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Haraoui LP, Rizk A, Landecker H. States of Resistance: nosocomial and environmental approaches to antimicrobial resistance in Lebanon. HISTORY AND PHILOSOPHY OF THE LIFE SCIENCES 2024; 46:28. [PMID: 39090452 PMCID: PMC11294430 DOI: 10.1007/s40656-024-00624-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 06/24/2024] [Indexed: 08/04/2024]
Abstract
Drawing on institutional historical records, interviews and student theses, this article charts the intersection of hospital acquired illness, the emergence of antimicrobial resistance (AMR), environments of armed conflict, and larger questions of social governance in the specific case of the American University of Beirut Medical Center (AUBMC) in Lebanon. Taking a methodological cue from approaches in contemporary scientific work that understand non-clinical settings as a fundamental aspect of the history and development of AMR, we treat the hospital as not just nested in a set of social and environmental contexts, but frequently housing within itself elements of social and environmental history. AMR in Lebanon differs in important ways from the settings in which global protocols for infection control or rubrics for risk factor identification for resistant nosocomial outbreaks were originally generated. While such differences are all too often depicted as failures of low and middle-income countries (LMIC) to maintain universal standards, the historical question before us is quite the reverse: how have the putatively universal rubrics of AMR and hospital infection control failed to take account of social and environmental conditions that clearly matter deeply in the evolution and spread of resistance? Focusing on conditions of war as an organized chaos in which social, environmental and clinical factors shift dramatically, on the social and political topography of patient transfer, and on a missing "meso" level of AMR surveillance between the local and global settings, we show how a multisectoral One Health approach to AMR could be enriched by an answering multisectoral methodology in history, particularly one that unsettles a canonical focus on the story of AMR in the Euro-American context.
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Affiliation(s)
- Louis-Patrick Haraoui
- Department of Microbiology and Infectious Diseases, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche Charles-Le Moyne, CISSS Montérégie-Centre, Greenfield Park, QC, Canada
| | - Anthony Rizk
- Department of Anthropology and Sociology, Geneva Graduate Institute (IHEID), Geneva, Switzerland
| | - Hannah Landecker
- Department of Sociology, Institute for Society and Genetics, 264 Haines Hall, 375 Portola Plaza, Los Angeles, CA, 90095, USA.
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Arnold L, Bimczok S, Schütt H, Lisak-Wahl S, Buchberger B, Stratil JM. How to protect long-term care facilities from pandemic-like events? - A systematic review on the effectiveness of non-pharmacological measures to prevent viral respiratory infections. BMC Infect Dis 2024; 24:589. [PMID: 38880893 PMCID: PMC11181531 DOI: 10.1186/s12879-024-09271-7] [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: 11/01/2023] [Accepted: 03/28/2024] [Indexed: 06/18/2024] Open
Abstract
BACKGROUND The SARS-CoV-2 pandemic underscored the need for pandemic preparedness, with respiratory-transmitted viruses considered as a substantial risk. In pandemics, long-term care facilities (LTCFs) are a high-risk setting with severe outbreaks and burden of disease. Non-pharmacological interventions (NPIs) constitute the primary defence mechanism when pharmacological interventions are not available. However, evidence on the effectiveness of NPIs implemented in LTCFs remains unclear. METHODS We conducted a systematic review assessing the effectiveness of NPIs implemented in LTCFs to protect residents and staff from viral respiratory pathogens with pandemic potential. We searched Medline, Embase, CINAHL, and two COVID-19 registries in 09/2022. Screening and data extraction was conducted independently by two experienced researchers. We included randomized controlled trials and non-randomized observational studies of intervention effects. Quality appraisal was conducted using ROBINS-I and RoB2. Primary outcomes encompassed number of outbreaks, infections, hospitalizations, and deaths. We synthesized findings narratively, focusing on the direction of effect. Certainty of evidence (CoE) was assessed using GRADE. RESULTS We analysed 13 observational studies and three (cluster) randomized controlled trials. All studies were conducted in high-income countries, all but three focused on SARS-CoV-2 with the rest focusing on influenza or upper-respiratory tract infections. The evidence indicates that a combination of different measures and hand hygiene interventions can be effective in protecting residents and staff from infection-related outcomes (moderate CoE). Self-confinement of staff with residents, compartmentalization of staff in the LTCF, and the routine testing of residents and/or staff in LTCFs, among others, may be effective (low CoE). Other measures, such as restricting shared spaces, serving meals in room, cohorting infected and non-infected residents may be effective (very low CoE). An evidence gap map highlights the lack of evidence on important interventions, encompassing visiting restrictions, pre-entry testing, and air filtration systems. CONCLUSIONS Although CoE of interventions was low or very low for most outcomes, the implementation of NPIs identified as potentially effective in this review often constitutes the sole viable option, particularly prior to the availability of vaccinations. Our evidence-gap map underscores the imperative for further research on several interventions. These gaps need to be addressed to prepare LTCFs for future pandemics. TRIAL REGISTRATION CRD42022344149.
