Act 2008 to have a single standard aseptic technique, demonstrable by the clinical governance indicators of education, training, competency assessment and compliance audit. In Scotland, an education-based initiative was launched by NHS Education for Scotland in 2012. To review the impact of these and other initiatives on the current status of aseptic technique, all NHS trusts in England and NHS health boards in Scotland were assessed under the Freedom of Information procedure. Findings: 93% of NHS trusts in England use a single standard for aseptic technique. In 88% of these trusts the single standard was stipulated as being ANTT. In Scotland, 62% of NHS acute and community care hospitals within health boards use a single standard. In 56% of these, the single standard was ANTT. When including those that use ANTT in combination with other techniques ANTT usage is 73%. Conclusion: These data demonstrate significant progress in standardising aseptic technique education, assessment and governance, and confirms ANTT as the de facto aseptic technique used in NHS trusts in England and health boards in Scotland.
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Affiliation(s)
- Stephen Rowley
- Clinical Director, The Association for Safe Aseptic Practice
| | - Simon Clare
- Research and Practice Development Director, The Association for Safe Aseptic Practice
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de Paula Menezes R, Silva FF, Melo SGO, Alves PGV, Brito MO, de Souza Bessa MA, Amante Penatti MP, Pedroso RS, Abdallah VOS, Röder DVDB. Characterization of Candida species isolated from the hands of the healthcare workers in the neonatal intensive care unit. Med Mycol 2019; 57:588-594. [PMID: 30388269 DOI: 10.1093/mmy/myy101] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Revised: 09/06/2018] [Accepted: 09/13/2018] [Indexed: 01/01/2023] Open
Abstract
Colonization of health professional hands by potentially pathogenic microorganisms capable to expressing virulence factors, such as Candida spp., is worrisome because of the high contact between patients and professionals. The study aims to evaluate, in vitro, the following virulence factors: hemolytic activity, DNAse expression, biofilm formation, and susceptibility for antifungal agents of Candida species isolated from health professionals hands of a neonatal intensive care unit (NICU). The study includes 50 isolates of Candida spp.: 19 C. parapsilosis sensu stricto, three C. metapsilosis, one C. orthopsilosis, seven C. albicans, six C. famata, five C. lusitaniae, three C. krusei, two C. kefyr, two C. tropicalis, one C. glabrata, and one C. guilliermondii. The hemolytic activity and DNAse were investigated using blood agar and DNAse agar, respectively. Biofilm production was evaluated through XTT sodium salt reduction ability, and the susceptibility of the isolates to antifungals through the microdilution methodology. Forty-nine isolates presented at least one of the three virulence factors investigated. C. albicans showed more intense hemolytic activity. DNAse production was statistically significant between the C. parapsilosis complex and C. albicans, as well as between the C. parapsilosis complex and C. krusei, even as between C. famata and C. albicans, and between C. famata and C. krusei. Forty-three isolates produced biofilm. Seventy-eight percent of the isolates were sensitive to the three antifungals tested. This study demonstrated that Candida isolated from healthcare professionals' hands has virulence.
