Hospital outpatient clinics as a potential hazard for healthcare associated infections

Knowledge, attitude and practice of healthcare workers on infection prevention and control in Ethiopia: A systematic review and meta-analysis

INTRODUCTION

Infectious diseases remain the leading causes of death in low and middle-income countries including Ethiopia. The existence of emerging, re-emerging, and drug-resistant infectious agents maximizes the importance of infection prevention and control. Healthcare workers are the key actors in the prevention and control of infection. As a result assessing the knowledge, attitude, and practice of healthcare workers toward infection prevention and control is very critical in the prevention and control of infectious diseases. Therefore, this systematic review and meta-analysis aimed to assess the knowledge, attitude, and practice of healthcare providers toward infection prevention in Ethiopia.

METHOD

PubMed, Scopus, SEMANTIC SCHOLAR, Google Scholar, and Addis Ababa University Digital Library were systematically searched for relevant literature until November 18/2023. The quality of the included studies was assessed using the Joanna Briggs Institute quality appraisal tool. Data were abstracted using a Microsoft Excel spreadsheet and analyzed using STATA version 11. A random-effects model was used to estimate the pooled prevalence. Heterogeneity among reported studies was assessed by Forest plot, Cochran's Q-statistics, and I2 test. Publication bias was checked using funnel plots, and Egger's regression test. In addition, sub-group and sensitivity analyses were conducted.

RESULT

A total of 7,681 articles were retrieved of which 19 studies with 5,650 healthcare workers were included in this systematic review and meta-analysis. About 74.5% (95% CI, 65.88, 83.12), 66.71% (95% CI 55.15, 78.28), and 55.2% (95% CI 48.22, 62.18) of healthcare workers were knowledgeable, had positive attitudes, and good standard of practice on infection prevention respectively.

CONCLUSION

Despite acceptable knowledge and attitude, about half of the healthcare workers have unsafe infection prevention and control practices in Ethiopia. Hence, serious attention should be given to healthcare workers' application of infection prevention standards in their working environment.

Radiology Department: A Potential Source of Multidrug-Resistant Microorganisms: A Cross-Sectional Study at Tertiary Hospital, Palestine

Introduction

Globally, healthcare facilities face a great challenge in the form of hospital-acquired infections (HAIs). Aside from the morbidity and mortality they cause, these illnesses are also extremely costly. Research on infection transmission in the medical field has been considerable, but not so much in the radiology department.

Aim

This study aims to identify the presence of multidrug-resistant (MDR) microbes on surfaces that are frequently touched in computed tomography (CT), magnetic resonance imaging (MRI), ultrasound (US), plain X-ray examination rooms, and portable radiography that are susceptible to contamination as well as to investigate the potential dangers of contracting MDR organisms to patients and healthcare providers. Materials and Method. In this study, 160 swab samples were collected from the radiology department during May and June 2022. Samples were obtained from 80 predefined surfaces twice within and outside of CT and MRI examination rooms as well as from US and plain X-ray machines and portable X-ray machines. Samples were taken at 7:00 a.m. using cotton swabs following the regular cleaning procedure. Bacterial colony-forming units (CFUs) per square centimeter were calculated after swabbing a 100 cm2 surface.

Results

Nearly all of the surfaces tested had bacterial CFUs. The highest contamination rate was found on keyboards ranging from (1.2-8) CFU/cm2, the sides of patient tables (1.2-20) CFU/cm2, knee coil (2.4-3) CFU/cm2, and patient leg supports (1.2-8) CFU/cm2. A noticeable increase in the contamination was noticed in June compared to May, and this was consistent with the increase in the number of isolated patients in the hospital, the workload in the radiology department, and the number of patients referred to the hospital. In our study, none of the examined sites showed contamination with MDR Gram-negative bacteria such as extended-spectrum beta-lactamases producing Enterobacterales (ESPL) or Carbapenemase-producing Enterobacterales (CPE). On the other hand, methicillin-resistant Staphylococcus (MRS), vancomycin-resistant Staphylococcus (VRS), and vancomycin-resistant Enterococcus (VRE) were detected.

Conclusion

All of the radiology department equipment and sites could be a source of bacterial infection including MDR, so the obligatory and committed disinfection protocol must be revised and implemented in the morning and between patients.

Examining outpatients' hand hygiene behaviour and its relation to COVID-19 infection prevention measures

BACKGROUND

The increasing demand for outpatient care is associated with a higher risk of infection transmission in these settings. However, there is limited research on infection prevention and control practices in ambulatory clinics, and none focuses on patients.

