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Ng'ambi D, O'Byrne T, Jingini E, Chadwala H, Musopole O, Kamchedzera W, Tancred T, Feasey N. An assessment of infection prevention and control implementation in Malawian hospitals using the WHO Infection Prevention and Control Assessment Framework (IPCAF) tool. Infect Prev Pract 2024; 6:100388. [PMID: 39286836 PMCID: PMC11402029 DOI: 10.1016/j.infpip.2024.100388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 08/02/2024] [Indexed: 09/19/2024] Open
Abstract
Background Infection prevention and control (IPC) is important for the reduction of healthcare-associated infections (HAI). The World Health Organization (WHO) developed the IPC Assessment Framework (IPCAF) tool to assess the level of IPC implementation and to identify areas for improvement in healthcare facilities. Methods A cross -sectional survey was conducted using the WHO IPCAF tool from May to June 2023. The aim was to provide a baseline assessment of the IPC programme and activities within health care facilities in Malawi. Forty healthcare facilities were invited to participate. IPC teams were requested to complete the IPCAF and return the scores. The IPCAF tool scores were assessed as recommended in the WHO IPCAF tool. Results The response rate was 82.5%. The median IPCAF score was 445 out of 800 corresponding to an intermediate IPC implementation level. The results revealed that 66.7% facilities were at intermediate level, 26.4% at basic level, and 6.9% at advanced level. Most facilities (76%) had an IPC program in place with clear objectives and an IPC focal person. Few had a dedicated budget for IPC. The IPCAF domain "monitoring/audit of IPC practices and feedback" had the lowest median score of 15/100, and in 90% of facilities, no monitoring, audit, and feedback was done. HAI surveillance median score was 40/100, workload, staffing and bed occupancy median score was 45/100. Conclusions Whilst there has been some degree of implementation of WHO IPC guidelines in Malawi's healthcare system, there is significant room for improvement. The IPCAF tool revealed that monitoring/audit and feedback, HAI surveillance and workload, staffing and bed occupancy need to be strengthened. The IPCAF scoring system may need reconsidering given the centrality of these domains to IPC.
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Affiliation(s)
- Dorica Ng'ambi
- Malawi-Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, England, UK
| | - Thomasena O'Byrne
- Malawi-Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, England, UK
| | - Emmie Jingini
- Quality Management Directorate - Ministry of Health, Lilongwe, Malawi
- Infection Prevention and Control Association of Malawi (IPCAM), Lilongwe, Malawi
| | - Hope Chadwala
- Infection Prevention and Control Association of Malawi (IPCAM), Lilongwe, Malawi
| | - Owen Musopole
- Quality Management Directorate - Ministry of Health, Lilongwe, Malawi
- Infection Prevention and Control Association of Malawi (IPCAM), Lilongwe, Malawi
| | - Wala Kamchedzera
- Malawi-Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, England, UK
| | - Tara Tancred
- Malawi-Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Nicholas Feasey
- Malawi-Liverpool Wellcome Programme, Kamuzu University of Health Sciences, Blantyre, Malawi
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, England, UK
- The School of Medicine, University of St Andrews, St Andrews, Scotland, UK
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Guedes M, Almeida F, Andrade P, Moreira L, Pedrosa A, Azevedo A, Rocha-Pereira N. Surgical site infection surveillance in knee and hip arthroplasty: optimizing an algorithm to detect high-risk patients based on electronic health records. Antimicrob Resist Infect Control 2024; 13:90. [PMID: 39148104 PMCID: PMC11328479 DOI: 10.1186/s13756-024-01445-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2024] [Accepted: 07/31/2024] [Indexed: 08/17/2024] Open
Abstract
BACKGROUND Surgical site infection (SSI) is an important cause of disease burden and healthcare costs. Fully manual surveillance is time-consuming and prone to subjectivity and inter-individual variability, which can be partly overcome by semi-automated surveillance. Algorithms used in orthopaedic SSI semi-automated surveillance have reported high sensitivity and important workload reduction. This study aimed to design and validate different algorithms to identify patients at high risk of SSI after hip or knee arthroplasty. METHODS Retrospective data from manual SSI surveillance between May 2015 and December 2017 were used as gold standard for validation. Knee and hip arthroplasty were included, patients were followed up for 90 days and European Centre for Disease Prevention and Control SSI classification was applied. Electronic health records data was used to generate different algorithms, considering combinations of the following variables: ≥1 positive culture, ≥ 3 microbiological requests, antimicrobial therapy ≥ 7 days, length of hospital stay ≥ 14 days, orthopaedics readmission, orthopaedics surgery and emergency department attendance. Sensitivity, specificity, negative and predictive value, and workload reduction were calculated. RESULTS In total 1631 surgical procedures were included, of which 67.5% (n = 1101) in women; patients' median age was 69 years (IQR 62 to 77) and median Charlson index 2 (IQR 1 to 3). Most surgeries were elective (92.5%; n = 1508) and half were hip arthroplasty (52.8%; n = 861). SSI incidence was 3.8% (n = 62), of which 64.5% were deep or organ/space infections. Positive culture was the single variable with highest sensitivity (64.5%), followed by orthopaedic reintervention (59.7%). Twenty-four algorithms presented 90.3% sensitivity for all SSI types and 100% for deep and organ/space SSI. Workload reduction ranged from 59.7 to 67.7%. The algorithm including ≥ 3 microbiological requests, length of hospital stay ≥ 14 days and emergency department attendance, was one of the best options in terms of sensitivity, workload reduction and feasibility for implementation. CONCLUSIONS Different algorithms with high sensitivity to detect all types of SSI can be used in real life, tailored to clinical practice and data availability. Emergency department attendance can be an important variable to identify superficial SSI in semi-automated surveillance.
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Affiliation(s)
- Mariana Guedes
- Infection and Antimicrobial Resistance Control and Prevention Unit, Hospital Epidemiology Centre, Unidade Local de Saúde São João, Porto, Portugal.
- Unidad Clínica de Enfermedades Infecciosas y Microbiología, Departamento de Medicina, Instituto de Biomedicina de Sevilla (IBiS)/CSIC, Hospital Universitario Virgen Macarena, Universidad de Sevilla, Seville, Spain.
| | - Francisco Almeida
- Infection and Antimicrobial Resistance Control and Prevention Unit, Hospital Epidemiology Centre, Unidade Local de Saúde São João, Porto, Portugal
- Department of Public Health and Forensic Sciences and Medical Education, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
| | - Paulo Andrade
- Infection and Antimicrobial Resistance Control and Prevention Unit, Hospital Epidemiology Centre, Unidade Local de Saúde São João, Porto, Portugal
- Infectious Diseases Department, Unidade Local de Saúde São João, Porto, Portugal
| | - Lucybell Moreira
- Hospital Epidemiology Centre, Unidade Local de Saúde São João, Porto, Portugal
| | - Afonso Pedrosa
- Data Intelligence Service, Unidade Local de Saúde São João, Porto, Portugal
| | - Ana Azevedo
- Department of Public Health and Forensic Sciences and Medical Education, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- EPIUnit & Laboratório para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - Nuno Rocha-Pereira
- Infection and Antimicrobial Resistance Control and Prevention Unit, Hospital Epidemiology Centre, Unidade Local de Saúde São João, Porto, Portugal
- Department of Medicine, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
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Rondoni C, Scotto di Luzio F, Tamantini C, Tagliamonte NL, Chiurazzi M, Ciuti G, Zollo L. Navigation benchmarking for autonomous mobile robots in hospital environment. Sci Rep 2024; 14:18334. [PMID: 39112664 PMCID: PMC11306802 DOI: 10.1038/s41598-024-69040-z] [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: 12/08/2023] [Accepted: 07/30/2024] [Indexed: 08/10/2024] Open
Abstract
The widespread adoption of robotic technologies in healthcare has opened up new perspectives for enhancing accuracy, effectiveness and quality of medical procedures and patients' care. Special attention has been given to the reliability of robots when operating in environments shared with humans and to the users' safety, especially in case of mobile platforms able to navigate autonomously. From the analysis of the literature, it emerges that navigation tests carried out in a hospital environment are preliminary and not standardized. This paper aims to overcome the limitations in the assessment of autonomous mobile robots navigating in hospital environments by proposing: (i) a structured benchmarking protocol composed of a set of standardized tests, taking into account conditions with increasing complexity, (ii) a set of quantitative performance metrics. The proposed approach has been used in a realistic setting to assess the performance of two robotic platforms, namely HOSBOT and TIAGo, with different technical features and developed for different applications in a clinical scenario.
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Affiliation(s)
- Cristiana Rondoni
- Research Unit of Advanced Robotics and Human-Centred Technologies, Universitá Campus Bio-Medico di Roma, 00128, Rome, Italy
| | - Francesco Scotto di Luzio
- Research Unit of Advanced Robotics and Human-Centred Technologies, Universitá Campus Bio-Medico di Roma, 00128, Rome, Italy.
| | - Christian Tamantini
- Research Unit of Advanced Robotics and Human-Centred Technologies, Universitá Campus Bio-Medico di Roma, 00128, Rome, Italy
- Institute of Cognitive Sciences and Technologies, National Research Council of Italy, Rome, Italy
| | - Nevio Luigi Tagliamonte
- Research Unit of Advanced Robotics and Human-Centred Technologies, Universitá Campus Bio-Medico di Roma, 00128, Rome, Italy
- Laboratory of Robotic Neurorehabilitation, Neurorehabilitation 1 Department, Fondazione Santa Lucia, Rome, Italy
| | - Marcello Chiurazzi
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127, Pisa, Italy
| | - Gastone Ciuti
- The BioRobotics Institute, Scuola Superiore Sant'Anna, 56127, Pisa, Italy
- Department of Excellence in Robotics and AI, Scuola Superiore Sant'Anna, 56127, Pisa, Italy
| | - Loredana Zollo
- Research Unit of Advanced Robotics and Human-Centred Technologies, Universitá Campus Bio-Medico di Roma, 00128, Rome, Italy
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Han KT, Kim S, Kim GO, Lee S, Kwon YU. Quality control efforts of medical institutions: the impacts of a value-based payment system on medical staff and healthcare-associated infections. J Hosp Infect 2024; 153:3-13. [PMID: 39094740 DOI: 10.1016/j.jhin.2024.06.021] [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: 04/08/2024] [Revised: 06/07/2024] [Accepted: 06/18/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND In South Korea, various quality assessments have been introduced to improve the quality of care; as such, the overall level of quality of medical institutions has improved. However, gaps still exist between institutions. AIM To evaluate the impact of quality management efforts of medical institutions on securing medical staff and healthcare-associated infections in intensive care units (ICUs). METHODS This study used data from the second and third ICU quality assessments conducted by the Health Insurance Review and Assessment Service, which included 265 hospitals and 39,096 inpatients. The continuous quality improvement efforts of medical institutions were measured according to changes in their grade based on quality assessment results. In addition, healthcare-associated infection rates were measured, including rates for ventilator-associated pneumonia and catheter-associated infections. The incidence rate ratio (IRR) was calculated using generalized estimating equation Poisson regression models that included hospital and patient characteristics. RESULTS Healthcare-associated infections occurred in approximately 2% of patients using ventilators or catheters. Ventilator-associated pneumonia increased significantly in institutions with a decline in grade [IRR 2.038, 95% confidence interval (CI) 1.426-2.915]. In institutions with an improvement in grade, infections associated with central venous catheters (IRR 0.484, 95% CI 0.330-0.711) and urinary catheters (IRR 0.587, 95% CI 0.398-0.866) decreased. CONCLUSIONS Although quality assessment has been introduced in ICUs in South Korea, some gaps remain between medical institutions. Differences in securing medical resources through the quality management efforts of medical institutions were observed, and the infection rate was low in hospitals with high-quality management and high in hospitals with low-quality management.
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Affiliation(s)
- K-T Han
- Division of Cancer Control and Policy, National Cancer Control Institute, National Cancer Centre, Goyang, Republic of Korea
| | - S Kim
- Department of Health System, College of Nursing, The Catholic University of Korea, Seoul, Republic of Korea; Research Institute for Hospice/Palliative Care, The Catholic University of Korea, Seoul, Republic of Korea.
| | - G O Kim
- Department of Quality Assessment, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - S Lee
- Department of Quality Assessment, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
| | - Y U Kwon
- Healthcare Review and Assessment Committee, Health Insurance Review and Assessment Service, Wonju, Republic of Korea
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Cappelli E, Fiorini J, Zaghini F, Canzan F, Sili A. Head Nurse Leadership: Facilitators and Barriers to Adherence to Infection Prevention and Control Programs-A Qualitative Study Protocol. NURSING REPORTS 2024; 14:1849-1858. [PMID: 39189268 PMCID: PMC11348038 DOI: 10.3390/nursrep14030138] [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: 04/10/2024] [Revised: 07/24/2024] [Accepted: 07/25/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND The effective management of Healthcare-Associated Infections (HAIs) relies on the implementation of good practice across the entire multidisciplinary team. The organizational context and the role of head nurses influence the team's performance and behavior. Understanding how decision-making processes influence healthcare professionals' behavior in the management of HAIs could help identify alternative interventions for reducing the risk of infection in healthcare organizations. This study aims to explore how the behaviors promoted and actions implemented by the head nurse can influence healthcare professionals' adherence to Infection Prevention and Control (IPC) programs. METHODS A multi-center qualitative study will be conducted using a Grounded Theory approach. Observations will be conducted, followed by individual interviews and/or focus groups. A constructive and representative sample of healthcare professionals who care directly for patients will be enrolled in the study. The COnsolidated criteria for REporting Qualitative research (COREQ) checklist will be followed to ensure the quality of this study protocol. A multistep inductive process will be used to analyze the data. CONCLUSIONS The study results will provide an understanding of how nurses perceive the influence of leadership and how they modify their behaviors and activities toward patients according to IPC programs. The study will identify barriers and facilitators to IPC compliance and suggest strategies to minimize negative patient outcomes, such as the development of an HAI.
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Affiliation(s)
- Eva Cappelli
- Department of Diagnostic and Public Health, University of Verona, Verona 37129, Italy;
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome 00133, Italy;
| | - Jacopo Fiorini
- Nursing Department Tor Vergata University of Rome Tor Vergata, Rome 00133, Italy; (J.F.); (A.S.)
| | - Francesco Zaghini
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome 00133, Italy;
| | - Federica Canzan
- Department of Diagnostic and Public Health, University of Verona, Verona 37129, Italy;
| | - Alessandro Sili
- Nursing Department Tor Vergata University of Rome Tor Vergata, Rome 00133, Italy; (J.F.); (A.S.)
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Chen Y, Zhang Y, Nie S, Ning J, Wang Q, Yuan H, Wu H, Li B, Hu W, Wu C. Risk assessment and prediction of nosocomial infections based on surveillance data using machine learning methods. BMC Public Health 2024; 24:1780. [PMID: 38965513 PMCID: PMC11223322 DOI: 10.1186/s12889-024-19096-3] [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: 10/25/2023] [Accepted: 06/10/2024] [Indexed: 07/06/2024] Open
Abstract
BACKGROUND Nosocomial infections with heavy disease burden are becoming a major threat to the health care system around the world. Through long-term, systematic, continuous data collection and analysis, Nosocomial infection surveillance (NIS) systems are constructed in each hospital; while these data are only used as real-time surveillance but fail to realize the prediction and early warning function. Study is to screen effective predictors from the routine NIS data, through integrating the multiple risk factors and Machine learning (ML) methods, and eventually realize the trend prediction and risk threshold of Incidence of Nosocomial infection (INI). METHODS We selected two representative hospitals in southern and northern China, and collected NIS data from 2014 to 2021. Thirty-nine factors including hospital operation volume, nosocomial infection, antibacterial drug use and outdoor temperature data, etc. Five ML methods were used to fit the INI prediction model respectively, and to evaluate and compare their performance. RESULTS Compared with other models, Random Forest showed the best performance (5-fold AUC = 0.983) in both hospitals, followed by Support Vector Machine. Among all the factors, 12 indicators were significantly different between high-risk and low-risk groups for INI (P < 0.05). After screening the effective predictors through importance analysis, prediction model of the time trend was successfully constructed (R2 = 0.473 and 0.780, BIC = -1.537 and -0.731). CONCLUSIONS The number of surgeries, antibiotics use density, critical disease rate and unreasonable prescription rate and other key indicators could be fitted to be the threshold predictions of INI and quantitative early warning.