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Affiliation(s)
- Ralciane de Paula Menezes
- HealthTechnical School- ESTES, Federal University of Uberlandia (UFU), Uberlandia, MG, Brazil
- Health Sciences Postgraduate Program, Faculty of Medicine- FAMED, UFU, Uberlandia, MG, Brazil
| | - Felipe F Silva
- Health Sciences Postgraduate Program, Faculty of Medicine- FAMED, UFU, Uberlandia, MG, Brazil
| | | | - Priscila G V Alves
- Health Sciences Postgraduate Program, Faculty of Medicine- FAMED, UFU, Uberlandia, MG, Brazil
| | - Murilo O Brito
- Health Sciences Postgraduate Program, Faculty of Medicine- FAMED, UFU, Uberlandia, MG, Brazil
| | | | | | - Reginaldo S Pedroso
- HealthTechnical School- ESTES, Federal University of Uberlandia (UFU), Uberlandia, MG, Brazil
- Health Sciences Postgraduate Program, Faculty of Medicine- FAMED, UFU, Uberlandia, MG, Brazil
| | - Vânia O S Abdallah
- Health Sciences Postgraduate Program, Faculty of Medicine- FAMED, UFU, Uberlandia, MG, Brazil
| | - Denise von D B Röder
- Health Sciences Postgraduate Program, Faculty of Medicine- FAMED, UFU, Uberlandia, MG, Brazil
- Institute of Biomedical Sciences, ICBIM, UFU, Uberlandia, MG, Brazil
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Abstract
Invasive candida infections are the most important causes of nosocomial infections in intensive care units and in risky groups such as immunosuppressed patients. These infections lead to undesirable consequences such as increased morbidity and mortality in patients, prolongation of hospital stay, and increased hospital costs. In recent years, the incidence of non-albicans Candida spp.'s has increased. Unfortunately, some of these species are naturally resistant to first-line antifungals. In addition, biofilm formation on the central venous catheter and invasive devices may cause treatment failure. The age of the patients, co-morbid diseases, the units where they are treated, the antibiotics and antifungals that are used for the treatment, and invasive devices are risk factors for invasive candida infections. Some of these risk factors can be reduced by the behavior of health-care workers. The most important goal is to take precautions before the occurrence of invasive candida infections. Infection control measures to prevent hospital transmission of candida are very important. Compliance with hand hygiene before and after contact with the patient is the most important step to prevent the spreading of Candida spp. Observation of maximal barrier precautions during invasive catheterization is another important clause of this aim. Avoiding unnecessary invasive devices, antibiotics, and parenteral nutrition are also important to reduce the colonization of candida.
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Affiliation(s)
- Zeynep Ture
- a Department of Infectious Diseases and Clinical Microbiology , Health Ministry University of Kayseri Education and Research Hospital , Kayseri , Turkey
| | - Emine Alp
- b Department of Infectious Diseases and Clinical Microbiology, Infection Control Committee, Faculty of Medicine , Erciyes University , Kayseri , Turkey
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Kreidl P, Mayr A, Hinterberger G, Berktold M, Knabl L, Fuchs S, Posch W, Eschertzhuber S, Obwegeser A, Lass-Flörl C, Orth-Höller D. Outbreak report: a nosocomial outbreak of vancomycin resistant enterococci in a solid organ transplant unit. Antimicrob Resist Infect Control 2018; 7:86. [PMID: 30034798 PMCID: PMC6052578 DOI: 10.1186/s13756-018-0374-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 07/04/2018] [Indexed: 11/15/2022] Open
Abstract
Background Vancomycin resistant enterococci (VRE) are an emerging problem in health care settings. The purpose of the investigation was to assess the extent of the outbreak including environmental contamination and to limit further transmission. Methods We used retrospective patient and laboratory data including pulse field gel electrophoresis (PFGE) typing and virulence and resistance gene analysis. For comparison of medians the Mann-Whitney and for comparison of proportions the Fisher exact tests were used. Results PFGE typing of VRE strains of an outbreak of 15 VRE cases in a solid transplant unit revealed that nine of the cases belonged to one identical pattern (A), which was only found twice in the environment. Eleven further positive environmental samples showed a different, but identical PFGE pattern E. Only one patient was infected with this environmental strain. Two of nine (22.2%) PFGE A, but nine of eleven (81.2%) PFGE E samples were positive for gelatinase E (p = 0.01), which is described as enhancing biofilm production, suggesting a survival benefit for this strain on inanimate surfaces. Conclusion Routine disinfection was not able to stop the cluster, but after repeated enforcement of the infection prevention and control (IPC) bundle such as training, strict adherence to hand hygiene and surface disinfection no further cases were observed. We conclude that certain VRE strains predominate in the environment whereas others predominate in humans. Enforcement of the IPC bundle is essential for controlling VRE outbreaks and reducing further transmission.
