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Asgedom AA. Status of infection prevention and control (IPC) as per the WHO standardised Infection Prevention and Control Assessment Framework (IPCAF) tool: existing evidence and its implication. Infect Prev Pract 2024; 6:100351. [PMID: 38469414 PMCID: PMC10926125 DOI: 10.1016/j.infpip.2024.100351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 02/09/2024] [Indexed: 03/13/2024] Open
Abstract
Healthcare settings have a high prevalence of infectious agents. This narrative review examines the existing evidence regarding infection prevention and control (IPC) using the WHO Infection Prevention and Control Assessment Framework (IPCAF) tool in healthcare facilities. A total of 13 full length papers from Africa, Asia and Europe were considered for this review. The findings showed that there are discrepancies in the IPCAF values from insufficient to advanced level. The current review shows an advanced IPCAF level in middle income and high income countries. Low income countries showed a lower IPCAF score. There is a need to enhance the IPC capacity building and to supply infection prevention resources to prevent healthcare associated infection (HAI) with a focus on low income countries.
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Affiliation(s)
- Akeza Awealom Asgedom
- Department of Environmental Health Science, School of Public Health, College of Health Sciences, Mekelle University, Mekelle, Ethiopia
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2
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Urso R, Del Prete S, D'Antonio G, Sorace L, Albore M, Bolino G. A case of surgical site infection with severe spondylitis caused by Streptococcus gordonii in an adult healthy woman: how to apply medico-legal method to deny malpractice hypothesis in suspected healthcare-associated infection. Med Leg J 2024:258172241227658. [PMID: 38619146 DOI: 10.1177/00258172241227658] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2024]
Abstract
We describe a rare case of severe primary spondylitis caused by Streptococcus gordonii in a 45-year-old immunocompetent woman with no relevant comorbidities. The surgical site infection arose after a L4-L5 microdiscectomy and resulted in severe clinical disability. Allegations of possible negligence as the cause prompted a forensic review to clarify the original source and transmission of this uncommon pathogen, which dismissed its cause as due to malpractice during treatment.
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Affiliation(s)
- Rocco Urso
- Department of Anatomic, Histologic, Medical-Legal Sciences and of Locomotor System, Rome University Sapienza, Italy
| | - Sossio Del Prete
- Department of Anatomic, Histologic, Medical-Legal Sciences and of Locomotor System, Rome University Sapienza, Italy
| | - Gianpiero D'Antonio
- Department of Anatomic, Histologic, Medical-Legal Sciences and of Locomotor System, Rome University Sapienza, Italy
| | - Letizia Sorace
- Department of Anatomic, Histologic, Medical-Legal Sciences and of Locomotor System, Rome University Sapienza, Italy
| | - Marco Albore
- Department of Anatomic, Histologic, Medical-Legal Sciences and of Locomotor System, Rome University Sapienza, Italy
| | - Giorgio Bolino
- Department of Anatomic, Histologic, Medical-Legal Sciences and of Locomotor System, Rome University Sapienza, Italy
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3
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Gozdzielewska L, Kc D, Butcher J, Molesworth M, Davis K, Barr L, DiBari C, Mortgat L, Deeves M, Kothari KU, Storr J, Allegranzi B, Reilly J, Price L. Interventions for preventing or controlling health care-associated infection among health care workers or patients within primary care facilities: A scoping review. Am J Infect Control 2024; 52:479-487. [PMID: 37944755 DOI: 10.1016/j.ajic.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 10/27/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND This review aimed to synthesize the evidence on infection prevention and control interventions for the prevention of health care-associated infection among health care workers or patients within primary care facilities. METHODS PubMed, CINAHL, EMBASE, and CENTRAL databases were searched for quantitative studies published between 2011 and 2022. Study selection, data extraction, and quality assessment using Cochrane and Joanna Briggs tools, were conducted by independent review with additional sensitivity checking performed on study selection. RESULTS Four studies were included. A randomized trial and a cross-sectional survey, respectively, found no statistical difference in laboratory-confirmed influenza in health care workers wearing N95 versus medical masks (P = .18) and a significant inverse association between the implementation of tuberculosis control measures and tuberculosis incidence (P = .02). For the prevention of surgical site infections following minor surgery, randomized trials found nonsterile gloves (8.7%; 95% confidence interval, 4.9%-12.6%) to be noninferior to sterile gloves (9.3%; 95% confidence interval, 7.4%-11.1%) and no significant difference between prophylactic antibiotics compared to placebo (P = .064). All studies had a high risk of bias. CONCLUSIONS Evidence for infection prevention and control interventions for the prevention of health care-associated infection in primary care is very limited and insufficient to make practice recommendations. Nevertheless, the findings highlight the need for future research.