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Affiliation(s)
- Ying Chen
- Department of Laboratory Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518003, PR China
| | - Yonghong Zhang
- Department of Medical Affairs, People's Hospital of Ningxia Hui Autonomous Region, Yinchuan, 750004, PR China
| | - Shuping Nie
- Department of Laboratory Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518003, PR China
| | - Jie Ning
- Department of Laboratory Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518003, PR China
| | - Qinjin Wang
- Department of Laboratory Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518003, PR China
| | - Hanmei Yuan
- Department of Laboratory Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518003, PR China
| | - Hui Wu
- Department of Laboratory Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518003, PR China
| | - Bin Li
- Department of Laboratory Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518003, PR China
| | - Wenbiao Hu
- School of Public Health and Social Work, Institute of Health and Biomedical Innovation, Queensland University of Technology, Brisbane, Australia.
| | - Chao Wu
- Department of Laboratory Medicine, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, 518003, PR China.
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Moolasart V, Srijareonvijit C, Charoenpong L, Kongdejsakda W, Anugulruengkitt S, Kulthanmanusorn A, Thienthong V, Usayaporn S, Kaewkhankhaeng W, Rueangna O, Sophonphan J, Manosuthi W, Tangcharoensathien V. Prevalence and Risk Factors of Healthcare-Associated Infections among Hospitalized Pediatric Patients: Point Prevalence Survey in Thailand 2021. CHILDREN (BASEL, SWITZERLAND) 2024; 11:738. [PMID: 38929317 PMCID: PMC11202135 DOI: 10.3390/children11060738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2024] [Revised: 06/02/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024]
Abstract
BACKGROUND Healthcare-associated infections (HAIs) pose a grave threat to patient safety, morbidity, and mortality, contributing to antimicrobial resistance. Thus, we estimated the point prevalence, risk factors, types, and pathogens of HAIs in hospitalized pediatric patients. METHODS A point prevalence survey (PPS) of HAIs in hospitalized pediatric patients < 18 years old was conducted from March to May 2021. Outcomes, risk factors, and types of HAIs associated with HAIs in 41 hospitals across Thailand were collected. RESULTS The prevalence of HAIs was 3.9% (95% CI 2.9-5.0%) (56/1443). By ages < 1 month, 1 month-2 years, 2-12 years, and 12-18 years, the prevalence of HAIs was 4.2%, 3.3%, 4.1%, and 3.0%, respectively (p = 0.80). Significant independent risk factors were extended hospital length of stay (LOS) and central venous catheter (CVC) use. Compared to an LOS of <4 days, LOSs of 4-7 days, 8-14 days, and >14 days had adjusted odds ratios (aORs) of 2.65 (95% CI 1.05, 6.68), 5.19 (95% CI 2.00, 13.4), and 9.03 (95% CI 3.97, 20.5), respectively. The use of a CVC had an aOR of 2.45 (95% CI 1.06-5.66). Lower respiratory tract infection (LRTI) was the most common HAI type (46.4%: 26/56). The highest prevalence of HAIs was predominantly observed in LRTI diagnoses, with the highest among these in the <1 month age category at 2.3% (17/738). CONCLUSION The prevalence of HAIs in hospitalized pediatric patients was 3.9%. Extended LOS and use of CVC were HAI risk factors. A strategy for reducing LOS and reviewing insertion indications or the early planned removal of a CVC was implemented. The surveillance of HAIs stands as a cornerstone and fundamental component of IPC, offering invaluable insights that enhance hospital IPC interventions aimed at preventing HAIs.
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Affiliation(s)
- Visal Moolasart
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand; (C.S.); (L.C.); (W.K.); (W.M.)
| | - Chaisiri Srijareonvijit
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand; (C.S.); (L.C.); (W.K.); (W.M.)
| | - Lantharita Charoenpong
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand; (C.S.); (L.C.); (W.K.); (W.M.)
| | - Winnada Kongdejsakda
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand; (C.S.); (L.C.); (W.K.); (W.M.)
| | - Suvaporn Anugulruengkitt
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Faculty of Medicine, Chulalongkorn University, Bangkok 10330, Thailand;
- Center of Excellence for Pediatric Infectious Diseases and Vaccines, Chulalongkorn University, Bangkok 10330, Thailand
| | - Anond Kulthanmanusorn
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (A.K.); (W.K.); (O.R.); (V.T.)
| | - Varaporn Thienthong
- Division of International Disease Control Ports and Quarantine, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand;
| | - Sang Usayaporn
- Department of Pharmacy Practice, Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok 10330, Thailand;
| | - Wanwisa Kaewkhankhaeng
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (A.K.); (W.K.); (O.R.); (V.T.)
| | - Oranat Rueangna
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (A.K.); (W.K.); (O.R.); (V.T.)
| | - Jiratchaya Sophonphan
- The HIV Netherlands Australia Thailand Research Collaboration (HIV-NAT), The Thai Red Cross AIDS Research Centre, Bangkok 10330, Thailand;
| | - Weerawat Manosuthi
- Bamrasnaradura Infectious Diseases Institute, Department of Disease Control, Ministry of Public Health, Nonthaburi 11000, Thailand; (C.S.); (L.C.); (W.K.); (W.M.)
| | - Viroj Tangcharoensathien
- International Health Policy Program, Ministry of Public Health, Nonthaburi 11000, Thailand; (A.K.); (W.K.); (O.R.); (V.T.)
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Schechner V, Cohen A, Carmeli Y. Tailoring Interventions for Control of Endemic Carbapenem-Resistant Acinetobacter baumannii: An Interrupted Time Series Analysis. Open Forum Infect Dis 2024; 11:ofae301. [PMID: 38872846 PMCID: PMC11170493 DOI: 10.1093/ofid/ofae301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 05/26/2024] [Indexed: 06/15/2024] Open
Abstract
Background We examined temporal trends in carbapenem-resistant Acinetobacter baumannii (CRAB) infections in a hospital with hyperendemic CRAB and assessed the efficacy of varied infection control strategies in different ward types. Methods We retrospectively analyzed all CRAB clinical samples from 2006 to 2019 and categorized infections as hospital-onset (HO) or community-onset. We used interrupted time series analysis to assess the impact of interventions on the incidence of all HO-CRAB infections and bloodstream infections (BSIs) at the hospital and ward group levels. Results Over 14 years, 4009 CRAB infections were identified (89.7% HO), with 813 CRAB BSI (93.2% HO). The incidence per 100 000 patient-days of CRAB infections peaked in 2008 at 79.1, and that of CRAB BSI peaked in 2010 at 16.2. These rates decreased by two-thirds by 2019. In the general intensive care unit (ICU), hand hygiene and environmental cleaning interventions were followed by a significant reduction in the level of HO-CRAB infections, with an additional decrease in the slope after the introduction of active surveillance and 2% chlorhexidine bathing. In the surgical ICU and surgical department, a reduction in slope or level of CRAB infection was observed after moving ventilated patients to single rooms. In medical wards, a multimodal intervention was followed by a reduction in the slope of HO-CRAB infections and BSIs. In wards where CRAB infections were uncommon, the incidence of HO-CRAB infections decreased throughout the study period. Conclusions Ward-specific variables determine the success of interventions in reducing CRAB infections; therefore, interventions should be tailored to each setting.
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Affiliation(s)
- Vered Schechner
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
- School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Adi Cohen
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
| | - Yehuda Carmeli
- National Institute for Antibiotic Resistance and Infection Control, Ministry of Health, Tel Aviv, Israel
- School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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9
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Ülgüt R, Tomsic I, Chaberny IF, von Lengerke T. Human resource management to assist infection prevention and control professionals: a scoping review. J Hosp Infect 2024; 148:145-154. [PMID: 38679391 DOI: 10.1016/j.jhin.2024.04.004] [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: 12/22/2023] [Revised: 04/09/2024] [Accepted: 04/11/2024] [Indexed: 05/01/2024]
Abstract
Infection prevention and control (IPC) professionals are key intermediaries between hospital managers and frontline staff. During the novel coronavirus disease pandemic, IPC professionals faced new challenges. Unfortunately, research on human resource management (HRM) to support IPC during and between pandemics is lacking. Therefore, this scoping review aimed to elucidate the existing knowledge on HRM measures in this context and thus contribute to the pandemic preparedness of healthcare facilities. It was conducted as part of the "PREparedness and PAndemic REsponse in Germany (PREPARED)" project within the Network University Medicine (NUM), using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) checklist. PubMed was searched without time restriction until 2023 (filter: English, German). Two reviewers assessed titles/abstracts and full texts, respectively. A total of nine publications were included, eight of which were published in the USA. All publications reported survey data (quantitative: six). Measures targeting personnel development and the qualification of IPC personnel were reported in six studies, i.e., almost two-thirds of the studies, of which five focused on the tasks of IPC professionals. In contrast, management of personnel costs and remuneration systems were reported less frequently (three studies), and only regarding issues around retention, compensation and dismissal. In conclusion, research gaps include trials on implementation and effectiveness of HRM for IPC. Given the increasing shortage of IPC professionals, HRM measures during and between pandemics become more important for establishing pandemic preparedness.
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Affiliation(s)
- R Ülgüt
- Hannover Medical School, Department of Medical Psychology, Hannover, Germany
| | - I Tomsic
- Hannover Medical School, Department of Medical Psychology, Hannover, Germany
| | - I F Chaberny
- Leipzig University Hospital, Institute of Hygiene, Hospital Epidemiology and Environmental Medicine, Leipzig, Germany; Christian-Albrecht University of Kiel and University Medical Center Schleswig-Holstein, Institute of Hospital Epidemiology and Environmental Hygiene, Kiel, Germany
| | - T von Lengerke
- Hannover Medical School, Department of Medical Psychology, Hannover, Germany.
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10
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Karagiannidou S, Kourlaba G, Zaoutis T, Maniadakis N, Papaevangelou V. Attributable Mortality for Pediatric and Neonatal Central Line-Associated Bloodstream Infections in Greece. J Pediatr Intensive Care 2024; 13:174-183. [PMID: 38919688 PMCID: PMC11196133 DOI: 10.1055/s-0041-1740448] [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: 09/09/2021] [Accepted: 11/02/2021] [Indexed: 10/19/2022] Open
Abstract
Central line-associated bloodstream infections (CLABSIs) are the most frequent pediatric hospital-acquired infections and significantly impact outcomes. The aim of this study was to estimate the attributable mortality for CLABSIs in pediatric and neonatal patients in Greece. A retrospective matched-cohort study was performed, in two tertiary pediatric hospitals. Inpatients with a central line in neonatal and pediatric intensive care units (NICUs and PICUs), hematology/oncology units, and a bone marrow transplantation unit between June 2012 and June 2015 were eligible. Patients with confirmed CLABSI were enrolled on the day of the event and were matched (1:1) to non-CLABSI patients by hospital, hospitalization unit, and length of stay prior to study enrollment (188 children enrolled, 94 CLABSIs). Attributable mortality was estimated. During the study period, 22 patients with CLABSI and nine non-CLABSI patients died (23.4 vs. 9.6%, respectively, p = 0.011), leading to an attributable mortality of 13.8% (95% confidence interval [CI] = 3.4-24.3%). Children in PICUs were more likely to die, presenting an attributable mortality of 20.2% (95% CI = - 1.4-41.8%), without reaching, however, statistical significance. After multiple logistic regression, patients with CLABSI were four times more likely to die (odds ratio [OR] = 4.29, 95% CI = 1.28-14.36, p = 0.018). Survival analysis showed no difference in time to death after study enrollment between patients with CLABSI and non-CLABSI patients (log-rank p = 0.137, overall median survival time = 7.8 months). Greek pediatric mortality rates are increased by the CLABSI occurrence, highlighting the importance of infection prevention strategies.
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Affiliation(s)
- Sofia Karagiannidou
- Center for Clinical Epidemiology and Outcomes Research, Non-Profit Civil Partnership, Athens, Greece
| | - Georgia Kourlaba
- Center for Clinical Epidemiology and Outcomes Research, Non-Profit Civil Partnership, Athens, Greece
- ECONCARE, LP, Athens, Greece
| | - Theoklis Zaoutis
- Center for Clinical Epidemiology and Outcomes Research, Non-Profit Civil Partnership, Athens, Greece
- Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Nikolaos Maniadakis
- Department of Health Services Management, National School of Public Health, Athens, Greece
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, University General Hospital ATTIKON, Athens, Greece
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Porchera BR, da Silva CM, Miranda RP, Gomes ARQ, Fernandes PHDS, de Menezes CGO, Laurindo PDSDODC, Dolabela MF, Brígido HPC. Linezolid and vancomycin for nosocomial infections in pediatric patients: a systematic review. J Pediatr (Rio J) 2024; 100:242-249. [PMID: 38145631 PMCID: PMC11065658 DOI: 10.1016/j.jped.2023.08.011] [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] [Received: 04/12/2023] [Revised: 08/13/2023] [Accepted: 08/30/2023] [Indexed: 12/27/2023] Open
Abstract
OBJECTIVE To investigate the effectiveness of linezolid and vancomycin for the treatment of nosocomial infections in children under 12 years old. DATA SOURCES This is a systematic review in which five randomized clinical trials about the effectiveness of linezolid and vancomycin, involving a total of 429 children with nosocomial infections, were evaluated. They were searched in scientific databases: PubMed, Bvs, and SciELO. SUMMARY OF FINDINGS The main nosocomial infections that affected children were bacteremia, skin, and soft tissue infections followed by nosocomial pneumonia. Most infections were caused by Gram-positive bacteria, which all studies showed infections caused by Staphylococcus aureus, with methicillin-resistant S. aureus (MRSA) and methicillin-resistant coagulase-negative staphylococci strains being isolated. Both linezolid and vancomycin showed high therapeutic efficacy against different types of nosocomial infections, ranging from 84.4% to 94% for linezolid and 76.9% to 90% for vancomycin. Patients receiving linezolid had lower rates of rash and red man syndrome compared to those receiving vancomycin. However, despite the adverse reactions, antimicrobials can be safely administered to children to treat nosocomial infections caused by resistant Gram-positive bacteria. CONCLUSION Both linezolid and vancomycin showed good efficacy in the treatment of bacterial infections caused by resistant Gram-positive bacteria in hospitalized children. However, linezolid stands out regarding its pharmacological safety. Importantly, to strengthen this conclusion, further clinical trials are needed to provide additional evidence.
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Affiliation(s)
- Bruno Russo Porchera
- Centro Universitário do Estado do Pará (CESUPA), Curso de Medicina, Belém, PA, Brazil
| | | | | | - Antônio Rafael Quadros Gomes
- Universidade Federal do Pará (UFPA), Programa de Pós-graduação em Inovação Farmacêutica (PPGIF), Belém, PA, Brazil
| | | | | | | | - Maria Fani Dolabela
- Universidade Federal do Pará (UFPA), Programa de Pós-graduação em Inovação Farmacêutica (PPGIF), Belém, PA, Brazil
| | - Heliton Patrick Cordovil Brígido
- Universidade Federal do Pará (UFPA), Programa de Pós-graduação em Inovação Farmacêutica (PPGIF), Belém, PA, Brazil; Centro Universitário Metropolitano da Amazônia (UNIFAMAZ), Curso de Medicina, Belém, PA, Brazil.
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12
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Parra LM, Cantero M, Ortí-Lucas RM, Salcedo-Leal I, Asensio Á. Evaluation of infection prevention and control programmes according to the European Centre for Disease Prevention and Control and the World Health Organization in Spain 2012-2022: indicators of core component 1. J Hosp Infect 2024; 147:17-24. [PMID: 38432588 DOI: 10.1016/j.jhin.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 03/05/2024]
Abstract
BACKGROUND Key and core components of effective infection prevention and control programmes (IPCPs) issued by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) have been described. WHO core component 1 relates to the structure, organization and management of IPCPs. AIM The objective of this study was to assess the status and the time trends of some indicators of core component 1 of IPCPs in acute hospitals in Spain throughout the period 2012-2022. METHODS Hospital-level data from the Spanish point prevalence survey for years 2012-2022 were analysed. Core component 1 indicators were calculated and tested for association to healthcare-associated infections (HAIs). In addition, trends were also examined. RESULTS Overall, 67.0% and 57.2% of Spanish hospitals reported having an annual infection prevention and control (IPC) plan and an annual IPC report that was approved by the hospital managing director, respectively. The global median number of full-time equivalent (FTE) IPC nurses per 250 beds for the period was 0.87 and the global median number of FTE IPC doctors was 0.70. The rates of blood cultures and stool tests for Clostridioides difficile were 39.9 and 6.1 per 1000 patient-days, respectively. No significant correlation was found between core component 1 indicators and HAI prevalence. CONCLUSION Spain is currently at a basic level on the structure, organization and management of IPCPs. Profound differences were found between hospitals depending on size and type.
