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Boyce JM, Pittet D. Rinse, gel, and foam - is there any evidence for a difference in their effectiveness in preventing infections? Antimicrob Resist Infect Control 2024; 13:49. [PMID: 38730473 PMCID: PMC11084031 DOI: 10.1186/s13756-024-01405-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/01/2024] [Indexed: 05/12/2024] Open
Abstract
BACKGROUND Following publication of the 2009 World Health Organizations Guidelines for Hand Hygiene in Health Care, a debate has emerged regarding the relative antimicrobial efficacy of the different formats (rinse, gel, foam) of ABHRs and their ability to contribute to reduction of healthcare-associated infections (HAIs). METHODS Data regarding the in-vivo antimicrobial efficacy of ABHRs and other factors that likely affect their effectiveness in reducing HAIs were reviewed, and a comprehensive review of studies that reported the effectiveness of each of the three ABHR formats to improve hand hygiene compliance and reduce HAIs was conducted. RESULTS The amount of rubbing time it takes for hands to feel dry (dry time) is the major driver of ABHR antimicrobial efficacy. ABHR format is not a major factor, and several studies found that rinse, gel, and foam ABHRs have comparable in-vivo antimicrobial efficacy. Other factors that likely impact the ability of ABHRs to reduce transmission of healthcare-associated pathogens and HAIs include ABHR formulation, the volume applied to hands, aesthetic characteristics, skin tolerance, acceptance by healthcare personnel, and hand hygiene compliance rates. When accompanied by complementary strategies, promoting the use of each of the three ABHR formats has been associated with improvements in hand hygiene compliance rates. A review of 67 studies failed to identify an ABHR format that was significantly more effective in yielding statistically significant reductions in transmission of healthcare-associated pathogens or HAIs. CONCLUSIONS Current evidence is insufficient to definitively determine if one ABHR format is more effective in reducing transmission of healthcare-associated pathogens and HAIs. More rigorous studies such as multicenter randomized controlled trials comparing the different formats are needed to establish if one format is significantly more effective in reducing HAIs.
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Affiliation(s)
| | - Didier Pittet
- Faculty of Medicine, University of Geneva, Geneva, Switzerland
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Ciccacci F, De Santo C, Mosconi C, Orlando S, Carestia M, Guarente L, Liotta G, Palombi L, Emberti Gialloreti L. Not only COVID-19: a systematic review of anti-COVID-19 measures and their effect on healthcare-associated infections. J Hosp Infect 2024; 147:133-145. [PMID: 38423132 DOI: 10.1016/j.jhin.2024.02.008] [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: 11/13/2023] [Revised: 02/19/2024] [Accepted: 02/20/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) burden healthcare globally. Amid the SARS-CoV-2 pandemic, intensified infection control measures, such as mask usage and hand hygiene, were implemented. AIM To assess the efficacy of these measures in preventing HAIs among hospitalized patients. METHODS Using the PICO framework (Population, Intervention, Comparison, Outcome), the study focused on hospitalized patients and the effectiveness of anti-COVID-19 measures in preventing HAIs. A systematic review of literature published in 2020-2022 was conducted, examining interventions such as mask usage, hand hygiene, and environmental cleaning. FINDINGS This systematic review analysed 42 studies: two in 2020, 21 in 2021, and 19 in 2022. Most studies were from high-income countries (28). Most studies (30 out of 42) reported a reduction in HAIs after implementing anti-COVID-19 measures. Gastrointestinal infections and respiratory tract infections showed significant reduction, unlike bloodstream infections and urinary tract infections. Some wards, like cardiology and neurology, experienced reduced HAIs, unlike intensive care units and coronary care units. There was an increase in studies reporting no effect of hygiene measures on HAIs in 2022, eventually indicating a shift in effectiveness over time. CONCLUSION Anti-COVID-19 measures have shown selective efficacy in preventing HAIs. The study emphasizes the need for context-specific strategies and increased focus on regions with limited resources. Continued research is essential to refine infection control practices, especially in high-risk settings.
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Affiliation(s)
- F Ciccacci
- Departmental Faculty of Medicine and Surgery, Saint Camillus International University of Health and Medical Sciences, Rome, Italy
| | - C De Santo
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - C Mosconi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - S Orlando
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy.
| | - M Carestia
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - L Guarente
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - G Liotta
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - L Palombi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy; Catholic University Our Lady of Good Counsel, Tirana, Albania
| | - L Emberti Gialloreti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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3
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Teus JK, Mithen L, Green H, Hutton A, Fernandez R. Impact of infection prevention and control practices, including personal protective equipment, on the prevalence of hospital-acquired infections in acute care hospitals during COVID-19: a systematic review and meta-analysis. J Hosp Infect 2024; 147:32-39. [PMID: 38423134 DOI: 10.1016/j.jhin.2024.02.010] [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: 11/27/2023] [Revised: 01/31/2024] [Accepted: 02/07/2024] [Indexed: 03/02/2024]
Abstract
BACKGROUND The COVID-19 pandemic has posed an unprecedented challenge to healthcare systems globally. Personal protective equipment has played a fundamental role in protecting healthcare workers and patients, but its effectiveness in reducing hospital-acquired infections (HAIs) during the pandemic remains a subject of debate. AIM To conduct a synthesis and meta-analysis of the best available evidence of the prevalence of HAIs using a before/after approach. METHODS A three-step search strategy was undertaken to locate published and unpublished studies. A search was performed in MEDLINE, CINAHL, Embase, PsycINFO, and Google Scholar. Screening of studies, data extraction and critical appraisal were performed by four independent reviewers. Meta-analysis was conducted using Review Manager. The review is reported in accordance with PRISMA and JBI guidelines for systematic reviews. FINDINGS Fifteen studies were included in the review. Three studies indicated a statistically significant increase in the number of positive cultures during the COVID-19 period compared to the pre-COVID-19 period. Pooled data showed a non-significant decrease in the number of patients with positive cultures in the COVID-19 period compared to pre-COVID-19. There were no significant differences in various bacterial infections except for a significant decrease in respiratory infections. Pooled data for central line-associated bloodstream infections (CLABSIs) indicated a significant increase during the COVID-19 period, but one study reported an increase in CLABSI incidence. CONCLUSION The evidence from this review demonstrates a mixed impact of the COVID-19 pandemic precautions on HAIs.
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Affiliation(s)
- J K Teus
- Centre for Research in Nursing and Health, St George Hospital, Kogarah, NSW, Australia; School of Nursing, University of Wollongong, NSW, Australia.
| | - L Mithen
- School of Nursing and Midwifery, University of Newcastle, NSW, Australia
| | - H Green
- Australian Centre for Health Engagement, Evidence and Values (ACHEEV), School of Health and Society, University of Wollongong, NSW, Australia; Centre for Transformative Nursing, Midwifery and Health Research: A JBI Affiliated Centre, NSW, Australia
| | - A Hutton
- School of Nursing and Midwifery, University of Newcastle, NSW, Australia; Centre for Transformative Nursing, Midwifery and Health Research: A JBI Affiliated Centre, NSW, Australia; School of Nursing, Johns Hopkins University, MD, USA
| | - R Fernandez
- School of Nursing and Midwifery, University of Newcastle, NSW, Australia; Centre for Transformative Nursing, Midwifery and Health Research: A JBI Affiliated Centre, NSW, Australia
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4
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Cuyàs B, Huerta A, Poca M, Alvarado-Tapias E, Brujats A, Román E, Guarner C, Escorsell À, Soriano G. Impact of the COVID-19 pandemic on the incidence and type of infections in hospitalized patients with cirrhosis: a retrospective study. Sci Rep 2024; 14:2718. [PMID: 38302563 PMCID: PMC10834517 DOI: 10.1038/s41598-024-52452-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 01/18/2024] [Indexed: 02/03/2024] Open
Abstract
Infections are a major cause of morbidity and mortality in cirrhosis, especially those caused by multi-drug resistant bacteria. During the COVID-19 pandemic, the incidence and type of infection in these patients may have been influenced by the restrictive measures implemented. We aimed to compare the infections in patients with cirrhosis hospitalized before the COVID-19 pandemic versus those hospitalized during the pandemic. We retrospectively compared infections in patients with cirrhosis hospitalized in the hepatology unit during the pre-pandemic period (3/2019-2/2020) with infections in patients hospitalized during the pandemic (3/2020-2/2021). Baseline characteristics, type of infections, type of bacteria, antimicrobial resistance and mortality were evaluated. There were 251 hospitalizations in 170 patients during the pre-pandemic period and 169 hospitalizations in 114 patients during the pandemic period. One or more infections were identified in 40.6% of hospitalizations during the pre-pandemic period and 43.8% of hospitalizations during the pandemic, P = 0.52. We found 131 infections in the pre-pandemic period and 75 infections during the pandemic. The percentage of nosocomial infections decreased in the pandemic period (25.3% vs. 37.4% in the pre-pandemic period, P = 0.06). We found a non-significant trend to a higher incidence of infections by multi-drug resistant organisms (MDRO) in the pandemic period than in the pre-pandemic period (6.5% vs. 4%). The incidence of infections was similar in both periods. However, during the pandemic, we observed a trend to a lower incidence of nosocomial infections with a higher incidence of MDRO infections.
