Recommendations for change in infection prevention programs and practice

Epidemiology and Microbiology of Healthcare-Associated Infections in Neurosurgery Department: A Cross-Sectional Study

Objective: Hospital-acquired infections (HAIs) present a significant challenge in neurosurgical settings. This study aimed to assess the prevalence, risk factors, and clinical impact of HAIs in a neurosurgery department. Methods: A retrospective cross-sectional study was conducted on 5474 patients hospitalized in a neurosurgery department (2019-2023). HAIs were diagnosed in 93 patients (2.7%), accounting for 147 infections. The final cohort included 273 patients: 93 with HAIs and 181 matched controls (age, sex, mortality). Demographic, clinical, and microbiological data were analyzed. Nutritional status was assessed using the Nutritional Risk Screening (NRS, 2002) and consciousness was assessed using the Glasgow Coma Scale (GCS). Infections were classified according to Centers for Disease Control and Prevention (CDC) criteria. Results: The most frequent HAIs were pneumonia (PN, 18.3%), bloodstream infections (BSI, 16.2%), and surgical site infections (SSI, 16.3%). Malnutrition (NRS ≥3) was significantly more common in infected patients (65.6% vs. 11%, p < .001). Patients with GCS ≤8 had higher rates of PN (44.7%) and urinary tract infections (UTI, 32.5%) (p = .004), while GCS 13-15 was linked to SSI (91.7%). HAIs occurred more frequently after emergency procedures (57.8% vs. 30%, p < .0001). Hospital stay was significantly longer in infected patients (40 vs. 5.4 days, p = .001). Klebsiella pneumoniae (15.1%) and Staphylococcus aureus (11.5%) were the most common. Age and sex were not significant risk factors. Conclusion: HAIs in neurosurgical patients are associated with malnutrition and procedural urgency. Targeted infection control, early nutrition support, and antimicrobial stewardship are essential to improving outcomes.

Unveiling the impact: COVID-19's influence on bacterial resistance in the Kingdom of Bahrain

BACKGROUND

Antibiotic resistance is a growing global health threat, and understanding local trends in bacterial isolates and their susceptibility patterns is crucial for effective infection control and antimicrobial stewardship. The coronavirus disease 2019 (COVID-19) pandemic has introduced additional complexities, potentially influencing these patterns.

AIM

To analyze trends in bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex from 2018 to 2023, with a specific focus on the impact of the COVID-19 pandemic on these trends.

METHODS

A retrospective analysis of microbiological data was conducted, covering the period from 2018 to 2023. The study included key bacterial pathogens such as Escherichia coli (E. coli), Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Staphylococcus aureus, among others. The antibiotic susceptibility profiles of these isolates were assessed using standard laboratory methods. To contextualize the findings, the findings were compared with similar studies from other regions, including China, India, Romania, Saudi Arabia, the United Arab Emirates, Malaysia, and United States.

RESULTS

The study revealed fluctuating trends in the prevalence of bacterial isolates, with notable changes during the COVID-19 pandemic. For example, a significant increase in the prevalence of Staphylococcus aureus was observed during the pandemic years, while the prevalence of E. coli showed a more variable pattern. Antibiotic resistance rates varied among the different pathogens, with a concerning rise in resistance to commonly used antibiotics, particularly among Klebsiella pneumoniae and E. coli. Additionally, the study identified an alarming increase in the prevalence of multidrug-resistant (MDR) strains, especially within Klebsiella pneumoniae and E. coli isolates. The impact of the COVID-19 pandemic on these trends was evident, with shifts in the frequency, resistance patterns, and the emergence of MDR bacteria among several key pathogens.

CONCLUSION

This study highlights the dynamic nature of bacterial isolates and their antibiotic susceptibility patterns at Salmaniya Medical Complex, particularly in the context of the COVID-19 pandemic. The findings underscore the need for continuous monitoring and effective anti-microbial stewardship programs to combat the evolving threat of antibiotic resistance. Further research and policy initiatives are required to address the identified challenges and improve patient outcomes in the face of these ongoing challenges.