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Affiliation(s)
- Peter Kreidl
- 1Department of Hygiene, Microbiology and Social Medicine, Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Schoepfstr. 41, 6020 Innsbruck, Austria
| | - Astrid Mayr
- 1Department of Hygiene, Microbiology and Social Medicine, Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Schoepfstr. 41, 6020 Innsbruck, Austria
| | - Guido Hinterberger
- 1Department of Hygiene, Microbiology and Social Medicine, Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Schoepfstr. 41, 6020 Innsbruck, Austria
| | - Michael Berktold
- 1Department of Hygiene, Microbiology and Social Medicine, Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Schoepfstr. 41, 6020 Innsbruck, Austria
| | - Ludwig Knabl
- 1Department of Hygiene, Microbiology and Social Medicine, Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Schoepfstr. 41, 6020 Innsbruck, Austria
| | - Stefan Fuchs
- 1Department of Hygiene, Microbiology and Social Medicine, Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Schoepfstr. 41, 6020 Innsbruck, Austria
| | - Wilfried Posch
- 1Department of Hygiene, Microbiology and Social Medicine, Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Schoepfstr. 41, 6020 Innsbruck, Austria
| | - Stephan Eschertzhuber
- 2Department of Anesthesia and Critical Care, Centre of Operative Medicine, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Alois Obwegeser
- 3Department of Neurosurgery, University Hospital of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Cornelia Lass-Flörl
- 1Department of Hygiene, Microbiology and Social Medicine, Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Schoepfstr. 41, 6020 Innsbruck, Austria
| | - Dorothea Orth-Höller
- 1Department of Hygiene, Microbiology and Social Medicine, Division of Hygiene and Medical Microbiology, Medical University of Innsbruck, Innsbruck, Schoepfstr. 41, 6020 Innsbruck, Austria
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Cresswell P, Monrouxe LV. 'And you'll suddenly realise 'I've not washed my hands': medical students', junior doctors' and medical educators' narratives of hygiene behaviours. BMJ Open 2018; 8:e018156. [PMID: 29572392 PMCID: PMC5875678 DOI: 10.1136/bmjopen-2017-018156] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE Compliance to hygiene behaviours has long been recognised as important in the prevention and control of healthcare associated infections, but medical doctors still display some of the lowest rates of compliance of all healthcare workers. We aim to understand compliance to hygiene behaviours by analysing medical students', junior doctors' and medical educators' narratives of these behaviours to identify their respective attitudes and beliefs around compliance and how these are learnt during training. Such an understanding can inform future interventions to improve compliance targeted to areas of greatest need. DESIGN A qualitative study, using narrative interviews (nine focus groups and one individual interview). Data were analysed thematically using inductive framework analysis. SETTING Teaching hospitals in the UK. PARTICIPANTS Convenience sample of 25 participants: third-year medical students in their first clinical year (n=13), junior doctors (n=6) and medical educators (n=6). RESULTS We identified four main themes: (1) knowledge, (2) constraints, (3) role models/culture and (4) hygiene as an added extra. Knowledge varied across participant groups and appeared to influence behaviours; medical students relied on what they have been told by seniors, while medical educators relied on their own knowledge and experience. There was a strong belief that evidence for the effectiveness of good hygiene behaviours is lacking. Furthermore, medical educators' behaviour appears to strongly influence others. Finally, hygiene was predominately viewed as an added extra rather than an integral part of the process. CONCLUSIONS Awareness of the evidence around good hygiene needs to be improved at all levels. Medical students and junior doctors should be encouraged to consider why they are asked to perform certain hygiene behaviours in order to improve ownership of those behaviours. Medical educators need to recognise their responsibilities as role models for their junior counterparts, thereby understanding their role in developing the culture of hygiene practices within their clinical domains.
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Affiliation(s)
- Penelope Cresswell
- NHS East and North Hertfordshire Clinical Commissioning Group, Welwyn Garden City, UK
| | - Lynn V Monrouxe
- Chang Gung Medical Education Research Centre (CG-MERC), Chang Gung Memorial Hospital, Linkou, Taoyuan, Taiwan (R.O.C.)