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Affiliation(s)
- Lucyna Gozdzielewska
- SHIP Research Group, Research Centre for Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland.
| | - Deepti Kc
- SHIP Research Group, Research Centre for Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - John Butcher
- SHIP Research Group, Research Centre for Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Mark Molesworth
- SHIP Research Group, Research Centre for Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Katie Davis
- SHIP Research Group, Research Centre for Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Lisa Barr
- SHIP Research Group, Research Centre for Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Carlotta DiBari
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Laure Mortgat
- Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Miranda Deeves
- Infection Prevention and Control Hub, Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Kavita U Kothari
- Consultant to Library & Digital Information Networks / Quality Assurance, Norms and Standards / Science Division, World Health Organization, Kobe, Japan
| | - Julie Storr
- Infection Prevention and Control Hub, Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Benedetta Allegranzi
- Infection Prevention and Control Hub, Integrated Health Services, World Health Organization, Geneva, Switzerland
| | - Jacqui Reilly
- SHIP Research Group, Research Centre for Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
| | - Lesley Price
- SHIP Research Group, Research Centre for Health, School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland
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Althiyabi FS, Khuded FM, Alzaidi FM, Alswat ASG, Alotaibi FSB, Alotaibi WSB, Alotaibi KIA, Alshehri FAH, Almutairi AMA, Alnathli JAA. Assessment of nursing knowledge and practice toward prevention of acquired infections in the emergency department of King Faisal Medical Complex in Taif. SAGE Open Med 2024; 12:20503121231222341. [PMID: 38268946 PMCID: PMC10807387 DOI: 10.1177/20503121231222341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 12/07/2023] [Indexed: 01/26/2024] Open
Abstract
Background Hospital-acquired infections constitute a significant source of morbidity and mortality for both patients and healthcare professionals. Nursing professionals constitute an integral component of any quality-related program in a hospital, given their oversight and provision of nearly all healthcare services. Nurses' knowledge and attitudes play a significant role in healthcare delivery. Within Saudi Arabia, the prevalence of hospital-acquired infections in hospital settings has prompted a growing emphasis on evaluating nursing knowledge and adherence to practice standards aimed at hospital-acquired infection prevention. Methods This single-center cross-sectional study was conducted at the emergency department of King Faisal Medical Complex, Taif, between October and December 2022, involving 168 nurses. The study utilized a pre-validated structured online questionnaire comprising three sections: demographics, knowledge assessment, and practice evaluation. Knowledge and practice levels were categorized as good, moderate, and poor using quartiles. Results The study encompassed 168 nurses employed in the emergency department of the hospital, revealing their proficiency in standard practices for preventing hospital-acquired infections. Notably, 63.8% of participants demonstrated a commendable "Good" level of knowledge, while 10.6% exhibited a "Moderate" level and 25.5% manifested a "Poor" level in terms of knowledge. Similarly, concerning practice levels, 56.4% showcased a commendable "Good" practice level, 22.3% maintained a "Moderate" practice level, and 21.3% presented a "Poor" practice level. Chi-square analysis unveiled a significant association between age and knowledge levels (p = 0.000). In addition, age (p = 0.000) and years of clinical experience (p = 0.000) were significantly linked to nurses' practice levels The nurses aged 40-50 years (82%) and those with 10-15 years of clinical experience (83.3%) showed good levels of knowledge and practice, respectively. Overall, most of the nurses demonstrated effective knowledge and compliance with infection prevention practices. Conclusion Sociodemographic factors such as age and clinical experience exert a notable impact on nurses' knowledge and practices regarding hospital-acquired infections.
