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Mitchell BG, McDonagh J, Dancer SJ, Ford S, Sim J, Thottiyil Sultanmuhammed Abdul Khadar B, Russo PL, Maillard JY, Rawson H, Browne K, Kiernan M. Risk of organism acquisition from prior room occupants: An updated systematic review. Infect Dis Health 2023; 28:290-297. [PMID: 37385863 DOI: 10.1016/j.idh.2023.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 06/05/2023] [Accepted: 06/06/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Evidence from a previous systematic review indicates that patients admitted to a room where the previous occupant had a multidrug-resistant bacterial infection resulted in an increased risk of subsequent colonisation and infection with the same organism for the next room occupant. In this paper, we have sought to expand and update this review. METHODS A systematic review and meta-analysis was undertaken. A search using Medline/PubMed, Cochrane and CINHAL databases was conducted. Risk of bias was assessed by the ROB-2 tool for randomised control studies and ROBIN-I for non-randomised studies. RESULTS From 5175 identified, 12 papers from 11 studies were included in the review for analysis. From 28,299 patients who were admitted into a room where the prior room occupant had any of the organisms of interest, 651 (2.3%) were shown to acquire the same species of organism. In contrast, 981,865 patients were admitted to a room where the prior occupant did not have an organism of interest, 3818 (0.39%) acquired an organism(s). The pooled acquisition odds ratio (OR) for all the organisms across all studies was 2.45 (95% CI: 1.53-3.93]. There was heterogeneity between the studies (I2 89%, P < 0.001). CONCLUSION The pooled OR for all the pathogens in this latest review has increased since the original review. Findings from our review provide some evidence to help inform a risk management approach when determining patient room allocation. The risk of pathogen acquisition appears to remain high, supporting the need for continued investment in this area.
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Affiliation(s)
- Brett G Mitchell
- Central Coast Local Health District, Gosford Hospital, NSW, Australia; School of Nursing, Avondale University, Lake Macquarie, NSW, Australia; Nursing and Midwifery, Monash University, Victoria, Australia; Hunter Medical Research Institute, Newcastle, NSW, Australia. https://twitter.com/1healthau
| | - Julee McDonagh
- Centre for Chronic and Complex Care, Blacktown Hospital, Western Sydney Local Health District, NSW, Australia; School of Nursing, Faculty of Science, Medicine and Health, The University of Wollongong, NSW, Australia. https://twitter.com/JuleeMcDonagh
| | - Stephanie J Dancer
- Department of Microbiology, Hairmyres Hospital, Glasgow, and Edinburgh Napier University, Glasgow, UK
| | - Sindi Ford
- Central Coast Local Health District, Gosford, NSW, Australia; School of Health Science, University of Newcastle, Ourimbah, NSW, Australia
| | - Jenny Sim
- WHO Collaborating Centre for Nursing, Midwifery & Health Development, University of Technology Sydney, NSW Australia; School of Nursing & Midwifery, University of Newcastle, NSW Australia; School of Nursing, University of Wollongong, NSW Australia; Australian Health Services Research Institute, University of Wollongong, NSW Australia. https://twitter.com/jennysim_1
| | | | - Philip L Russo
- School of Nursing, Avondale University, Lake Macquarie, NSW, Australia; Nursing and Midwifery, Monash University, Victoria, Australia; Cabrini Research, Cabrini Health, Victoria, Australia. https://twitter.com/PLR_aus
| | - Jean-Yves Maillard
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, UK
| | - Helen Rawson
- Nursing and Midwifery, Monash University, Victoria, Australia. https://twitter.com/DrHelenRawson
| | - Katrina Browne
- Central Coast Local Health District, Gosford Hospital, NSW, Australia; School of Nursing, Avondale University, Lake Macquarie, NSW, Australia. https://twitter.com/savvy_science
| | - Martin Kiernan
- School of Nursing, Avondale University, Lake Macquarie, NSW, Australia; Richard Wells Research Centre, University of West London, UK. https://twitter.com/emrsa15
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Dancer SJ. Hospital cleaning: past, present, and future. Antimicrob Resist Infect Control 2023; 12:80. [PMID: 37608396 PMCID: PMC10464435 DOI: 10.1186/s13756-023-01275-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 07/10/2023] [Indexed: 08/24/2023] Open
Abstract
INTRODUCTION The importance of hospital cleaning for controlling healthcare-associated infection (HAI) has taken years to acknowledge. This is mainly because the removal of dirt is inextricably entwined with gender and social status, along with lack of evidence and confusion over HAI definitions. Reducing so-called endogenous infection due to human carriage entails patient screening, decolonisation and/or prophylaxis, whereas adequate ventilation, plumbing and cleaning are needed to reduce exogenous infection. These infection types remain difficult to separate and quantitate. Patients themselves demonstrate wide-ranging vulnerability to infection, which further complicates attempted ranking of control interventions, including cleaning. There has been disproportionate attention towards endogenous infection with less interest in managing environmental reservoirs. QUANTIFYING CLEANING AND CLEANLINESS Finding evidence for cleaning is compromised by the fact that modelling HAI rates against arbitrary measurements of cleaning/cleanliness requires universal standards and these are not yet established. Furthermore, the distinction between cleaning (soil removal) and cleanliness (soil remaining) is usually overlooked. Tangible bench marking for both cleaning methods and all surface types within different units, with modification according to patient status, would be invaluable for domestic planning, monitoring and specification. AIMS AND OBJECTIVES This narrative review will focus on recent history and current status of cleaning in hospitals. While its importance is now generally accepted, cleaning practices still need attention in order to determine how, when and where to clean. Renewed interest in removal and monitoring of surface bioburden would help to embed risk-based practice in hospitals across the world.