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Sakita KM, Faria DR, Silva EMD, Tobaldini-Valério FK, Kioshima ES, Svidzinski TIE, Bonfim-Mendonça PDS. Healthcare workers' hands as a vehicle for the transmission of virulent strains of Candida spp.: A virulence factor approach. Microb Pathog 2017; 113:225-232. [PMID: 29074432 DOI: 10.1016/j.micpath.2017.10.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 09/11/2017] [Accepted: 10/22/2017] [Indexed: 11/15/2022]
Abstract
BACKGROUND Although the majority of Candida infections are thought to come from endogenous sources, the healthcare workers' (HCWs) hands are being increasingly reported as vehicles for the transmission of pathogens. The aim of the present study was to evaluate the susceptibility of yeast isolated from the HCWs' hands and ICU (Intensive Care Unit) surfaces to antifungal agents and to determine the virulence potential and the genetic similarity between the same. METHODS The susceptibility of yeasts from the HCWs' hands (n = 57) and ICU surfaces (n = 98) to conventional antifungals (fluconazole, voriconazole, amphotericin B and micafungin) was evaluated using the broth microdilution assay accordance with CLSI M27-A3. Additionally, some virulence factors such as adhesion and biofilm capacity on abiotic surfaces and on endothelial cells were evaluated, as well as germ tube formation. The similarity among yeast isolates were evaluated by the RAPD technique using the P4, OPA18 and OPE18 primers. RESULTS Five species of Candida were found on the HCWs' hands (C. albicans, C. parapsilosis (sensu stricto), C. glabrata, C. tropicalis and C. krusei) and two on ICU surfaces (C. albicans and C. parapsilosis (sensu stricto)). The isolates from hands had higher resistance rates, with C. glabrata having the highest indices (100% FLU; 100% MFG). The similarity of C. albicans from HCWs and ICU surfaces was ≥80% according to the three primers analyzed. Candida spp. from hands had a greater potential for adhesion and biofilm formation on abiotic surfaces (p < 0.05). C. albicans from ICU surfaces had the greatest potential of adhesion on endothelial cells after 2 and 24 h, and presented high filamentation in SEM images and formed more and larger germ tubes (p < 0.05). CONCLUSION the present study showed the significant virulence potential of yeasts transmitted in the hospital environment for the first time. Additionally, healthy people working in the ICU can carry these yeasts, which are capable of surviving in hospital surfaces, on their hands, offering a risk to patients, especially those who are immunocompromised.
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Affiliation(s)
- Karina Mayumi Sakita
- Division of Medical Mycology, Teaching and Research Laboratory in Clinical Analyses, Department of Clinical Analysis of State University of Maringá, Paraná, Brazil
| | - Daniella Renata Faria
- Division of Medical Mycology, Teaching and Research Laboratory in Clinical Analyses, Department of Clinical Analysis of State University of Maringá, Paraná, Brazil
| | - Eliane Martins da Silva
- Division of Medical Mycology, Teaching and Research Laboratory in Clinical Analyses, Department of Clinical Analysis of State University of Maringá, Paraná, Brazil
| | - Flávia Kelly Tobaldini-Valério
- Division of Medical Mycology, Teaching and Research Laboratory in Clinical Analyses, Department of Clinical Analysis of State University of Maringá, Paraná, Brazil
| | - Erika Seki Kioshima
- Division of Medical Mycology, Teaching and Research Laboratory in Clinical Analyses, Department of Clinical Analysis of State University of Maringá, Paraná, Brazil
| | - Terezinha Inez Estivalet Svidzinski
- Division of Medical Mycology, Teaching and Research Laboratory in Clinical Analyses, Department of Clinical Analysis of State University of Maringá, Paraná, Brazil
| | - Patricia de Souza Bonfim-Mendonça
- Division of Medical Mycology, Teaching and Research Laboratory in Clinical Analyses, Department of Clinical Analysis of State University of Maringá, Paraná, Brazil.
