Development and evaluation of an ultra-wide bandwidth based electronic hand hygiene monitoring system

BACKGROUND

A large variety of electronic hand hygiene monitoring systems (EHHMS) are being developed and applied in health care settings. Monitoring hand hygiene (HH) opportunity at bed-level has been the key technical challenge. Accuracy evaluation needs more attention as the prerequisite upon widespread acceptance and adoption.

METHODS

For the first time, we explored, debugged and upgraded an EHHMS based on ultra-wide bandwidth (UWB) which can obtain HH opportunities at bed-level. The real-time positioning and electronic fence of UWB technology was applied for EHHMS. The accuracy of EHHMS was compared with the simultaneous manual direct observations in real-world clinical setting. Sensitivity and specificity were calculated for EHHMS capturing HH action and opportunity.

RESULTS

Two generations of EHHMS were constructed. For the first generation, the system properly recorded 84% and 78% of the pre-identified HH actions and opportunities performed by experimenters. For the second generation, sensitivity and specificity of the system capturing HH action were 89% (84.83-92.36) and 100% (98.26-100.00), respectively. For capturing HH opportunity, the system showed the sensitivity and specificity of 86.52% (82.52-89.89) and 88.10% (84.14-91.36)), respectively.

CONCLUSION

The EHHMS based on UWB could accurately identify HH action and opportunity with equivalent accuracy compared with simultaneous direct observation.

Vaccine or Garlic-Is It a Choice? Awareness of Medical Personnel on Prevention of Influenza Infections

BACKGROUND

Preventing the spread of the influenza virus is one of the primary health policy challenges of many countries worldwide. One of the more effective ways to prevent infection is influenza vaccination, and the people who enjoy the most public confidence in preventive health care are health workers (HWs). For this reason, it is crucial to study the attitudes of HWs toward influenza vaccination.

METHODS

The survey was conducted among 950 medical (physicians and nurses) and administrative staff in three academic hospitals. Respondents to the survey were selected on a random-target basis to represent hospital employees in the study best. The survey was conducted using the PAPI method between August and September 2020.

RESULTS

Respondents considered hand washing (52.8%) and avoiding contact with sick people (49.3%) the most effective ways to prevent influenza infection. Three in ten respondents considered wearing a protective mask (30.1%) and getting vaccinated against influenza (29.9%) is fully effective in preventing influenza. Influenza vaccination as effective in preventing influenza virus infection was chosen more often by those who worked in a pediatric hospital. Nurses were twice less likely than physicians to declare that influenza vaccination prevents infection (42.4% for nurses vs. 84.0% for physicians). At the same time, 20.4% of nurses believed that eating garlic effectively prevented influenza infection, and 28.1% declared daily vitamin C helpful.

CONCLUSIONS

The study pointed to significant educational gaps regarding the role and effectiveness of influenza vaccination in the process of influenza virus infection and indicated a firm belief in medical myths, especially in the nursing community, related to protection against influenza virus infection.

Evaluation of Fourier Transform Infrared Spectroscopy as a First-Line Typing Tool for the Identification of Extended-Spectrum β-Lactamase-Producing Klebsiella pneumoniae Outbreaks in the Hospital Setting