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Affiliation(s)
- Stephanie J Dancer
- Department of Microbiology, NHS Lanarkshire & School of Applied Sciences, Edinburgh Napier University, Scotland, UK.
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No-Touch Automated Disinfection System Based on Hydrogen Peroxide and Ethyl Alcohol Aerosols for Use in Healthcare Environments. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084868. [PMID: 35457735 PMCID: PMC9029184 DOI: 10.3390/ijerph19084868] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Revised: 04/10/2022] [Accepted: 04/15/2022] [Indexed: 02/04/2023]
Abstract
Healthcare-related infections are sustained by various bacteria and fungi. In recent years, various technologies have emerged for the sanitation of healthcare-related environments. This study evaluated the effectiveness of a no-touch disinfection system that aerosolizes 5% hydrogen peroxide and 10% ethyl alcohol. After selecting an environment, the Total Bacterial Count and the Total Fungal Count in the air and on a surface of the room were determined to evaluate the effectiveness of the aerosolization system. In addition, sterile stainless-steel plates inoculated with S. aureus, P. aeruginosa, and Aspergillus spp. isolated from hospitalized patients and reference strains were used to evaluate the effectiveness of the system. For each organism, three plates were used: A (cleaned), B (not cleaned), and C (control). The A plates were treated with non-ionic surfactant and the aerosolization system, the B plates were subjected to the aerosolization system, and the plates C were positioned outside the room that was sanitized. Following sanitization, air and surface sampling was conducted, after which, swabs were processed for bacterial and fungal enumeration. The results showed that the air sanitization system had good efficacy for both bacteria and fungi in the air and on stainless-steel plates, particularly for the A plates.
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Bonadonna L, Briancesco R, Coccia AM, Meloni P, Rosa GL, Moscato U. Microbial Air Quality in Healthcare Facilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6226. [PMID: 34207509 PMCID: PMC8296088 DOI: 10.3390/ijerph18126226] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 05/26/2021] [Accepted: 06/04/2021] [Indexed: 12/26/2022]
Abstract
There is increasing evidence that indoor air quality and contaminated surfaces provide an important potential source for transmission of pathogens in hospitals. Airborne hospital microorganisms are apparently harmless to healthy people. Nevertheless, healthcare settings are characterized by different environmental critical conditions and high infective risk, mainly due to the compromised immunologic conditions of the patients that make them more vulnerable to infections. Thus, spread, survival and persistence of microbial communities are important factors in hospital environments affecting health of inpatients as well as of medical and nursing staff. In this paper, airborne and aerosolized microorganisms and their presence in hospital environments are taken into consideration, and the factors that collectively contribute to defining the infection risk in these facilities are illustrated.