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Affiliation(s)
- Fahad Sulaiman Althiyabi
- Head Nurse of Home Health Care, Nursing Services Department, King Faisal Medical Complex, Taif, Saudi Arabia
| | - Fares Mabrok Khuded
- Nursing Services Department, King Faisal Medical Complex, Taif, Saudi Arabia
| | - Fawaz Mohammed Alzaidi
- Head of Nursing Education and Training, Nursing Services Department, King Faisal Medical Complex, Taif, Saudi Arabia
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Garvey M. Medical Device-Associated Healthcare Infections: Sterilization and the Potential of Novel Biological Approaches to Ensure Patient Safety. Int J Mol Sci 2023; 25:201. [PMID: 38203372 PMCID: PMC10778788 DOI: 10.3390/ijms25010201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
Healthcare-associated infections caused by multi-drug-resistant pathogens are increasing globally, and current antimicrobial options have limited efficacy against these robust species. The WHO details the critically important bacterial and fungal species that are often associated with medical device HAIs. The effective sterilization of medical devices plays a key role in preventing infectious disease morbidity and mortality. A lack of adherence to protocol and limitations associated with each sterilization modality, however, allows for the incidence of disease. Furthermore, issues relating to carcinogenic emissions from ethylene oxide gas (EtO) have motivated the EPA to propose limiting EtO use or seeking alternative sterilization methods for medical devices. The Food and Drug Administration supports the sterilization of healthcare products using low-temperature VH2O2 as an alternative to EtO. With advances in biomaterial and medical devices and the increasing use of combination products, current sterilization modalities are becoming limited. Novel approaches to disinfection and sterilization of medical devices, biomaterials, and therapeutics are warranted to safeguard public health. Bacteriophages, endolysins, and antimicrobial peptides are considered promising options for the prophylactic and meta-phylactic control of infectious diseases. This timely review discusses the application of these biologics as antimicrobial agents against critically important WHO pathogens, including ESKAPE bacterial species.
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Affiliation(s)
- Mary Garvey
- Department of Life Science, Atlantic Technological University, F91 YW50 Sligo, Ireland;
- Centre for Precision Engineering, Materials and Manufacturing Research (PEM), Atlantic Technological University, F91 YW50 Sligo, Ireland
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Urrutia AR, Schlener SD, Eid S, Bock KA, Worrilow KC. The Effects of an Advanced Air Purification Technology on Environmental and Clinical Outcomes in a Long-Term Care Facility. J Gerontol A Biol Sci Med Sci 2023; 78:2325-2332. [PMID: 37132185 PMCID: PMC10692422 DOI: 10.1093/gerona/glad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Long-term care facilities (LTCFs) are constantly working to reduce sources of infectious pathogens to improve resident care. LTCF residents are particularly susceptible to health care-associated infections (HAIs), many of which originate from the air. An advanced air purification technology (AAPT) was designed to comprehensively remediate volatile organic compounds (VOCs) and all airborne pathogens including all airborne bacteria, fungi, and viruses. The AAPT contains a unique combination of proprietary filter media, high-dose ultraviolet germicidal irradiation, and high-efficiency particulate air (HEPA) filtration. METHODS The AAPT was installed in an LTCF's heating, ventilation, and air-conditioning ductwork and 2 floors were studied: the study floor with comprehensive AAPT remediation and HEPA filtration and the control floor with only HEPA filtration. VOC loading and airborne and surface pathogen loading were measured in 5 locations on both floors. Clinical metrics such as HAI rates were also studied. RESULTS There was a statistically significant 98.83% reduction in airborne pathogens, which are responsible for illness and infection, an 89.88% reduction in VOCs, and a 39.6% reduction in HAIs. Surface pathogen loading was reduced in all locations except 1 resident room where the detected pathogens were linked to direct touch. CONCLUSIONS The removal of airborne and surface pathogens by the AAPT led to a dramatic reduction in HAIs. The comprehensive removal of airborne contaminants has a direct positive impact on resident wellness and quality of life. It is critical that LTCFs incorporate aggressive airborne purification methods with their current infection control protocols.