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Affiliation(s)
- L M Parra
- Preventive Medicine Department, Puerta de Hierro-Majadahonda University Hospital, Majadahonda, Spain; Spanish Society of Preventive Medicine, Public Health and Health Management, Madrid, Spain.
| | - M Cantero
- Preventive Medicine Department, Puerta de Hierro-Majadahonda University Hospital, Majadahonda, Spain; Spanish Society of Preventive Medicine, Public Health and Health Management, Madrid, Spain
| | - R M Ortí-Lucas
- Preventive Medicine Department, University Clinical Hospital of Valencia, Valencia, Spain; Spanish Society of Preventive Medicine, Public Health and Health Management, Madrid, Spain
| | - I Salcedo-Leal
- Preventive Medicine Department, Reina Sofia Hospital, Cordoba, Spain; Spanish Society of Preventive Medicine, Public Health and Health Management, Madrid, Spain
| | - Á Asensio
- Preventive Medicine Department, Puerta de Hierro-Majadahonda University Hospital, Majadahonda, Spain; Spanish Society of Preventive Medicine, Public Health and Health Management, Madrid, Spain
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13
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Singh C, Abdullah R. Impact of Ventilator-Associated Pneumonia Preventative Measures and Ventilator Bundle Care in a Tertiary Care Hospital's Adult Intensive Care Unit. Cureus 2024; 16:e59877. [PMID: 38854202 PMCID: PMC11157479 DOI: 10.7759/cureus.59877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Accepted: 05/07/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND The mitigation of ventilator-associated pneumonia (VAP) is a vital undertaking in safeguarding patient well-being. The research aimed to evaluate the impact of a multidisciplinary, comprehensive monitoring approach on VAP incidence in a tertiary medical-surgical-trauma critical care unit. METHODOLOGY The research was conducted within an adult medical-surgical ICU from June 2021 to December 2022. VAP data were collected by prospective targeted surveillance in accordance with the guidelines provided by the National Healthcare Safety Network (NHSN) and the Centers for Disease Control and Prevention. In contrast, a cross-sectional design was used to gather bundle data, according to the defined methodology of the Institute for Healthcare Improvement (IHI), and the rate of variation in admission prior to the bundle's installation was evaluated. RESULT The features of ventilated patients in adult medical-surgical ICUs were studied between 2021 and 2022. Regarding demographics, men comprised 42.6% and 45.3% of VAP patients and 65.3% and 50.7% of bundle care patients, respectively. Notably, 33.1% of patients in VAP and 54.5% in bundle care were over 60 years old. Clinical indicators such as median age (12.6 vs. 8 months for non-VAP vs. VAP patients), antibiotic usage (65% vs. 99% for non-VAP vs. VAP patients), and risk factors like trauma diagnosis (HR: 2.59, 95% CI: 2.07-3.23), and accidental extubation (HR: 4.11, 95% CI: 1.93-8.73) differed significantly between the bundle and non-bundle care groups. A significant increase in bundle compliance was seen from 90% in 2021 to 97% in 2022 (P-value <0.001), which helped to lower VAP rates and highlight the need for ongoing quality improvement in ICU treatment. CONCLUSION The use of ventilator bundles at a tertiary care hospital resulted in improvements in ventilator utilization, with an approximate increase of 20% and VAP rates of over 70% for adult critical patients.
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Affiliation(s)
- Chandni Singh
- Department of Cardiac Anaesthesia, Laxmipat Singhania Institute of Cardiology, Kanpur, IND
| | - Rashid Abdullah
- Department of Anaesthesiology and Critical Care, Chandni Hospital, Kanpur, IND
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Bun RS, Aït Bouziad K, Daouda OS, Miliani K, Eworo A, Espinasse F, Seytre D, Casetta A, Nérome S, Temime L, Hocine MN, Astagneau P. Identifying individual and organizational predictors of accidental exposure to blood (AEB) among hospital healthcare workers: A longitudinal study. Infect Control Hosp Epidemiol 2024; 45:491-500. [PMID: 38086622 PMCID: PMC11007361 DOI: 10.1017/ice.2023.248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 09/10/2023] [Accepted: 10/11/2023] [Indexed: 04/10/2024]
Abstract
BACKGROUND Accidental exposure to blood (AEB) poses a risk of bloodborne infections for healthcare workers (HCWs) during hospital activities. In this study, we identified individual behavioral and organizational predictors of AEB among HCWs. METHODS The study was a prospective, 1-year follow-up cohort study conducted in university hospitals in Paris, France. Data were collected from the Stress at Work and Infectious Risk in Patients and Caregivers (STRIPPS) study. Eligible participants included nurses, nursing assistants, midwives, and physicians from 32 randomly selected wards in 4 hospitals. AEB occurrences were reported at baseline, 4 months, 8 months, and 12 months, and descriptive statistical and multilevel risk-factor analyses were performed. RESULTS The study included 730 HCWs from 32 wards, predominantly nurses (52.6%), nursing assistants (41.1%), physicians (4.8%), and midwives (1.5%). The incidence rate of AEB remained stable across the 4 visits. The multilevel longitudinal analysis identified several significant predictors of AEB occurrence. Individual-level predictors included younger age, occupation as nurses or midwives, irregular work schedule, rotating shifts, and lack of support from supervisors. The use of external nurses was the most significant ward-level predictor associated with AEB occurrence. CONCLUSIONS AEBs among HCWs are strongly associated with organizational predictors, highlighting the importance of complementing infection control policies with improved staff management and targeted training. This approach can help reduce AEB occurrences and enhance workplace safety for HCWs.
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Affiliation(s)
- René Sosata Bun
- IPLESP, INSERM, Sorbonne University, Paris, France
- INSERM CIC1410, CHU Réunion, Saint-Pierre, France
| | - Karim Aït Bouziad
- MESuRS Laboratory, Conservatoire National des Arts et Métiers, Paris, France
| | - Oumou Salama Daouda
- MESuRS Laboratory, Conservatoire National des Arts et Métiers, Paris, France
| | | | | | | | | | | | | | - Laura Temime
- MESuRS Laboratory, Conservatoire National des Arts et Métiers, Paris, France
- PACRI Unit, Institut Pasteur, Conservatoire National des Arts et Métiers, Paris, France
| | - Mounia N. Hocine
- MESuRS Laboratory, Conservatoire National des Arts et Métiers, Paris, France
| | - Pascal Astagneau
- IPLESP, INSERM, Sorbonne University, Paris, France
- CPIAS Ile de France, Paris, France
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15
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Hill H, Wagenhäuser I, Schuller P, Diessner J, Eisenmann M, Kampmeier S, Vogel U, Wöckel A, Krone M. Establishing semi-automated infection surveillance in obstetrics and gynaecology. J Hosp Infect 2024; 146:125-133. [PMID: 38295904 DOI: 10.1016/j.jhin.2024.01.010] [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: 11/14/2023] [Revised: 01/11/2024] [Accepted: 01/13/2024] [Indexed: 03/10/2024]
Abstract
BACKGROUND Surveillance is an acknowledged method to decrease nosocomial infections, such as surgical site infections (SSIs). Electronic healthcare records create the opportunity for automated surveillance. While approaches for different types of surgeries and indicators already exist, there are very few for obstetrics and gynaecology. AIM To analyse the sensitivity and workload reduction of semi-automated surveillance in obstetrics and gynaecology. METHODS In this retrospective, single-centre study at a 1438-bed tertiary care hospital in Germany, semi-automated SSI surveillance using the indicators 'antibiotic prescription', 'microbiological data' and 'administrative data' (diagnosis codes, readmission, post-hospitalization care) was compared with manual analysis and categorization of all patient files. Breast surgeries (BSs) conducted in 2018 and caesarean sections (CSs) that met the inclusion criteria between May 2013 and December 2019 were included. Indicators were analysed for sensitivity, number of analysed procedures needed to identify one case, and potential workload reduction in detecting SSIs in comparison with the control group. FINDINGS The reference standard showed nine SSIs in 416 BSs (2.2%). Sensitivities for the indicators 'antibiotic prescription', 'diagnosis code', 'microbiological sample taken', and the combination 'diagnosis code or microbiological sample' were 100%, 88.9%, 66.7% and 100%, respectively. The reference standard showed 54 SSIs in 3438 CSs (1.6%). Sensitivities for the indicators 'collection of microbiological samples', 'diagnosis codes', 'readmission/post-hospitalization care', and the combination of all indicators were 38.9%, 27.8%, 85.2% and 94.4%, respectively. CONCLUSIONS Semi-automated surveillance systems may reduce workload by maintaining high sensitivity depending on the type of surgery, local circumstances and thorough digitalization.
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Affiliation(s)
- H Hill
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany; Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany
| | - I Wagenhäuser
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany; Department of Internal Medicine I, University Hospital Würzburg, Würzburg, Germany
| | - P Schuller
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany
| | - J Diessner
- Department of Obstetrics and Gynaecology, University Hospital Würzburg, Würzburg, Germany
| | - M Eisenmann
- Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany
| | - S Kampmeier
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany; Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany
| | - U Vogel
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany; Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany
| | - A Wöckel
- Department of Obstetrics and Gynaecology, University Hospital Würzburg, Würzburg, Germany
| | - M Krone
- Institute for Hygiene and Microbiology, University of Würzburg, Würzburg, Germany; Infection Control and Antimicrobial Stewardship Unit, University Hospital Würzburg, Würzburg, Germany.
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Ahmed A, Hossain L, Banik G, Sayeed A, Sajib MRUZ, Hasan MM, Hoque DE, Hasan ASM, Raghuyamshi V, Zaman S, Akter E, Nusrat N, Rahman F, Raza S, Hasan MR, Uddin J, Sarkar S, Adnan SD, Rahman A, Ameen S, Jabeen S, El Arifeen S, Rahman AE. Measuring the effectiveness of an integrated intervention package to improve the level of infection prevention and control: a multi-centre study in Bangladesh. J Hosp Infect 2024; 145:22-33. [PMID: 38157940 DOI: 10.1016/j.jhin.2023.11.023] [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: 09/05/2023] [Revised: 11/21/2023] [Accepted: 11/23/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND Infection prevention and control (IPC) is a critical component of delivering safe, effective and high-quality healthcare services, and eliminating avoidable healthcare-associated infections (HAIs) in health facilities, predominantly in population-dense settings such as Bangladesh. AIM Our study aimed to assess the effect of an integrated intervention package in improving the IPC level of the health facilities in Bangladesh. METHODS We conducted a pre-post intervention study in six district hospitals (DHs) and 13 Upazila Health Complexes (UHCs) in the six districts of Bangladesh. Baseline and endline assessments were conducted between March and December 2021 using the adapted World Health Organization Infection Prevention and Control Assessment Framework (WHO-IPCAF) tool. The IPCAF score, ranging from 0-800, was calculated by adding the scores of eight components, and the IPC promotion and practice level was categorized as Inadequate (0-200), Basic (201-400), Intermediate (401-600) and Advanced (601-800). The integrated intervention package including IPC committee formation, healthcare provider training, logistics provision, necessary guidelines distribution, triage/flu corners establishment, and infrastructure development was implemented in all facilities. RESULTS The average IPCAF score across all the facilities showed a significant increase from 16% (95% CI: 11.5-20.65%) to 54% (95% CI: 51.4-57.1%). Overall, the IPCAF score increased by 34 percentage points (P<0.001) in DHs and 40 percentage points (P<0.001) in UHCs. Following the intervention, 12 (three DHs, nine UHCs) of 19 facilities progressed from inadequate to intermediate, and another three DHs upgraded from basic to intermediate in terms of IPC level. CONCLUSION The integrated intervention package improved IPCAF score in all facilities.
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Affiliation(s)
- A Ahmed
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh.
| | - L Hossain
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - G Banik
- Health and Nutrition Sector, Save the Children, Dhaka, Bangladesh
| | - A Sayeed
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - M R U-Z Sajib
- Department of Kinesiology and Community Health, College of Applied Health Science, University of Illinois Urbana-Champaign, USA
| | - M M Hasan
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | | | | | | | - E Akter
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - N Nusrat
- Department of Statistics, North Carolina State University, Raleigh, NC, USA
| | - F Rahman
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - S Raza
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - M R Hasan
- Sir Salimullah Medical College & Mitford Hospital, Dhaka, Bangladesh
| | - J Uddin
- Projahnmo Research Foundation, Dhaka, Bangladesh
| | - S Sarkar
- Hospital Service Management, Directorate General of Health Services, Government of Bangladesh, Bangladesh
| | - S D Adnan
- Hospital and Clinics, Directorate General of Health Services, Government of Bangladesh, Bangladesh
| | - A Rahman
- Communicable Disease Control, Directorate General of Health Services, Government of Bangladesh, Bangladesh
| | - S Ameen
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - S Jabeen
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - S El Arifeen
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - A E Rahman
- Maternal and Child Health Division (MCHD), International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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Gastaldi S, Festa MG, Nieddu A, Zavagno G, Cau E, Barbieri C, Beccaria E, D'Ancona F. Identification of essential contents and a standard framework for the development of an Infection Prevention and Control manual for healthcare facilities: A scoping review. Am J Infect Control 2024; 52:358-364. [PMID: 37689122 DOI: 10.1016/j.ajic.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Several international organizations have outlined the components of infection prevention and control (IPC) programs. To successfully implement an IPC program, hospital staff may adopt a manual that provides support for implementing the IPC measures, even requiring significant efforts. This study aims to identify essential aspects and develop a standardized structure for an IPC manual. The IPC manual framework can be customized and utilized by any health care facility, thereby facilitating adherence to international and national legislation. METHODS The study was conducted using the Joanna Briggs Institute methodology for scoping reviews. Reporting followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews standard. The search for evidence was performed on PubMed and Web of Science. Methodological quality was evaluated blindly by 2 reviewers using the Critical Appraisal Skills Program checklist. RESULTS Nineteen papers were included in the review. Data extraction considered the most recent guidelines and the categorization into the 8 Core Components established by the World Health Organization. Through the literature review, the essential elements and challenges of an IPC hospital manual were identified, and a framework was proposed. CONCLUSIONS By incorporating these essential elements into their IPC manual, health care facilities can establish a robust IPC framework. A potential future development stemming from this work could involve the creation of a standardized national IPC manual tailored for hospital settings.
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Affiliation(s)
- Silvana Gastaldi
- National Association of Nurses for Prevention of Hospital Infections (ANIPIO), Bologna, Italy.
| | | | - Alma Nieddu
- HAI Group Contact, Hospital and Territory Clinical Government Operating Unit, USL Parma, Parma, Italy
| | - Giulia Zavagno
- Sant'Antonio Hospital, San Daniele del Friuli (ASUFC-Azienda Sanitaria Universitaria Friuli Centrale), Udine, Italy
| | - Ennio Cau
- Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco", Catania, Italy
| | - Corinna Barbieri
- AULSS 3 Serenissima, Medical Department Ospedale dell'Angelo - Mestre, Venice, Italy
| | | | - Fortunato D'Ancona
- Department of Communicable Diseases, Istituto Superiore di Sanità, Rome, Italy
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Horgan S, Hegarty J, Drennan J, Keane D, Saab MM. The effect of interventions on the incidence of surgical site infections in acute care settings: A systematic review. J Tissue Viability 2024; 33:75-88. [PMID: 37977894 DOI: 10.1016/j.jtv.2023.11.004] [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: 05/06/2023] [Revised: 09/22/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
AIM Surgical site infections (SSIs) are common healthcare associated infections with serious consequences for patients and healthcare organisations. It is critical that healthcare professionals implement prevention strategies to reduce the incidence of such infections. Prevention strategies are key to reducing the incidence of SSIs. The aim of this systematic review is to describe the effect of interventions conducted in acute care settings on the incidence of SSIs (primary outcome), length of stay, intensive care unit admission, and mortality rate (secondary outcomes). MATERIALS AND METHODS This review is reported using the Preferred Reporting Items for Systematic review and Meta-Analysis checklist. A search was undertaken in Academic Search Complete, CINAHL, ERIC, MEDLINE, PsycARTICLES, PsycINFO and Web of Science for studies published between January 2017 and March 2022. Studies that focused on interventions within acute hospital settings in patients undergoing elective surgery with the aim of reducing the incidences of SSIs were included. Due to heterogeneity results were synthesised narratively. RESULTS In total, 23 studies were included. Findings show that interventions that are effective in reducing the incidences of SSIs have multiple components including care bundles, stakeholder engagement, targeted surveillance and education. Few studies were identified that evaluated the effect of SSI prevention interventions on length of stay and mortality, and none assessed intensive care admission rates. CONCLUSIONS The included interventions varied widely, which made it difficult to draw definitive conclusions regarding specific interventions that reduce SSI. Multicomponent interventions and care bundles showed promise in reducing the occurrence of SSIs. Further studies should focus on standardised evidence-based interventions and compliance using randomised controlled designs.