Temporal Patterns and Treatment Associations in Complications Following Hip Arthroplasty

Background and Objectives: Hip arthroplasty is commonly performed to enhance mobility and quality of life in patients with severe joint degeneration. However, post-surgery complications such as infections, dislocations, and mechanical failures remain prevalent and vary over time. This study examines the relationship between time intervals post-surgery and the occurrence of complications and explores the associations between specific treatment modalities and complications. It also investigates temporal patterns of infectious and mechanical complications to inform more effective post-surgery care. Materials and Methods: A retrospective cohort study was conducted on hip arthroplasty patients to analyze the occurrence and distribution of complications across medium-term (1-5 years) and long-term (≥6 years) intervals. Treatment modalities, including joint debridement, lavage, antibiotics, and mechanical interventions, were analyzed for their association with complications. Chi-Square tests were used, with significance set at p < 0.05. Results: A significant association was found between time intervals and complications (χ2 = 58.149, df = 19, p < 0.001). Infections were more prevalent in the medium-term, while mechanical complications such as dislocation, implant loosening, and periprosthetic fractures were more common in the long-term. Antibiotics were strongly linked to infectious complications (χ2 = 279.000, p < 0.001), and mechanical treatments were associated with fractures and dislocations. Conclusions: The study confirms that the timing of complications post-surgery plays a critical role in their occurrence. Specific complications become more prevalent at different intervals, emphasizing the need for tailored treatment strategies. Antibiotics for infections and mechanical interventions for fractures and dislocations should be adjusted based on timing. These findings highlight the importance of time-specific post-surgery care and suggest areas for further research on long-term strategies and risk factors.

mRNA vaccine platforms: linking infectious disease prevention and cancer immunotherapy

The advent of mRNA vaccines, accelerated by the global response to the COVID-19 pandemic, marks a transformative shift in vaccine technology. In this article, we discuss the development, current applications, and prospects of mRNA vaccines for both the prevention and treatment of infectious diseases and oncology. By leveraging the capacity to encode antigens within host cells directly, mRNA vaccines provide a versatile and scalable platform suitable for addressing a broad spectrum of pathogens and tumor-specific antigens. We highlight recent advancements in mRNA vaccine design, innovative delivery mechanisms, and ongoing clinical trials, with particular emphasis on their efficacy in combating infectious diseases, such as COVID-19, Zika, and influenza, as well as their emerging potential in cancer immunotherapy. We also address critical challenges, including vaccine stability, optimization of immune responses, and the broader issue of global accessibility. Finally, we review potential strategies for advancing next-generation mRNA vaccines, with the aim of overcoming current limitations in vaccine technology and enhancing both preventive and therapeutic approaches for infectious and oncological diseases.

Quantifying the progressing landscape of infection preventionists: A survey-based analysis of workload and resource needs

BACKGROUND

Current infection preventionist (IP) staffing ratio recommendations are inadequate to address the increasing demands and complexities of the role. This study sought to characterize current staffing levels and workloads for IPs, while investigating the relationships between these factors and the number of licensed inpatient beds, the complexity of acute care hospital services, and the geographical location of the facility.

METHODS

A cross-sectional, web-based survey questionnaire was administered to 91 acute care facilities to assess staffing and resource allocation strategies for infection prevention departments from August to September 2023.

RESULTS

The analysis revealed associations between IP full-time equivalents and the number of inpatient licensed beds (P<.001) and geographical regions (P<.001). The average work hours of an IP exceeded the traditional 40-hour workweek, participants (n=91) reported working an average of 43.6 hours per week. Cross-sharing of IP full-time equivalents increased with the complexity of the health care delivery services, with IPs most frequently supporting the Quality department.

CONCLUSIONS

This study highlights that infection prevention departments are persistently understaffed, and IPs are consistently working excessive hours across health care settings. Factors such as geographic location and interdepartmental collaboration significantly influence staffing needs and workload demands.