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Affiliation(s)
- Berta Cuyàs
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Institut de Recerca Sant Pau, Barcelona, Spain.
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Anna Huerta
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Institut de Recerca Sant Pau, Barcelona, Spain
| | - Maria Poca
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Institut de Recerca Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Edilmar Alvarado-Tapias
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Institut de Recerca Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Anna Brujats
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Institut de Recerca Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eva Román
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Institut de Recerca Sant Pau, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
- Escola Universitària d'Infermeria EUI-Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Carlos Guarner
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Institut de Recerca Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - Àngels Escorsell
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Institut de Recerca Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
| | - German Soriano
- Department of Gastroenterology, Hospital Santa Creu i Sant Pau, Institut de Recerca Sant Pau, Barcelona, Spain
- Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Instituto de Salud Carlos III, Madrid, Spain
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Linn KZ, Sutjipto S, Ng OT, Teo J, Cherng BPZ, Tan TY, Pada SK, Ooi ST, Smitasin N, Thoon KC, Huan X, De PP, Chan D, Tee NWS, Ang M, Hsu LY, Lin RTP, Ng TY, Deepak RN, Koh TH, Apisarnthanarak A, Ponnampalavanar S, Venkatachalam I, Marimuthu K. Impact of COVID-19 pandemic on carbapenem-resistant Enterobacterales incidence in the South-East Asia region: an observational study. ANTIMICROBIAL STEWARDSHIP & HEALTHCARE EPIDEMIOLOGY : ASHE 2023; 3:e208. [PMID: 38156208 PMCID: PMC10753475 DOI: 10.1017/ash.2023.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 12/30/2023]
Abstract
The COVID-19 pandemic led to an initial increase in the incidence of carbapenem-resistant Enterobacterales (CRE) from clinical cultures in South-East Asia hospitals, which was unsustained as the pandemic progressed. Conversely, there was a decrease in CRE incidence from surveillance cultures and overall combined incidence. Further studies are needed for future pandemic preparedness.
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Affiliation(s)
- Kyaw Zaw Linn
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Stephanie Sutjipto
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
| | - Oon Tek Ng
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Jeanette Teo
- National University Hospital and National University Health System, Singapore, Singapore
| | - Benjamin Pei Zhi Cherng
- Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | | | | | - Say Tat Ooi
- Khoo Teck Puat Hospital, Singapore, Singapore
| | - Nares Smitasin
- National University Hospital and National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Koh Cheng Thoon
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
- KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Xiaowei Huan
- National Centre for Infectious Diseases, Singapore, Singapore
| | | | - Douglas Chan
- Ng Teng Fong General Hospital, Singapore, Singapore
| | - Nancy Wen Sim Tee
- National University Hospital and National University Health System, Singapore, Singapore
| | - Michelle Ang
- National Centre for Infectious Diseases, Singapore, Singapore
| | - Li Yang Hsu
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
- Singapore Centre for Environmental Life Sciences Engineering, National University of Singapore, Singapore, Singapore
| | - Raymond Tzer Pin Lin
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
- National Public Health Laboratory, Singapore, Singapore
| | | | | | - Tse Hsien Koh
- Singapore General Hospital, Singapore, Singapore
- Duke-NUS Medical School, National University of Singapore, Singapore, Singapore
| | | | | | | | - Kalisvar Marimuthu
- National Centre for Infectious Diseases, Singapore, Singapore
- Tan Tock Seng Hospital, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
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6
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Ismaeil R, Nahas ARF, Kamarudin NB, Abubakar U, Mat-Nor MB, Mohamed MHN. Evaluation of the impact of COVID-19 pandemic on hospital-acquired infections in a tertiary hospital in Malaysia. BMC Infect Dis 2023; 23:779. [PMID: 37946158 PMCID: PMC10636815 DOI: 10.1186/s12879-023-08770-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/30/2023] [Indexed: 11/12/2023] Open
Abstract
BACKGROUND Infection prevention measures are the gold standard for preventing the spread of hospital-acquired infections (HAIs). COVID-19 pandemic caused major disruptions in infection prevention measures, and this has implications on the rate of HAIs. This study assessed the impact of COVID-19 pandemic on the rate and the types of HAIs at Sultan Ahmed Shah Hospital. METHOD This is a retrospective cohort study that compared the rate of HAIs from April to October 2019 (pre COVID period) and April to October 2020 (during COVID period). Data was collected through the review of patients' electronic medical records. RESULTS There were a total of 578 patients included in the selected wards during the pre- and during the pandemic. Thirty-nine episodes (12.1%) of HAIs were report in the pre COVID period and 29 (11.3%) during COVID-19. In both periods, hospital-acquired pneumonia (HAP) was the most frequent HAI among the patients. There was a rise in catheter-associated bloodstream infections (CLABSI) (0.8%) and ventilator associated pneumonia (VAP) (1.1%) during the COVID-19 period. The most common bacteria were methicillin-resistant Staphylococcus aureus (MRSA) (28.2%) and Enterococcus faecalis (17.9%) in the Pre COVID-19 period, and Pseudomonas aeruginosa (27.6%) and Stenotrophomonas maltophilia (6.9%) during COVID-19. CONCLUSION Our research concluded that the rates of HAIs during the COVID-19 pandemic were not significantly impacted by the improved in-hospital infection prevention efforts to control the pandemic. There is need for further efforts to promote adherence to preventive practices.
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Affiliation(s)
- Rehab Ismaeil
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia (IIUM), Jalan Sultan Ahmad Shah, 25200, Kuantan, Pahang, Malaysia
| | - Abdul Rahman Fata Nahas
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia (IIUM), Jalan Sultan Ahmad Shah, 25200, Kuantan, Pahang, Malaysia
| | - Norhidayah Binti Kamarudin
- Department of Medical Microbiology, Kulliyyah of Medicine, International Islamic University Malaysia, 25200, Kuantan, Malaysia
| | - Usman Abubakar
- Department of Clinical Pharmacy and Practice, College of Pharmacy, QU Health, Qatar University, 2713, Doha, Qatar.
| | - Mohamad Basri Mat-Nor
- Department of Intensive Care, Kulliyyah of Medicine, International Islamic University Malaysia, 25200, Kuantan, Malaysia
| | - Mohamad Haniki Nik Mohamed
- Department of Pharmacy Practice, Kulliyah of Pharmacy, International Islamic University Malaysia (IIUM), Jalan Sultan Ahmad Shah, 25200, Kuantan, Pahang, Malaysia.
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7
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O' Connor M, Mc Namara C, Doody O. Healthcare workers experiences of caring for patients colonized with Carbapenemase-Producing Enterobacterale (CPE) in an acute hospital setting - A qualitative descriptive study. Infect Dis Health 2023; 28:186-194. [PMID: 37029044 DOI: 10.1016/j.idh.2023.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 03/01/2023] [Accepted: 03/02/2023] [Indexed: 04/09/2023]
Abstract
BACKGROUND Carbapenemase-Producing Enterobacterale (CPE) is a multi-drug resistant organism, that is of growing concern within hospitals worldwide. This leads to an increased workload on healthcare workers. PURPOSE To explore the experiences of healthcare workers who care for patients colonized with CPE. METHODS A qualitative descriptive research design. Semi-structured interviews undertaken and analysed using a thematic analysis framework resulting in the identification of four main themes. RESULTS This study explores the barriers and facilitators healthcare workers encounter when caring for patients colonized with CPE and their experience of the effect that a CPE diagnosis has on the provision of patient care across four themes: education, the COVID effect, fear, and staffing/resource issues. The study is reported utilising the COREQ checklist. CONCLUSION Healthcare workers were aware of the IPC guidance and education was the main facilitator to knowledge and practice. Barriers such as poor staffing levels and the impact of COVID-19 were highlighted in relation to care provision and reducing fear associated with CPE. Healthcare workers priority is to provide safe and effective care for their patients and barriers that impact their ability to provide such care need to be addressed to ensure an optimal experience for both healthcare workers and patients.
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Affiliation(s)
- Majella O' Connor
- University of Limerick, Ireland. Clinical Nurse Manager 2 Infection Prevention and Control, University Hospital, Limerick, Ireland.
| | - Claire Mc Namara
- Department of Nursing and Midwifery, University of Limerick, Ireland.
| | - Owen Doody
- Health Research Institute, Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland.