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Affiliation(s)
| | | | - Sherrine Eid
- Sherrine Eid Consulting, Macungie, Pennsylvania, USA
| | - Kelly A Bock
- Phoebe Ministries Allentown, Allentown, Pennsylvania, USA
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Amodeo D, Manzi P, De Palma I, Puccio A, Nante N, Barcaccia M, Marini D, Pietrella D. Efficacy of Violet-Blue (405 nm) LED Lamps for Disinfection of High-Environmental-Contact Surfaces in Healthcare Facilities: Leading to the Inactivation of Microorganisms and Reduction of MRSA Contamination. Pathogens 2023; 12:1338. [PMID: 38003802 PMCID: PMC10674356 DOI: 10.3390/pathogens12111338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 10/24/2023] [Accepted: 11/08/2023] [Indexed: 11/26/2023] Open
Abstract
Effective disinfection procedures in healthcare facilities are essential to prevent transmission. Chemical disinfectants, hydrogen peroxide vapour (HPV) systems and ultraviolet (UV) light are commonly used methods. An emerging method, violet-blue light at 405 nm, has shown promise for surface disinfection. Its antimicrobial properties are based on producing reactive oxygen species (ROS) that lead to the inactivation of pathogens. Studies have shown significant efficacy in reducing bacterial levels on surfaces and in the air, reducing nosocomial infections. The aim of this study was to evaluate the antimicrobial effectiveness of violet-blue (405 nm) LED lamps on high-contact surfaces in a hospital infection-control laboratory. High-contact surfaces were sampled before and after 7 days of exposure to violet-blue light. In addition, the effect of violet-blue light on MRSA-contaminated surfaces was investigated. Exposure to violet-blue light significantly reduced the number of bacteria, yeasts and moulds on the sampled surfaces. The incubator handle showed a low microbial load and no growth after irradiation. The worktable and sink showed an inconsistent reduction due to shaded areas. In the second experiment, violet-blue light significantly reduced the microbial load of MRSA on surfaces, with a greater reduction on steel surfaces than on plastic surfaces. Violet-blue light at 405 nm has proven to be an effective tool for pathogen inactivation in healthcare settings Violet-blue light shows promise as an additional and integrated tool to reduce microbial contamination in hospital environments but must be used in combination with standard cleaning practices and infection control protocols. Further research is needed to optimise the violet-blue, 405 nm disinfection method.
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Affiliation(s)
- Davide Amodeo
- Department of Medical Biotechnology, University of Siena, 53100 Siena, Italy;
| | - Pietro Manzi
- Hospital of Santa Maria di Terni, 05100 Terni, Italy;
| | - Isa De Palma
- Department of Medical Biotechnology, University of Siena, 53100 Siena, Italy;
| | - Alessandro Puccio
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy; (A.P.); (N.N.)
| | - Nicola Nante
- Department of Molecular and Developmental Medicine, University of Siena, 53100 Siena, Italy; (A.P.); (N.N.)
| | | | - Daniele Marini
- Medical Microbiology Section, Department of Medicine and Surgery, University of Perugia, 06100 Perugia, Italy; (D.M.); (D.P.)
| | - Donatella Pietrella
- Medical Microbiology Section, Department of Medicine and Surgery, University of Perugia, 06100 Perugia, Italy; (D.M.); (D.P.)