Early detection of pathogen cross-transmission events and environmental reservoirs is needed to control derived nosocomial outbreaks. Whole-genome sequencing (WGS) is considered the gold standard for outbreak confirmation, but, in most cases, it is time-consuming and has elevated costs. Consequently, the timely incorporation of WGS results to conventional epidemiology (CE) investigations for rapid outbreak detection is scarce. Fourier transform infrared spectroscopy (FTIR) is a rapid technique that establishes similarity among bacteria based on the comparison of infrared light absorption patterns of bacterial polysaccharides and has been used as a typing tool in recent studies. The aim of the present study was to evaluate the performance of the FTIR as a first-line typing tool for the identification of extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-Kp) outbreaks in the hospital setting in comparison with CE investigations using WGS as the gold standard method. Sixty-three isolates of ESBL-Kp collected from 2018 to 2021 and classified according to CE were typed by both FTIR and WGS. Concordance was measured using the Adjusted Rand index (AR) and the Adjusted Wallace coefficient (AW) for both CE and FTIR clustering considering WGS as the reference method. Both AR and AW were significantly higher for FTIR clustering than CE clustering (0.475 vs. 0.134, p = 0.01, and 0.521 vs. 0.134, p = 0.009, respectively). Accordingly, FTIR inferred more true clustering relationships than CE (38/42 vs. 24/42, p = 0.001). However, a similar proportion of genomic singletons was detected by both FTIR and CE (13/21 vs. 12/21, p = 1). This study demonstrates the utility of the FTIR method as a quick, low-cost, first-line tool for the detection of ESBL-Kp outbreaks, while WGS analyses are being performed for outbreak confirmation and isolate characterization. Thus, clinical microbiology laboratories would benefit from integrating the FTIR method into CE investigations for infection control measures in the hospital setting.

Electronic Monitoring Systems for Hand Hygiene: Systematic Review of Technology

BACKGROUND

Hand hygiene is one of the most effective ways of preventing health care-associated infections and reducing their transmission. Owing to recent advances in sensing technologies, electronic hand hygiene monitoring systems have been integrated into the daily routines of health care workers to measure their hand hygiene compliance and quality.

OBJECTIVE

This review aims to summarize the latest technologies adopted in electronic hand hygiene monitoring systems and discuss the capabilities and limitations of these systems.

METHODS

A systematic search of PubMed, ACM Digital Library, and IEEE Xplore Digital Library was performed following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Studies were initially screened and assessed independently by the 2 authors, and disagreements between them were further summarized and resolved by discussion with the senior author.

RESULTS

In total, 1035 publications were retrieved by the search queries; of the 1035 papers, 89 (8.60%) fulfilled the eligibility criteria and were retained for review. In summary, 73 studies used electronic monitoring systems to monitor hand hygiene compliance, including application-assisted direct observation (5/73, 7%), camera-assisted observation (10/73, 14%), sensor-assisted observation (29/73, 40%), and real-time locating system (32/73, 44%). A total of 21 studies evaluated hand hygiene quality, consisting of compliance with the World Health Organization 6-step hand hygiene techniques (14/21, 67%) and surface coverage or illumination reduction of fluorescent substances (7/21, 33%).

CONCLUSIONS

Electronic hand hygiene monitoring systems face issues of accuracy, data integration, privacy and confidentiality, usability, associated costs, and infrastructure improvements. Moreover, this review found that standardized measurement tools to evaluate system performance are lacking; thus, future research is needed to establish standardized metrics to measure system performance differences among electronic hand hygiene monitoring systems. Furthermore, with sensing technologies and algorithms continually advancing, more research is needed on their implementation to improve system performance and address other hand hygiene-related issues.

Internet of Things to Explore Moment 2 of "WHO My Five Moments" for Hand Hygiene

Background: Electronic hand hygiene surveillance systems are developing and considered to be more reliable than direct observation for hand hygiene monitoring. However, none have the capability to assess compliance in complex nursing care.

Materials and Methods: We combined two different technologies, a hand hygiene monitoring system (radiofrequency identification, RFID) and a nursing care recorder at the bedside, and we merge their data to assess hand hygiene performance during nursing. Nursing tasks were classified as standard task procedures or aseptic task procedures corresponding to moment 2 among the five moments for hand hygiene recommended by the WHO. All statistical analyses were performed using R, version 3.6.2. For mixed models, the package “lme4” was used.

Results: From the merged database over the 2-year study period, 30,164 nursing tasks were identified for analysis, 25,633 were classified as standard task procedures, and 4,531 were classified as aseptic task procedures for nursing care. Hand disinfection with an alcohol-based solution was not detected with our system in 42.5% of all the recorded tasks, 37% of all the aseptic task procedures, and 47.1% of all the standard task procedures for nursing (p = 0.0362), indicating that WHO moment 2 was not respected in 37% of mandatory situations.