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8
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Mitchell BG, Stewardson AJ, Kerr L, Ferguson JK, Curtis S, Busija L, Lydeamore MJ, Graham K, Russo PL. The incidence of nosocomial bloodstream infection and urinary tract infection in Australian hospitals before and during the COVID-19 pandemic: an interrupted time series study. Antimicrob Resist Infect Control 2023; 12:61. [PMID: 37400858 DOI: 10.1186/s13756-023-01268-2] [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: 03/15/2023] [Accepted: 06/20/2023] [Indexed: 07/05/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a significant impact on healthcare including increased awareness of infection prevention and control (IPC). The aim of this study was to explore if the heightened awareness of IPC measures implemented in response to the pandemic influenced the rates of healthcare associated infections (HAI) using positive bloodstream and urine cultures as a proxy measure. METHODS A 3 year retrospective review of laboratory data from 5 hospitals (4 acute public, 1 private) from two states in Australia was undertaken. Monthly positive bloodstream culture data and urinary culture data were collected from January 2017 to March 2021. Occupied bed days (OBDs) were used to generate monthly HAI incidence per 10,000 OBDs. An interrupted time series analysis was undertaken to compare incidence pre and post February 2020 (the pre COVID-19 cohort and the COVID-19 cohort respectively). A HAI was assumed if positive cultures were obtained 48 h after admission and met other criteria. RESULTS A total of 1,988 bloodstream and 7,697 urine positive cultures were identified. The unadjusted incident rate was 25.5 /10,000 OBDs in the pre-COVID-19 cohort, and 25.1/10,000 OBDs in the COVID-19 cohort. The overall rate of HAI aggregated for all sites did not differ significantly between the two periods. The two hospitals in one state which experienced an earlier and larger outbreak demonstrated a significant downward trend in the COVID-19 cohort (p = 0.011). CONCLUSION These mixed findings reflect the uncertainty of the effect the pandemic has had on HAI's. Factors to consider in this analysis include local epidemiology, differences between public and private sector facilities, changes in patient populations and profiles between hospitals, and timing of enhanced IPC interventions. Future studies which factor in these differences may provide further insight on the effect of COVID-19 on HAIs.
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Affiliation(s)
- Brett G Mitchell
- School of Nursing, Avondale University, Cooranbong, NSW, 2265, Australia
- Nursing and Midwifery, Monash University, Frankston, VIC, 3199, Australia
- Gosford Hospital, Central Coast Local Health District, NSW, 2250, Australia
| | - Andrew J Stewardson
- Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia
| | - Lucille Kerr
- Nursing and Midwifery, Monash University, Frankston, VIC, 3199, Australia
- Department of Nursing Research, Cabrini Institute, Malvern, VIC, 3144, Australia
- School of Nursing and Midwifery, Deakin University, Burwood, Australia
| | - John K Ferguson
- Division of Medicine, John Hunter Hospital, Newcastle Regional Mail Centre, 2310, NSW, Australia
- University of Newcastle, Callaghan, NSW, 2308, Australia
- Infection Prevention Service, Hunter New England Health, John Hunter Hospital, NSW, 2310, Australia
| | - Stephanie Curtis
- Department of Infectious Diseases, The Alfred and Central Clinical School, Monash University, Melbourne, VIC, 3004, Australia
| | - Ljoudmila Busija
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, 3004, Australia
| | - Michael J Lydeamore
- Department of Econometrics and Business Statistics, Monash University, Melbourne, 3800, Australia
| | - Kirsty Graham
- Infection Prevention and Control, Central Coast Local Health District, Gosford, NSW, 2250, Australia
| | - Philip L Russo
- School of Nursing, Avondale University, Cooranbong, NSW, 2265, Australia.
- Nursing and Midwifery, Monash University, Frankston, VIC, 3199, Australia.
- Department of Nursing Research, Cabrini Institute, Malvern, VIC, 3144, Australia.
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9
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Bolikas E, Astrinaki E, Panagiotaki E, Vitsaxaki E, Saplamidou S, Drositis I, Stafylaki D, Chamilos G, Gikas A, Kofteridis DP, Kritsotakis EI. Impact of SARS-CoV-2 Preventive Measures against Healthcare-Associated Infections from Antibiotic-Resistant ESKAPEE Pathogens: A Two-Center, Natural Quasi-Experimental Study in Greece. Antibiotics (Basel) 2023; 12:1088. [PMID: 37508184 PMCID: PMC10376605 DOI: 10.3390/antibiotics12071088] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/30/2023] Open
Abstract
The COVID-19 pandemic led to unprecedented stress on healthcare systems worldwide, forming settings of concern for increasing antimicrobial resistance. We investigated the impact of SARS-CoV-2 preventive measures against healthcare-associated infections (HAIs) from antibiotic-resistant bacteria in two tertiary-care hospitals. We compared infection rates between March 2019 and February 2020 (pre-intervention period) and March 2020 and February 2021 (COVID-19 intervention period) from drug-resistant ESKAPEE bacteria (methicillin-resistant Staphylococcus aureus; vancomycin-resistant Enterococci; carbapenem-resistant Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter species and Escherichia coli). Over 24 months, 586 drug-resistant ESKAPEE HAIs occurred in 439 patients (0.3% of 179,629 inpatients) with a mean age of 63 years, with 43% being treated in intensive care units (ICUs), and having a 45% inpatient mortality rate. Interrupted time series analysis revealed increasing infection rates before the intervention that were sharply interrupted by abrupt drops for most pathogens and henceforth remained stable in the ICUs but progressively increased in ordinary wards. In the ICUs, the pooled infection rate was 44% lower over the intervention period compared to the pre-intervention period (incidence rate ratio (IRR) 0.56, 95%CI 0.41-0.75, p < 0.001). Pooled infection rates in the wards were slightly higher over the COVID-19 period (IRR 1.12, 95%CI 0.87-1.45, p = 0.368). The findings confirmed the ancillary beneficial impact of the enhanced bundle of transmission-based precautions adopted against SARS-CoV-2 in rapidly constraining antimicrobial-resistant HAIs in two Greek hospitals.
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Affiliation(s)
- Emmanouil Bolikas
- Laboratory of Biostatistics, School of Medicine, University of Crete, 71003 Heraklion, Greece
- Infection Control Committee, Venizeleio-Pananeio General Hospital, 71409 Heraklion, Greece
| | - Eirini Astrinaki
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Evangelia Panagiotaki
- Infection Control Committee, Venizeleio-Pananeio General Hospital, 71409 Heraklion, Greece
- Department of Clinical Microbiology, Venizeleio-Pananeio General Hospital, 71409 Heraklion, Greece
| | - Efsevia Vitsaxaki
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Stamatina Saplamidou
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Ioannis Drositis
- Infection Control Committee, Venizeleio-Pananeio General Hospital, 71409 Heraklion, Greece
- Department of Medical Oncology, Venizeleio-Pananeio General Hospital, 71409 Heraklion, Greece
| | - Dimitra Stafylaki
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Georgios Chamilos
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
- Department of Clinical Microbiology and Microbial Pathogenesis, University Hospital of Heraklion, 71110 Heraklion, Greece
| | - Achilleas Gikas
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
- Department of Internal Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Diamantis P Kofteridis
- Infection Control Committee, University Hospital of Heraklion, 71110 Heraklion, Greece
- Department of Internal Medicine, School of Medicine, University of Crete, 71003 Heraklion, Greece
| | - Evangelos I Kritsotakis
- Laboratory of Biostatistics, School of Medicine, University of Crete, 71003 Heraklion, Greece
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10
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Ju JW, You J, Hong H, Kang CK, Kim WH, Lee HJ. Impact of Enhanced in-Hospital Infection Prevention During the COVID-19 Pandemic on Postoperative Pneumonia in Older Surgical Patients. Int J Gen Med 2023; 16:1943-1951. [PMID: 37251284 PMCID: PMC10224724 DOI: 10.2147/ijgm.s411502] [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: 03/15/2023] [Accepted: 05/19/2023] [Indexed: 05/31/2023] Open
Abstract
Purpose We aimed to investigate the impact of enhanced in-hospital infection prevention during the coronavirus disease 2019 (COVID-19) pandemic on postoperative pneumonia in older surgical patients. Patients and Methods We retrospectively reviewed the electronic medical records of consecutive patients ≥70 years who underwent elective surgery between 2017 and 2021 at our institution. All perioperative variables were retrieved from the electronic medical records. The primary outcome was new-onset postoperative pneumonia during the hospitalization period. Since February 2020, our institution implemented a series of policies to enhance infection prevention, hence patients were divided into groups according to whether they underwent surgery before or during the COVID-19 pandemic. An interrupted time series analysis was performed to evaluate the difference between pre- and post-intervention slopes of the primary outcome. Results Among the 29,387 patients included in the study, 10,547 patients underwent surgery during the COVID-19 pandemic. Although there was a decreasing trend of the monthly incidence rate of postoperative pneumonia compared to before the COVID-19 pandemic, there was no statistical significance in the trend (slope before COVID-19 period: β-coefficient, -0.007; 95% CI, -0.022 to 0.007). Conclusion Our study revealed that enhanced in-hospital infection prevention implemented to manage the COVID-19 pandemic did not significantly affect the decreasing trend of postoperative pneumonia at our institution.