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Affiliation(s)
- Sinéad Horgan
- South/South West Hospitals Group, Department of Nursing and Midwifery, Erinville, Western Road, Cork, Ireland; Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland.
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland.
| | - Jonathan Drennan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
| | - Danielle Keane
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland.
| | - Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland.
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Schlosser B, Weikert B, Fucini GB, Kohlmorgen B, Kola A, Weber A, Thoma N, Behnke M, Schwab F, Gastmeier P, Geffers C, Aghdassi SJS. Risk factors for transmission of carbapenem-resistant Acinetobacter baumannii in outbreak situations: results of a case-control study. BMC Infect Dis 2024; 24:120. [PMID: 38263063 PMCID: PMC10807151 DOI: 10.1186/s12879-024-09015-7] [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: 11/28/2023] [Accepted: 01/11/2024] [Indexed: 01/25/2024] Open
Abstract
BACKGROUND An increase in patients with multidrug-resistant organisms and associated outbreaks during the COVID-19 pandemic have been reported in various settings, including low-endemic settings. Here, we report three distinct carbapenem-resistant Acinetobacter baumannii (CRAB) outbreaks in five intensive care units of a university hospital in Berlin, Germany during the COVID-19 pandemic. METHODS A case-control study was conducted with the objective of identifying risk factors for CRAB acquisition in outbreak situations. Data utilized for the case-control study came from the investigation of three separate CRAB outbreaks during the COVID-19 pandemic (August 2020- March 2021). Cases were defined as outbreak patients with hospital-acquired CRAB. Controls did not have any CRAB positive microbiological findings and were hospitalized at the same ward and for a similar duration as the respective case. Control patients were matched retrospectively in a 2:1 ratio. Parameters routinely collected in the context of outbreak management and data obtained retrospectively specifically for the case-control study were included in the analysis. To analyze risk factors for CRAB acquisition, univariable and multivariable analyses to calculate odds ratios (OR) and 95% confidence intervals (CI) were performed using a conditional logistic regression model. RESULTS The outbreaks contained 26 cases with hospital-acquired CRAB in five different intensive care units. Two exposures were identified to be independent risk factors for nosocomial CRAB acquisition by the multivariable regression analysis: Sharing a patient room with a CRAB patient before availability of the microbiological result was associated with a more than tenfold increase in the risk of nosocomial CRAB acquisition (OR: 10.7, CI: 2.3-50.9), while undergoing bronchoscopy increased the risk more than six times (OR: 6.9, CI: 1.3-38.1). CONCLUSIONS The risk factors identified, sharing a patient room with a CRAB patient and undergoing bronchoscopy, could point to an underperformance of basic infection control measure, particularly hand hygiene compliance and handling of medical devices. Both findings reinforce the need for continued promotion of infection control measures. Given that the outbreaks occurred in the first year of the COVID-19 pandemic, our study serves as a reminder that a heightened focus on airborne precautions should not lead to a neglect of other transmission-based precautions.
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Affiliation(s)
- Beate Schlosser
- Institute of Hygiene and Environmental Medicine, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany.
| | - Beate Weikert
- Institute of Hygiene and Environmental Medicine, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
| | - Giovanni-Battista Fucini
- Institute of Hygiene and Environmental Medicine, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
| | - Britta Kohlmorgen
- Institute of Hygiene and Environmental Medicine, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
| | - Axel Kola
- Institute of Hygiene and Environmental Medicine, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
| | - Anna Weber
- Institute of Hygiene and Environmental Medicine, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
| | - Norbert Thoma
- Institute of Hygiene and Environmental Medicine, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
| | - Michael Behnke
- Institute of Hygiene and Environmental Medicine, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
| | - Frank Schwab
- Institute of Hygiene and Environmental Medicine, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
| | - Christine Geffers
- Institute of Hygiene and Environmental Medicine, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
| | - Seven Johannes Sam Aghdassi
- Institute of Hygiene and Environmental Medicine, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt- Universität zu Berlin, Hindenburgdamm 27, 12203, Berlin, Germany
- BIH Charité Digital Clinician Scientist Program, Berlin Institute of Health at Charité- Universitätsmedizin Berlin, BIH Biomedical Innovation Academy, Anna-Louisa-Karsch-Straße 2, 10178, Berlin, Germany
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Arzilli G, De Vita E, Pasquale M, Carloni LM, Pellegrini M, Di Giacomo M, Esposito E, Porretta AD, Rizzo C. Innovative Techniques for Infection Control and Surveillance in Hospital Settings and Long-Term Care Facilities: A Scoping Review. Antibiotics (Basel) 2024; 13:77. [PMID: 38247635 PMCID: PMC10812752 DOI: 10.3390/antibiotics13010077] [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: 11/30/2023] [Revised: 01/05/2024] [Accepted: 01/11/2024] [Indexed: 01/23/2024] Open
Abstract
Healthcare-associated infections (HAIs) pose significant challenges in healthcare systems, with preventable surveillance playing a crucial role. Traditional surveillance, although effective, is resource-intensive. The development of new technologies, such as artificial intelligence (AI), can support traditional surveillance in analysing an increasing amount of health data or meeting patient needs. We conducted a scoping review, following the PRISMA-ScR guideline, searching for studies of new digital technologies applied to the surveillance, control, and prevention of HAIs in hospitals and LTCFs published from 2018 to 4 November 2023. The literature search yielded 1292 articles. After title/abstract screening and full-text screening, 43 articles were included. The mean study duration was 43.7 months. Surgical site infections (SSIs) were the most-investigated HAI and machine learning was the most-applied technology. Three main themes emerged from the thematic analysis: patient empowerment, workload reduction and cost reduction, and improved sensitivity and personalization. Comparative analysis between new technologies and traditional methods showed different population types, with machine learning methods examining larger populations for AI algorithm training. While digital tools show promise in HAI surveillance, especially for SSIs, challenges persist in resource distribution and interdisciplinary integration in healthcare settings, highlighting the need for ongoing development and implementation strategies.
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Affiliation(s)
- Guglielmo Arzilli
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (G.A.); (M.P.); (L.M.C.); (M.P.); (M.D.G.); (E.E.); (A.D.P.); (C.R.)
| | - Erica De Vita
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (G.A.); (M.P.); (L.M.C.); (M.P.); (M.D.G.); (E.E.); (A.D.P.); (C.R.)
| | - Milena Pasquale
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (G.A.); (M.P.); (L.M.C.); (M.P.); (M.D.G.); (E.E.); (A.D.P.); (C.R.)
| | - Luca Marcello Carloni
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (G.A.); (M.P.); (L.M.C.); (M.P.); (M.D.G.); (E.E.); (A.D.P.); (C.R.)
| | - Marzia Pellegrini
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (G.A.); (M.P.); (L.M.C.); (M.P.); (M.D.G.); (E.E.); (A.D.P.); (C.R.)
| | - Martina Di Giacomo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (G.A.); (M.P.); (L.M.C.); (M.P.); (M.D.G.); (E.E.); (A.D.P.); (C.R.)
| | - Enrica Esposito
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (G.A.); (M.P.); (L.M.C.); (M.P.); (M.D.G.); (E.E.); (A.D.P.); (C.R.)
| | - Andrea Davide Porretta
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (G.A.); (M.P.); (L.M.C.); (M.P.); (M.D.G.); (E.E.); (A.D.P.); (C.R.)
- University Hospital of Pisa, 56124, Pisa, Italy
| | - Caterina Rizzo
- Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, 56126 Pisa, Italy; (G.A.); (M.P.); (L.M.C.); (M.P.); (M.D.G.); (E.E.); (A.D.P.); (C.R.)
- University Hospital of Pisa, 56124, Pisa, Italy
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21
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Glenn OJ, Faux I, Pratschke KM, Bowlt Blacklock KL. Evaluation of a client questionnaire at diagnosing surgical site infections in an active surveillance system. Vet Surg 2024; 53:184-193. [PMID: 37597218 DOI: 10.1111/vsu.14011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 06/06/2023] [Accepted: 07/05/2023] [Indexed: 08/21/2023]
Abstract
OBJECTIVE To report sensitivity, specificity, predictive values and accuracy of a client questionnaire at diagnosing surgical site infections (SSIs) and describe the impact of active surveillance on SSI detection. STUDY DESIGN Prospective, cohort study. ANIMALS Dogs and cats undergoing soft tissue or orthopedic surgery over a 12-month period at a referral hospital. METHODS Clients were emailed a questionnaire 30 days postoperatively, or 90 days where an implant was used. Three algorithms were developed to diagnose SSIs using one or both of two criteria: (1) presence of any wound healing problems; (2) wound dehiscence or antibiotic prescription, and either purulent discharge or two or more clinical signs (redness, pain, heat, swelling, discharge). Algorithmic diagnoses were compared to gold standard diagnoses made by veterinarians. RESULTS Of 754 surgical procedures, 309 responses were completed with 173 corresponding gold standard diagnoses. The most accurate algorithm determined "SSI" or "No SSI" from 90.2% of responses with 95.5% (92.4-98.6) accuracy, 82.6% (77-88.3) sensitivity, 97.7% (95.5-100) specificity, 86.4% (81.2-91.5) positive predictive value, and 97% (94.5-99.6) negative predictive value. "No SSI" was diagnosed in responses not meeting criterion 1, and "SSI" in responses meeting criteria 1 and 2. "Inconclusive" responses, comprising 9.8% of responses, met criterion 1 but not 2. Overall SSI rate was 62/754 (8.2%) and 12/62 (19.4%) SSIs were detected by active surveillance only. CONCLUSION Use of this client questionnaire accurately diagnosed SSIs; active surveillance increased SSI detection. CLINICAL SIGNIFICANCE Surveillance of SSIs should be active and can be simplified by using a client questionnaire and algorithmic diagnoses, allowing automated distribution, data collection and analysis.
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Affiliation(s)
- Owen J Glenn
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Edinburgh, UK
| | - Ian Faux
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Edinburgh, UK
| | - Kathryn M Pratschke
- Royal (Dick) School of Veterinary Studies, The University of Edinburgh, Edinburgh, UK
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22
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Hakim H, Glasgow HL, Brazelton JN, Gilliam CH, Richards L, Hayden RT. A prospective bacterial whole-genome-sequencing-based surveillance programme for comprehensive early detection of healthcare-associated infection transmission in paediatric oncology patients. J Hosp Infect 2024; 143:53-63. [PMID: 37939882 DOI: 10.1016/j.jhin.2023.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 10/05/2023] [Accepted: 10/20/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND Bacterial whole-genome sequencing (WGS) and determination of genetic relatedness is an important tool for investigation of epidemiologically suspected outbreaks. AIM This prospective cohort study evaluated a comprehensive, prospective bacterial WGS-based surveillance programme for early detection of transmission of most bacterial pathogens among patients at a paediatric oncology hospital. METHODS Cultured bacterial isolates from clinical diagnostic specimens collected prospectively from both inpatient and outpatient encounters between January 2019 and December 2021 underwent routine WGS and core genome multi-locus sequence typing to determine isolates' relatedness. Previously collected isolates from January to December 2018 were retrospectively analysed for identification of prior or ongoing transmission. Multi-patient clusters were investigated to identify potential transmission events based on temporal and spatial epidemiological links and interventions were introduced. FINDINGS A total of 1497 bacterial isolates from 1025 patients underwent WGS. A total of 259 genetically related clusters were detected, of which 18 (6.9%) multi-patient clusters involving 38 (3.7%) patients were identified. Sixteen clusters involved two patients each, and two clusters involved three patients. Following investigation, epidemiologically plausible transmission links were identified in five (27.8%) multi-patient clusters. None of the multi-patient clusters were suspected by conventional epidemiological surveillance. CONCLUSION Bacterial WGS-based surveillance for early detection of hospital transmission detected several limited multi-patient clusters that were unrecognized by conventional epidemiological methods. Genomic surveillance helped efficiently focus interventions while reducing unnecessary investigations.
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Affiliation(s)
- H Hakim
- Department of Infectious Diseases, St. Jude Children's Research Hospital, Memphis, TN, USA; Infection Prevention and Control, St. Jude Children's Research Hospital, Memphis, TN, USA.
| | - H L Glasgow
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - J N Brazelton
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - C H Gilliam
- Infection Prevention and Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - L Richards
- Infection Prevention and Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - R T Hayden
- Department of Pathology, St. Jude Children's Research Hospital, Memphis, TN, USA
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23
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Guest JF, Fuller GW, Griffiths B. Cohort study to characterise surgical site infections after open surgery in the UK's National Health Service. BMJ Open 2023; 13:e076735. [PMID: 38110388 DOI: 10.1136/bmjopen-2023-076735] [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: 12/20/2023] Open
Abstract
OBJECTIVE To characterise surgical site infections (SSIs) after open surgery in the UK's National Health Service. DESIGN Retrospective cohort analysis of electronic records of patients from Clinical Practice Research Datalink, linked with Hospital Episode Statistics' secondary care datasets. SETTING Clinical practice in the community and secondary care. PARTICIPANTS Cohort of 50 000 adult patients who underwent open surgery between 2017 and 2022. OUTCOME MEASURES Incidence of SSI, clinical outcomes, patterns of care and costs of wound management. RESULTS 11% (5281/50 000) of patients developed an SSI a mean of 18.4±14.7 days after their surgical procedure, of which 15% (806/5281) were inpatients and 85% (4475/5281) were in the community after hospital discharge. The incidence of SSI varied according to anatomical site of surgery. The incidence also varied according to a patient's risk and whether they underwent an emergency procedure. SSI onset reduced the 6 months healing rate by a mean of 3 percentage points and increased time to wound healing by a mean of 15 days per wound. SSIs were predominantly managed in the community by practice and district nurses and 16% (850/5281) of all patients were readmitted into hospital. The total health service cost of surgical wound management following SSI onset was a mean of £3537 per wound ranging from £2542 for a low-risk patient who underwent an elective procedure to £4855 for a high-risk patient who underwent an emergency procedure. CONCLUSIONS This study provides important insights into several aspects of SSI management in clinical practice in the UK that have been difficult to ascertain from surveillance data. Surgeons are unlikely to be fully aware of the true incidence of SSI and how they are managed once patients are discharged from hospital. Current SSI surveillance services appear to be under-reporting the actual incidence.
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Affiliation(s)
| | | | - Ben Griffiths
- Manchester University NHS Foundation Trust, Manchester, UK
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24
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Nakayama A, Yamaguchi I, Okamoto K, Maesaki S. Targeted Infection Control Practices in Japanese Hospitals for Multidrug-Resistant Organisms: Guidance From the Public Health Center. Cureus 2023; 15:e50680. [PMID: 38229815 PMCID: PMC10791020 DOI: 10.7759/cureus.50680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/17/2023] [Indexed: 01/18/2024] Open
Abstract
Introduction The study conducted by the Kawaguchi City Public Health Center (PHC) in 2023 on hospital infection control (IC) programs revealed that hospitals can improve their IC programs if the PHC provides training sessions (TSs) that have numerical effects. In this study, we expected that we could help hospitals develop their IC practices by providing targeted guidance. This study aimed to clarify targeted guidance on IC practices and TS programs to develop hospitals'hospitals' IC programs on multidrug-resistant organisms (MDROs) by examining hospitals'hospitals' IC programs in reference to the study conducted in 2023 and other case reports. Methods In June 2022, the Kawaguchi City PHC conducted TSs for 19 hospitals and eight affiliated (AFs) clinics with beds, providing guidelines and practices on infection control (IC) for MDROs. After the TSs, we sent a questionnaire to these hospitals and affiliated clinics. The questionnaire inquired about current and planned IC policies, hand hygiene compliance programs (HHCPs), the usefulness of the TSs conducted by the PHC, and IC programs that the facilities intended to implement or develop in the future. This study examined the relationship between the perceived usefulness of the information provided and the IC programs planned for development, referencing a study conducted in 2023 and other case reports. Results Seventeen hospitals and six AFs with beds responded to the survey, yielding an 85.2% response rate. IC policies for methicillin-resistant Staphylococcus aureus (MRSA) were prepared by 21 hospitals (91.3%), whereas only five hospitals (21.7%) had prepared IC policies for carbapenem-resistant Enterobacteriaceae. Regarding HHCPs, an increase in the availability of alcohol-based hand sanitizer was identified by 17 hospitals (73.9%), while 13 hospitals (56.5%) reported using posters or symbols, 12 hospitals (52.2%) reported using TS and hand sanitizers, and nine hospitals (39.1%) assessed HH compliance and provided feedback. Furthermore, nine hospitals (39.1%) identified HHCPs and Environmental Cleaning (EC) for carbapenemase-producing Enterobacteriaceae (CPE) as useful information. There was a statistically significant association between TSs on HHCPs and the development of new HHCPs (p = 0.027). Additionally, information on EC for CPE was significantly associated with the development of staff cohorting strategies (p = 0.007). However, TS programs were not significantly connected to EC, nor were TSs to be developed. Conclusion The PHC should advise hospitals to assess if their HHCPs effectively contribute to improving HH compliance. It is essential for the PHC to furnish hospitals with resources and information that aid in the development of EC training. Additionally, the PHC should support the creation of specific and effective TS programs focused on EC or TS development. Conducting surveys to identify barriers to implementing staff cohorting strategies is also recommended. We propose that TS programs should include quantifiable data on HHCPs and EC, such as.