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Wille I, Mayr A, Kreidl P, Brühwasser C, Hinterberger G, Fritz A, Posch W, Fuchs S, Obwegeser A, Orth-Höller D, Lass-Flörl C. Cross-sectional point prevalence survey to study the environmental contamination of nosocomial pathogens in intensive care units under real-life conditions. J Hosp Infect 2017; 98:90-95. [PMID: 28964884 DOI: 10.1016/j.jhin.2017.09.019] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/21/2017] [Indexed: 01/09/2023]
Abstract
BACKGROUND In intensive care units (ICUs), inanimate surfaces and equipment may be contaminated by nosocomial pathogens, including multi-drug-resistant micro-organisms. AIMS To assess the degree of environmental contamination close to and distant from patients, and contamination of healthcare workers' (HCWs) hands with nosocomial pathogens under real-life conditions and to investigate potential transmission events. METHODS Over the course of three weeks, agar contact samples were taken close to and distant from patient areas and from HCWs' hands in eight ICUs of a tertiary care hospital in Innsbruck, Austria. Each ICU was visited once without announcement. Species identification and antimicrobial susceptibility testing were performed according to standard methods, and corresponding strains from patient, environment and hand samples were genotyped using pulsed-field gel electrophoresis. FINDINGS Among 523 samples, HCWs' hands were most frequently contaminated with potentially pathogenic bacteria (15.2%), followed by areas close to patients (10.9%) and areas distant from patients (9.1%). Gram-positive bacteria were identified most often (67.8%), with Enterococcus spp. being the most prevalent species (70% vancomycin sensitive and 30% vancomycin resistant) followed by Staphylococcus aureus, of which 64% were classified as meticillin-resistant Staphylococcus aureus. Molecular typing documented identical strains among patient, environment and hand isolates. CONCLUSION This study found widespread contamination of the ICU environment with clinically relevant pathogens, including multi-drug-resistant micro-organisms, despite cleaning and disinfection. The bioburden might not be restricted to areas close to patients. The role of extended environmental disinfection of areas distant from patients in order to improve infection prevention needs further discussion.
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Affiliation(s)
- I Wille
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Invasive Fungal Infections, Innsbruck, Austria
| | - A Mayr
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Invasive Fungal Infections, Innsbruck, Austria.
| | - P Kreidl
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Innsbruck, Austria
| | - C Brühwasser
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Invasive Fungal Infections, Innsbruck, Austria
| | - G Hinterberger
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Innsbruck, Austria
| | - A Fritz
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Invasive Fungal Infections, Innsbruck, Austria
| | - W Posch
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Innsbruck, Austria
| | - S Fuchs
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Innsbruck, Austria
| | - A Obwegeser
- Department of Neurosurgery, University Hospital of Innsbruck, Austria
| | - D Orth-Höller
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Innsbruck, Austria
| | - C Lass-Flörl
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Invasive Fungal Infections, Innsbruck, Austria
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12
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Clare S, Rowley S. Implementing the Aseptic Non Touch Technique (ANTT®) clinical practice framework for aseptic technique: a pragmatic evaluation using a mixed methods approach in two London hospitals. J Infect Prev 2017; 19:6-15. [PMID: 29317909 DOI: 10.1177/1757177417720996] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2015] [Accepted: 06/19/2017] [Indexed: 12/30/2022] Open
Abstract
Background Aseptic technique is an important infection prevention competency for protecting patients from healthcare-associated infection (HAI). Healthcare providers using the Aseptic Non Touch Technique (ANTT®) aseptic technique have demonstrated reduced variability and improved compliance with aseptic technique. Objectives The primary aim of this study is to determine whether standardizing aseptic technique for invasive IV procedures, using the ANTT® - Clinical Practice Framework (CPF), increases staff compliance with the infection prevention actions designed to achieve a safe and effective aseptic technique, and whether this is sustainable over time. Methods A pragmatic evaluation using a mixed-methods approach consisting of an observational audit of practice, a self-report survey and structured interviews with key stakeholders. Compliance with aseptic technique before and after the implementation of ANTT® was measured by observation of 49 registered healthcare professionals. Results Mean compliance with competencies was 94%; each component of practice was improved over baseline: hand hygiene = 63% (P ≤ 0.001); glove use = 14% (P ≤ 0.037); Key-Part protection = 54% (P ≤ 0.001); a non-touch technique = 45% (P ≤ 0.001); Key-Part cleaning = 82% (P ≤ 0.001); and aseptic field management = 80% (P ≤ 0.001). Conclusions Results show implementation of ANTT® improved compliance with the prerequisite steps for safe and effective aseptic technique as defined by the ANTT®-CPF. Improvements in compliance were sustained over four years.