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Affiliation(s)
- Jae-Woo Ju
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jiwon You
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyunsook Hong
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chang Kyung Kang
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Won Ho Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Ho-Jin Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
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11
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Lyman M, Forsberg K, Sexton DJ, Chow NA, Lockhart SR, Jackson BR, Chiller T. Worsening Spread of Candida auris in the United States, 2019 to 2021. Ann Intern Med 2023; 176:489-495. [PMID: 36940442 DOI: 10.7326/m22-3469] [Citation(s) in RCA: 50] [Impact Index Per Article: 50.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/22/2023] Open
Abstract
BACKGROUND Candida auris is an emerging fungal threat that has been spreading in the United States since it was first reported in 2016. OBJECTIVE To describe recent changes in the U.S. epidemiology of C auris occurring from 2019 to 2021. DESIGN Description of national surveillance data. SETTING United States. PATIENTS Persons with any specimen that was positive for C auris. MEASUREMENTS Case counts reported to the Centers for Disease Control and Prevention by health departments, volume of colonization screening, and antifungal susceptibility results were aggregated and compared over time and by geographic region. RESULTS A total of 3270 clinical cases and 7413 screening cases of C auris were reported in the United States through 31 December 2021. The percentage increase in clinical cases grew each year, from a 44% increase in 2019 to a 95% increase in 2021. Colonization screening volume and screening cases increased in 2021 by more than 80% and more than 200%, respectively. From 2019 to 2021, 17 states identified their first C auris case. The number of C auris cases that were resistant to echinocandins in 2021 was about 3 times that in each of the previous 2 years. LIMITATION Identification of screening cases depends on screening that is done on the basis of need and available resources. Screening is not conducted uniformly across the United States, so the true burden of C auris cases may be underestimated. CONCLUSION C auris cases and transmission have risen in recent years, with a dramatic increase in 2021. The rise in echinocandin-resistant cases and evidence of transmission is particularly concerning because echinocandins are first-line therapy for invasive Candida infections, including C auris. These findings highlight the need for improved detection and infection control practices to prevent spread of C auris. PRIMARY FUNDING SOURCE None.
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Affiliation(s)
- Meghan Lyman
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.L., K.F., D.J.S., N.A.C., S.R.L., B.R.J., T.C.)
| | - Kaitlin Forsberg
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.L., K.F., D.J.S., N.A.C., S.R.L., B.R.J., T.C.)
| | - D Joseph Sexton
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.L., K.F., D.J.S., N.A.C., S.R.L., B.R.J., T.C.)
| | - Nancy A Chow
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.L., K.F., D.J.S., N.A.C., S.R.L., B.R.J., T.C.)
| | - Shawn R Lockhart
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.L., K.F., D.J.S., N.A.C., S.R.L., B.R.J., T.C.)
| | - Brendan R Jackson
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.L., K.F., D.J.S., N.A.C., S.R.L., B.R.J., T.C.)
| | - Tom Chiller
- Mycotic Diseases Branch, Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (M.L., K.F., D.J.S., N.A.C., S.R.L., B.R.J., T.C.)
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12
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Alaidaroos OA, Almuhaydib MN, Alhossan MA, Aldossari AN, Fallatta MO, Alotaibi SM, Alowid FK, Salem AA, Alsaygh KA, Alshammary HS. Unexpected Benefits of Coronavirus Disease 2019: Impact of Coronavirus Disease 2019 Pandemic on Surgical Site Infection: A Systematic Review and Meta-Analysis. Surg Infect (Larchmt) 2023; 24:119-130. [PMID: 36847343 DOI: 10.1089/sur.2022.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
Background: We aimed to summarize and synthesize the current evidence regarding the indirect impact of the coronavirus disease 2019 (COVID-19) pandemic and its associated measures on the surgical site infection (SSI) rate compared with the pre-pandemic period. Methods: A computerized search was conducted on MEDLINE via PubMed, Web of Science, and Scopus using the relevant keywords. Two-stage screening and data extraction were done. The National Institutes of Health (NIH) tools were used for the quality assessment. The Review Manager 5.4.1 program was used for the analysis. Results: Sixteen articles (n = 157,426 patients) were included. The COVID-19 pandemic and lockdown were associated with reduced risk of SSIs after surgery (odds ratio [OR], 0.65; 95% confidence interval [CI], 0.56-0.75; p < 0.00001) and (OR, 0.49; 95% CI, 0.29-0.84; p = 0.009), respectively. There was no significant reduction in the SSIs rate after applying the extended use of masks (OR, 0.73; 95% CI, 0.30-1.73; p = 0.47). A reduction in the superficial SSI rate during the COVID-19 pandemic compared with the pre-COVID-19 pandemic period was observed (OR, 0.58; 95% CI, 0.45-0.75; p < 0.0001). Conclusions: The current evidence suggests that the COVID-19 pandemic may have some unexpected benefits, including improved infection control protocols, which resulted in reduced SSI rates, especially superficial SSIs. In contrast to extended mask use, the lockdown was associated with reduced rates of SSIs.
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Affiliation(s)
| | | | - Mashari Ahmed Alhossan
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Abdulkarem Naif Aldossari
- College of Medicine, Najran University, Najran, Saudi Arabia.,Emergency Department, King Khalid Hospital, Najran, Saudi Arabia
| | - Mawadda Omar Fallatta
- College of Medicine, Umm Al Qura University, Makkah, Saudi Arabia.,General Surgery Department, Althaghr Hospital, Jeddah, Saudi Arabia
| | | | - Fay Khalid Alowid
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
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13
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Langford BJ, Soucy JPR, Leung V, So M, Kwan AT, Portnoff JS, Bertagnolio S, Raybardhan S, MacFadden DR, Daneman N. Antibiotic resistance associated with the COVID-19 pandemic: a systematic review and meta-analysis. Clin Microbiol Infect 2023; 29:302-309. [PMID: 36509377 PMCID: PMC9733301 DOI: 10.1016/j.cmi.2022.12.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 51.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Revised: 11/29/2022] [Accepted: 12/02/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND COVID-19 and antimicrobial resistance (AMR) are two intersecting global public health crises. OBJECTIVE We aimed to describe the impact of the COVID-19 pandemic on AMR across health care settings. DATA SOURCE A search was conducted in December 2021 in WHO COVID-19 Research Database with forward citation searching up to June 2022. STUDY ELIGIBILITY Studies evaluating the impact of COVID-19 on AMR in any population were included and influencing factors were extracted. Reporting of enhanced infection prevention and control and/or antimicrobial stewardship programs was noted. METHODS Pooling was done separately for Gram-negative and Gram-positive organisms. Random-effects meta-analysis was performed. RESULTS Of 6036 studies screened, 28 were included and 23 provided sufficient data for meta-analysis. The majority of studies focused on hospital settings (n = 25, 89%). The COVID-19 pandemic was not associated with a change in the incidence density (incidence rate ratio 0.99, 95% CI: 0.67-1.47) or proportion (risk ratio 0.91, 95% CI: 0.55-1.49) of methicillin-resistant Staphylococcus aureus or vancomycin-resistant enterococci cases. A non-statistically significant increase was noted for resistant Gram-negative organisms (i.e. extended-spectrum beta-lactamase, carbapenem-resistant Enterobacterales, carbapenem or multi-drug resistant or carbapenem-resistant Pseudomonas aeruginosa or Acinetobacter baumannii, incidence rate ratio 1.64, 95% CI: 0.92-2.92; risk ratio 1.08, 95% CI: 0.91-1.29). The absence of reported enhanced infection prevention and control and/or antimicrobial stewardship programs initiatives was associated with an increase in gram-negative AMR (risk ratio 1.11, 95% CI: 1.03-1.20). However, a test for subgroup differences showed no statistically significant difference between the presence and absence of these initiatives (p 0.40). CONCLUSION The COVID-19 pandemic may have hastened the emergence and transmission of AMR, particularly for Gram-negative organisms in hospital settings. But there is considerable heterogeneity in both the AMR metrics used and the rate of resistance reported across studies. These findings reinforce the need for strengthened infection prevention, antimicrobial stewardship, and AMR surveillance in the context of the COVID-19 pandemic.
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Affiliation(s)
- Bradley J. Langford
- Public Health Ontario, Toronto, Ontario, Canada,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada,Corresponding author. Bradley J. Langford, Public Health Ontario, Health Protection, 480 University Avenue, Toronto, Ontario M5G 1V2, Canada
| | - Jean-Paul R. Soucy
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Valerie Leung
- Public Health Ontario, Toronto, Ontario, Canada,Toronto East Health Network, Toronto, Ontario, Canada
| | - Miranda So
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
| | - Angela T.H. Kwan
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Jacob S. Portnoff
- Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Silvia Bertagnolio
- Department of Surveillance, Prevention and Control, Division of Antimicrobial Resistance, World Health Organization, Geneva, Switzerland
| | | | - Derek R. MacFadden
- Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada,The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Nick Daneman
- Public Health Ontario, Toronto, Ontario, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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14
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Healthcare-associated infections on the intensive care unit in 21 Brazilian hospitals during the early months of the coronavirus disease 2019 (COVID-19) pandemic: An ecological study. Infect Control Hosp Epidemiol 2023; 44:284-290. [PMID: 35300742 PMCID: PMC8987658 DOI: 10.1017/ice.2022.65] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has caused a global health crisis and may have affected healthcare-associated infection (HAI) prevention strategies. We evaluated the impact of the COVID-19 pandemic on HAI incidence in Brazilian intensive care units (ICUs). METHODS In this ecological study, we compared adult patients admitted to the ICU from April through June 2020 (pandemic period) with the same period in 2019 (prepandemic period) in 21 Brazilian hospitals. We used the Wilcoxon signed rank-sum test in a pairwise analysis to compare the following differences between the pandemic and the prepandemic periods: microbiologically confirmed central-line-associated bloodstream infection (CLABSI) and ventilator-associated pneumonia (VAP) incidence density (cases per 1,000 central line and ventilator days, respectively), the proportion of organisms that caused HAI, and antibiotic consumption (DDD). RESULTS We detected a significant increase in median CLABSI incidence during the pandemic: 1.60 (IQR, 0.44-4.20) vs 2.81 (IQR, 1.35-6.89) (P = .002). We did not detect a significant difference in VAP incidence between the 2 periods. In addition, we detected a significant increase in the proportion of CLABSI caused by Enterococcus faecalis and Candida spp during the pandemic, although only the latter retained statistical significance after correction for multiple comparisons. We did not detect a significant change in ceftriaxone, piperacillin-tazobactam, meropenem, or vancomycin consumption between the studied periods. CONCLUSIONS There was an increase in CLABSI incidence in Brazilian ICUs during the first months of COVID-19 pandemic. Additionally, we detected an increase in the proportion of CLABSI caused by E. faecalis and Candida spp during this period. CLABSI prevention strategies must be reinforced in ICUs during the COVID-19 pandemic.