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Wardal E, Żabicka D, Skalski T, Kubiak-Pulkowska J, Hryniewicz W, Sadowy E. Characterization of a Tigecycline-, Linezolid- and Vancomycin-Resistant Clinical Enteroccoccus faecium Isolate, Carrying vanA and vanB Genes. Infect Dis Ther 2023; 12:2545-2565. [PMID: 37821741 PMCID: PMC10651664 DOI: 10.1007/s40121-023-00881-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 09/22/2023] [Indexed: 10/13/2023] Open
Abstract
INTRODUCTION Increasing incidence of Enterococcus faecium resistant to key antimicrobials used in therapy of hospitalized patients is a worrisome phenomenon observed worldwide. Our aim was to characterize a tigecycline-, linezolid- and vancomycin-resistant E. faecium isolate with the vanA and vanB genes, originating from a hematoma of a patient hospitalized in an intensive care unit in Poland. METHODS Antimicrobial susceptibility (a broad panel) was tested using gradient tests with predefined antibiotic concentrations. The complete genome sequence was obtained from a mixed assembly of Illumina MiSeq and Oxford Nanopore's MinION reads. The genome was analyzed with appropriate tools available at the Center for Genomic Epidemiology, PubMLST and GenBank. Transferability of oxazolidinone, tigecycline and vancomycin resistance genes was investigated by conjugation, followed by PCR screen of transconjugants for antimicrobial resistance genes and plasmid rep genes characteristic for the donor and genomic sequencing of selected transconjugants. RESULTS The isolate was resistant to most antimicrobials tested; susceptibility to daptomycin, erythromycin and chloramphenicol was significantly reduced, and only oritavancin retained the full activity. The isolate represented sequence type 18 (ST18) and carried vanA, vanB, poxtA, fexB, tet(L), tet(M), aac(6')-aph(2''), ant(6)-Ia and ant(6')-Ii. The vanA, poxtA and tet(M) genes located on ~ 40-kb plasmids were transferable by conjugation yielding transconjugants resistant to vancomycin, linezolid and tigecycline. The substitutions in LiaS, putative histidine kinase, SulP, putative sulfate transporter, RpoB and RpoC were potential determinants of an elevated daptomycin MIC. Comparative analyses of the studied isolate with E. faecium isolates from other countries revealed its similarity to ST18 isolates from Ireland and Uganda from human infections. CONCLUSIONS We provide the detailed characteristics of the genomic determinants of antimicrobial resistance of a clinical E. faecium demonstrating the concomitant presence of both vanA and vanB and resistance to vancomycin, linezolid, tigecycline and several other compounds and decreased daptomycin susceptibility. This isolate is a striking example of an accumulation of resistance determinants involving various mechanisms by a single hospital strain.
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Affiliation(s)
- Ewa Wardal
- Department of Molecular Microbiology, National Medicines Institute, ul. Chełmska 30/34, 00-725, Warsaw, Poland
| | - Dorota Żabicka
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, ul. Chełmska 30/34, 00-725, Warsaw, Poland
| | - Tomasz Skalski
- Department of Clinical Microbiology and Molecular Diagnostics, University Hospital No 2, ul. Ujejskiego 75, Bydgoszcz, Poland
| | - Joanna Kubiak-Pulkowska
- Department of Clinical Microbiology and Molecular Diagnostics, University Hospital No 2, ul. Ujejskiego 75, Bydgoszcz, Poland
| | - Waleria Hryniewicz
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, ul. Chełmska 30/34, 00-725, Warsaw, Poland
| | - Ewa Sadowy
- Department of Molecular Microbiology, National Medicines Institute, ul. Chełmska 30/34, 00-725, Warsaw, Poland.