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Affiliation(s)
- Simon Clare
- The Association for Safe Aseptic Practice, Surrey, UK
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13
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Brühwasser C, Heinrich H, Lass-Flörl C, Mayr A. Self-disinfecting surfaces and activity against Staphyloccocus aureus ATCC 6538 under real-life conditions. J Hosp Infect 2017. [PMID: 28647424 DOI: 10.1016/j.jhin.2017.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Environmental surface contamination provides a potential reservoir for pathogens to cause infections. As such, self-disinfecting surfaces have been developed to possibly reduce exogenous transmission. Five different self-disinfecting surfaces were evaluated for activity against Staphylococcus aureus ATCC 6538 under real-life conditions using the dry inoculation method. Various antimicrobial effects were detected. However, following disinfection with alcoholic wipes, these effects disappeared. Further development is necessary to produce self-disinfecting surfaces that are stable in the presence of hospital disinfectants, as it is impossible to guarantee that self-disinfecting surfaces in healthcare settings will not be exposed to disinfectants.
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Affiliation(s)
- C Brühwasser
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Invasive Fungal Infections, Innsbruck, Austria
| | - H Heinrich
- EGGER Holzwerkstoffe Wismar GmbH & CoKG, Wismar, Germany
| | - C Lass-Flörl
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Invasive Fungal Infections, Innsbruck, Austria
| | - A Mayr
- Division of Hygiene and Medical Microbiology, Department of Hygiene, Microbiology and Public Health, Medical University of Innsbruck, Innsbruck, Austria; Christian Doppler Laboratory for Invasive Fungal Infections, Innsbruck, Austria.
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14
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Arise K, Nishizaki S, Morita T, Yagi Y, Takeuchi S. Continued direct observation and feedback of hand hygiene adherence can result in long-term improvement. Am J Infect Control 2016; 44:e211-e214. [PMID: 27810069 DOI: 10.1016/j.ajic.2016.07.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Revised: 07/26/2016] [Accepted: 07/26/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hospital-wide multifaceted approaches can improve hand hygiene compliance in health care workers. However, the true effects of monitoring and feedback interventions are not clear. METHODS Hand hygiene compliance was evaluated by applying direct observation techniques over 5 years (2005-2009) in a tertiary care general hospital in Japan. The observed results were periodically reported as feedback to the health care workers. RESULTS The overall hand hygiene compliance rate increased from 50.8% in 2005 to 61.0% in 2006 (P = .004) and was sustained at approximately 60% through the completion of the study. The compliance rate for the indication before entering the room increased from 2005 to 2009 (P = .005). The compliance rates for 4 before patient contact indications increased from 2005 to 2009 (P = .002). The combined compliance rate for the 6 indications with the lowest compliance rates in 2005 increased from 2005 to 2009 (P = .001). CONCLUSIONS Direct observation and feedback methods are effective strategies that resulted in a long-lasting improvement in hand hygiene compliance that was sustained over 5 years through the completion of the study. Focusing on the procedures with high baseline noncompliance rates can be an effective way to improve the overall compliance.
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Affiliation(s)
- Kazumi Arise
- Department of Infection Control and Prevention, Kochi Medical School Hospital, Nankoku, Japan
| | - Sayaka Nishizaki
- Department of Infection Control and Prevention, Kochi Medical School Hospital, Nankoku, Japan
| | - Tamae Morita
- Department of Infection Control and Prevention, Kochi Medical School Hospital, Nankoku, Japan; Department of Clinical Laboratory, Kochi Medical School Hospital, Nankoku, Japan
| | - Yusuke Yagi
- Department of Infection Control and Prevention, Kochi Medical School Hospital, Nankoku, Japan; Department of Pharmacy, Kochi Medical School Hospital, Nankoku, Japan
| | - Seisho Takeuchi
- Department of Infection Control and Prevention, Kochi Medical School Hospital, Nankoku, Japan; Department of General Medicine, Kochi Medical School Hospital, Nankoku, Japan.
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