AIM

To examine outpatients' hand hygiene behaviours, their determinants, and their associations with other infection prevention measures during the COVID-19 pandemic.

METHODS

We observed the hand hygiene behaviour of one cohort of patients in one outpatient clinic and surveyed a separate sample in five clinics about their hand hygiene practice in outpatient facilities. A questionnaire based on the Theoretical Domains Framework (TDF) was used to examine predictors of the behaviour. Moreover, patients indicated their compliance with COVID-19 infection prevention measures, vaccination status, disease risk perception, and vaccine hesitancy.

FINDINGS

Observed hand hygiene rates among 618 patients were low (12.8%), while 67.3% of the 300 surveyed patients indicated sanitizing their hands upon entering the clinic. The TDF domains 'memory, attention, and decision processes' and 'emotions' significantly predicted both current (today's) and general hand hygiene behaviour in outpatient clinics. Hand hygiene behaviour and compliance with COVID-19 infection prevention showed a positive association; however, no significant connection was found with patients' vaccination status, suggesting different behavioural motivators.

CONCLUSION

Hand hygiene among outpatients should be improved through interventions focusing on helping patients remember to clean their hands. More research on infection prevention in outpatient facilities is needed to ensure patient safety.

Assessment of the Knowledge and Practice of Infection Control among Radiographers in Saudi Arabia: A Cross-Sectional Survey Study

Effective control of healthcare-associated infections (HAIs) involves a collaborative effort among various healthcare stakeholders, including healthcare workers, patients, and professionals. Radiographers, as essential members of the healthcare team, play a crucial role in HAI prevention by diligently adhering to standard infection control precautions (SICP) and maintaining a high level of knowledge regarding infection control procedures. The study aimed to assess the knowledge and practice of radiographers concerning infection control in radiology departments in Saudi Arabia.

METHODS

A descriptive cross-sectional study was conducted in Saudi Arabia in the period from February to May 2022, with data collected using an online survey in the form of a google forms questionnaire disseminated through social media as an electronic link and including the patient's demographic characteristic such as age, gender, education level, experience, and prior infection control training and multiple closed ended questions to assess knowledge of standard infection control precautions and the practice of infection control. Overall, 113 participants responded to the survey and entered their responses directly, and the data were analyzed using the SPSS (statistical package for social science).

RESULTS

The study revealed that the mean score of knowledge and awareness of the practice of infection control among radiographers in Saudi Arabia was (63.0 and 61.9, respectively), which were considered moderate levels. Females were significantly more knowledgeable about infection control and more aware of the practice than males (p-values = 0.019). The participants who previously attended courses of infection control training had a significantly higher score with a mean rank of (60.9) than those who had not (43.4), (p-value = 0.013). The radiographers' level of experience, age, and academic qualification had no significant influence on overall knowledge and practice of infection control (p-values > 0.05).

CONCLUSIONS

In Saudi Arabia, radiographers have a moderate level of knowledge and practice of infection control. There is a need for an ongoing training and education program for practicing radiographers to ensure they perform better in infection control measures.

Health Science Students' Perceptions of Hand Hygiene Education and Practice in a South African University: Introducing the University Hand Hygiene Improvement Model

Hand hygiene serves as a critical preventative measure against the spread of acquired infections in healthcare facilities and is an integral component of patient safety programs. While healthcare students in training are typically introduced to the principles underlying hand hygiene, the translation of this understanding into practice is often lacking, and compliance has remained low. This study aimed to evaluate health science students' in biomedical sciences, chiropractic and emergency medical care, environmental health, complementary medicine, medical imaging and radiation sciences, nursing, optometry, podiatry, and sports and movement studies perceptions regarding hand hygiene education (knowledge and attitude) and practice at a university in South Africa. Consenting students were asked to complete an online questionnaire that tested their knowledge, practices, and skills in handwashing. The ANOVA analysis results suggested significant differences in hand hygiene scores across departments and years of study. The multiple regression analyses confirmed these findings, suggesting that the department of study significantly influenced all aspects of hand hygiene, while the year of study affected hand hygiene skills, and age group influenced hand hygiene practices. Based on these findings, a conceptual model, the University Hand Hygiene Improvement Model (UHHIM), was proposed to enhance the teaching and learning of hand hygiene at the university level. The model underscores the necessity of targeted education, continuous monitoring, and feedback, and the pivotal roles of hand hygiene facilitators and student participation in enhancing hand hygiene behaviors.