Prevention of Vascular Access Device-Associated Hospital-Onset Bacteremia and Fungemia: A Review of Emerging Perspectives and Synthesis of Technical Aspects

Significant events that have impacted healthcare over the last several years have been associated with escalating rates of healthcare-associated infections. This has resulted in increased efforts to reinstitute well-established and evidence-based infection prevention (IP) practices, particularly for central line-associated bloodstream infections. However, implementation of prevention initiatives beyond central lines has not received the same level of acknowledgment and response as being a considerable risk to patients. This article, authored by IP, infectious disease, and vascular access professionals, provides emerging perspectives and technical aspects associated with the complete "life cycle" of a vascular access device. The intent is to provide insight and perspective on enhancing current IP practices in the acute care hospital setting. This will also help prepare hospitals for upcoming broader surveillance and intervention activities aimed at reducing hospital-onset bacteremia and fungemia associated with all types of vascular access devices.

Comprehensive Review of Environmental Surveillance for Azole-Resistant Aspergillus fumigatus: A Practical Roadmap for Hospital Clinicians and Infection Control Teams

As azole-resistant Aspergillus fumigatus emerges globally, healthcare facilities face mounting challenges in managing invasive aspergillosis. This review synthesizes worldwide azole resistance data to reveal profound regional variability, demonstrating that findings from other regions cannot be directly extrapolated to local settings. Consequently, hospital-level environmental surveillance is crucial for tailoring interventions to local epidemiology and detecting resistant strains in real-time. We outline practical approaches-encompassing sampling site prioritization, diagnostic workflows (culture-based and molecular), and PDCA-driven continuous improvement-so that even resource-limited facilities can manage resistant isolates more effectively. By linking real-time surveillance findings with clinical decisions, hospitals can tailor antifungal stewardship programs and swiftly adjust prophylaxis or treatment regimens. Our approach aims to enable accurate, ongoing evaluations of emerging resistance patterns, ensuring that institutions maintain efficient and adaptive programs. Ultimately, we advocate for sustained, collaborative efforts worldwide, where facilities adapt protocols to local conditions, share data through international networks, and contribute to a global knowledge base on resistance mechanisms. Through consistent application of these recommendations, healthcare systems can better preserve azole efficacy, safeguard immunocompromised populations, and refine infection control practices in the face of evolving challenges.

Spine surgical site infection outcome with preoperative application of a presaturated 10% povidone-iodine nasal decolonization product in a 32-bed surgical hospital

BACKGROUND

To pursue an irreducible minimum overall surgical site infection (SSI) rate, a 32-bed surgical hospital employed an outside consultant and performed sterile processing and surgery internal audits: No obvious improvements were identified. A 10-year review determined that 70% of SSI's were spine procedure patients. After a nasal decolonization product literature review, an intervention was implemented. The purpose of this study was to assess if the intervention impacted spine SSI rates.

METHODS

A 36-month implementation science study was conducted. The 18-month intervention was the immediate preoperative application of a manufactured presaturated 10% povidone-iodine nasal decolonization product in spine surgery patients, with monthly product application documentation surveillance feedback to the preoperative staff. Chi-square test was used to determine the difference in types of spine SSI surgery rates pre and post intervention.

RESULTS

Overall spine SSI decreased 35.7% (P = .04) with a 58.7% reduction in superficial incisional SSI (P = .02). The 16.1% decline in deep incisional SSI was not significant (P = .29).

CONCLUSIONS

Within this hospital, conducting 7,576 surgical spine procedures over 36 months, with the immediate preoperative application of a presaturated 10% povidone-iodine nasal decolonization product, the only intervention in SSI prevention protocol, produced a statistically significant decrease in spine patient SSI rate percent.

How effective are monthly departmental tracer surveys? A 5-year retrospective study of 138 surveys in 96 departments

BACKGROUND

Repeat department-wide surveys are commonly employed for infection control. There remains debate concerning their cost-effectivess. The aim of the study was to measure the impact of repeat department-wide surveys in major in-patient departments (IPDs) and ambulatory facilities (AFs) in a tertiary care hospital. This was a retrospective study of 138 surveys condcuted in 96 departments over a 5-year period.

METHODS

Two itemized questionnaires were designed to assess the most frequently inadequately adhered to infection control measures: one for IPD (with 21 items) and the other for AF (with 17 items).