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Affiliation(s)
- Laura Arnold
- Academy of Public Health Services, Kanzlerstraße 4, Duesseldorf, 40472, Germany
- Department of International Health, Care and Public Health Research Institute-CAPHRI, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Simon Bimczok
- Academy of Public Health Services, Kanzlerstraße 4, Duesseldorf, 40472, Germany
| | - Hannah Schütt
- Academy of Public Health Services, Kanzlerstraße 4, Duesseldorf, 40472, Germany
| | - Stefanie Lisak-Wahl
- Academy of Public Health Services, Kanzlerstraße 4, Duesseldorf, 40472, Germany
| | - Barbara Buchberger
- Robert Koch Institute, Berlin, Germany
- University of Duisburg-Essen, Institute for Health Care Management and Research, Essen, Germany
| | - Jan M Stratil
- Robert Koch Institute, Berlin, Germany.
- Department of Infectious Disease Epidemiology, Robert Koch Institute, Berlin, Germany.
- Postgraduate Training for Applied Epidemiology (PAE), Robert Koch Institute, Berlin, Germany.
- Field Epidemiology Path (EPIET), European Centre for Disease Prevention and Control (ECDC), ECDC Fellowship Programme, Stockholm, Sweden.
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Institutional quality and patient safety programs: An overview for the healthcare epidemiologist. Infect Control Hosp Epidemiol 2020; 42:6-17. [PMID: 32883390 DOI: 10.1017/ice.2020.409] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
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Ioannou S, Andrianou XD, Charisiadis P, Makris KC. Biomarkers of end of shift exposure to disinfection byproducts in nurses. J Environ Sci (China) 2017; 58:217-223. [PMID: 28774612 DOI: 10.1016/j.jes.2017.06.031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2017] [Revised: 06/24/2017] [Accepted: 06/24/2017] [Indexed: 06/07/2023]
Abstract
Increased disinfectant use commonly takes place in hospitals and other health care settings. A cross-sectional study among active nurses in two Cypriot public hospitals (n=179) was conducted to examine the prevalence of exposure to disinfection byproducts (DBPs), such as trihalomethanes (THMs) using both self-reported information and biomarker measurements. The objectives of this study were to: i) quantify the magnitude and variability of occupational exposure to disinfectants/DBPs in nurses, ii) generate job exposure matrices (JEM) and job task exposure matrices (JTEM) for disinfectants, and iii) assess the major determinants of urinary THMs in nurses. End of shift urinary total THM values showed high variability among the nurses, but did not differ between hospitals. The disinfectant group of alcohols/phenols was used by >98% of nurses, followed by octenidine (82%), iodine and chlorine (39%, each), chlorhexidine (25%), formaldehyde (12%), hydrogen peroxide (11%), and peracetic acid/ammonia/quaternary ammonium compounds (QACs), all being <8% each. Chlorine use during the past 24hr was associated with significantly (p<0.05) lower brominated THMs (BrTHMs) after adjusting for age, gender and BMI, while a positive association was shown for TCM and the sum of all THMs (TTHMs), albeit not significant. Nurses were exposed to nearly double the levels of TTHMs and BrTHMs (median and IQR, 1027 [560, 2475] ng/g and 323 [212, 497] ng/g, respectively) when compared to those of the general population (552 [309,989] ng/g and 152 [87,261] ng/g, respectively). This was the first occupational health dataset reporting measurements of biomarkers of end of shift exposures to disinfectants/DBPs.
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Affiliation(s)
- Solomon Ioannou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3041, Cyprus
| | - Xanthi D Andrianou
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3041, Cyprus
| | - Pantelis Charisiadis
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3041, Cyprus
| | - Konstantinos C Makris
- Cyprus International Institute for Environmental and Public Health, Cyprus University of Technology, Limassol 3041, Cyprus.