Knowledge of Medical Imaging Professionals on Healthcare-Associated Infections: A Systematic Review and Meta-Analysis

Healthcare-associated infections (HCAIs) are a significant concern for both healthcare professionals and patients. With recent advances in imaging modalities, there is an increase in patients visiting the radiology department for diagnosis and therapeutic examination. The equipment used for the investigator is contaminated, which may result in HCAIs to the patients and healthcare professionals. Medical imaging professionals (MIPs) should have adequate knowledge to overcome the spread of infection in the radiology department. This systematic review aimed to examine the literature on the knowledge and precaution standard of MIPs on HCIAs. This study was performed with a relative keyword using PRISMA guidelines. The articles were retrieved from 2000 to 2022 using Scopus, PubMed, and ProQuest databases. The NICE public health guidance manual was used to assess the quality of the full-length article. The search yielded 262 articles, of which Scopus published 13 articles, PubMed published 179 articles, and ProQuest published 55 articles. In the present review, out of 262 articles, only 5 fulfilled the criteria that reported MIPs' knowledge of Jordan, Egypt, Sri Lanka, France, and Malawi populations. The present review reported that MIPs have moderate knowledge and precautionary standards regarding HCIAs in the radiology department. However, due to the limited studies published in the literature, the current review limits the application of the outcome in the vast MIPs population. This review recommended further studies to be conducted among the MIPs worldwide to know the actual knowledge and precaution standards regarding HCIAs.

Healthcare associated infections in gynecologic oncology: clinical and economic impact

OBJECTIVE

The purpose of this study was to assess the rate and type of infections in gynecological cancer patients. We also performed an economic analysis to provide an overview of costs related to healthcare associated infections.

METHODS

We retrospectively collected data from culture samples at the site of infection from patients undergoing surgery or chemotherapy, admitted to the Gynecologic Oncology Unit, Fondazione Policlinico Agostino Gemelli IRCCS, from January 2017 to December 2018. We performed univariate and multivariate analyses to calculate potential risk factors for prolonged length of hospitalization. The average cost per patient was calculated, including the cost of hospital stay, operating room, medications, and diagnostic and invasive procedures.

RESULTS

Among 5682 patients, 322 (5.6%) gynecological cancer patients with healthcare associated infections were identified. A total of 249 patients (77.3%) had undergone surgery in the previous 30 days and 73 (22.7%) patients were receiving chemotherapy. In the whole population, the most common healthcare associated infections were urinary infections (58%) and surgical wound infections (42.1%). In addition, 14.5% of patients had central venous catheter infections and 21.7% had blood stream infections. Median length of stay was 20 days (range 1-100). Among surgical patients, advanced age (odds ratio (OR) 1.233, 95% confidence interval (CI) 1.001 to 1.519, p=0.049), bowel resection (OR 2.659, 95% CI 1.493 to 4.735, p=0.001), surgical site infection (OR 10.447, 95% CI 1.143 to 95.5, p=0.038), and central venous catheter infection (OR 9.856, 95% CI 1.139 to 85.319, p=0.038) were independently associated with an increased risk of prolonged hospital stay (>20 days). The overall direct cost of healthcare associated infections was $6 273 852 per year.

CONCLUSIONS

The infection rate in our population was 5.6%. The most common healthcare associated infections were urinary and surgical wound infections. Among surgical patients, advanced age, bowel resection, surgical site, and central venous catheter infection were associated with an increased length of hospitalization. Healthcare associated infections cause an increase in the length of stay after surgery and hospital costs.

Healthcare-associated hepatitis B and C transmission to patients in the EU/EEA and UK: a systematic review of reported outbreaks between 2006 and 2021

Healthcare-associated transmission was the second most common hepatitis B (HBV) and hepatitis C (HCV) transmission route according to 2006-2012 European surveillance data, but data quality and completeness issues hinder comprehensive characterisation of this important issue. We carried out a systematic review of published literature on healthcare-associated transmission of HBV or HCV in European Union (EU) and European Economic Area (EEA) countries and the United Kingdom to complement surveillance data and identify higher-risk settings. We searched the PubMed and Embase databases and grey literature over the period January 2006 to September 2021, for publications reporting transmission events after 2000 in the EU/EEA and UK related to a healthcare setting or procedure. We collected data on the country, number of patients, setting type and route of transmission. In 65 publications from 16 countries, 43 HBV and 48 HCV events were identified resulting in 442 newly infected patients. Most events were reported from Italy (7 HBV and 12 HCV), Germany (8 HBV and 5 HCV) and the United Kingdom (8 HBV and 5 HCV). The number of patients infected from a single source within an event ranged from 1 to 53. Five large outbreaks of over 20 cases were identified, including two in Poland and one each in Belgium, Hungary and Slovakia. The majority of transmission events occurred through blood transfusions or in dialysis units. However, there were a number of outbreaks in seemingly low risk settings such as CT/MRI scanning units. A failure to adequately follow infection prevention control (IPC) precautions was reported in 30% of included studies. Healthcare-associated transmission of hepatitis B and C continues to occur in a range of community and hospital settings across EU/EEA countries and often results in large outbreaks, although the true extent of the situation cannot be fully determined due to under-reporting. Strict IPC precautions should be implemented across all healthcare settings and regularly audited, and surveillance systems strengthened and standardised to allow for comprehensive and consistent reporting of nosocomial transmission of hepatitis across the EU.