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Affiliation(s)
- Lucia Bonadonna
- Department of Environment and Health, Italian National Institute of Health, 00161 Rome, Italy; (R.B.); (A.M.C.); (P.M.); (G.L.R.)
| | - Rossella Briancesco
- Department of Environment and Health, Italian National Institute of Health, 00161 Rome, Italy; (R.B.); (A.M.C.); (P.M.); (G.L.R.)
| | - Anna Maria Coccia
- Department of Environment and Health, Italian National Institute of Health, 00161 Rome, Italy; (R.B.); (A.M.C.); (P.M.); (G.L.R.)
| | - Pierluigi Meloni
- Department of Environment and Health, Italian National Institute of Health, 00161 Rome, Italy; (R.B.); (A.M.C.); (P.M.); (G.L.R.)
| | - Giuseppina La Rosa
- Department of Environment and Health, Italian National Institute of Health, 00161 Rome, Italy; (R.B.); (A.M.C.); (P.M.); (G.L.R.)
| | - Umberto Moscato
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy;
- Section of Occupational Medicine, Institute of Public Health, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
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Li F, Wu Y, Bian W, Huang L, Zhu X, Chen X, Wang M. Features and associated factors of bacterial skin infections in hospitalized patients with pemphigus: a single-center retrospective study. Ann Clin Microbiol Antimicrob 2020; 19:46. [PMID: 33032608 PMCID: PMC7545872 DOI: 10.1186/s12941-020-00388-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Infections were the primary cause of death (34.3-55.5%) in patients with pemphigus. Skin was usually the origin of infections. The study aimed to explore features and associated factors of bacterial skin infections (BSIs) in inpatients with pemphigus. METHODS One hundred and seventy-seven inpatients with pemphigus hospitalizing from November 2014 to April 2019 were continuously recruited through Peking University First Hospital's inpatient records inpatients with pemphigus hospitalizing from November 2014 to April 2019 were continuously recruited through Peking University First Hospital's inpatient records. Then, we retrieved the clinical and laboratory data to explore the characteristics and associated factors of BSIs. RESULTS Of patients enrolled, pemphigus vulgaris (PV, n = 142) and pemphigus foliaceus (PF, n = 9) were most common, followed by pemphigus erythematosus (PE, n = 25) and pemphigus vegetans (Pveg, n = 1). Eighty-seven of 177 (49.2%) inpatients developed BSIs, and they had a longer length of stay compared with inpatients without BSIs (median: 18.9 vs. 14.1 days, p = 0.008). Staphylococcus aureus was the most common bacteria (71.3%, 62/87) and highly resistant to penicillin (91.9%, 57/62). Higher levels of anti-Dsg1 autoantibodies (> 124.2 U/mL) (p < 0.001, odds ratio [OR] = 3.564, 95% confidence interval [CI]: 1.784-7.123) and anti-Dsg3 autoantibodies (> 169.5 U/mL) (p = 0.03, OR = 2.074, 95% CI: 1.084-3.969) were underlying risk factors of BSIs when analyzed by binary regression analysis. As for Gram's stain of bacteria, females had a lower rate of Gram-positive infections (p = 0.03). Patients using oral antibiotics (p = 0.05) had a higher rate of Gram-negative infections. Inpatients who were hospitalized in other hospitals within 2 weeks before the current admission had a higher rate of Gram-negative and co-infections (p = 0.03). CONCLUSIONS Inpatients with pemphigus had a high incidence of BSIs. Some factors were associated with the susceptibility of BSIs and bacterial species.
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Affiliation(s)
- Furong Li
- Department of Dermatology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Yejun Wu
- Department of Eight-year Clinical Medical Education, Peking University People's Hospital, Beijing, China
| | - Wenjie Bian
- Department of Eight-year Clinical Medical Education, Peking University People's Hospital, Beijing, China
| | - Lei Huang
- Department of Clinical Laboratory, Peking University First Hospital, Beijing, China
| | - Xuejun Zhu
- Department of Dermatology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Xixue Chen
- Department of Dermatology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China.,National Clinical Research Center for Skin and Immune Diseases, Beijing, China.,Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China
| | - Mingyue Wang
- Department of Dermatology, Peking University First Hospital, 8 Xishiku Street, Xicheng District, Beijing, 100034, China. .,National Clinical Research Center for Skin and Immune Diseases, Beijing, China. .,Beijing Key Laboratory of Molecular Diagnosis on Dermatoses, Beijing, China.
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Dancer S. Visualising the invisible; why cleaning is important in the control of hospital-acquired infection. Evid Based Nurs 2019; 22:117. [PMID: 31154355 DOI: 10.1136/ebnurs-2018-103026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/23/2019] [Indexed: 06/09/2023]
Affiliation(s)
- Stephanie Dancer
- Department of Microbiology, Hairmyres Hospital, NHS Lanarkshire, Glasgow, UK
- School of Applied Sciences, Edinburgh Napier University, Scotland, UK
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