Conclusion: Using a combination of different technologies, we were able to assess hand hygiene performance in the riskiest circumstances.

Hand Hygiene, an Update

Hand hygiene by health care personnel is an important measure for preventing health care-associated infections, but adherence rates and technique remain suboptimal. Alcohol-based hand rubs are the preferred method of hand hygiene in most clinical scenarios, are more effective and better tolerated than handwashing, and their use has facilitated improved adherence rates. Obtaining accurate estimates of hand hygiene adherence rates using direct observations of personnel is challenging. Combining automated hand hygiene monitoring systems with direct observations is a promising strategy, and is likely to yield the best estimates of adherence. Greater attention to hand hygiene technique is needed.

Contagion Management at the Méditerranée Infection University Hospital Institute

The Méditerranée Infection University Hospital Institute (IHU) is located in a recent building, which includes experts on a wide range of infectious disease. The IHU strategy is to develop innovative tools, including epidemiological monitoring, point-of-care laboratories, and the ability to mass screen the population. In this study, we review the strategy and guidelines proposed by the IHU and its application to the COVID-19 pandemic and summarise the various challenges it raises. Early diagnosis enables contagious patients to be isolated and treatment to be initiated at an early stage to reduce the microbial load and contagiousness. In the context of the COVID-19 pandemic, we had to deal with a shortage of personal protective equipment and reagents and a massive influx of patients. Between 27 January 2020 and 5 January 2021, 434,925 nasopharyngeal samples were tested for the presence of SARS-CoV-2. Of them, 12,055 patients with COVID-19 were followed up in our out-patient clinic, and 1888 patients were hospitalised in the Institute. By constantly adapting our strategy to the ongoing situation, the IHU has succeeded in expanding and upgrading its equipment and improving circuits and flows to better manage infected patients.

COVID-19 outbreak and healthcare worker behavioural change toward hand hygiene practices

BACKGROUND

The coronavirus disease (COVID-19) pandemic has affected healthcare workers (HCWs) in their clinical practice. HCWs were challenged with new guidelines and practices to protect themselves from occupational risks.

AIM

To determine whether hand hygiene behaviour by real-time measurement was related to the dynamic of the epidemic, and the type of patient being cared for in France.

METHODS

This study used an automated hand hygiene recording system to measure HCW hand hygiene on entry to and exit from patient rooms throughout the COVID-19 pandemic. The correlation between hand hygiene compliance and COVID-19 epidemiological data was analysed. Analysis of variance was performed to compare compliance rate during the different periods of the epidemic.

FINDINGS

HCW hand hygiene rate on room entry decreased over time; on room exit, it increased by 13.73% during the first wave of COVID-19, decreased by 9.87% during the post-lockdown period, then rebounded by 2.82% during the second wave of the epidemic. Hand hygiene during patient care and hand hygiene on room exit had a positive relationship with the local COVID-19 epidemic; conversely, hand hygiene on room entry did not depend on the trend of the epidemic, nor on nursing of COVID-19 patients, and it decreased over time.

CONCLUSION

HCWs modified their behaviours to face the risk propensity of the pandemic. However, to improve the poor compliance at room entry, reducing confusion between the hand hygiene recommendation and glove recommendation may be necessary; disinfection of gloving hands might solve this issue.

Information technology on hand hygiene compliance among health care professionals: A systematic review and meta-analysis

AIM

To determine the effectiveness of information technology interventions on hand hygiene compliance among health care professionals.

BACKGROUND

Performing hand hygiene is the optimal approach to prevent the transmission of health care-associated infections. However, results regarding the effectiveness of information technology interventions on hand hygiene compliance were inconsistent to date.

EVALUATION

A search for studies published up to May 2020 was undertaken. A meta-analysis was conducted using RevMan 5.3 software.

KEY ISSUES

The most commonly used information technology systems were as follows: automated training, electronic counting devices and remote monitoring, real-time hand hygiene reminders and feedback, and automated monitoring. These four types of technology systems can significantly improve hand hygiene compliance among health care professionals (odds ratio = 3.06, p < .001).