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Affiliation(s)
- Ayako Nakayama
- Department of Administration, Kawaguchi Public Health Center, Kawaguchi City, JPN
| | - Ichiro Yamaguchi
- Department of Environmental Health, National Institute of Public Health, Saitama, JPN
| | - Koji Okamoto
- Department of Administration, Kawaguchi Public Health Center, Kawaguchi City, JPN
| | - Shigefumi Maesaki
- Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, JPN
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Chen D, Cojocaru S. Navigating a Pandemic: Leadership Dynamics and Challenges within Infection Prevention and Control Units in Israel. Healthcare (Basel) 2023; 11:2966. [PMID: 37998458 PMCID: PMC10671528 DOI: 10.3390/healthcare11222966] [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: 09/29/2023] [Revised: 11/07/2023] [Accepted: 11/13/2023] [Indexed: 11/25/2023] Open
Abstract
This study investigates the impact of the coronavirus disease 2019 (COVID-19) pandemic on leadership within infection prevention and control (IPC) units across public hospitals in Israel. Through qualitative interviews with ten IPC managers from nine hospitals, equivalent to 30% of the country's acute care facilities, the research uncovers significant changes in managerial approaches due to the health crisis. The results reveal four main themes: (1) Enhanced managerial autonomy and leadership skills, with a noted rise in self-efficacy against the pandemic's backdrop; (2) Shifted perceptions of IPC units by upper management, recognizing their strategic value while identifying the need for a more profound understanding of IPC operations; (3) The increased emphasis on adaptability and rapid decision-making for effective crisis management; (4) The dual effect on job satisfaction and well-being, where greater commitment coincides with risks of burnout. The study underscores the essential nature of effective IPC leadership during emergencies, highlighting the need for clear communication, prompt action, and empathetic leadership. The conclusions point to the necessity for continuous research into IPC leadership, promoting strategic advancements in management to bolster IPC units against future health threats.
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Affiliation(s)
- Dafna Chen
- Department of Sociology and Social Work, Alexandru Ioan Cuza University from Iasi, 700506 Iasi, Romania;
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26
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Nakayama A, Yamaguchi I, Okamoto K, Maesaki S. Public Health Centers' Training Session Programs to Develop Programs on Infection Control Practices for Multidrug-Resistant Organisms in Hospitals in Kawaguchi City, Japan. Cureus 2023; 15:e48178. [PMID: 38046751 PMCID: PMC10693389 DOI: 10.7759/cureus.48178] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2023] [Indexed: 12/05/2023] Open
Abstract
Introduction The Kawaguchi City Public Health Center (PHC) conducted training sessions focusing on infection control practices on multidrug-resistant organisms (MDROs) for 19 hospitals and eight affiliated clinics (AFs) with beds in June 2022. Issues with infection control programs were identified via a survey implemented following the training sessions. These included providing feedback on infection control policies for MDROs, hand hygiene compliance programs (HHCPs), environmental cleaning (EC), and training sessions programs that hospitals or AFs with beds (hospitals) intended to implement in the future or develop (to be developed). We planned to examine whether the PHC training sessions programs have an effect on the development of hospital infection control programs designed to address these issues. The purpose of this study is to clarify the training session program provided by the Kawaguchi City PHC, which was effective in developing hospital infection control programs based on the results of the survey conducted after the training session. Methods In June 2023, a second training session that offered information on infection control practices was completed for 30 hospitals. This was followed by sending a questionnaire. We examined infection control programs to be developed and analyzed associations with the first learned information by training session (the first learned information). Results Twenty-four hospitals responded to the survey with a response rate of 80.0%. Half the respondents (12, 50.0%) had prepared for the infection control policy on carbapenem-resistant Enterobacteriaceae (CRE), 11 hospitals (45.8%) had provided feedback on HHC, and four (16.7%) planned to conduct feedback on HHC. HHCPs were planned to be developed by 19 hospitals (79.2%), EC by five hospitals (20.8%), training session by 12 hospitals (50.0%), and screening of MDROs upon hospital admission (AS) by nine hospitals (37.5%). The first learned information, "the prevention of healthcare-associated infections and cost savings by implementing cleaning bundles (the effects of cleaning bundles)," was identified by 10 hospitals (41.7%), and "specific programs on providing feedback effective for developing hand hygiene compliance (specific feedback)" was learned by eight hospitals (33.3%). The first learned information regarding specific feedback was significantly associated with HHCPs to be developed (p = 0.044). The first learned information on the effects of cleaning bundles was significantly associated with HHCPs and HHC feedback to be developed (p = 0.023, 0.034). The training session programs were not significantly connected to EC, training session, or AS to be developed. Conclusions Infection control programs to be developed were linked to the provision of information on numerical effects by implementing specific feedback and cleaning bundles. We suggest that the PHC should develop infection control programs for the hospitals and provide training sessions, including numerical effects.
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Affiliation(s)
- Ayako Nakayama
- Administration Department, Kawaguchi Public Health Center, Saitama, JPN
| | - Ichiro Yamaguchi
- Department of Environmental Health, National Institute of Public Health, Saitama, JPN
| | - Koji Okamoto
- Administration Department, Kawaguchi Public Health Center, Saitama, JPN
| | - Shigefumi Maesaki
- Department of Infectious Disease and Infection Control, Saitama Medical University, Saitama, JPN
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Sartelli M, Barie PS, Coccolini F, Abbas M, Abbo LM, Abdukhalilova GK, Abraham Y, Abubakar S, Abu-Zidan FM, Adebisi YA, Adamou H, Afandiyeva G, Agastra E, Alfouzan WA, Al-Hasan MN, Ali S, Ali SM, Allaw F, Allwell-Brown G, Amir A, Amponsah OKO, Al Omari A, Ansaloni L, Ansari S, Arauz AB, Augustin G, Awazi B, Azfar M, Bah MSB, Bala M, Banagala ASK, Baral S, Bassetti M, Bavestrello L, Beilman G, Bekele K, Benboubker M, Beović B, Bergamasco MD, Bertagnolio S, Biffl WL, Blot S, Boermeester MA, Bonomo RA, Brink A, Brusaferro S, Butemba J, Caínzos MA, Camacho-Ortiz A, Canton R, Cascio A, Cassini A, Cástro-Sanchez E, Catarci M, Catena R, Chamani-Tabriz L, Chandy SJ, Charani E, Cheadle WG, Chebet D, Chikowe I, Chiara F, Cheng VCC, Chioti A, Cocuz ME, Coimbra R, Cortese F, Cui Y, Czepiel J, Dasic M, de Francisco Serpa N, de Jonge SW, Delibegovic S, Dellinger EP, Demetrashvili Z, De Palma A, De Silva D, De Simone B, De Waele J, Dhingra S, Diaz JJ, Dima C, Dirani N, Dodoo CC, Dorj G, Duane TM, Eckmann C, Egyir B, Elmangory MM, Enani MA, Ergonul O, Escalera-Antezana JP, Escandon K, Ettu AWOO, Fadare JO, Fantoni M, Farahbakhsh M, Faro MP, Ferreres A, Flocco G, Foianini E, Fry DE, Garcia AF, Gerardi C, Ghannam W, Giamarellou H, Glushkova N, Gkiokas G, Goff DA, Gomi H, Gottfredsson M, Griffiths EA, Guerra Gronerth RI, Guirao X, Gupta YK, Halle-Ekane G, Hansen S, Haque M, Hardcastle TC, Hayman DTS, Hecker A, Hell M, Ho VP, Hodonou AM, Isik A, Islam S, Itani KMF, Jaidane N, Jammer I, Jenkins DR, Kamara IF, Kanj SS, Jumbam D, Keikha M, Khanna AK, Khanna S, Kapoor G, Kapoor G, Kariuki S, Khamis F, Khokha V, Kiggundu R, Kiguba R, Kim HB, Kim PK, Kirkpatrick AW, Kluger Y, Ko WC, Kok KYY, Kotecha V, Kouma I, Kovacevic B, Krasniqi J, Krutova M, Kryvoruchko I, Kullar R, Labi KA, Labricciosa FM, Lakoh S, Lakatos B, Lansang MAD, Laxminarayan R, Lee YR, Leone M, Leppaniemi A, Hara GL, Litvin A, Lohsiriwat V, Machain GM, Mahomoodally F, Maier RV, Majumder MAA, Malama S, Manasa J, Manchanda V, Manzano-Nunez R, Martínez-Martínez L, Martin-Loeches I, Marwah S, Maseda E, Mathewos M, Maves RC, McNamara D, Memish Z, Mertz D, Mishra SK, Montravers P, Moro ML, Mossialos E, Motta F, Mudenda S, Mugabi P, Mugisha MJM, Mylonakis E, Napolitano LM, Nathwani D, Nkamba L, Nsutebu EF, O’Connor DB, Ogunsola S, Jensen PØ, Ordoñez JM, Ordoñez CA, Ottolino P, Ouedraogo AS, Paiva JA, Palmieri M, Pan A, Pant N, Panyko A, Paolillo C, Patel J, Pea F, Petrone P, Petrosillo N, Pintar T, Plaudis H, Podda M, Ponce-de-Leon A, Powell SL, Puello-Guerrero A, Pulcini C, Rasa K, Regimbeau JM, Rello J, Retamozo-Palacios MR, Reynolds-Campbell G, Ribeiro J, Rickard J, Rocha-Pereira N, Rosenthal VD, Rossolini GM, Rwegerera GM, Rwigamba M, Sabbatucci M, Saladžinskas Ž, Salama RE, Sali T, Salile SS, Sall I, Kafil HS, Sakakushev BE, Sawyer RG, Scatizzi M, Seni J, Septimus EJ, Sganga G, Shabanzadeh DM, Shelat VG, Shibabaw A, Somville F, Souf S, Stefani S, Tacconelli E, Tan BK, Tattevin P, Rodriguez-Taveras C, Telles JP, Téllez-Almenares O, Tessier J, Thang NT, Timmermann C, Timsit JF, Tochie JN, Tolonen M, Trueba G, Tsioutis C, Tumietto F, Tuon FF, Ulrych J, Uranues S, van Dongen M, van Goor H, Velmahos GC, Vereczkei A, Viaggi B, Viale P, Vila J, Voss A, Vraneš J, Watkins RR, Wanjiru-Korir N, Waworuntu O, Wechsler-Fördös A, Yadgarova K, Yahaya M, Yahya AI, Xiao Y, Zakaria AD, Zakrison TL, Zamora Mesia V, Siquini W, Darzi A, Pagani L, Catena F. Ten golden rules for optimal antibiotic use in hospital settings: the WARNING call to action. World J Emerg Surg 2023; 18:50. [PMID: 37845673 PMCID: PMC10580644 DOI: 10.1186/s13017-023-00518-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 09/23/2023] [Indexed: 10/18/2023] Open
Abstract
Antibiotics are recognized widely for their benefits when used appropriately. However, they are often used inappropriately despite the importance of responsible use within good clinical practice. Effective antibiotic treatment is an essential component of universal healthcare, and it is a global responsibility to ensure appropriate use. Currently, pharmaceutical companies have little incentive to develop new antibiotics due to scientific, regulatory, and financial barriers, further emphasizing the importance of appropriate antibiotic use. To address this issue, the Global Alliance for Infections in Surgery established an international multidisciplinary task force of 295 experts from 115 countries with different backgrounds. The task force developed a position statement called WARNING (Worldwide Antimicrobial Resistance National/International Network Group) aimed at raising awareness of antimicrobial resistance and improving antibiotic prescribing practices worldwide. The statement outlined is 10 axioms, or "golden rules," for the appropriate use of antibiotics that all healthcare workers should consistently adhere in clinical practice.
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Lian L, Pang C, Wei H, Hong L. Citronellol-Based Long-Lasting Antibacterial Cotton Fabrics without Bacterial Resistance. Macromol Biosci 2023; 23:e2300169. [PMID: 37306307 DOI: 10.1002/mabi.202300169] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 06/01/2023] [Indexed: 06/13/2023]
Abstract
Antibacterial cotton helps prevent the growth and spread of harmful microorganisms, reduces the risk of infection, and has a prolonged service life by reducing bacterial degradation. However, most antibacterial agents used are toxic to humans and the environment. Citronellol-poly(N,N-dimethyl ethyl methacrylate) (CD), a highly effective antibacterial polymer, is synthesized from natural herbal essential oils (EOs). CD exhibited efficient, rapid bactericidal activity against Gram-positive, Gram-negative, and drug-resistant bacteria. Citronellol's environmental benignity makes CDs less hemolytic. Notably, negligible drug resistance developed after 15 bacterial subcultures. The CD-treated cotton fabric displayed better antibacterial performance than AAA-grade antibacterial fabric, even after repeated washing. This study extends the practical application of EOs to antibacterial surfaces and fabrics, which is promising for use in personal care products and medical settings.
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Affiliation(s)
- Liqin Lian
- Faculty of Materials Science and Engineering, South China University of Technology, Guangzhou, 510640, China
| | - Chuming Pang
- Faculty of Materials Science and Engineering, South China University of Technology, Guangzhou, 510640, China
| | - Hongxin Wei
- Faculty of Materials Science and Engineering, South China University of Technology, Guangzhou, 510640, China
| | - Liangzhi Hong
- Faculty of Materials Science and Engineering, South China University of Technology, Guangzhou, 510640, China
- Guangdong Provincial Key Laboratory of Luminescence from Molecular Aggregates, South China University of Technology, Guangzhou, 510640, China
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Price L, Gozdzielewska L, Hendry K, McFarland A, Reilly J. Effectiveness of national and subnational interventions for prevention and control of health-care-associated infections in acute hospitals in high-income and upper-middle-income counties: a systematic review update. THE LANCET. INFECTIOUS DISEASES 2023; 23:e347-e360. [PMID: 37023784 DOI: 10.1016/s1473-3099(23)00049-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/17/2023] [Accepted: 01/17/2023] [Indexed: 04/05/2023]
Abstract
This systematic review, commissioned and funded by WHO, aimed to update a review of infection prevention and control (IPC) interventions at a national level to inform a review of their IPC Core Components guidelines (PROSPERO CRD42021297376). CENTRAL, CINAHL, Embase, MEDLINE, and WHO IRIS were searched for studies meeting Cochrane's Effective Practice and Organisation of Care (EPOC) design criteria, published from April 19, 2017, to Oct 14, 2021. Primary research studies examining national IPC interventions in acute hospitals in any country with outcomes related to rates of health-care-associated infections were included. Two independent reviewers extracted data and assessed quality using the EPOC risk of bias criteria. 36 studies were categorised per intervention type and synthesised narratively: care bundles (n=2), care bundles with implementation strategies (n=9), IPC programmes (n=16), and regulations (n=9). Designs included 21 interrupted time-series, nine controlled before-and-after studies, four cluster-randomised trials, and two non-randomised trials. Evidence supports the effectiveness of care bundles with implementation strategies. However, evidence for IPC programmes and regulations was inconclusive as studies were heterogeneous regarding populations, interventions, and outcomes. The overall risk of bias was high. Recommendations include the involvement of implementation strategies in care bundles and for further research on national IPC interventions with robust study designs and in low-income and middle-income settings.