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15
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Fukushige M, Syue LS, Morikawa K, Lin WL, Lee NY, Chen PL, Ko WC. Trend in healthcare-associated infections due to vancomycin-resistant Enterococcus at a hospital in the era of COVID-19: More than hand hygiene is needed. JOURNAL OF MICROBIOLOGY, IMMUNOLOGY, AND INFECTION = WEI MIAN YU GAN RAN ZA ZHI 2022; 55:1211-1218. [PMID: 35989164 PMCID: PMC9357275 DOI: 10.1016/j.jmii.2022.08.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 07/20/2022] [Accepted: 08/01/2022] [Indexed: 12/27/2022]
Abstract
BACKGROUND Variable control measures for vancomycin-resistant Enterococcus (VRE) infections were adopted among different hospitals and areas. We investigated the burden and patient characteristics of healthcare-associated VRE infections in 2018-2019 and 2020, when multiple preventive measures for COVID-19 were taken. METHODS During the COVID-19 pandemic, mask waring and hand hygiene were enforced in the study hospital. The incidence densities of healthcare-associated infections (HAIs), including overall HAIs, methicillin-resistant Staphylococcus aureus (MRSA) HAIs, VRE HAIs, and VRE healthcare-associated bloodstream infections (HABSIs), consumption of broad-spectrum antibiotics and hygiene products, demographic characteristics and medical conditions of affected patients, were compared before and after the pandemic. RESULTS The incidence density of both VRE HAIs and VRE HABSIs did not change statistically significantly, however, the highest in 2020 than that in 2018 and 2019. This was in spite of universal mask waring and increased consumption of 75% alcohol in 2020 and consistent implementation of an antibiotic stewardship program in three observed years. The increased prescriptions of broad-spectrum cephalosporins might partially explain the increase of VRE infection. CONCLUSION Increased mask wearing and hand hygiene may not result in the decline in the development of VRE HAIs in the hospital during the COVID-19 pandemic, and continued monitoring of the dynamics of HAIs remains indispensable.
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Affiliation(s)
- Mizuho Fukushige
- Faculty of Medicine, University of Tsukuba, Ibaraki, Japan,Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Ling-Shang Syue
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | | | - Wen-Liang Lin
- Department of Pharmacy, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Nan-Yao Lee
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Po-Lin Chen
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Wen-Chien Ko
- Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Center for Infection Control, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Department of Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan,Corresponding author. Department of Internal Medicine, National Cheng Kung University Hospital, No. 138, Sheng Li Road, Tainan, 704, Taiwan. Fax: +886 6 2752038
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16
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Sedda L, Ashish A, Unsworth A, Martindale J, Sundar R, Farrier M. Comparison of COVID-19 survival in relation to CPAP length of treatment and by comorbidity and transmission setting (community or hospital acquired) in a medium-sized UK hospital in 2020: a retrospective study. BMJ Open 2022; 12:e060994. [PMID: 36414291 PMCID: PMC9684282 DOI: 10.1136/bmjopen-2022-060994] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To estimate continuous positive airway pressure (CPAP) length of treatment effect on survival of hospitalised COVID-19 patients in a medium-sized UK Hospital, and how this effect changes according to the patient's comorbidity and COVID-19 route of acquisition (community or nosocomial) during the two waves in 2020. SETTING The acute inpatient unit in Wrightington, Wigan and Leigh Teaching Hospitals National Health Service (NHS) Foundation Trust (WWL), a medium-sized NHS Trust in north-west of England. DESIGN Retrospective cohort of all confirmed COVID-19 patients admitted in WWL during 2020. PARTICIPANTS 1830 patients (568 first wave, 1262 s wave) with antigen confirmed COVID-19 disease and severe acute respiratory syndrome admitted between 17 March 2020 (first confirmed COVID-19 case) and 31 December 2020. OUTCOME MEASURE COVID-19 survival rate in all patients and survival rate in potentially hospital-acquired COVID-19 (PHA) patients were modelled using a predictor set which include comorbidities (eg, obesity, diabetes, chronic ischaemic heart disease (IHD), chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD)), wave, age, sex and care home residency, and interventions (remdesivir, dexamethasone, CPAP, intensive care unit (ICU), intubation). Secondary outcome measure was CPAP length, which was modelled using the same predictors of the survival rate. RESULTS Mortality rate in the second wave was significantly lower than in the first wave (43.4% vs 28.1%, p<0.001), although for PHA COVID-19 patients mortality did not reduce, remaining at very high levels independently of wave and CPAP length. For all cohort, statistical modelling identified CPAP length (HR 95% CI 0.86 to 0.96) and women (HR 95% CI 0.71 to 0.81) were associated with improved survival, while being older age (HR 95% CI 1.02 to 1.03) admitted from care homes (HR 95% CI 2.22 to 2.39), IHD (HR 95% CI 1.13 to 1.24), CKD (HR 95% CI 1.14 to 1.25), obesity (HR 95% CI 1.18 to 1.28) and COPD-emphysema (HR 95% CI 1.18 to 1.57) were associated with reduced survival. Despite the detrimental effect of comorbidities, patients with CKD (95% CI 16% to 30% improvement in survival), IHD (95% CI 1% to 10% improvement in survival) and asthma (95% CI 8% to 30% improvement in survival) benefitted most from CPAP length, while no significant survival difference was found for obese and patients with diabetes. CONCLUSIONS The experience of an Acute Trust during the COVID-19 outbreak of 2020 is documented and indicates the importance of care home and hospitals in disease acquisition. Death rates fell between the first and second wave only for community-acquired COVID-19 patients. The fall was associated to CPAP length, especially for some comorbidities. While uncovering some risk and protective factors of mortality in COVID-19 studies, the study also unravels how little is known about PHA COVID-19 and the interaction between CPAP and some comorbidities.
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Affiliation(s)
- Luigi Sedda
- Lancaster Ecology and Epidemiology Group, Lancaster University, Lancaster, UK
| | - Abdul Ashish
- Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Alison Unsworth
- Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Jane Martindale
- Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Ramachandaran Sundar
- Department of Respiratory Medicine, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
| | - Martin Farrier
- Paediatrics, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
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17
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Gasch O, Badia-Cebada L, Carmezim J, Vaqué M, Pomar V, Moreno E, Marrón A, Jiménez-Martínez E, García-Quesada MJ, Garcia-Alarcón X, Domènech D, Càmara J, Andrés M, Peñafiel J, Porrón R, Limón E, Calbo E, Pujol M. Effects of the COVID-19 Pandemic on Incidence and Epidemiology of Catheter-Related Bacteremia, Spain. Emerg Infect Dis 2022; 28:2181-2189. [PMID: 36191608 PMCID: PMC9622263 DOI: 10.3201/eid2811.220547] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
We compared hospital-acquired catheter-related bacteremia (CRB) episodes diagnosed at acute care hospitals in Catalonia, Spain, during the COVID-19 pandemic in 2020 with those detected during 2007–2019. We compared the annual observed and predicted CRB rates by using the negative binomial regression model and calculated stratified annual root mean squared errors. A total of 10,030 episodes were diagnosed during 2007–2020. During 2020, the observed CRB incidence rate was 0.29/103 patient-days, whereas the predicted CRB rate was 0.14/103 patient-days. The root mean squared error was 0.153. Thus, a substantial increase in hospital-acquired CRB cases was observed during the COVID-19 pandemic in 2020 compared with the rate predicted from 2007–2019. The incidence rate was expected to increase by 1.07 (95% CI 1–1.15) for every 1,000 COVID-19–related hospital admissions. We recommend maintaining all CRB prevention efforts regardless of the coexistence of other challenges, such as the COVID-19 pandemic.