Effect of Peer Benchmarking on Specialist Electronic Consult Performance in a Los Angeles Safety-Net: a Cluster Randomized Trial

BACKGROUND

Since the advent of COVID-19, accelerated adoption of systems that reduce face-to-face encounters has outpaced training and best practices. Electronic consultations (eConsults), structured communications between PCPs and specialists regarding a case, have been effective in reducing face-to-face specialist encounters. As the health system rapidly adapts to multiple new practices and communication tools, new mechanisms to measure and improve performance in this context are needed.

OBJECTIVE

To test whether feedback comparing physicians to top performing peers using co-specialists' ratings improves performance.

DESIGN

Cluster-randomized controlled trial PARTICIPANTS: Eighty facility-specialty clusters and 214 clinicians INTERVENTION: Providers in the feedback arms were sent messages that announced their membership in an elite group of "Top Performers" or provided actionable recommendations with feedback for providers that were "Not Top Performers."

MAIN MEASURES

The primary outcomes were changes in peer ratings in the following performance dimensions after feedback was received: (1) elicitation of information from primary care practitioners; (2) adherence to institutional clinical guidelines; (3) agreement with peer's medical decision-making; (4) educational value; (5) relationship building.

KEY RESULTS

Specialists showed significant improvements on 3 of the 5 consultation performance dimensions: medical decision-making (odds ratio 1.52, 95% confidence interval 1.08-2.14, p<.05), educational value (1.86, 1.17-2.96) and relationship building (1.63, 1.13-2.35) (both p<.01).

CONCLUSIONS

The pandemic has shed light on clinicians' commitment to professionalism and service as we rapidly adapt to changing paradigms. Interventions that appeal to professional norms can help improve the efficacy of new systems of practice. We show that specialists' performance can be measured and improved with feedback using aspirational norms.

TRIAL REGISTRATION

clinicaltrials.gov NCT03784950.

Healthcare providers infection prevention practices and associated factors in community clinics in Bangladesh: A cross-sectional study

Healthcare associated infections impose serious challenges to safe and high-quality healthcare delivery, and have been closely associated with poor infection prevention practices. Infection prevention practices are poorly studied in Bangladesh, and no previous studies have examined these practices among healthcare providers of community clinics. The study aimed to assess infection prevention practices and associated factors among healthcare providers of community clinics in the rural area of Bangladesh. A cross-sectional study was conducted among 128 community healthcare providers in the Kurigram district of Bangladesh who were identified from 128 community clinics using a stratified random sampling technique. Data were collected between November and December, 2019 via face-to-face survey using a pre-tested semi-structured questionnaire. Only 37.5% community healthcare providers had adequate knowledge on infection prevention measures, and 39.1% had good infection prevention practices. Community healthcare providers with higher education were significantly more likely to have good infection prevention practices, and good infection prevention practices were associated with availability of hand washing facilities, and of soap in community clinic, and adequate knowledge of infection prevention. Implementation of an effective training program regarding infection prevention, along with adequate supply of infection prevention basic resources, and continuous monitoring and supervision are required to improve the currently faltering infection prevention knowledge and practices among community healthcare providers in Bangladesh.