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Affiliation(s)
- Lesley Price
- Research Centre for Health, Glasgow Caledonian University, Glasgow UK
| | | | - Katie Hendry
- Research Centre for Health, Glasgow Caledonian University, Glasgow UK
| | - Agi McFarland
- Research Centre for Health, Glasgow Caledonian University, Glasgow UK
| | - Jacqui Reilly
- Research Centre for Health, Glasgow Caledonian University, Glasgow UK
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Saito H, Okamoto K, Fankhauser C, Tartari E, Pittet D. Train-the-Trainers in hand hygiene facilitate the implementation of the WHO hand hygiene multimodal improvement strategy in Japan: evidence for the role of local trainers, adaptation, and sustainability. Antimicrob Resist Infect Control 2023; 12:56. [PMID: 37296481 PMCID: PMC10250848 DOI: 10.1186/s13756-023-01262-8] [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: 03/30/2023] [Accepted: 05/30/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND "Train-the-Trainers in hand hygiene" (TTT) is a standardized training to train infection prevention and control (IPC) practitioners with the aim to promote hand hygiene in health care according to the World Health Organization (WHO) multimodal improvement strategy. Little is known in the literature about the sustained impact of hand hygiene and IPC trainings adapted locally. The aim of this study is to describe the impact of three TTT courses conducted annually in Japan on the adoption of the WHO multimodal improvement strategy by local IPC practitioners who became a "trainer" after their first TTT participation as a "trainee". METHODS Three TTT courses were conducted annually from 2020 to 2022 in Japan. A team "TTT-Japan" composed of more than 20 IPC practitioners who completed their first TTT participation adapted the original TTT program to reflect the local healthcare context in Japan, and subsequently convened the 2nd and 3rd TTTs. Pre- and post-course evaluations and post-course satisfaction surveys of the course participants were conducted to assess improvement in knowledge on hand hygiene and perception towards the course, respectively. Attitude and practice surveys of the TTT-Japan trainers were conducted to assess their perception and experience in hand hygiene promotion. The Hand Hygiene Self-Assessment Framework (HHSAF), a validated tool created by WHO to monitor the capacity of hand hygiene promotion at facility level, was applied at TTT-Japan trainers' facilities to compare results before and after trainers' engagement. We applied inductive thematic analysis for qualitative analyses of open-ended survey questions of the trainers' attitude and practice surveys, and the Wilcoxon Sign Rank test for quantitive comparisons of pre- and post-data for the surveys and HHSAF. RESULTS 158 Japanese healthcare workers participated in three TTT courses, the majority of whom (131, 82.9%) were nurses. Twenty-seven local trainers were involved in 2nd and 3rd TTTs. The scores of pre- and post-course evaluations significantly improved after the course (P < 0.001) and the improvement was consistent across all three TTTs. Post-course satisfaction survey showed that over 90% of the participants reported that the course met their expectations and that what they learned in the courses would be useful for their practice. Trainers' attitude and practice survey showed that more than three quarters (76.9%) of the trainers reported that their experience as a trainer had a positive impact on their practice at their own facilities. Qualitative analysis of the trainers' attitude and practice survey revealed that trainers appreciated continuous learning as a trainer, and group effort to promote hand hygiene as the TTT-Japan team. The HHSAF institutional climate change element at the trainers' facilities significantly improved after their engagement as a trainer (P = 0.012). CONCLUSIONS TTTs were successfully adapted and implemented in Japan, leading to sustained hand hygiene promotion activities by local trainers over three years. Further research is warranted to assess the long-term impact on local hand hygiene promotion in different settings.
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Affiliation(s)
- Hiroki Saito
- Department of Emergency and Critical Care Medicine, St. Marianna University Yokohama Seibu Hospital, 1197-1, Yasashi-Cho, Asahi-Ku, Yokohama, Kanagawa, Japan.
- Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland.
| | - Koh Okamoto
- Department of Infectious Diseases, The University of Tokyo Hospital, Tokyo, Japan
| | - Carolina Fankhauser
- Infection Control Programme, Faculty of Medicine, University of Geneva Hospitals, Geneva, Switzerland
| | - Ermira Tartari
- Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Didier Pittet
- Infection Control Programme, Faculty of Medicine, University of Geneva Hospitals, Geneva, Switzerland
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Jakobsen RS, Nielsen TD, Leutscher P, Koch K. Clinically explainable machine learning models for early identification of patients at risk of hospital-acquired urinary tract infection. J Hosp Infect 2023:S0195-6701(23)00106-8. [PMID: 37004787 DOI: 10.1016/j.jhin.2023.03.017] [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: 02/21/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Machine learning (ML) models for early identification of patients at risk of hospital-acquired urinary tract infection (HA-UTI) may enable timely and targeted preventive and therapeutic strategies. However, clinicians are often challenged in the interpretation of the predictive outcomes provided by the ML models, which often reach different performances. AIM To train ML models for predicting patients at risk of HA-UTI using available data from electronic health records at the time of hospital admission. This study focused on the performance of different ML models and clinical explainability. METHODS This retrospective study investigated patient data representing 138,560 hospital admissions in the North Denmark Region from 1st January 2017 to 31st December 2018. Fifty-one health sociodemographic and clinical features were extracted as the full dataset, and χ2 test and expert knowledge were used for feature selection, resulting in two reduced datasets. Seven different ML models were trained and compared between the three datasets. The SHapley Additive exPlanation (SHAP) method was used to support population- and patient-level explainability. FINDINGS The best-performing ML model was the neural network model based on the full dataset, with an area under the curve (AUC) of 0.758. The neural network model was also the best-performing ML model based on the reduced datasets, with an AUC of 0.746. Clinical explainability was demonstrated with a SHAP summary and forceplot. CONCLUSION Within 24 h of hospital admission, the ML models were able to identify patients at risk of developing HA-UTI, providing new opportunities to develop efficient strategies for the prevention of HA-UTI. SHAP was used to demonstrate how risk predictions can be explained at individual patient level and for the patient population in general.
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Affiliation(s)
- R S Jakobsen
- Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark; Business Intelligence and Analysis, The North Denmark Region, Denmark.
| | - T D Nielsen
- Department of Computer Science, Aalborg University, Aalborg, Denmark
| | - P Leutscher
- Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - K Koch
- Centre for Clinical Research, North Denmark Regional Hospital, Hjørring, Denmark; Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
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Sartelli M, Bartoli S, Borghi F, Busani S, Carsetti A, Catena F, Cillara N, Coccolini F, Cortegiani A, Cortese F, Fabbri E, Foghetti D, Forfori F, Giarratano A, Labricciosa FM, Marini P, Mastroianni C, Pan A, Pasero D, Scatizzi M, Viaggi B, Moro ML. Implementation Strategies for Preventing Healthcare-Associated Infections across the Surgical Pathway: An Italian Multisociety Document. Antibiotics (Basel) 2023; 12:antibiotics12030521. [PMID: 36978388 PMCID: PMC10044660 DOI: 10.3390/antibiotics12030521] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/08/2023] Open
Abstract
Healthcare-associated infections (HAIs) result in significant patient morbidity and can prolong the duration of the hospital stay, causing high supplementary costs in addition to those already sustained due to the patient’s underlying disease. Moreover, bacteria are becoming increasingly resistant to antibiotics, making HAI prevention even more important nowadays. The public health consequences of antimicrobial resistance should be constrained by prevention and control actions, which must be a priority for all health systems of the world at all levels of care. As many HAIs are preventable, they may be considered an important indicator of the quality of patient care and represent an important patient safety issue in healthcare. To share implementation strategies for preventing HAIs in the surgical setting and in all healthcare facilities, an Italian multi-society document was published online in November 2022. This article represents an evidence-based summary of the document.
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Affiliation(s)
- Massimo Sartelli
- Department of Surgery, Macerata Hospital, 62100 Macerata, Italy
- Correspondence:
| | - Stefano Bartoli
- Vascular Surgery Unit, S. Eugenio Hospital, 00100 Roma, Italy
| | - Felice Borghi
- Oncologic Surgery Unit, Candiolo Cancer Institute FPO–IRCCS, 10060 Torino, Italy
| | - Stefano Busani
- Anaesthesia and Intensive Care Unit, University Hospital of Modena, 41124 Modena, Italy
| | - Andrea Carsetti
- Anesthesia and Intensive Care Unit, Azienda Ospedaliero Universitaria delle Marche, 60100 Ancona, Italy
- Department of Biomedical Sciences and Public Health, Università Politecnica delle Marche, 60100 Ancona, Italy
| | - Fausto Catena
- General and Emergency Surgery Unit, “Bufalini” Hospital, 47521 Cesena, Italy
| | - Nicola Cillara
- General Surgery Unit, Santissima Trinità Hospital, 09121 Cagliari, Italy
| | - Federico Coccolini
- General and Emergency Surgery Unit, Trauma Center, New Santa Chiara Hospital, University of Pisa, 56100 Pisa, Italy
| | - Andrea Cortegiani
- Department of Surgical Oncological and Oral Science, University of Palermo, 90134 Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency, University Hospital “Policlinico Paolo Giaccone”, 90134 Palermo, Italy
| | - Francesco Cortese
- Emergency Surgery Unit, San Filippo Neri Hospital, 00135 Roma, Italy
| | - Elisa Fabbri
- Health and Social Services, Emilia-Romagna Region, 40127 Bologna, Italy
| | | | - Francesco Forfori
- Department of Surgical, Medical, Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy
| | - Antonino Giarratano
- Department of Surgical Oncological and Oral Science, University of Palermo, 90134 Palermo, Italy
- Department of Anesthesia Intensive Care and Emergency, University Hospital “Policlinico Paolo Giaccone”, 90134 Palermo, Italy
| | | | - Pierluigi Marini
- General and Emergency Surgery Unit, S. Camillo-Forlanini Hospital, 00152 Roma, Italy
| | - Claudio Mastroianni
- Department of Public Health and Infectious Diseases, Sapienza University, 00185 Rome, Italy
| | - Angelo Pan
- Unit of Infectious Diseases, ASST Cremona, 26100 Cremona, Italy
| | - Daniela Pasero
- Department of Medicine, Surgery and Pharmacy, University of Sassari, 07100 Sassari, Italy
- Department of Emergency, Anaesthesia and Intensive Care Unit, AOU Sassari, 07100 Sassari, Italy
| | - Marco Scatizzi
- General Surgery Unit, Santa Maria Annunziata Hospital, 50012 Firenze, Italy
| | - Bruno Viaggi
- Neuro-Intensive Care Unit, Department of Anesthesiology, Careggi University Hospital, 50139 Florence, Italy
| | - Maria Luisa Moro
- Italian Multidisciplinary Society for the Prevention of Healthcare-Associated Infections, 20159 Milano, Italy
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Jeong SY, Kim OS. Development and Application of an Educational-Training Programme for Infection Control Practitioners in Long-Term Care Hospitals. Healthcare (Basel) 2023; 11:healthcare11040542. [PMID: 36833076 PMCID: PMC9957071 DOI: 10.3390/healthcare11040542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 02/01/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023] Open
Abstract
Elderly persons are at risk of infection due to underlying diseases and weak immune systems. All elderly persons do not require hospitalization in LTCHs, even if have chronic illness or weakened immune systems, but they require care in long-term care hospitals (LTCHs) that have well-trained infection control practitioners (ICPs). This study aimed to develop an educational-training programme for ICPs working in LTCHs using the Developing A Curriculum (DACUM) method. Based on the results of the literature review and the DACUM committee workshop, 12 duties and 51 tasks of ICPs were identified. A total of 209 ICPs participated in the survey, rating 12 duties and 51 tasks on a 5-point scale in terms of frequency, importance, and difficulty. An educational-training programme consisting of five modules was developed, focusing on tasks higher than the mean for each of frequency (2.71 ± 0.64), importance (3.90 ± 0.05), and difficulty (3.67 ± 0.44). Twenty nine ICPs participated in a pilot educational-training programme. The mean programme satisfaction level was 93.23 (standard deviation: ±3.79 points) out of 100 points. The average total knowledge and skill scores were significantly higher after the programme (26.13 ± 1.09, 24.91 ± 2.46, respectively) than before the programme (18.89 ± 2.39, 13.98 ± 3.56, respectively) (p < 0.001, p < 0.001, respectively). This programme will improve the knowledge and skills of ICPs, and thereby contribute to the reduction in healthcare-associated infections in LTCHs.
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Affiliation(s)
- Sun Young Jeong
- College of Nursing, Konyang University, Daejeon 35365, Republic of Korea
| | - Og Son Kim
- Department of Nursing, Gangseo University, Seoul 07630, Republic of Korea
- Correspondence:
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Dekker M, Jongerden IP, Caris MG, de Bruijne MC, Vandenbroucke-Grauls CMJE, van Mansfeld R. Evaluation of an infection control link nurse program: an analysis using the RE-AIM framework. BMC Health Serv Res 2023; 23:140. [PMID: 36759832 PMCID: PMC9912654 DOI: 10.1186/s12913-023-09111-5] [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: 10/27/2022] [Accepted: 01/25/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Important elements of programs that train and support infection control link nurses (ICLN) are the engagement of stakeholders, support from hospital and ward management and a structure for iterative improvement. The effects of programs, that combine all these elements, are unknown. We evaluated such a comprehensive program to explore its impact on link nurses and infection prevention practices and routines. METHODS We used the RE-AIM framework, a robust, evidence-based framework within the field of Implementation Science, to evaluate the impact of our ICLN training and support program. We used a mixed methods approach and organized the outcomes along its five dimensions: Reach, Effectiveness, Adoption, Implementation and Maintenance. RESULTS Between 2014 and 2018, on average 91% of the inpatient wards and 58% of the outpatient clinics participated in the program (Reach) and impacted guideline adherence in inpatient wards. Link nurses felt engaged and empowered, and perceived their contribution to these results as pivotal. Ward managers confirmed the value of ICLN to help with implementing IPC practices (Effectiveness). The program was adopted both at the hospital and at the ward level (Adoption). Based on ongoing evaluations, the program was adapted by refining education, training and support strategies with emphasis on ward specific aspects (Implementation). The ICLN program was described as a key component of the infection prevention policy to sustain its effects (Maintenance). CONCLUSIONS Our infection control link nurse program helped ICLN to improve infection prevention practices, especially in inpatient wards. The key to these improvements lay within the adaptability of our link nurse program. The adjustments to the program led to a shift of focus from hospital goals to goals tailored to the ward level. It allowed us to tailor activities to align them with the needs specific to each ward.
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Affiliation(s)
- Mireille Dekker
- Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV, Amsterdam, The Netherlands.
| | - Irene P. Jongerden
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Martine G. Caris
- grid.12380.380000 0004 1754 9227Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
| | - Martine C. de Bruijne
- grid.12380.380000 0004 1754 9227Department of Public and Occupational Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Christina M. J. E. Vandenbroucke-Grauls
- grid.12380.380000 0004 1754 9227Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands ,grid.7048.b0000 0001 1956 2722Department of Clinical Medicine – Department of Clinical Epidemiology, Aarhus University, Aarhus, Denmark
| | - Rosa van Mansfeld
- grid.12380.380000 0004 1754 9227Department of Medical Microbiology and Infection Prevention, Amsterdam UMC, Vrije Universiteit Amsterdam, De Boelelaan 1118, 1081 HV Amsterdam, The Netherlands
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Biscione A, Corrado G, Quagliozzi L, Federico A, Franco R, Franza L, Tamburrini E, Spanu T, Scambia G, Fagotti A. Healthcare associated infections in gynecologic oncology: clinical and economic impact. Int J Gynecol Cancer 2023; 33:278-284. [PMID: 36581487 DOI: 10.1136/ijgc-2022-003847] [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: 12/31/2022] Open
Abstract
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.