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Smith PW, Watkins K, Hewlett A. Infection control through the ages. Am J Infect Control 2012; 40:35-42. [PMID: 21783278 DOI: 10.1016/j.ajic.2011.02.019] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 02/09/2011] [Accepted: 02/09/2011] [Indexed: 11/29/2022]
Abstract
To appreciate the current advances in the field of health care epidemiology, it is important to understand the history of hospital infection control. Available historical sources were reviewed for 4 different historical time periods: medieval, early modern, progressive, and post-World War II. Hospital settings for the time periods are described, with particular emphasis on the conditions related to hospital infections.
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Affiliation(s)
- Philip W Smith
- Division of Infectious Diseases, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-5400, USA.
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Manning ML. Expanding infection preventionists' influence in the 21st Century: looking back to move forward. Am J Infect Control 2010; 38:778-83. [PMID: 21093695 DOI: 10.1016/j.ajic.2010.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2010] [Revised: 08/05/2010] [Accepted: 08/12/2010] [Indexed: 10/18/2022]
Abstract
The 5th Decennial International Conference on Healthcare-Associated Infections took place in Atlanta in March 2010. The conference was unprecedented in the variety, depth, and breath of scientific sessions and research abstracts informing the practice of health care epidemiology and infection prevention. However, noticeably absent were topics or related discussions focused on essential leadership skills and influence strategies required to implement the science into practice.
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Bartley JM, Olmsted RN. Reservoirs of Pathogens Causing Health Care-Associated Infections in the 21st Century: Is Renewed Attention to Inanimate Surfaces Warranted? ACTA ACUST UNITED AC 2008. [DOI: 10.1016/j.clinmicnews.2008.07.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Memish ZA, Cunningham G, Soule BM. Infection control in the Eastern Mediterranean region: time for collaborative action. Am J Infect Control 2005; 33:131-3. [PMID: 15798665 DOI: 10.1016/j.ajic.2005.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Larson E, Olmsted RN. Research Priorities Project, year 2000: the Lone Ranger rides again. Am J Infect Control 2001; 29:69-72. [PMID: 11287871 DOI: 10.1067/mic.2001.114194] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Nguyêñ GT, Proctor SE, Sinkowitz-Cochran RL, Garrett DO, Jarvis WR. Status of infection surveillance and control programs in the United States, 1992-1996. Association for Professionals in Infection Control and Epidemiology, Inc. Am J Infect Control 2000; 28:392-400. [PMID: 11114608 DOI: 10.1067/mic.2000.110298] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Nosocomial infections have been recognized as a source of morbidity and mortality throughout the world for several decades. In the United States, an estimated 2.1 million nosocomial infections occur annually in acute care hospitals alone. Infection surveillance and control programs (ISCPs) play a vital role in addressing this problem, but no national studies have described the status and composition of these programs since the 1970s. METHODS In January 1997, a voluntary survey was sent by mail to members of the Association for Professionals in Infection Control and Epidemiology, Inc. Only one response per facility was requested. The survey asked for information for the years 1992 to 1996 (study period), and questions pertained to characteristics of the health care facility in which the respondent worked, characteristics of the ISCP and its personnel, and the overall level of administration support for infection control activities. RESULTS Completed questionnaires were received from personnel at 187 health care facilities located in 40 states and the District of Columbia. The majority (76.5%) of responding facilities were nongovernment owned, and 57.2% were classified as general acute care facilities. The number of licensed beds at these facilities remained stable throughout the study period, but all other measures of facility size and activity (eg, number of patient days and number of nurses) decreased by as much as 28.9%. In 1992, ISCPs were most likely to be organizationally located in the Nursing Department, but by 1996, many had been transferred to departments of Medical Records, Quality Assurance, or Risk Management. Throughout the course of the study period, the number of facilities performing surveillance for health care-associated infections in outpatient settings increased by 44.0%, from 100 to 144. In 1996, only 47.6% of facilities had a hospital epidemiologist (HE), and HEs devoted a median of 15% or less of their time to infection control activities. For the most part, HEs were trained in infectious diseases, and few had certification in infection control. Infection control professionals (ICPs) were much more common than were HEs (ICPs were reported at 97.9% of respondents' facilities in 1996), and they spent the majority (80% in 1996) of their time on infection control activities. During the course of the study period, increasing numbers of facilities had ICPs who had certification in infection control. Furthermore, most respondents did not report a change over time in the level of administration support for infection control activities. CONCLUSIONS Health care delivery has changed dramatically during the past 20 years. This study presents an updated description of ISCPs in the United States. Our results illustrate several changing parameters, such as departmental shifts and increased outpatient surveillance, that reflect adjustments in health care priorities during the study period. As the transformation of the health care system continues, continued evaluation of the status of ISCPs on a national level will be necessary. Diligent monitoring, proactive measures, and collaboration between infection control organizations and government agencies will be vital for the prevention and control of health care-associated infections in the future.