Microbiological Contamination of the Office Environment in Dental and Medical Practice

The microbiological contamination of the environment in independent healthcare facilities such as dental and general practitioner offices was poorly studied. The aims of this study were to describe qualitatively and quantitatively the bacterial and fungal contamination in these healthcare facilities and to analyze the antibiotic resistance of bacterial pathogens identified. Microbiological samples were taken from the surfaces of waiting, consulting, and sterilization rooms and from the air of waiting room of ten dental and general practitioner offices. Six surface samples were collected in each sampled room using agar contact plates and swabs. Indoor air samples were collected in waiting rooms using a single-stage impactor. Bacteria and fungi were cultured, then counted and identified. Antibiograms were performed to test the antibiotic susceptibility of bacterial pathogens. On the surfaces, median concentrations of bacteria and fungi were 126 (range: 0–1280) and 26 (range: 0–188) CFU/100 cm², respectively. In indoor air, those concentrations were 403 (range: 118–732) and 327 (range: 32–806) CFU/m³, respectively. The main micro-organisms identified were Gram-positive cocci and filamentous fungi, including six ubiquitous genera: Micrococcus, Staphylococcus, Cladosporium, Penicillium, Aspergillus, and Alternaria. Some antibiotic-resistant bacteria were identified in general practitioner offices (penicillin- and erythromycin-resistant Staphylococcus aureus), but none in dental offices. The dental and general practitioner offices present a poor microbiological contamination with rare pathogenic micro-organisms.

Indoor Air Quality in Healthcare and Care Facilities: Chemical Pollutants and Microbiological Contaminants

The indoor air quality of healthcare and care facilities is poorly studied. The aim of this study was to qualitatively and quantitatively describe the chemical pollution and the microbiological contaminations of the indoor environment of these facilities. Methods: A wide range of chemical compounds (39 volatile and 13 semi-volatile organic compounds, carbon dioxide, fine particulate matter) and microorganisms (fungi and bacteria) were studied. Sampling campaigns were conducted in two French cities in summer 2018 and winter 2019 in six private healthcare facilities (general practitioner’s offices, dental offices, pharmacies) and four care facilities (nursing homes). Results: The highest median concentrations of chemical compounds (μg/m3) were measured for alcohols (ethanol: 378.9 and isopropanol: 23.6), ketones (acetone: 18.8), aldehydes (formaldehyde: 11.4 and acetaldehyde: 6.5) and terpenes (limonene: 4.3). The median concentration of PM2.5 was 9.0 µg/m3. The main bacteria of these indoor environments were Staphylococcus, Micrococcus and Bacillus genera, with median bacterial concentrations in the indoor air of 14 cfu/m3. The two major fungal genera were Cladosporium and Penicillium, with median fungal concentrations of 7 cfu/m3. Conclusions: Indoor air in healthcare and care facilities contains a complex mixture of many pollutants found in higher concentrations compared to the indoor air in French hospitals in a previous study.

Shedding of methicillin-resistant Staphylococcus aureus and multidrug-resistant gram-negative bacilli during outpatient appointments and procedures outside hospital rooms

BACKGROUND

Limited information is available on the frequency of and risk factors for shedding of health care-associated pathogens in settings outside patient rooms.

METHODS

We conducted a cohort study of hospitalized or recently discharged patients with methicillin-resistant Staphylococcus aureus (MRSA) (N = 39) or multidrug-resistant gram-negative bacilli (MDR-GNB) (N = 11) colonization to determine the frequency of environmental shedding during appointments outside hospital rooms or during outpatient clinic visits. Chi-square tests were performed to identify patient-level factors associated with environmental shedding. Spa typing was performed for environmental and nasal MRSA isolates.

RESULTS

Of 50 patients enrolled, 39 were colonized with MRSA and 11 with MDR-GNB. Shedding during 1 or more appointments occurred more often for patients colonized with MRSA versus MDR-GNB (15 of 39, 38.5% versus 0 of 11, 0%; P = .02). The presence of a wound with a positive culture for MRSA was associated with shedding of MRSA during appointments (11 of 15, 73.3% with shedding versus 4 of 24, 16.7% with no shedding; P = .008). Eighty percent of environmental MRSA isolates were genetically related to concurrent nasal isolates based on spa typing.

CONCLUSIONS

Environmental shedding of MRSA occurs frequently during appointments outside hospital rooms or during outpatient clinic visits. Decontamination of surfaces and strategies that reduce shedding of MRSA could reduce the risk for transmission in these settings.

Microbial bioburden of inpatient and outpatient areas beyond patient hospital rooms

OBJECTIVE

To investigate the frequency of environmental contamination in hospital areas outside patient rooms and in outpatient healthcare facilities.

DESIGN

Culture survey.

SETTING

This study was conducted across 4 hospitals, 4 outpatient clinics, and 1 surgery center.