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Affiliation(s)
- Antonella Biscione
- Department for Women's and Children's Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Giacomo Corrado
- Department for Women's and Children's Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Lorena Quagliozzi
- Department for Women's and Children's Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Alex Federico
- Department for Women's and Children's Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Rita Franco
- Department for Women's and Children's Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Laura Franza
- Department of Infectious Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Enrica Tamburrini
- Department of Infectious Diseases, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Teresa Spanu
- Department of Laboratory and Infectious Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Giovanni Scambia
- Department for Women's and Children's Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, Roma, Italy
| | - Anna Fagotti
- Department for Women's and Children's Health and Public Health, Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.,Universita Cattolica del Sacro Cuore Facolta di Medicina e Chirurgia, Roma, Italy
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Stead S, Vogt L, Antons D, Salge TO, Gecht J, Klasen M, Sopka S. Hospital resource endowments and nosocomial infections: longitudinal evidence from the English National Health Service on Clostridioides difficile between 2011 and 2019. J Hosp Infect 2023; 134:129-137. [PMID: 36750139 DOI: 10.1016/j.jhin.2023.01.014] [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: 10/27/2022] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To identify key factors associated with Clostridioides difficile infections (CDIs) in healthcare at the hospital organization level. DESIGN Longitudinal study covering the period 2011-2019. Hospital reports were analysed to determine the number of CDIs and several hospital-related environmental factors: financial resources (i.e., cleaning expenditure), spatial resources (i.e., number of single rooms with a private bathroom), human resources (i.e., number of physicians and nursing staff) and cultural resources (i.e., error reporting climate). The relationships between the environmental factors and CDIs were analysed in a hybrid within- and between-hospital random-effect model. SETTING A total of 129 general hospital Trusts operating in the English National Health Service (NHS). PARTICIPANTS All inpatients in 129 general hospital trusts of the NHS in the years 2011-2019, covering 120,629 cases of CDI. MAIN OUTCOME MEASURE Annual number of CDIs per hospital trust. RESULTS Single rooms were associated with fewer CDIs at the within-hospital level, but not at the between-hospital level. Similarly, more nursing staff was associated with fewer CDIs at the within-hospital level, but not at the between-hospital level. This effect was not observed for physician staffing. A different picture emerged for the protective effect of cultural resources, with a weakly significant effect of between-hospital differences, but no within-hospital effect. Financial resources were not associated with CDIs either between hospitals or within them over time. CONCLUSIONS The present study identified hospital resources with a beneficial influence on CDI rates. Healthcare organizations can use this knowledge for active CDI prevention.
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Affiliation(s)
- S Stead
- Institute for Technology and Innovation Management, RWTH Aachen University, Aachen, Germany
| | - L Vogt
- Department of Anaesthesiology, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany; AIXTRA - Interdisciplinary Center for Training and Patient Safety, Medical Faculty RWTH Aachen, Aachen, Germany.
| | - D Antons
- Institute for Technology and Innovation Management, RWTH Aachen University, Aachen, Germany
| | - T O Salge
- Institute for Technology and Innovation Management, RWTH Aachen University, Aachen, Germany
| | - J Gecht
- Department of Anaesthesiology, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany; AIXTRA - Interdisciplinary Center for Training and Patient Safety, Medical Faculty RWTH Aachen, Aachen, Germany
| | - M Klasen
- Department of Anaesthesiology, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany; AIXTRA - Interdisciplinary Center for Training and Patient Safety, Medical Faculty RWTH Aachen, Aachen, Germany
| | - S Sopka
- Department of Anaesthesiology, Medical Faculty, University Hospital RWTH Aachen, Aachen, Germany; AIXTRA - Interdisciplinary Center for Training and Patient Safety, Medical Faculty RWTH Aachen, Aachen, Germany
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Rickert J. On Patient Safety: Combating Antibiotic Resistance With Effective Hand Hygiene. Clin Orthop Relat Res 2023; 481:219-221. [PMID: 36534111 PMCID: PMC10482084 DOI: 10.1097/corr.0000000000002527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022]
Affiliation(s)
- James Rickert
- President, The Society for Patient Centered Orthopedics, Bloomington, IN, USA
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Dreikausen L, Blender B, Trifunovic-Koenig M, Salm F, Bushuven S, Gerber B, Henke M. Analysis of microbial contamination during use and reprocessing of surgical instruments and sterile packaging systems. PLoS One 2023; 18:e0280595. [PMID: 36668667 PMCID: PMC9858816 DOI: 10.1371/journal.pone.0280595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 01/03/2023] [Indexed: 01/21/2023] Open
Abstract
A surgical site infection (SSI) is one of the most common surgical complications. This study analyzed different sources of microorganisms in the air, on reusable surgical instruments, and the outer surface of sterile packaging systems during the use and reprocessing of sterile goods (from the operating room (OR) to the Central Sterile Supply Department (CSSD)). The microbial load in the air was analyzed via active air sampling and settle plates. Furthermore, the airborne particle load was measured by a particle counter. Contact agar plates were used to determine the microbial load on surgical instruments and sterile packaging systems. The highest average microbial and particle load was measured in the air of the OR (active air sampling: max. 56 CFU/m3; settle plates: max. 9 CFU; ≥0.3 μm particles in size: 1,958,403 no./m3). However, no microbial load (0 CFU) was detected on surgical instruments sampled in the OR. The outer surface of stored sterile packaging systems showed a maximal microbial load of 64 CFU. The most common identified pathogen was coagulase-negative staphylococci. Compared to properly reprocessed reusable surgical instruments and sterile packaging systems, the air still seems to be the primary potential source of microbial contamination, especially within the OR.
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Affiliation(s)
- Lena Dreikausen
- Front End Innovation & Materials (FEIM), Aesculap AG, Tuttlingen, Germany
| | - Bernd Blender
- Front End Innovation & Materials (FEIM), Aesculap AG, Tuttlingen, Germany
| | - Milena Trifunovic-Koenig
- Institute for Infection Control and Infection Prevention, Health Care Association District of Constance, Konstanz, Germany
| | - Florian Salm
- Institute for Infection Control and Infection Prevention, Health Care Association District of Constance, Konstanz, Germany
| | - Stefan Bushuven
- Institute for Infection Control and Infection Prevention, Health Care Association District of Constance, Konstanz, Germany
| | - Bianka Gerber
- Institute for Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Hegau Bodensee Hospital Singen, Singen, Germany
| | - Matthias Henke
- Front End Innovation & Materials (FEIM), Aesculap AG, Tuttlingen, Germany
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Robinson J, Price L, Otter J, Burnett E. Designing an optimal infection prevention service: Part 2. J Infect Prev 2023; 24:11-22. [PMID: 36644523 PMCID: PMC9834426 DOI: 10.1177/17571774221127573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/04/2022] [Indexed: 01/18/2023] Open
Abstract
Background The importance of infection prevention and control (IPC) services to prevent threats from healthcare-associated infections and improve the quality of healthcare delivery is undeniable. However, IPC services across the UK and Ireland have substantial variability in terms of team structures and delivery models. Aim The aim of this study was to define an optimal IPC service in different contexts and settings within the United Kingdom and Ireland. Methods This mixed methods study adopted discussion huddles with IPC teams to explore various components of IPC programmes and services. A Nominal Group technique was then undertaken to achieve a group consensus of what an optimal infection prevention service should look like. Results Five discussion huddles were conducted which included 53 participants in total. Key themes arising were IPC Service Priorities, IPC Service Enablers for Success, and Necessary Skills and Expertise Required for Delivering an Effective IPC Service. For the nominal technique, 45 responses were identified which were determining the key priorities for an effective IPC service and 69 responses for establishing key enablers for success. Discussion These findings supported the development of a conceptual model for designing an optimal infection prevention service, which can be used to develop IPC services at an international, national, regional and local level. A focus is required around implementation of these highlighted enablers, so are effectively embedded into infection prevention and control services, and wider healthcare settings.
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Affiliation(s)
- Jude Robinson
- Infection Prevention and control, NHS England and Improvement, Midlands, UK
| | - Lesley Price
- School of Health and life sciences, Glasgow Caledonian University, Glasgow, UK
| | - Jon Otter
- Infection Prevention and control, Guy’s and St Thomas NHS, London, UK
| | - Emma Burnett
- Fatima College of Health Sciences, Al Ain, United Arab Emirates
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Arvidsson L, Skytt B, Lindberg M, Lindberg M. Nurses' assessed self-efficacy levels to medical asepsis and their relation to structural empowerment, work engagement and work-related stress. Work 2023; 74:501-513. [PMID: 36314182 PMCID: PMC9986691 DOI: 10.3233/wor-211305] [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: 10/20/2021] [Accepted: 01/25/2022] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Nurses' working conditions are important for their well-being at work and for their ability to provide patients with safe care. Self-efficacy can influence employees' behaviour at work. Therefore, it is valuable to study self-efficacy levels to medical asepsis in relation to working conditions. OBJECTIVE To investigate the relationship between nurses' assessed self-efficacy levels to medical asepsis in care situations and structural empowerment, work engagement and work-related stress. METHODS A cross-sectional study with a correlational design was conducted. A total of 417 registered nurses and licensed practical nurses at surgical and orthopaedic units responded to a questionnaire containing: the Infection Prevention Appraisal Scale, the Conditions of Work Effectiveness Questionnaire-II, the Utrecht Work Engagement Scale-9 and the Health & Safety Executive Management Standards Indicator Tool. Correlational analyses and group comparisons were performed. RESULTS The nurses rated high levels of self-efficacy to medical asepsis in care situations. The correlational analyses revealed that correlation coefficients between structural empowerment, work engagement, work-related stress and self-efficacy to medical asepsis were 0.254-0.268. Significant differences in self-efficacy were found in the grouped working conditions. CONCLUSIONS This study revealed that nurses rated high self-efficacy levels to medical asepsis and, to some extent, this seemed related to structural empowerment, work engagement and work-related stress. This valuable knowledge could enable improvements at the managerial and organisational levels, benefiting both nurses and patients in the long run.
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Affiliation(s)
- Lisa Arvidsson
- Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
| | - Bernice Skytt
- Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Maria Lindberg
- Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
- Centre for Research and Development, Uppsala University/County Council of Gävleborg, Gävle, Sweden
| | - Magnus Lindberg
- Department of Caring Sciences, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden
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Burnett E, Cooper T, Wares K, Wigglesworth N, Chiwera L, Settle C, Robinson J. Designing an optimal infection prevention service: Part 1. J Infect Prev 2023; 24:3-10. [PMID: 36644524 PMCID: PMC9834424 DOI: 10.1177/17571774221127695] [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: 04/14/2022] [Accepted: 09/04/2022] [Indexed: 01/18/2023] Open
Abstract
Background Healthcare-associated infections (HCAIs) pose a significant threat to the health and safety of patients, staff, and visitors. Infection prevention and control (IPC) teams play a crucial role in ensuring that systems and processes are in place to keep everyone safe within the healthcare environment. Aim The aim of this study was to identify components of infection prevention services, priorities, indicators of successes and how they are measured, and facilitators and barriers to success. Methods A survey questionnaire was developed and circulated to infection prevention leaders and managers. Findings/results Seventy IPC leaders/managers completed the survey. Participants were responsible for a range of IPC services within and across healthcare organisations, with significant variations to IPC delivery components. Additionally, a range of budget availability was reported. Several IPC service requirements were considered core work of IPC teams, including providing IPC advice and support, surveillance and audit and education and training. Discussion An optimal IPC service needs to be in place to ensure HCAIs are minimised or prevented. In a post pandemic era, this is more important than ever before. This is also as crucial for the health and wellbeing of those working in IPC, who have endured unprecedented demand for their services during the pandemic.
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Affiliation(s)
- Emma Burnett
- Health Sciences, Fatima College of Health Sciences, Abu Dhabi, United Arab Emirates
| | - Tracey Cooper
- Infection Prevention, Worcestershire Acute Hospitals NHS Trust, Worcester, UK
| | | | | | | | - Chris Settle
- South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
| | - Jude Robinson
- Infection prevention and Control, NHS England-Midlands, Nottinghamshire, UK
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van Dijk MD, Voor In 't Holt AF, Alp E, Hell M, Petrosillo N, Presterl E, Tsakris A, Severin JA, Vos MC. Infection prevention and control policies in hospitals and prevalence of highly resistant microorganisms: an international comparative study. Antimicrob Resist Infect Control 2022; 11:152. [PMID: 36474304 PMCID: PMC9727845 DOI: 10.1186/s13756-022-01165-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/20/2022] [Accepted: 10/08/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND There are differences in infection prevention and control (IPC) policies to prevent transmission of highly resistant microorganisms (HRMO). The aim of this study is to give an overview of the IPC policy of six European hospitals and their HRMO prevalence, to compare the IPC policies of these hospitals with international guidelines, and to investigate the hospitals' adherence to their own IPC policy. METHODS The participating hospitals were located in Salzburg (Austria), Vienna (Austria), Kayseri (Turkey), Piraeus (Greece), Rome (Italy) and Rotterdam (The Netherlands). Data were collected via an online survey. Questions were aimed at prevalence rates in the years 2014, 2015, 2016 of carbapenemase-producing Klebsiella pneumoniae (CPK), carbapenemase-producing Pseudomonas aeruginosa (CPPA), vancomycin-resistant Enterococcus faecium (VRE) and hospitals' IPC policies of 2017. Implemented IPC measures (i.e. with a self-reported adherence of > 90%) were counted (26 points maximal). RESULTS The self-reported prevalence of CPK per year was low in the Austrian and Dutch hospitals and high in the Turkish and Greek hospitals. CPPA was highly prevalent in the Turkish hospital only, while the prevalence of VRE in four hospitals, except the Austrian hospitals which reported lower prevalence numbers, was more evenly distributed. The Dutch hospital had implemented the most IPC measures (n = 21), the Turkish and Greek hospitals the least (n = 14 and 7, respectively). CONCLUSION Hospitals with the highest self-reported prevalence of CPK and CPPA reported the least implemented IPC measures. Also, hospitals with a higher prevalence often reported a lower adherence to own IPC policy.
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Affiliation(s)
- Manon D van Dijk
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Anne F Voor In 't Holt
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Emine Alp
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Erciyes University, Kayseri, Turkey
- Department of Infectious Diseases and Clinical Microbiology, Medical Faculty, Ankara Yıldırım Beyazıt University, Ankara, Turkey
| | - Markus Hell
- Department of Clinical Microbiology and Infection Control, MEDILAB-Academic Teaching Laboratories, Paracelsus Medical University, Salzburg, Austria
- Teaching Hospital, Kardinal Schwarzenberg Klinikum, Paracelsus Medical University, Schwarzach, Austria
| | - Nicola Petrosillo
- Clinical and Research Department for Infectious Diseases, National Institute for Infectious Diseases "Lazzaro Spallanzani", Rome, Italy
- Department of Infection Control, University Hospital Campus Bio-Medico, Rome, Italy
| | - Elisabeth Presterl
- Department of Infection Control and Hospital Epidemiology, Medical University of Vienna, Vienna, Austria
| | - Athanasios Tsakris
- Department of Microbiology, Medical School, University of Athens, Athens, Greece
| | - Juliëtte A Severin
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Margreet C Vos
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Centre Rotterdam, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands
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Ni K, Jin D, Wu Z, Sun L, Lu Q. The status of infection prevention and control structures in Eastern China based on the IPCAF tool of the World Health Organization. Antimicrob Resist Infect Control 2022; 11:46. [PMID: 35264208 PMCID: PMC8905555 DOI: 10.1186/s13756-022-01087-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/23/2022] [Indexed: 11/10/2022] Open
Abstract
Background The burden of healthcare-associated infections (HAIs) and the spread of antimicrobial resistance can be potentially preventable through comprehensive infection prevention and control (IPC) programs. However, information on the current state of IPC implementation is rare in China. Methods A cross-sectional study was conducted in Zhejiang province, China, from April to June 2021. The Zhejiang nosocomial infection control and quality improvement center (NICQI) cooperated with 11 municipal NICQI centers to introduce the purpose of this study and invite all licensed secondary and tertiary hospitals in Zhejiang province through WeChat group. The questionnaire had three sections, including information about participating hospitals, demographic information about IPs, and the Chinese version of the Infection Prevention and Control Assessment Framework that covered eight core components (CC).
Results Of the 382 hospitals invited, 222 (58.1% response rate) accepted and completed the online questionnaire. The overall median score of the participating hospitals was 682 (630–723), which corresponded to an advanced level of IPC. There was a significant difference in scores between hospitals types (P < 0.001). Profound differences were revealed regarding the scores of the individual components, with CC2 (IPC guidelines) and CC6 (Monitoring/audit of IPC practices and feedback) having the highest (100) and lowest (65) median scores, respectively. Only 23 (10.4%) hospitals reported assessing facility safety culture. Conclusions IPC structures are at a relatively high level in acute care hospitals in Eastern China. The identified potential areas for improvement were similar to those identified in developed countries, particularly regarding multimodal strategies for implementation and safety culture construction. Meanwhile, the Chinese government should pay more attention to IPC resources and practices among secondary care hospitals. Supplementary Information The online version contains supplementary material available at 10.1186/s13756-022-01087-x.