CONCLUSION

The four types of information technology can be effectively used to change the hand hygiene behaviour. Because the information systems can monitor personnel and conduct statistical analyses automatically, they save labour costs of human monitors, are more time efficient and eliminate accompanying human error.

IMPLICATIONS FOR NURSING MANAGEMENT

The use of the four types of information technology is convenient and could reduce health care-associated infections; thus, they could be widely used in the future as the key to increase hand hygiene compliance rate.

Identification and validation of the mode of action of the chalcone anti-mycobacterial compounds

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Chalcone 1a inhibits the growth of Mycobacterium bovis BCG (MIC 6.25 µg.ml⁻¹).

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Chalcone 1a directly targets InhA.

Objectives

The search for new TB drugs has become one of the great challenges for modern medicinal chemistry. An improvement in the outcomes of TB chemotherapy can be achieved by the development of new, shorter, cheap, safe and effective anti-TB regimens.

Methods

Chalcones (1a-1o) were synthesized and evaluated for their antimycobacterial activity against Mycobacterium bovis BCG using growth inhibition assays. Compound 1a was selected as a ‘hit’ compound. The mode of action of compound 1a, was identified by mycolic acid methyl esters (MAMEs) and fatty acid methyl esters (FAMEs) analysis using thin layer chromatography. Dose dependent experiments were conducted by over-expressing components of FAS-II in M. bovis BCG to confirm the target. Ligand binding using intrinsic tryptophan assay and molecular docking were used to further validate the target.

Results

MAMEs and FAMEs analysis showed dose-dependent reduction of MAMEs with the overall abundance of FAMEs suggesting that compound 1a targets mycolic acid biosynthesis. Direct binding of 1a to InhA was observed using an intrinsic tryptophan fluorescence binding assay, and a 2-fold IC₅₀ shift was observed with an InhA overexpressing strain confirming InhA as the cellular target.

Conclusion

The chalcone 1a exhibits potent antimycobacterial activity, displays a good safety profile and is a direct inhibitor of InhA, a key component in mycolic acid synthesis, validating this series for further anti-TB drug development.

Peripherally inserted central catheters: a hidden emerging cause of infection outbreaks

In our institution, between January 2010 and December 2017, 15 140 peripherally inserted central catheters (PICCs) were inserted in 12 314 patients. Using time-series analysis to evaluate the annual historical trend (AHT), we observed a significant increase in bloodstream infections (BSIs; AHT = 24; p < 0.001) and associated deaths (AHT = 3; p 0.02) in patient with PICCs. The risk of experiencing a BSI was significantly higher in patients with PICCs (odds ratio = 9.6; 95% confidence interval, 9.08–10.18; p < 0.001). To reduce PICC-related BSIs and their related mortality, it is important to limit the overuse of PICCs and to implement a ‘no PICC’ policy by limiting the insertion of PICCs to situations without other available options.

Excess Length of Acute Inpatient Stay Attributable to Acquisition of Hospital-Onset Gram-Negative Bloodstream Infection with and without Antibiotic Resistance: A Multistate Model Analysis

Excess length of stay (LOS) is an important outcome when assessing the burden of nosocomial infection, but it can be subject to survival bias. We aimed to estimate the change in LOS attributable to hospital-onset (HO) Escherichia coli/Klebsiella spp. bacteremia using multistate models to circumvent survival bias. We analyzed a cohort of all patients with HO E.coli/Klebsiella spp. bacteremia and matched uninfected control patients within the U.S. Veterans Health Administration System in 2003–2013. A multistate model was used to estimate the change in LOS as an effect of the intermediate state (HO-bacteremia). We stratified analyses by susceptibilities to fluoroquinolones (fluoroquinolone susceptible (FQ-S)/fluoroquinolone resistant (FQ-R)) and extended-spectrum cephalosporins (ESC susceptible (ESC-S)/ESC resistant (ESC-R)). Among the 5964 patients with HO bacteremia analyzed, 957 (16.9%) and 1638 (28.9%) patients had organisms resistant to FQ and ESC, respectively. Any HO E.coli/Klebsiella bacteremia was associated with excess LOS, and both FQ-R and ESC-R were associated with a longer LOS than susceptible strains, but the additional burdens attributable to resistance were small compared to HO bacteremia itself (FQ-S: 12.13 days vs. FQ-R: 12.94 days, difference: 0.81 days (95% CI: 0.56–1.05), p < 0.001 and ESC-S: 11.57 days vs. ESC-R: 16.56 days, difference: 4.99 days (95% CI: 4.75–5.24), p < 0.001). Accurate measurements of excess attributable LOS associated with resistance can help support the business case for infection control interventions.