METHODS

We conducted 3 point-prevalence culture surveys for methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Clostridioides difficile, Candida spp, and gram-negative bacilli including Enterobacteriaceae, Pseudomonas aeruginosa, Acinetobacter baumanii, and Stenotrophomonas maltophilia in each facility. In hospitals, high-touch surfaces were sampled from radiology, physical therapy, and mobile equipment and in emergency departments, waiting rooms, clinics, and endoscopy facilities. In outpatient facilities, surfaces were sampled in exam rooms including patient and provider areas, patient bathrooms, and waiting rooms and from portable equipment. Fluorescent markers were placed on high-touch surfaces and removal was assessed 1 day later.

RESULTS

In the hospitals, 110 (9.4%) of 1,195 sites were positive for 1 or more bacterial pathogens (range, 5.3%-13.7% for the 4 hospitals) and 70 (5.9%) were positive for Candida spp (range, 3.7%-5.9%). In outpatient facilities, 31 of 485 (6.4%) sites were positive for 1 or more bacterial pathogens (range, 2% to 14.4% for the 5 outpatient facilities) and 50 (10.3%) were positive for Candida spp (range, 3.9%-23.3%). Fluorescent markers had been removed from 33% of sites in hospitals (range, 28.4%-39.7%) and 46.3% of sites in outpatient clinics (range, 7.4%-82.8%).

CONCLUSIONS

Surfaces in hospitals outside patient rooms and in outpatient facilities are frequently contaminated with healthcare-associated pathogens. Improvements in cleaning and disinfection practices are needed to reduce contamination.

Risk factors for wound infection caused by Methicillin Resistant Staphylococcus aureus among hospitalized patients: a case control study from a tertiary care hospital in India

Background

Methicillin Resistant Staphylococcus aureus (MRSA) causes infection in hospitals and communities. The prevalence and risk factors of MRSA infection is not homogenous across the globe.

Objective

To find the risk factors of MRSA infection among hospitalized patients.

Methods

Cross-sectional case control study was conducted at a tertiary care hospital in India. The risk factors were collected using checklist from 130 MRSA and 130 Methicillin sensitive staphylococcus aureus (MSSA) infected patients. The pathogens were isolated from the wound swabs according to Clinical and Laboratory Standards Institute guidelines.

Results

Both the groups were comparable in terms of age, gender, diabetic status, undergoing invasive procedures, urinary catheterization and smoking (p>0.05). Multivariate logistic regression revealed surgical treatment (OR 4.355; CI 1.03, 18.328; p=0.045), prolonged hospitalization (OR 0.307; CI 0.11, 0.832; p=0.020), tracheostomy (OR 5.298, CI 1.16, 24.298; p=0.032), pressure/venous ulcer (OR 7.205; CI 1.75, 29.606; p=0.006) and previous hospitalization (OR 2.883; CI 1.25, 6.631; p=0.013) as significant risk factors for MRSA infection.

Conclusion

Surgical treatment, prolonged and history of hospitalization, having tracheostomy for ventilation and pressure/venous ulcer were the key risk factors. Therefore, special attention has to be given to the preventable risk factors while caring for hospitalized patients to prevent MRSA infection.

Measuring the Impact of Continuous Disinfection Strategies on Environmental Burden in Outpatient Settings: A Prospective Randomized Controlled Trial

Background

Our primary objective was to determine the effectiveness of 2 enhanced disinfection strategies compared with standard disinfection: “near-UV” light (Arm 1) and a persistent organosilane quaternary ammonium disinfectant (Arm 2) using a triple-blind study design. Our secondary objective was to characterize environmental contamination of outpatient clinics.

Methods

This trial was conducted at 2 clinics: the wound and pulmonary outpatient clinics at Duke University Health System in Durham, North Carolina. In Arm 1, room overhead lights were replaced with 405-nm near-UV visible light bulbs. In Arm 2, the organosilane quaternary ammonium disinfectant was applied to all room surfaces. The control arm received no intervention. All arms received routine disinfection. Room contamination was measured twice daily (before and after clinic) over 25 clinic days.

Results

The primary outcome was the change in total contamination, measured in colony forming units (CFUs), on environmental surfaces at the end of the clinic day compared with the beginning of the clinic day. Results from each intervention arm were compared against results from the control arm. The median delta total CFU for Arm 1 was 2092 CFUs (interquartile range [IQR], −1815 to 8566); the median delta for Arm 2 was 2016 CFUs (IQR, −1443 to 7430). Compared with the control arm (median delta = 1987 [IQR, −1611 to 15 857]), neither intervention led to a significant decrease in daily room contamination change (P for Arm 1 = 0.78 and P for Arm 2 = 0.71).