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Berthod D, Alvarez D, Perozziello A, Chabrol F, Lucet JC. Are there reasons behind high Handrub consumption? A French National in-depth qualitative assessment. Antimicrob Resist Infect Control 2022; 11:42. [PMID: 35197124 PMCID: PMC8867886 DOI: 10.1186/s13756-022-01074-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Accepted: 01/31/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Hand hygiene (HH) is the most important measure for preventing healthcare-associated infections. A significant correlation between alcohol-based handrub consumption (AHRC) and observed HH compliance rates has been established. In France, publicly reported AHRC displayed a large heterogeneity across healthcare facilities (HCFs). We aimed to describe programmes for promoting HH in the top and medium AHRC scorers and to assess factors and drivers leading to a high AHRC score in a panel of French HCFs.
Methods
We performed a nationwide qualitative comparative case study based on in-depth semi-structured interviews in 16 HCFs with high, 4-year AHRC scores, and a sample of seven university hospitals (UHs) with medium AHRC scores. Infection Prevention and Control Team (IPC) members (n = 62), quality managers/chief executive officers (n = 23) and frontline workers (n = 6) were interviewed, using a grounded theory approach and an iterative thematic approach.
Results
Ninety-one interviews were performed. There was a large heterogeneity in IPC structures and objectives, with specific patterns associated with high AHRC that were more organisational than technical. Four areas emerged: (1) strong cohesive team structure with supportive and outcome-oriented work attitude, (2) IPC structure within the organization, (3) active support from the institution, (4) leadership and role model. Among high AHRC scorers, a good core IPC organisation, a proactive and flexible management, a frequent presence in the clinical wards, and working in a constructive safety climate were prominent.
Conclusion
We highlighted that IPC structure and activity is heterogeneous, with organisational and behavioural characteristics associated with high AHRC score. Beyond technical challenge, our work underlines the importance of strong structure of the IPC and behavioural approaches in implementing key IPC programmes.
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Jeong Y. Status of infection prevention and control capacity in Korean hospitals: implications for disaster response and pandemic preparedness. Public Health 2022; 213:100-106. [PMID: 36402088 DOI: 10.1016/j.puhe.2022.10.008] [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: 06/20/2022] [Revised: 09/08/2022] [Accepted: 10/05/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study aims to explore the association of hospital infection prevention and control (IPC) structure (i.e. a dedicated IPC team and/or IPC committee) and IPC capacity in Korean hospitals, as well as its implications in the response and preparedness to COVID-19. STUDY DESIGN This was a cross-sectional study using data collected through a nationwide survey. METHODS Participating hospitals completed an online questionnaire. Participation was voluntary. The survey questionnaire was developed by the government in consultation with IPC experts. The questionnaire was distributed to 2108 hospitals, including both acute and long-term care hospitals. The independent variables were the presence of an IPC team and/or IPC committee. The dependent variables were IPC activities and capacity measures, which were based on the World Health Organisation (WHO) recommendations on the core components in IPC. RESULTS A total of 1442 hospitals completed the survey. Hospitals with IPC structures conducted significantly more IPC activities in all outcome measures compared with hospitals without IPC structures, with the exceptions of monitoring hand hygiene and screening for infectious diseases that showed non-significant differences. Hospitals with IPC structures showed a significant difference in performance in IPC risk assessment, operating outbreak response teams and appraisal of hospital IPC policies compared with hospitals without IPC structures. CONCLUSIONS The presence of a dedicated IPC team and IPC committee was associated with increased IPC activities and IPC capacity. Hospitals with IPC teams and IPC committees showed strong implementation of planning, appraisal, resource management and outbreak response, indicating that strengthening IPC structures within hospitals is the key to more effective IPC and disaster response.
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Affiliation(s)
- Y Jeong
- Ministry of Health and Welfare, Sejong, Republic of Korea.
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Jeong Y, Joo H, Bahk H, Koo H, Lee H, Kim K. A nationwide survey on the implementation of infection prevention and control components in 1442 hospitals in the Republic of Korea: comparison to the WHO Infection Prevention and Control Assessment Framework (IPCAF). Antimicrob Resist Infect Control 2022; 11:71. [PMID: 35562838 PMCID: PMC9101985 DOI: 10.1186/s13756-022-01107-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 04/27/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
The current SARS-CoV-2 pandemic continues to underscore the inadequacy of infection prevention and control (IPC) and the importance of its sound establishment in healthcare facilities. The Infection Prevention and Control Assessment Framework (IPCAF) by the World Health Organization allows systematic assessment of IPC capacity in healthcare facilities and has been applied in many national-level surveys. This study aims to assess the IPC capacity of Korean hospitals as well as their strengths and pitfalls by analyzing the results of the first government-led nationwide IPC survey in comparison to the IPCAF frame.
Methods
The Korean National Infection Prevention and Control Survey (KNIPCS) was conducted from February to March 2018. The survey questionnaire for KNIPCS was developed through a series of expert consultations and a round of pre-testing in two randomly selected hospitals. The survey questionnaire was distributed to a total of 2108 hospitals. Although the survey preceded the release of IPCAF, its contents complied with IPCAF to a large extent, allowing exploration of its results with regards to IPCAF.
Results
All tertiary hospitals and 96.5% of general hospitals had implemented IPC teams, whereas the percentage was lower for long-term care hospitals (6.3%). A similar trend was observed for IPC surveillance and monitoring activities across hospital types. The percentage of interactive IPC training was lower than 30% in all hospital groups. Disinfection was frequently monitored in all hospital types (e.g. 97.3% in general hospitals and 85.3% in long-term care hospitals). However, activities regarding antimicrobial resistance, such as multi-drug resistant pathogen screening, were weak in hospitals (25%) and long-term care hospitals (25%), compared to tertiary hospitals (83.3%) and general hospitals (57.7%).
Conclusions
In general, essential IPC structures, such as IPC teams and programs, were well in place in most tertiary and general hospitals in Korea. These hospital groups also actively conducted various IPC activities. As most previous legislative and multimodal policy measures have targeted these hospital groups, we speculate that future policy efforts should encompass long-term care hospitals and smaller-sized hospitals to strengthen the IPC capacity of these hospital groups. Efforts should also be put forth to promote IPC training and antimicrobial activities.
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Gomes DJ, Hazim C, Safstrom J, Herzig C, Luvsansharav U, Dennison C, Ahmed Y, Wesangula E, Hokororo J, Amone J, Tekle B, Owiso G, Mutayoba R, Lamorde M, Akello E, Kassa G, Feleke B, Ndegwa L, Kazaura K, Musisi D, Date A, Park BJ, Bancroft E. Infection Prevention and Control Initiatives to Prevent Healthcare-Associated Transmission of SARS-CoV-2, East Africa. Emerg Infect Dis 2022; 28:S255-S261. [PMID: 36502401 DOI: 10.3201/eid2813.212352] [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] [Indexed: 12/12/2022] Open
Abstract
The coronavirus disease pandemic has highlighted the need to establish and maintain strong infection prevention and control (IPC) practices, not only to prevent healthcare-associated transmission of SARS-CoV-2 to healthcare workers and patients but also to prevent disruptions of essential healthcare services. In East Africa, where basic IPC capacity in healthcare facilities is limited, the US Centers for Disease Control and Prevention (CDC) supported rapid IPC capacity building in healthcare facilities in 4 target countries: Tanzania, Ethiopia, Kenya, and Uganda. CDC supported IPC capacity-building initiatives at the healthcare facility and national levels according to each country's specific needs, priorities, available resources, and existing IPC capacity and systems. In addition, CDC established a multicountry learning network to strengthen hospital level IPC, with an emphasis on peer-to-peer learning. We present an overview of the key strategies used to strengthen IPC in these countries and lessons learned from implementation.
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Wen R, Li X, Liu T, Lin G. Effect of a real-time automatic nosocomial infection surveillance system on hospital-acquired infection prevention and control. BMC Infect Dis 2022; 22:857. [DOI: 10.1186/s12879-022-07873-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 11/11/2022] [Indexed: 11/17/2022] Open
Abstract
Abstract
Background
The systematic collection of valid data related to hospital-acquired infections (HAIs) is considered effective for nosocomial infection prevention and control programs. New strategies to reduce HAIs have recently fueled the adoption of real-time automatic nosocomial infection surveillance systems (RT-NISSs). Although RT-NISSs have been implemented in some hospitals for several years, the effect of RT-NISS on HAI prevention and control needs to be further explored.
Methods
A retrospective, descriptive analysis of inpatients from January 2017 to December 2019 was performed. We collected hospital-acquired infection (HAI) cases and multidrug resistant organism (MDRO) infection cases by traditional surveillance in period 1 (from January 2017 to December 2017), and these cases were collected in period 2 (from January 2018 to December 2018) and period 3 (from January 2019 to December 2019) using a real-time nosocomial infection surveillance system (RT-NISS). The accuracy of MDRO infection surveillance results over the 3 periods was examined. The trends of antibiotic utilization rates and pathogen culture rates in periods 2 and 3 were also analysed.
Results
A total of 114,647 inpatients, including 2242 HAI cases, were analysed. The incidence of HAIs in period 2 was significantly greater than that in period 1 (2.28% vs. 1.48%, χ2 = 61.963, p < 0.001) and period 3 (2.28% vs. 2.05%, χ2 = 4.767, p = 0.029). The incidence of five HAI sites, including respiratory infection, urinary tract infection (UTI), surgical site infection (SSI), bloodstream infection (BSI) and skin and soft tissue infection, was significantly greater in period 2 compared with period 1 (both p < 0.05) but was not significantly different from that in period 3. The incidence of hospital-acquired MDRO infections in period 3 was lower than that in period 2. The identification of MDRO infection cases using the RT-NISS achieved a high level of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV), especially in period 3 (Se = 100%, Sp = 100%, PPV = 100% and NPV = 100%).
Conclusion
The adoption of a RT-NISS to adequately and accurately collect HAI cases is useful to prevent and control HAIs. Furthermore, RT-NISSs improve accuracy in MDRO infection case reporting, which can timely and accurately guide and supervise clinicians in implementing MDRO infection prevention and control measures.
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Microbiology and Clinical Outcome of Hospital-Acquired Respiratory Infections in an Italian Teaching Hospital: A Retrospective Study. Healthcare (Basel) 2022; 10:healthcare10112271. [PMID: 36421594 PMCID: PMC9691183 DOI: 10.3390/healthcare10112271] [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: 10/06/2022] [Revised: 11/03/2022] [Accepted: 11/09/2022] [Indexed: 11/16/2022] Open
Abstract
The burden, microbial etiology and clinical impact of hospital-acquired respiratory infections (HARIs) were determined at an Italian teaching hospital over a 12-month period. For this purpose, overall ordinary hospitalizations ≥ 2 days of subjects over 18 years old with discharge from 1 January 2018 to 31 December 2018 were examined by cross-referencing demographic and clinical data from hospital discharge forms with microbiological data from the computer system of the Microbiology Unit. We identified 329 individuals with HARIs (96 females and 233 males; median age 70 years, range 18−93), who represented ¼ of the total hospital-acquired infections (HAIs) in the period. The inpatient setting was medical and surgical in similar proportions (169 vs. 160, respectively) and the mean hospital stay was 38.9 ± 33.6 days. One hundred and forty patients (42.6% of the total sample) were suffering from one or more chronic diseases. A total of 581 microorganisms (82 antibiotic-resistant and 499 non-resistant) were detected in HARI patients. The most common isolated species were Staphylococcus aureus (16.7%), Klebsiella pneumoniae (13.3%), Pseudomonas spp. (12.6%) and Acinetobacter baumannii (10.5%), followed by Enterobacter spp. (5.3%), Escherichia coli (5.2%) and Enterococcus spp. (4.8%). One hundred and sixty-seven individuals (49.0% of the total) had polymicrobial infections. One hundred thirty-one patients (39.8% of the total) underwent endotracheal intubation and mechanical ventilation and 62.6% of them died, compared to 17.7% of the non-intubated patients. Multivariable analysis confirmed a positive correlation between death and increased age (p = 0.05), surgical MDC (p = 0.007), number of microorganisms over the sample mean (p = 0.001), the presence of chronic diseases (p = 0.046), and intubation and mechanical ventilation (p < 0.0001). A positive correlation between intubation and antibiotic-resistant organisms (p = 0.003) was also found. HARIs are still a major public health problem and require constant surveillance due to their severe clinical outcome.
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Nomoto H, Saito H, Ishikane M, Gu Y, Ohmagari N, Pittet D, Kunishima H, Allegranzi B, Yoshida M. First nationwide survey of infection prevention and control among healthcare facilities in Japan: impact of the national regulatory system. Antimicrob Resist Infect Control 2022; 11:135. [PMID: 36352429 PMCID: PMC9647990 DOI: 10.1186/s13756-022-01175-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Accepted: 10/26/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Infection prevention and control (IPC) measures in Japan are facilitated by a financial incentive process at the national level, where facilities are categorized into three groups (Tier 1, Tier 2, or no financial incentive). However, its impact on IPC at the facility level using a validated tool has not been measured. METHODS A nationwide cross-sectional study was conducted from August 2019 to January 2020 to evaluate the situation of IPC programs in Japan, using the global IPC Assessment Framework (IPCAF) developed by the World Health Organization. Combined with the information on the national financial incentive system, the demographics of facilities and each IPCAF item were descriptively analyzed. IPCAF scores were analyzed according to the facility level of care and the national financial incentive system for IPC facility status, using Dunn-Bonferroni and Mann-Whitney U tests. RESULTS Fifty-nine facilities in Japan responded to the IPCAF survey: 34 private facilities (57.6%) and 25 public facilities (42.4%). Of these, 11 (18.6%), 29 (49.2%), and 19 (32.3%) were primary, secondary, and tertiary care facilities, respectively. According to the national financial incentive system for IPC, 45 (76.3%), 11 (18.6%), and three (5.1%) facilities were categorized as Tier 1, Tier 2, and no financial incentive system, respectively. Based on the IPCAF total score, more than half of the facilities were categorized as "Advanced" (n = 31, 55.3%), followed by "Intermediate" (n = 21, 37.5%). The IPCAF total score increased as the facility level of care increased, while no statistically significant difference was identified between the secondary and tertiary care facilities (p = 0.79). There was a significant difference between Tier 1 and Tier 2 for all core components and total scores. Core components 5 (multimodal strategies for implementation of IPC interventions) and 6 (monitoring/audit of IPC and feedback) were characteristically low in Japan with a median score of 65.0 (interquartile range 40.0-85.0) and 67.5 (interquartile range 52.5-87.5), respectively. CONCLUSIONS The national financial incentive system was associated with IPC programs at facility level in Japan. The current financial incentive system does not emphasize the multimodal strategy or cover monitoring/audit, and an additional systematic approach may be required to further promote IPC for more practical healthcare-associated infection prevention.
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Affiliation(s)
- Hidetoshi Nomoto
- grid.45203.300000 0004 0489 0290Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan ,grid.69566.3a0000 0001 2248 6943Emerging and Re-emerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Miyagi, Japan
| | - Hiroki Saito
- grid.8591.50000 0001 2322 4988Faculty of Medicine, Institute of Global Health, University of Geneva, Geneva, Switzerland ,grid.412764.20000 0004 0372 3116Department of Emergency and Critical Care Medicine, St. Marianna University School of Medicine Yokohama Seibu Hospital, Kanagawa, Japan ,grid.45203.300000 0004 0489 0290AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Masahiro Ishikane
- grid.45203.300000 0004 0489 0290Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan ,grid.45203.300000 0004 0489 0290AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Yoshiaki Gu
- grid.265073.50000 0001 1014 9130Department of Infectious Diseases, Tokyo Medical and Dental University, Tokyo, Japan
| | - Norio Ohmagari
- grid.45203.300000 0004 0489 0290Disease Control and Prevention Center, National Center for Global Health and Medicine, Tokyo, Japan ,grid.69566.3a0000 0001 2248 6943Emerging and Re-emerging Infectious Diseases, Graduate School of Medicine, Tohoku University, Miyagi, Japan ,grid.45203.300000 0004 0489 0290AMR Clinical Reference Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Didier Pittet
- grid.150338.c0000 0001 0721 9812Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Hiroyuki Kunishima
- grid.412764.20000 0004 0372 3116Department of Infectious Diseases, St Marianna University School of Medicine, Kanagawa, Japan
| | - Benedetta Allegranzi
- grid.3575.40000000121633745Infection Prevention and Control Hub, Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Masaki Yoshida
- grid.411898.d0000 0001 0661 2073Department of Infectious Diseases and Infection Control, The Jikei University School of Medicine, Tokyo, Japan
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