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18
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Metan G, Demir Çuha M, Hazirolan G, Telli Dizman G, Tanriverdi ES, Otlu B, Tas Z, Zarakolu P, Arik Z, Topeli A, Akinci SB, Ünal S, Uzun Ö. The impact of COVID-19 pandemic on nosocomial multidrug-resistant bacterial bloodstream infections and antibiotic consumption in a tertiary care hospital. GMS HYGIENE AND INFECTION CONTROL 2022; 17:Doc15. [PMID: 36157382 PMCID: PMC9487780 DOI: 10.3205/dgkh000418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
We investigated the change in the epidemiology of nosocomial bloodstream infections (BSIs) caused by multidrug-resistant bacteria during Coronavirus Disease (COVID-19) and antibiotic consumption rates at a pandemic hospital and at the Oncology Hospital which operated as COVID-19-free on the same university campus. Significant increases in the infection density rate (IDRs) of BSIs caused by carbapenem-resistant Acinetobacter baumannii (CRAB) and ampicillin-resistant Enterococcus faecium (ARE) were detected at the pandemic hospital, whereas carbapenem-resistant Klebsiella pneumoniae BSIs were increased at the non-pandemic Oncology Hospital. Pulsed field gel electrophoresis showed a polyclonal outbreak of CRAB in COVID-19 intensive care units. Antibiotic consumption rates were increased for almost all antibiotics, and was most significant for meropenem at both of the hospitals. Increased IDRs of CRAB and ARE BSIs as well as an increased consumption rate of broad-spectrum antibiotics emphasize the importance of a multimodal infection prevention strategy combined with an active antibiotic stewardship program.
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Affiliation(s)
- Gökhan Metan
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey,Infection Control Committee Hacettepe University Hospitals, Ankara, Turkey,*To whom correspondence should be addressed: Gökhan Metan, Hacettepe Üniversitesi Tıp Fakültesi Hastanesi İç Hastalıkları Binası Kat: 1, Enfeksiyon Hastalıkları ve Klinik Mikrobiyoloji Anabilim Dalı, Ankara, Turkey, E-mail: ,
| | - Mervenur Demir Çuha
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gülsen Hazirolan
- Department of Medical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Gülçin Telli Dizman
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey,Infection Control Committee Hacettepe University Hospitals, Ankara, Turkey
| | - Elif Seren Tanriverdi
- Department of Medical Microbiology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Baris Otlu
- Department of Medical Microbiology, İnönü University Faculty of Medicine, Malatya, Turkey
| | - Zahit Tas
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Pinar Zarakolu
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Zafer Arik
- Division of Medical Oncology, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Arzu Topeli
- Section of Intensive Care Medicine, Department of Internal Medicine, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Seda Banu Akinci
- Section of Intensive Care Medicine Department of Anesthesiology and Reanimation, Hacettepe University Faculty of Medicine, Ankara, Turkey
| | - Serhat Ünal
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey,Infection Control Committee Hacettepe University Hospitals, Ankara, Turkey
| | - Ömrüm Uzun
- Department of Infectious Diseases and Clinical Microbiology, Hacettepe University Faculty of Medicine, Ankara, Turkey
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Chiang SC, Chen WC. Daily Association between COVID-19 cases and parents' emotions: the role of marital relationship quality. CURRENT PSYCHOLOGY 2022; 42:1-6. [PMID: 35967511 PMCID: PMC9364279 DOI: 10.1007/s12144-022-03602-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/22/2022] [Accepted: 08/02/2022] [Indexed: 11/26/2022]
Abstract
The continuing impact of daily stress during the COVID-19 pandemic has disrupted the lives of families worldwide, and increased the risk of psychological problems for parents and their children. The current study investigated the daily effect of COVID-19 cases on parents' positive and negative emotions among 163 Taiwanese families using daily diary methodology across 10 weekdays. Results of multilevel modeling indicated that parents reported fewer positive emotions on days when COVID-19 cases were higher than average. Further moderating analyses showed the adverse effect of COVID-19 cases was only evident when the same-day marital relationship quality was lower than usual. The findings highlight the psychological stress of COVID-19 cases on parents' daily emotions and identify the protective role of marital relationship quality. Policies and clinical interventions should consider the implications of daily COVID-19 stressors for parents' emotional well-being, and target the protective role of marital relationship quality in daily life.
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Affiliation(s)
- Shou-Chun Chiang
- Department of Human Development and Family Studies, The Pennsylvania State University, Pennsylvania, United States
| | - Wan-Chen Chen
- Department of Education, National Chenchi University, Taipei, Taiwan
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20
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Face masks can reduce frequency of face touching: An observational crossover study. Int J Infect Dis 2022; 123:54-57. [PMID: 35926803 DOI: 10.1016/j.ijid.2022.07.072] [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: 06/19/2022] [Revised: 07/27/2022] [Accepted: 07/27/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The purpose of this study is to analyze face touching patterns with and without face mask. METHODS The behavior of face touching with and without a mask during an interview was assessed in forty individuals. The frequency of touching in different areas of the face covered by the mask was compared to areas not covered by the face mask. RESULTS There was an increase in the number of individuals who touched the hair and the eye, when they were not wearing the mask. There was an increase in the number of touches on the lips and hair when individuals were not wearing the face mask. When analysing the area covered by face mask, no difference was observed on the number of touches while using or not using masks. However, when area not covered by face mask was analysed, higher number of touches in individuals without masks was observed when compared to individuals wearing masks. CONCLUSION The use of face mask can reduce or change the face touching patterns in normal individuals, especially in areas not covered by the mask. The use of face mask can possibly reduce the chances of being infected by auto-inoculation.
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21
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Tham N, Fazio T, Johnson D, Skandarajah A, Hayes IP. Hospital Acquired Infections in Surgical Patients: Impact of COVID-19-Related Infection Prevention Measures. World J Surg 2022; 46:1249-1258. [PMID: 35384475 PMCID: PMC8985564 DOI: 10.1007/s00268-022-06539-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2022] [Indexed: 01/08/2023]
Abstract
Background Hospital acquired infections are common, costly, and potentially preventable adverse events. This study aimed to determine the effect of the COVID-19 pandemic-related escalation in infection prevention and control measures on the incidence of hospital acquired infection in surgical patients in a low COVID-19 environment in Australia. Method This was a retrospective cohort study in a tertiary institution. All patients undergoing a surgical procedure from 1 April 2020 to 30 June 2020 (COVID-19 pandemic period) were compared to patients pre-pandemic (1 April 2019–30 June 2019). The primary outcome investigated was odds of overall hospital acquired infection. The secondary outcome was patterns of involved microorganisms. Univariable and multivariable logistic regression analysis was performed to assess odds of hospital acquired infection. Results There were 5945 admission episodes included in this study, 224 (6.6%) episodes had hospital acquired infections in 2019 and 179 (7.1%) in 2020. Univariable logistic regression analysis demonstrated no evidence of change in odds of having a hospital acquired infection between cohorts (OR 1.08, 95% CI 0.88–1.33, P = 0.434). The multivariable regression analysis adjusting for potentially confounding co-variables also demonstrated no evidence of change in odds of hospital acquired infection (OR 0.93, 95% CI 0.74–1.16, P = 0.530). Conclusion Increased infection prevention and control measures did not affect the incidence of hospital acquired infection in surgical patients in our institution, suggesting that there may be a plateau effect with these measures in a system with a pre-existing high baseline of practice. Supplementary Information The online version contains supplementary material available at 10.1007/s00268-022-06539-4.
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Affiliation(s)
- Nicole Tham
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Parkville, VIC, Australia. .,Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, VIC, Australia. .,Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia.
| | - Timothy Fazio
- Department of General Medicine and Infectious Diseases, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia.,Health Intelligence Unit, The Royal Melbourne Hospital, Parkville, VIC, Australia
| | - Douglas Johnson
- Department of General Medicine and Infectious Diseases, The Royal Melbourne Hospital, Melbourne, VIC, Australia.,Department of Medicine, The Royal Melbourne Hospital, University of Melbourne, Parkville, VIC, Australia
| | - Anita Skandarajah
- Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
| | - Ian P Hayes
- Colorectal Surgical Unit, The Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of General Surgical Specialties, The Royal Melbourne Hospital, Parkville, VIC, Australia.,Department of Surgery, The Royal Melbourne Hospital, The University of Melbourne, Parkville, VIC, Australia
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22
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Mohammadi A, Khatami F, Azimbeik Z, Khajavi A, Aloosh M, Aghamir SMK. Hospital-acquired infections in a tertiary hospital in Iran before and during the COVID-19 pandemic. Wien Med Wochenschr 2022; 172:220-226. [PMID: 35254565 PMCID: PMC8900468 DOI: 10.1007/s10354-022-00918-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 01/24/2022] [Indexed: 12/01/2022]
Abstract
Infection prevention protocols are the accepted standard to control nosocomial infections. These protective measures intensified after the coronavirus 2019 (COVID-19) pandemic to reduce the risk of viral transmission. It is the rationale that this practice reduces nosocomial infections. We evaluated the impact of these protective measures on nosocomial infections in our center with more than 20,000 records of annual patient admission. In a retrospective study, we evaluated the incidence of nosocomial infections in Sina hospital for 9 months (April–December 2020) during the COVID-19 period and compared it with the 8 months in the pre-COVID period (April–November 2019). Despite decreasing the number of admissions during the COVID era (hospitalizations showed a reduction of 43.79%), the total hospital nosocomial infections remained unchanged; 4.73% in the pre-COVID period versus 4.78% during the COVID period. During the COVID period the infection percentages increased in the cardiovascular care unit (p-value = 0.002) and intensive care units (p-value = 0.045), and declined in cardiology (p-value = 0.046) and neurology (p-value = 0.019) wards. This study showed that intensifying the infection prevention protocols is important in decreasing the nosocomial infections in some wards (cardiology and neurology). Still, we saw increased nosocomial infection in some wards, e.g., the intensive care unit (ICU) and coronary care unit (CCU). Thus, enhanced infection prevention protocols implemented in hospitals to prevent the spread of a pandemic infection may not always decrease rates of other hospital-acquired infections during a pandemic. Due to limited resources, transfer of staff, and staff shortage due to quarantine measures may prohibit improved prevention procedures from effectively controlling nosocomial infections.