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Affiliation(s)
- G T Nguyêñ
- Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, United States Department of Health and Human Services, Atlanta, GA 30333, USA
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Garcia R, Barnard B, Kennedy V. The fifth evolutionary era in infection control: interventional epidemiology. Am J Infect Control 2000; 28:30-43. [PMID: 10679135 DOI: 10.1016/s0196-6553(00)90009-9] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
A historical review of infection control over the last 4 decades indicates that the field has evolved from being one whose investigative work laid the foundation for understanding the chain of infection to an influential profession whose research on effective prevention methods have revoluntionized clinical practice throughout the world. Underlying our successes is the fact that growth in the profession has brought with it an enormous expansion in responsibilities, which in turn has impacted, in some cases severely, the personnel and time resources of infection control departments. At the same time, the economic pressures brought on by the upheavals in the business of health care have trickled down wherein it now influences the makeup and effectiveness of infection control programs. To continue with our mission of reducing morbidity and mortality, and perhaps to avoid a diminishing of our own professional influence, it will become essential that new approaches to the management of infection control programs be implemented. The approach must start by incorporating a basic mandate for change in the infection control professional.
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Affiliation(s)
- R Garcia
- Brookdale University Hospital and Medical Center, Brooklyn, NY 11212, USA
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Murphy CL, McLaws M. Credentialing, diversity, and professional recognition-foundations for an Australian infection control career path. Am J Infect Control 1999; 27:240-6. [PMID: 10358226 DOI: 10.1053/ic.1999.v27.a96387] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND There are no regulatory, legislative, or professional criteria stipulating minimum qualifications or experience that a health care worker must meet to be capable of coordinating an Australian infection control (IC) program. Measurement of IC competence is important to protect the public and for the ongoing credibility and growth of the profession. METHOD Our study group was all 1078 nonmedical and nonindustry members of the Australian Infection Control Association in 1996. The survey examined perceived level of proficiency, level of education, and experience in health care and infection control. Almost three quarters (65%) of the members responded, and almost all (85%) of these respondents fulfilled the inclusion criterion of coordinating an IC program. RESULTS Experience in IC ranged from less than 2 years (33.6%) to more than 20 years (10.0%). The majority (65.0%) of infection control professionals (ICPs) had between 8 years and 12 years IC experience. The respective proportions of respondents' self-ranked levels of proficiency on a 5-point scale were novice (3.6%), advanced beginner (21.2%), competent (33.8%), proficient (34.7%), and expert (6.8%). Almost half (47%) of the novices agreed that a registered nursing (RN) qualification was required, whereas a majority (41%) of advanced beginners considered both an RN and a basic IC course (BASIC) were required. Competent ICPs agreed less often than the other levels about their requirements. However, 27% of competents identified a BASIC and an undergraduate degree (UG) as the minimum requirements for a competent ICP. Proficient ICPs agreed that they required an RN, UG, BASIC, and a postbasic course in IC. Nearly all experts (80.0%) agreed that they required an RN, UG, BASIC, postbasic course, and a course in hospital epidemiology (EP). Two thirds of experts expected a master's degree as a requirement. CONCLUSION The Australian IC profession is in an exciting period of development; however, the variation in ICP perception of the most appropriate qualifications and experience threatens the credibility and viability of the profession. This variation indicates the need for a clear-cut pathway that includes a system of credentialing, recognition of expertise, adoption of divergent roles, and improved networking. This pathway will lead to an increasingly credible and viable IC profession in Australia. Developing IC communities globally can benefit from the Australian experience.
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Affiliation(s)
- C L Murphy
- AIDS and Infectious Disease Unit, New South Wales Health Department, North Sydney, NSW, Australia
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Soule BM, Huskins WC. A global perspective on the past, present, and future of nosocomial infection prevention and control. Am J Infect Control 1997; 25:289-93. [PMID: 9276539 DOI: 10.1016/s0196-6553(97)90019-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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