Medical textiles with silver/nanosilver and their potential application for the prevention and control of healthcare-associated infections – mini-review

Healthcare-associated infections (HAI), especially those in hospitalized patients, can be regarded as an important public health problem worldwide. In this article we presented an overview on the use of antimicrobial textiles, including those with silver/nanosilver, as a new approach to countering HAI by reducing the potential risk of the pathogen transmission between patients and healthcare workers. The strong antimicrobial in vitro activity of these engineered textiles was confirmed in vitro against several HAI-associated pathogens, including multiresistant strains belonging to alert pathogens. However, according to literature data, the sole use of antimicrobial clothing by healthcare workers appears to not be sufficient for the prevention and control of HAI. Further comprehensive and controlled studies are needed to assess the real-time efficacy of the antimicrobial textiles in healthcare settings. Moreover, there is a need to control the silver use not only for medical applications, but also for non-medical purposes due to a possibility for the emergence and spread of silver resistance among microorganisms, especially Gram-negative bacteria.

Effect of gloved hand disinfection on hand hygiene before infection-prone procedures on a stem cell ward

BACKGROUND

Hand hygiene compliance even before infection-prone procedures (indication 2, 'before aseptic tasks', according to the World Health Organization (WHO)) remains disappointing.

AIM

To improve hand hygiene compliance by implementing gloved hand disinfection as a resource-neutral process optimization strategy.

METHODS

We performed a three-phase intervention study on a stem cell transplant ward. After baseline evaluation of hand hygiene compliance (phase 1) gloved hand disinfection was allowed (phase 2) and restricted (phase 3) to evaluate and differentiate intervention derived from learning and time effects. The incidence of severe infections as well as of hospital-acquired multidrug-resistant bacteria was recorded by active surveillance.

FINDINGS

Hand hygiene compliance improved significantly from 50% to 76% (P < 0.001) when gloved hand disinfection was allowed. The biggest increase was for infection-prone procedures (WHO 2) from 31% to 65%; P < 0.001. Severe infections decreased by trend (from 6.0 to 2.5 per 1000 patient-days) whereas transmission of multidrug-resistant organisms was not affected.

CONCLUSION

Gloved hand disinfection significantly improved compliance with the hand hygiene, especially in activities relevant to infections and infection prevention. Thus, this process optimization may be an additional, easy implementable, resource-neutral tool for a highly vulnerable patient cohort.

Low prevalence of resistance genes in sheltered homeless population in Marseille, France, 2014-2018

Objectives: The present study has explored the prevalence and potential factors contributing to the presence of nasal/pharyngeal resistant genes in homeless people. Methods: During the winters 2014-2018, we enrolled sheltered homeless adults and controls and collected nasal/pharyngeal samples. Sixteen antibiotic resistance genes (ARGs), including genes encoding for beta-lactamases and colistin-resistance genes, were searched by real-time polymerase chain reaction (qPCR) performed directly on respiratory samples and followed by conventional PCR and sequencing. Results: Over a 5-year period, using qPCR, we identified in homeless group (n=715) the presence of bla _TEM (396/710, 54.7%), bla_SHV (27/708, 3.6%), bla _OXA-23 (1/708, 0.1%), while other genes including colistin-resistance genes (mcr-1 to mcr-5) were absent. We found a significantly higher proportion of ARG carriage among controls (74.1%) compared to homeless population (57.1%), p=0.038. Tobacco smoking (OR=4.72, p<0.0001) and respiratory clinical signs (OR=4.03, p=0.002) were most prevalent in homeless people, while vaccination against influenza (OR=0.31, p=0.016) was lower compared to controls. Among homeless people, type of housing (shelter A versus B, OR=1.59, p=0.006) and smoking tobacco (smoker versus non-smoker, OR=0.55, p=0.001) were independent factors associated with ARG carriage. By sequencing, we obtained a high diversity of bla _TEM and bla_SHV in both populations. Conclusion: The lower risk for ARGs in the homeless population could be explained by limited access to health care and subsequently reduced exposure to antibiotics.