Conclusions

Neither near-UV lights or a persistent organosilane quaternary ammonium disinfectant reduced environmental contamination in 2 outpatient clinics compared with control rooms but did reduce the number of clinically important pathogens recovered.

Current infection control practices used in Australian and New Zealand cystic fibrosis centers

BACKGROUND

The 2013 update of the Infection Prevention and Control (IP&C) Guideline outlined recommendations to prevent the spread of CF respiratory pathogens. We aimed to investigate the current infection control practices used in Australian and New Zealand (NZ) CF centers.

METHODS

Two online surveys were distributed to Australian and NZ CF centers regarding the uptake of selected IP&C recommendations. One survey was distributed to all the Medical Directors and Lead CF Nurses and the second survey was distributed to all the Lead CF Physiotherapists.

RESULTS

The response rate was 60% (60/100) for medical/nursing and 58% (14/24) for physiotherapy. Over 90% (55/60) of CF centers followed CF-specific infection control guidelines and consistent infection control practices were seen in most CF centers; 76% (41/54) had implemented segregation strategies for ambulatory care and no CF centers housed people with CF in shared inpatient accommodation. However, the application of contact precautions (wearing gloves and apron/gown) by healthcare professionals when reviewing a CF person was variable between CF center respondents but was most often used when seeing CF persons with MRSA infection in both ambulatory care and hospital admission (20/50, 40% and 42/45, 93% of CF centers, respectively). Mask wearing by people with CF was implemented into 61% (36/59) of centers. Hospital rooms were cleaned daily in 79% (37/47) of CF centers and the ambulatory care consult rooms were always cleaned between consults (49/49, 100%) and at the end of the clinic session (51/51, 100%); however the staff member tasked with cleaning changed with 37% (18/49) of CF centers responding that CF multidisciplinary team (MDT) members cleaned between patients whereas at the end of the clinic session, only 12% (6/51) of the CF MDT cleaned the consult room.

CONCLUSIONS

Overall, Australian and NZ CF centers have adopted many recommendations from the IP&C. Although, the application of contact precautions was inconsistent and had overall a low level of adoption in CF centers. In ~ 25% of centers, mixed waiting areas occurred in the ambulatory care. Given the variability of responses, additional work is required to achieve greater consistency between centers.

Health Care-Associated Infections and the Radiology Department

Health care-associated infections (HCAIs) are a significant concern for both health care workers (HCWs) and patients. They are a major contributing factor of disease in industrialized countries, and are responsible for significant morbidity, mortality, and a direct annual financial loss of $6-7 billion in North America alone. They are an increasingly challenging health issue due to multidrug-resistant pathogens such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci among others, along with an increasing number of susceptible patients. Over the last three decades, the risk of HCAIs has increased in the radiology department (RD) in part because of an increased number of patients visiting the department and an increase in the utilization of imaging modalities. In this review, we will discuss how patients and staff can be exposed to HCAIs in the RD, including contaminated inanimate surfaces, radiology equipment, and associated medical devices. As the role of medical imaging has extended from primarily diagnosis to include more interventions, the implementation and development of standardized infection minimization protocols and infection control procedures are vital in the RD, particularly in interventional radiology. With globalisation and the rapid movement of people regionally, nationally, and globally, there is greater risk of exposure to contagious diseases such as Ebola, especially if infected patients are undiagnosed when they travel. For effective infection control, advanced training and education of HCWs in the RD is essential. The purpose of this article is to provide an overview of HCAIs as related to activities of the RD. We will discuss the following major topics including the variety of HCAIs commonly encountered, the role of the RD in HCAIs, transmission of infections to patients and HCWs in the RD, standard infection prevention measures, and the management of susceptible/infected patients in the RD. We shall also examine the role of, and the preparedness of, HCWs, including RD technologists and interventional radiologists, who may be exposed to undiagnosed, yet infected patients. We shall conclude with a brief discussion of the role of further research related to HCAIs. Learning Objectives After the completion of this review article, the readers will • Understand the exposure and role of radiology department in health care-associated infections, • Know the causes/modes/transmission of infections in radiology department, • Be conscious of standard disinfection protocols, • Be aware of current and future strategies required for the effective control of health care-associated infection in the radiology department. This is a CME article and provides the equivalent of 2 hours of continuing education that may be applied to your professional development credit system. A 10-question multiple-choice quiz follows this reading. Please note that no formalized credit (category A) is available from CAMRT.