RESULTS

A total of 72 surveys were conducted in 49 IPDs, of which 39 (54%) were repeat surveys, and 66 surveys in 47 AFs, of which 33 (50%) were repeat surveys. The baseline rate of adherence/department was 71% ± 14 for the IPD, with an increase from the first to the last survey to 82% ± 13 (P = .037). In 15/21 measured infection control items, adherence improved. Adherence to infection control items was lower at baseline in the AFs than in the IPDs (63 ± 27), with an increase to 76 ± 20 (non significant). Although adherence improved for 9 items, it deteriorated in another 8, producing an overall statistically unchanged outcome.

CONCLUSION

Repeat whole-department surveys contribute moderately to increased adherence to infection control guidelines. AFs demonstrate lower rates of adherence to infection control guidelines and are less receptive to educational measures.

How to protect long-term care facilities from pandemic-like events? - A systematic review on the effectiveness of non-pharmacological measures to prevent viral respiratory infections

BACKGROUND

The SARS-CoV-2 pandemic underscored the need for pandemic preparedness, with respiratory-transmitted viruses considered as a substantial risk. In pandemics, long-term care facilities (LTCFs) are a high-risk setting with severe outbreaks and burden of disease. Non-pharmacological interventions (NPIs) constitute the primary defence mechanism when pharmacological interventions are not available. However, evidence on the effectiveness of NPIs implemented in LTCFs remains unclear.

METHODS

We conducted a systematic review assessing the effectiveness of NPIs implemented in LTCFs to protect residents and staff from viral respiratory pathogens with pandemic potential. We searched Medline, Embase, CINAHL, and two COVID-19 registries in 09/2022. Screening and data extraction was conducted independently by two experienced researchers. We included randomized controlled trials and non-randomized observational studies of intervention effects. Quality appraisal was conducted using ROBINS-I and RoB2. Primary outcomes encompassed number of outbreaks, infections, hospitalizations, and deaths. We synthesized findings narratively, focusing on the direction of effect. Certainty of evidence (CoE) was assessed using GRADE.

RESULTS

We analysed 13 observational studies and three (cluster) randomized controlled trials. All studies were conducted in high-income countries, all but three focused on SARS-CoV-2 with the rest focusing on influenza or upper-respiratory tract infections. The evidence indicates that a combination of different measures and hand hygiene interventions can be effective in protecting residents and staff from infection-related outcomes (moderate CoE). Self-confinement of staff with residents, compartmentalization of staff in the LTCF, and the routine testing of residents and/or staff in LTCFs, among others, may be effective (low CoE). Other measures, such as restricting shared spaces, serving meals in room, cohorting infected and non-infected residents may be effective (very low CoE). An evidence gap map highlights the lack of evidence on important interventions, encompassing visiting restrictions, pre-entry testing, and air filtration systems.

CONCLUSIONS

Although CoE of interventions was low or very low for most outcomes, the implementation of NPIs identified as potentially effective in this review often constitutes the sole viable option, particularly prior to the availability of vaccinations. Our evidence-gap map underscores the imperative for further research on several interventions. These gaps need to be addressed to prepare LTCFs for future pandemics.

TRIAL REGISTRATION

CRD42022344149.

Infection preventionists in public health, consultant and academic roles: Results from the 2020 APIC MegaSurvey

BACKGROUND

Infection preventionists (IPs) work and practice in a variety of roles across many practice settings. While the health care-based IP role has been well studied, less is known about IPs who work in public health, consultant, and academic roles.

METHODS

Data were collected as a subset of the Association for Professionals in Infection Prevention and Control and Epidemiology 2020 MegaSurvey. Descriptive and bivariate analyses were performed to compare the responses of 147 IPs working in public health, consulting, or academic roles.

RESULTS

Respondents identified their primary IP role as public health (40%), consulting (39%), or academic (21%). Most were White and non-Hispanic females working in long-term care, acute care, and outpatient settings. Most had over 11 years of experience in health care before IP, with nursing being the most common. More consultants were certified in infection control (74%). While half of the respondents in public health reported being certified in infection control, and a third had 6 or more years of experience in infection prevention and control, they reported the lowest annual salary and satisfaction with total compensation.