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Affiliation(s)
- Abdolreza Mohammadi
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Khatami
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zohreh Azimbeik
- Urology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Khajavi
- Student Research Committee, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Mehdi Aloosh
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
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23
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24
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Thoma R, Seneghini M, Seiffert SN, Vuichard Gysin D, Scanferla G, Haller S, Flury D, Boggian K, Kleger GR, Filipovic M, Nolte O, Schlegel M, Kohler P. The challenge of preventing and containing outbreaks of multidrug-resistant organisms and Candida auris during the coronavirus disease 2019 pandemic: report of a carbapenem-resistant Acinetobacter baumannii outbreak and a systematic review of the literature. Antimicrob Resist Infect Control 2022; 11:12. [PMID: 35063032 PMCID: PMC8777447 DOI: 10.1186/s13756-022-01052-8] [Citation(s) in RCA: 54] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Accepted: 01/03/2022] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Despite the adoption of strict infection prevention and control measures, many hospitals have reported outbreaks of multidrug-resistant organisms (MDRO) during the Coronavirus 2019 (COVID-19) pandemic. Following an outbreak of carbapenem-resistant Acinetobacter baumannii (CRAB) in our institution, we sought to systematically analyse characteristics of MDRO outbreaks in times of COVID-19, focussing on contributing factors and specific challenges in controlling these outbreaks. METHODS We describe results of our own CRAB outbreak investigation and performed a systematic literature review for MDRO (including Candida auris) outbreaks which occurred during the COVID-19 pandemic (between December 2019 and March 2021). Search terms were related to pathogens/resistance mechanisms AND COVID-19. We summarized outbreak characteristics in a narrative synthesis and contrasted contributing factors with implemented control measures. RESULTS The CRAB outbreak occurred in our intensive care units between September and December 2020 and comprised 10 patients (thereof seven with COVID-19) within two distinct genetic clusters (both ST2 carrying OXA-23). Both clusters presumably originated from COVID-19 patients transferred from the Balkans. Including our outbreak, we identified 17 reports, mostly caused by Candida auris (n = 6) or CRAB (n = 5), with an overall patient mortality of 35% (68/193). All outbreaks involved intensive care settings. Non-adherence to personal protective equipment (PPE) or hand hygiene (n = 11), PPE shortage (n = 8) and high antibiotic use (n = 8) were most commonly reported as contributing factors, followed by environmental contamination (n = 7), prolonged critical illness (n = 7) and lack of trained HCW (n = 7). Implemented measures mainly focussed on PPE/hand hygiene audits (n = 9), environmental cleaning/disinfection (n = 9) and enhanced patient screening (n = 8). Comparing potentially modifiable risk factors and control measures, we found the largest discrepancies in the areas of PPE shortage (risk factor in 8 studies, addressed in 2 studies) and patient overcrowding (risk factor in 5 studies, addressed in 0 studies). CONCLUSIONS Reported MDRO outbreaks during the COVID-19 pandemic were most often caused by CRAB (including our outbreak) and C. auris. Inadequate PPE/hand hygiene adherence, PPE shortage, and high antibiotic use were the most commonly reported potentially modifiable factors contributing to the outbreaks. These findings should be considered for the prevention of MDRO outbreaks during future COVID-19 waves.
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Affiliation(s)
- Reto Thoma
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Marco Seneghini
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Salomé N. Seiffert
- Division of Human Microbiology, Center for Laboratory Medicine, St. Gallen, Switzerland
| | - Danielle Vuichard Gysin
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital Muensterlingen, Muensterlingen, Switzerland
| | - Giulia Scanferla
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Sabine Haller
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Domenica Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Katia Boggian
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Gian-Reto Kleger
- Division of Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Miodrag Filipovic
- Division of Intensive Care Medicine, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Oliver Nolte
- Division of Human Microbiology, Center for Laboratory Medicine, St. Gallen, Switzerland
| | - Matthias Schlegel
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | - Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
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Mitra M, Ghosh A, Pal R, Basu M. Prevention of hospital-acquired infections: A construct during Covid-19 pandemic. J Family Med Prim Care 2021; 10:3348-3354. [PMID: 34760756 PMCID: PMC8565103 DOI: 10.4103/jfmpc.jfmpc_742_21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Revised: 07/07/2021] [Accepted: 07/10/2021] [Indexed: 12/12/2022] Open
Abstract
Introduction: Hospital-acquired infection (HAI) rates were reported to have declined in healthcare settings during the Covid-19 pandemic. Needless to mention that HAI is of paramount interest and relevance to a primary care physician who need to care from womb to tomb inside pandemic. Objectives: This study was conducted to find the impact of Covid-19 pandemic on the four parameters of HAIs, namely, catheter-associated urinary tract infections (CAUTI), central-line-associated bloodstream infections (CLABSI), ventilator-associated pneumonia (VAP) and surgical site infections (SSIs) with hand hygiene compliance rates among healthcare workers. Materials and Methods: This retrospective data mining was undertaken in a 700 bed multispecialty teaching hospital in the Eastern India which was a Government of Bihar approved speciality Covid Care Hospital. Data from the monthly routine infection control monitoring and surveillance activities was collated from January 2019 to December 2020. Control charts with upper and lower control limit set at mean ± 1 SD were used to monitor monthly trends of HAIs. Results: The CAUTI rates reduced by 28.01%; the CLABSI rates declined by 37.61%, the SSI rates reduced by 62.39%, while the highest VAP rates were reported in November 2019 (1.9 per 1000 ventilator days). The hand hygiene compliance rates from January 2019 to December 2020 among different healthcare staffs showed a sharply rising trend. Conclusion: Covid-19 pandemic highlighted paramount importance regarding compliance to hand hygiene and implementation of standard infection control practices as recommended by World Health Organisation and Centres for Diseases Control and Prevention (CDC), which can drastically reduce range of HAIs.
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Affiliation(s)
- Manasij Mitra
- Department of Anesthesiology, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India
| | - Amrita Ghosh
- Department of Biochemistry, Medical College and Hospital, 88 College Street, Kolkata, West Bengal, India
| | - Ranabir Pal
- Department of Community Medicine, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India
| | - Maitraye Basu
- Department of Biochemistry, MGM Medical College and LSK Hospital, Kishanganj, Bihar, India
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26
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Kao YY, Chen YC, Hsu TW, Zhong HR, Cheng BC, Lee CT, Lee CH. Impact on Mental Well-Being and Resilience of Patients with Multiple Chronic Conditions in Different Periods during the Coronavirus Disease 2019 Outbreak in Taiwan. Healthcare (Basel) 2021; 9:healthcare9111457. [PMID: 34828503 PMCID: PMC8620477 DOI: 10.3390/healthcare9111457] [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: 09/30/2021] [Revised: 10/21/2021] [Accepted: 10/24/2021] [Indexed: 01/08/2023] Open
Abstract
Concerns over the coronavirus disease 2019 (COVID-19) pandemic and control measures have affected the routine outpatient visits of individuals with comorbidities and their mental well-being. From October 2019 to August 2020, this cross-sectional study enrolled 135 patients who sought medical attention at a medical center in Taiwan. This period covered the early (October to December 2019), peak (January to April 2020), and late (May to August 2020) periods of the COVID-19 outbreak in Taiwan. The demographic data, social support data, activities of daily living (ADL), resilience scale scores, and mental well-being scale scores of the participants were compared. There were no statistically significant differences in the participation rate, demographic data, and social support data between the three periods. The correlation analysis confirmed significant negative relationships between the number of COVID-19 cases and outpatient department visits per month (r = −0.764, p < 0.001), emergency department visits per month (r = −0.023, p < 0.001), ADL (r = −0.257, p = 0.03), resilience scale (r = −0.390, p < 0.001), and mental well-being scale (r = −0.475, p < 0.001). In conclusion, the severity of the COVID-19 outbreak in Taiwan was associated with declines in the ADL, mental well-being, and resilience of patients who sought medical attention.