Correlação entre métodos de monitoramento de limpeza e desinfecção de superfícies ambulatoriais

Resumo Objetivo Avaliar a correlação entre cultura microbiológica, teste de ATP por bioluminescência e inspeção visual na monitorização da eficiência da limpeza e da desinfecção de superfícies de uma unidade ambulatorial e determinar o valor de corte de ATP-bioluminescência capaz de indicar superfície limpa em relação à avaliação microbiológica. Métodos Estudo exploratório, longitudinal e correlacional. Foram realizadas 720 avaliações em cinco superfícies antes e após a limpeza e a desinfecção. Nos resultados, foram realizadas análises de duas proporções, a correlação de Spearman e a curva ROC. Resultados Ocorreram proporções semelhantes (p≥0,05) entre as taxas de reprovação apenas entre ATP-bioluminescência e contagem de colônias aeróbias (CCA) quando somadas as avaliações de todas as superfícies antes e depois da limpeza e da desinfecção. Houve correlação significativa entre os métodos de quantificação de ATP e a contagem microbiana para o balcão da recepção e a maca. A análise ROC indicou que a quantificação de ATP apresentou resultado significativo na comparação com a CCA (p=0,044). Conclusão Embora discreta, houve correlação significativa entre os métodos de quantificação de ATP e contagem microbiana para duas superfícies. Sugere-se que superfícies que apresentam valores ≤49 unidades relativas de luz estão limpas.

Hepatitis C Virus Infections Associated with Unsafe Injection Practices at a Pain Management Clinic, Michigan, 2014-2015

Background

In 2015, the Michigan Department of Health and Human Services (MDHHS) was notified of an acute case of hepatitis C virus (HCV). The patient had no traditional HCV risk factors. The only known subcutaneous exposure was health care received at a pain management clinic.

Design

A field investigation was undertaken to determine the likely route of HCV acquisition and assess potential risk to other patients.

Setting and Patients

The investigation involved a free-standing outpatient pain management clinic and its patients with a subcutaneous exposure.

Methods

Investigators utilized the Centers for Disease Control and Prevention’s (CDC) viral hepatitis health care-associated infection investigation protocol to guide field investigation, assess risk to patients, perform patient notification, and test patients for blood-borne pathogens.

Results

The index case was found to be the final patient seen in the clinic’s operating room for the week. Examining the MDHHS viral hepatitis registry revealed another acute HCV patient seen immediately before the index case. The second acute case was preceded by a patient chronically infected with HCV. Due to the possibility of patient-to-patient HCV transmission, 122 patients were recommended to be tested for blood-borne pathogens. Ninety-two patients presented for testing. No additional transmission events were discovered.

Conclusion

Health care-associated transmission of HCV likely occurred at an outpatient pain management clinic; possibly the result of multiple patient use of single-dose vials. Because no other cases were discovered this may represent an isolated incident as opposed to a systematic breakdown in infection control standards. This circumstance highlights the need for continued vigilance and adherence to CDC’s Minimum Expectations for Safe Care in Outpatient Settings.

A survey on the disposal of blood-contaminated tampon after dental extraction

OBJECTIVE

This paper was to assess the risk for cross infection caused by blood-contaminated tampon after dental extraction and whether this risk was reduced after relevant education towards both dentists and patients.

METHODS

From December 2014 to April 2015, a survey was conducted in dentists and patients randomly before and after relevant education. The questionnaire is being revised for this survey based on learning from Chatzoudi and Franklin' survey. This survey was approved by the institutional review board, and all participants were voluntary and all responses were anonymous.

RESULTS

Only 2.82 % of dentists provided patients with the postoperative-advices regarding how to dispose of blood-contaminated tampon at the first time and 47.10 % at the second time (P < 0.01). Only 1.41 % of dentists given special postoperative-advices regarding disposal of tampon to patients with blood-transmitted diseases at the first time and 24.64 % at the second time (P < 0.01). Before education, most patients were lack of nosocomial infection knowledge. After education, 22.4 % of patients threw the blood-contaminated tampon away in a proper way (P < 0.01). 66.67 % of them washed hands immediately and thoroughly after they touched the tampon (P < 0.05), 92.71 % knew the blood-contaminated tampon can cause cross-infection (P < 0.01), and 80.21 % knew how to dispose of the blood-contaminated tampon correctly (P < 0.01).

CONCLUSION

The high risk of cross infection caused by blood-contaminated tampon is evident, and a series of measures is proposed to control it. There is a need to improve both dentists' and patients' awareness, enhance the education of doctors and perfect the policies and guidelines.