DISCUSSION

These findings highlight the characteristics and contributions of infection prevention and control in nontraditional roles and settings. Certification and fair compensation are crucial factors for professional development and job satisfaction.

CONCLUSIONS

These insights can guide future education, recruitment, and retention strategies for IPs in public health, consulting, and academic roles.

Public Health Centers' Training Session Programs to Develop Programs on Infection Control Practices for Multidrug-Resistant Organisms in Hospitals in Kawaguchi City, Japan

Introduction The Kawaguchi City Public Health Center (PHC) conducted training sessions focusing on infection control practices on multidrug-resistant organisms (MDROs) for 19 hospitals and eight affiliated clinics (AFs) with beds in June 2022. Issues with infection control programs were identified via a survey implemented following the training sessions. These included providing feedback on infection control policies for MDROs, hand hygiene compliance programs (HHCPs), environmental cleaning (EC), and training sessions programs that hospitals or AFs with beds (hospitals) intended to implement in the future or develop (to be developed). We planned to examine whether the PHC training sessions programs have an effect on the development of hospital infection control programs designed to address these issues. The purpose of this study is to clarify the training session program provided by the Kawaguchi City PHC, which was effective in developing hospital infection control programs based on the results of the survey conducted after the training session. Methods In June 2023, a second training session that offered information on infection control practices was completed for 30 hospitals. This was followed by sending a questionnaire. We examined infection control programs to be developed and analyzed associations with the first learned information by training session (the first learned information). Results Twenty-four hospitals responded to the survey with a response rate of 80.0%. Half the respondents (12, 50.0%) had prepared for the infection control policy on carbapenem-resistant Enterobacteriaceae (CRE), 11 hospitals (45.8%) had provided feedback on HHC, and four (16.7%) planned to conduct feedback on HHC. HHCPs were planned to be developed by 19 hospitals (79.2%), EC by five hospitals (20.8%), training session by 12 hospitals (50.0%), and screening of MDROs upon hospital admission (AS) by nine hospitals (37.5%). The first learned information, "the prevention of healthcare-associated infections and cost savings by implementing cleaning bundles (the effects of cleaning bundles)," was identified by 10 hospitals (41.7%), and "specific programs on providing feedback effective for developing hand hygiene compliance (specific feedback)" was learned by eight hospitals (33.3%). The first learned information regarding specific feedback was significantly associated with HHCPs to be developed (p = 0.044). The first learned information on the effects of cleaning bundles was significantly associated with HHCPs and HHC feedback to be developed (p = 0.023, 0.034). The training session programs were not significantly connected to EC, training session, or AS to be developed. Conclusions Infection control programs to be developed were linked to the provision of information on numerical effects by implementing specific feedback and cleaning bundles. We suggest that the PHC should develop infection control programs for the hospitals and provide training sessions, including numerical effects.

Utilizing application scenarios to enhance a competency-based infection prevention orientation program

Infection Preventionists (IPs) are expected to be well-rounded and competent in their role, necessitating a robust orientation program. Feedback from IPs identified that orientation is task-based and lacks opportunities for meaningful application to the field. This team sought to enhance onboarding through focused interventions, including standardized resources and scenario-based applications. This department has engaged in an iterative process to refine and implement a robust orientation program, resulting in improvement in the department.

Moving Beyond Central Line-Associated Bloodstream Infections: Enhancement of the Prevention Process

The provision of medications and other treatments via intravenous (IV) therapy has provided millions of health care patients with extended benefits. IV therapy, however, is also associated with complications, such as associated bloodstream infections. Understanding the mechanisms of development and the factors that have contributed to the recent increases in such health care-acquired infections assists in formulating new preventive strategies that include the implementation of hospital-onset bacteremia, an innovative model that requires surveillance and prevention of bloodstream infections associated with all types of vascular access devices, expansion of vascular access service teams (VAST), and use of advanced antimicrobial dressings designed to reduce bacterial proliferation over the currently recommended time periods for maintenance of IV catheters.