Technological innovations in infection control: A rapid review of the acceptance of behavior monitoring systems and their contribution to the improvement of hand hygiene

BACKGROUND

Hand hygiene is crucial for preventing nosocomial infections; however, adherence rates need further attention. Prevention of nosocomial infections through regular hand hygiene monitoring and feedback is recommended by the World Health Organization. Technology holds the potential for achieving this goal. The aim of this study was to assess the influence of technological behavior monitoring innovations on hand hygiene adherence and their acceptance by healthcare professionals.

METHODS

A rapid review of the literature was conducted. A literature search was performed in electronic databases (Cochrane Library, Scopus, PubMed, CINAHL, PsycINFO, PsycARTICLES, PSYNDEX) and via citation tracking in November 2017. Records were screened for eligibility. Included studies were analyzed and synthesized in a narrative, tabular way.

RESULTS

Overall, 2,426 studies were identified, and 12 were included. Findings indicated that behavior monitoring technology improves hand hygiene adherence, resulting in adherence increases between 6.40%-54.97%. The majority of systems provided real-time feedback. Factors influencing acceptance of technology by healthcare professionals include transparency and confidentiality, user attitude and environment, device function, and device usability.

CONCLUSIONS

Recognizing the importance of hand hygiene adherence, active communication between behavior monitoring technology and healthcare workers seems to mediate improvement in sustainable hand hygiene adherence behavior.

Extremely and pandrug-resistant bacteria extra-deaths: myth or reality?

In 2009, the European Centre for Disease Prevention and Control (ECDC) estimated that multidrug-resistant (MDR) bacterial infections were responsible for 25,000 extra-deaths per year. In 2015, another report estimated that 12,500 extra-deaths were attributable to MDR bacteria every year in France. Recently, the United Nations claimed that resistance to antimicrobials was a global scourge, forecasting 10 million deaths in 2050. Surprisingly, our antibiotic resistance surveillance system in Marseille, France, did not allowed us to observe similar trends. We herein compared our data on extremely drug-resistant (XDR)/pandrug-resistant (PDR) patient extra-deaths to evaluations and predictions from these reports. First, we retrospectively collect and analyze antibiotic resistance data produced by our settings between November 2009 and March 2015 to look for 30-day deaths attributable to XDR/PDR strains belonging to 11 bacterial species/genus. In parallel, we performed a PubMed literature search to look for articles published prior to July 2016 and describing human deaths due to PDR strains. Overall, 35,723 patients were infected by at least one bacterial species/genus of interest and 85 by XDR/PDR strains. Of these patients, only one death was attributable to a XDR bacterial infection in a patient with strong comorbidities and two consecutive septic shocks. Our literature review shows that only four articles described human deaths due to PDR bacteria. All together, these data allowed us to conclude that there is a large discrepancy between the real count of deaths attributable to XDR/PDR bacteria and alarmist predictions.

Building an Intelligent Hospital to Fight Contagion

The idea of building hospitals to fight contagion was born with the lazarettos. At the time when the microorganisms were not yet known, the mechanisms of transmission of contagion were already well apprehended. Based on the same knowledge but thanks to new technologies, such hospitals have now been built downtown, next to the most highly performing technological plateau. Regrouping patient care, diagnostics, research, and development, the University Hospital Institute Méditerranée Infection building offers a wonderful tool to contain and understand contagion, in a well-designed setting, creating excellent working conditions that are attractive for interested scientists.