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Affiliation(s)
- Yu-Yin Kao
- Department of Nursing, Kaohsiung Chang Gung Memorial Hospital, College of Nursing, Kaohsiung Medical University, Kaohsiung 80708, Taiwan;
| | - Yi-Chun Chen
- Department of Internal Medicine, Division of Infectious Diseases, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan;
| | - Tsuen-Wei Hsu
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan; (T.-W.H.); (H.-R.Z.); (B.-C.C.); (C.-T.L.)
| | - Hua-Rong Zhong
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan; (T.-W.H.); (H.-R.Z.); (B.-C.C.); (C.-T.L.)
| | - Ben-Chung Cheng
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan; (T.-W.H.); (H.-R.Z.); (B.-C.C.); (C.-T.L.)
| | - Chien-Te Lee
- Department of Internal Medicine, Division of Nephrology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan; (T.-W.H.); (H.-R.Z.); (B.-C.C.); (C.-T.L.)
| | - Chen-Hsiang Lee
- Department of Internal Medicine, Division of Infectious Diseases, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Kaohsiung 83301, Taiwan;
- Correspondence: ; Tel.: +886-7-7317123
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27
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Anguraj S, Ketan P, Sivaradjy M, Shanmugam L, Jamir I, Cherian A, Sankar Sastry A. The effect of hand hygiene audit in COVID intensive care units in a tertiary care hospital in South India. Am J Infect Control 2021; 49:1247-1251. [PMID: 34303724 PMCID: PMC8299146 DOI: 10.1016/j.ajic.2021.07.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/12/2021] [Accepted: 07/13/2021] [Indexed: 01/28/2023]
Abstract
Background In the era of COVID-19 pandemic, there is an upsurge of healthcare-associated infections (HAI) in COVID intensive care units (ICUs), which can be reduced by following proper hand hygiene (HH) practice. Performing HH auditing in COVID ICU and providing timely feedback to the stake holders is crucial to reduce HAIs. Methods From November 2020- April 2021, HH audit was conducted in COVID ICUs. HH complete adherence rate (HHCAR), HH partial adherence rate (HHPAR) and HH total adherence rate (HHTAR) were analyzed. Profession-specific HHTAR and moment-specific HHTAR (for each WHO moment) were also calculated. Results HHCAR, HHPAR and HHTAR were found as 30.8%, 34.5% and 65.3% respectively. There was a significant increase in the monthly HHTAR from 26.7% to 68.4% (P < .001). The profession-specific HHAR was found to be highest among doctors (67.5%) and nurses (66.4%). As the HHTAR increases there is a significant decrease in device associated infection (DAI) rate from 24.7 to 11.5 per 1,000 device days. Conclusions Auditing HH and providing timely feedback significantly improved HH compliance. The need of the hour is to regularly conduct HH audit in COVID locations of all healthcare facilities to reduce HAI rate among the COVID- 19 infected patients in ICUs.
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Affiliation(s)
| | | | | | | | - Imola Jamir
- Department of Microbiology, JIPMER, Puducherry, India
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28
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Abstract
PURPOSE OF REVIEW The coronavirus disease (COVID-19) pandemic has resulted in necessary modifications of infection control policies and practices in acute healthcare facilities globally. This is often accompanied by infrastructure modifications, ward redesignations, as well as healthcare staff redeployments and changes to infection prevention and control (IPC) practices. We review the potential for both negative and positive impacts these major changes can have on nosocomial transmission of multidrug-resistant organisms (MDROs). RECENT FINDINGS Healthcare facilities around the world have reported outbreaks of MDROs during the COVID-19 pandemic. In contrast some centres have reported a decrease in baseline rates due to a number of possible factors. SUMMARY While implementing crucial preventive measures for COVID-19, is it important to consider any collateral effects of changes in IPC and antimicrobial stewardship program (ASP) practices. The disruption caused to IPC and ASP practices during the pandemic are likely to see a counter intuitive increase in transmission of MDROs.
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29
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Unterfrauner I, Hruby LA, Jans P, Steinwender L, Farshad M, Uçkay I. Impact of a total lockdown for pandemic SARS-CoV-2 (Covid-19) on deep surgical site infections and other complications after orthopedic surgery: a retrospective analysis. Antimicrob Resist Infect Control 2021; 10:112. [PMID: 34332632 PMCID: PMC8325206 DOI: 10.1186/s13756-021-00982-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 07/16/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND A total lockdown for pandemic SARS-CoV-2 (Covid-19) entailed a restriction of elective orthopedic surgeries in Switzerland. While access to the hospital and human contacts were limited, hygiene measures were intensified. The objective was to investigate the impact of those strict public health guidelines on the rate of intra-hospital, deep surgical site infections (SSI), wound healing disorders and non-infectious postoperative complications after orthopedic surgery during the first Covid-19 lockdown. METHODS In a single-center study, patients with orthopedic surgery during the first Covid-19 lockdown from March 16, 2020 to April 26, 2020 were compared to cohorts that underwent orthopedic intervention in the pre- and post-lockdown periods of six months each. Besides the implementation of substantial public health measures (promotion of respiratory etiquette and hand hygiene), no additional infection control bundles have been implemented. RESULTS 5791 patients were included in this study. In multivariate Cox regression analyses adjusting for the large case-mix, the lockdown was unrelated to SSI (hazard ratio (HR) 1.6; 95% confidence interval (CI) 0.6-4.8), wound healing disorders (HR 0.7; 95% CI 0.1-5.7) or other non-infectious postoperative complications (HR 0.7, 95% CI 0.3-1.5) after a median follow-up of seven months. CONCLUSION The risks for SSI, wound healing disorders and other complications in orthopedic surgery were not influenced by the extended public health measures of the total Covid-19 lockdown. Trial registration BASEC 2020-02646 (Cantonal Ethics Commission Zurich). LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Ines Unterfrauner
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Balgrist University Hospital, University of Zurich, Forchstrasse 340, 8008 Zurich, Switzerland
| | - Laura A. Hruby
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Peter Jans
- Medical Informatics Service, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Ludwig Steinwender
- Infection Control, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Mazda Farshad
- Department of Orthopedics, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
| | - Ilker Uçkay
- Infection Control, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
- Unit of Clinical and Applied Research, Balgrist University Hospital, University of Zurich, 8008 Zurich, Switzerland
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30
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Vázquez-Temprano N, Ursúa-Díaz MI, Salgado-Barreira Á, Vázquez-Gallardo R, Bastida VT, Anibarro L. [Decline of tuberculosis rates and Covid-19 pandemic. Fact or fiction?]. Arch Bronconeumol 2021; 58:272-274. [PMID: 34092895 PMCID: PMC8168331 DOI: 10.1016/j.arbres.2021.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Revised: 05/17/2021] [Accepted: 05/19/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Nuria Vázquez-Temprano
- Unidad de tuberculosis. Servicio de Medicina Interna. Complexo Hospitalario Universitario de Pontevedra, España
| | - María Isabel Ursúa-Díaz
- Programa gallego de tuberculosis. Dirección General de Salud Pública. Xunta de Galicia, Santiago de Compostela, España.,Grupo de Trabajo del Programa de Prevención y Control de la Tuberculosis de Galicia, España
| | - Ángel Salgado-Barreira
- Unidad de Metodología y Estadística. Instituto de Investigación Sanitaria Galicia Sur, Vigo, España
| | - Rafael Vázquez-Gallardo
- Unidad de tuberculosis. Servicio de Neumología. Complexo Hospitalario Universitario de Vigo, España.,Grupo de Trabajo del Programa de Prevención y Control de la Tuberculosis de Galicia, España
| | - Victoria Túñez Bastida
- Unidad de tuberculosis. Servicio de Medicina Preventiva. Hospital Clínico Universitario de Santiago de Compostela, A Coruña, España.,Grupo de Trabajo del Programa de Prevención y Control de la Tuberculosis de Galicia, España
| | - Luis Anibarro
- Unidad de tuberculosis. Servicio de Medicina Interna. Complexo Hospitalario Universitario de Pontevedra, España.,Grupo de Trabajo del Programa de Prevención y Control de la Tuberculosis de Galicia, España.,Grupo de investigación en Inmunología. Instituto de investigación Sanitaria Galicia Sur, Vigo, España
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31
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Asiamah N, Opuni FF, Mends-Brew E, Mensah SW, Mensah HK, Quansah F. Short-Term Changes in Behaviors Resulting from COVID-19-Related Social Isolation and Their Influences on Mental Health in Ghana. Community Ment Health J 2021; 57:79-92. [PMID: 33033971 PMCID: PMC7543965 DOI: 10.1007/s10597-020-00722-4] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 10/01/2020] [Indexed: 12/21/2022]
Abstract
This study assessed the behavioral outcomes of Coronavirus 2019 (COVID-19) social distancing protocols and their influences on mental health. An online survey hosted by Survey Monkey was utilized to collect data from residents of three Ghanaian cities of Accra, Kumasi and Tamale. A total of 621 surveys were analyzed, with a sensitivity analysis utilized to select covariates for the regression model. The average age of participants was about 36 years. Findings indicate that reduced physical activity time and a change in sexual activity and smoking frequency are some short-term changes in behavior resulting from social isolation during the lockdown. An increase in sedentary behavior had a negative influence on mental health. For the most part, changes in behaviors in the short-term were associated with lower mental health scores. The study implied that COVID-19 social distancing measures should be implemented alongside public education for discouraging unhealthy changes in behaviors.
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Affiliation(s)
- Nestor Asiamah
- Africa Centre for Epidemiology, Department of Behavioral Epidemiology, Accra North, P. O. Box AN 16284, Accra, Ghana.
| | | | - Edwin Mends-Brew
- Accra Technical University, Department of Statistics and Mathematics, Accra, Ghana
| | - Samuel Worlanyo Mensah
- Department of Development and Economics, Wisconsin International University College, Accra, Ghana
| | - Henry Kofi Mensah
- Department of Human Resources & Organizational Development, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Fidelis Quansah
- Faculty of Management Studies, University of Professional Studies Accra, Madina, Ghana
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