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Aiesh BM, Qashou R, Shemmessian G, Swaileh MW, Abutaha SA, Sabateen A, Barqawi AK, AbuTaha A, Zyoud SH. Nosocomial infections in the surgical intensive care unit: an observational retrospective study from a large tertiary hospital in Palestine. BMC Infect Dis 2023; 23:686. [PMID: 37833675 PMCID: PMC10576355 DOI: 10.1186/s12879-023-08677-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 10/06/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Nosocomial infections or hospital-acquired infections are a growing public health threat that increases patient morbidity and mortality. Patients at the highest risk are those in intensive care units. Therefore, our objective was to provide a pattern analysis of nosocomial infections that occurred in an adult surgical intensive care unit (ICU). METHODS This study was a retrospective observational study conducted in a 6-bed surgical intensive care unit (SICU) at An-Najah National University Hospital (NNUH) to detect the incidence of nosocomial infections from January 2020 until December 2021. The study group included 157 patients who received antibiotics during their stay in the SICU. RESULTS The incidence of nosocomial infections, either suspected or confirmed, in the SICU was 26.9% (95 out of 352 admitted patients). Pneumonia (36.8%) followed by skin and soft tissue infections (35.8%) were the most common causes. The most common causative microorganisms were in the following order: Pseudomonas aeruginosa (26.3%), Acinetobacter baumannii (25.3%), extended-spectrum beta lactamase (ESBL)-Escherichia coli (23.2%) and Klebsiella pneumonia (15.8%). The average hospital stay of patients with nosocomial infections in the SICU was 18.5 days. CONCLUSIONS The incidence of nosocomial infections is progressively increasing despite the current infection control measures, which accounts for an increased mortality rate among critically ill patients. The findings of this study may be beneficial in raising awareness to implement new strategies for the surveillance and prevention of hospital-acquired infections in Palestinian hospitals and health care centers.
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Affiliation(s)
- Banan M Aiesh
- Infection Control Department, An-Najah National University Hospital, Nablus, 44839, Palestine.
| | - Raghad Qashou
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Genevieve Shemmessian
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
| | - Mamoun W Swaileh
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Shatha A Abutaha
- Department of Internal Medicine, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Ali Sabateen
- Infection Control Department, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Abdel-Karim Barqawi
- Department of Medicine, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine.
- Department of General Surgery, An-Najah National University Hospital, Nablus, 44839, Palestine.
| | - Adham AbuTaha
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Department of Pathology, An-Najah National University Hospital, Nablus, 44839, Palestine
| | - Sa'ed H Zyoud
- Department of Clinical and Community Pharmacy, College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Poison Control and Drug Information Center (PCDIC), College of Medicine and Health Sciences, An-Najah National University, Nablus, 44839, Palestine
- Clinical Research Center, An-Najah National University Hospital, Nablus, 44839, Palestine
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10
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Carey E, Chen HYP, Baker D, Blankenhorn R, Munro S. Non-ventilator associated hospital acquired pneumonia (NV-HAP) risk among hospitalized veterans before and during the COVID-19 pandemic. Am J Infect Control 2023; 51:1163-1166. [PMID: 36603808 PMCID: PMC9807267 DOI: 10.1016/j.ajic.2022.12.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 12/22/2022] [Accepted: 12/23/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Among hospitalized US Veterans, the rate of non-ventilator associated hospital acquired pneumonia (NV-HAP) decreased between 2015 and 2020 then increased following the onset of 2019-nCoV (COVID-19). METHODS Veterans admitted to inpatient acute care for ≥48 hours at 135 Department of Veterans Affairs Medical Centers between 2015 and 2021 were identified (n = 1,567,275). Non-linear trends in NV-HAP incidence were estimated using generalized additive modeling, adjusted for seasonality and patient risk factors. RESULTS The incidence rate (IR) of NV-HAP decreased linearly by 32% (95% CI: 63-74) from 10/1/2015 to 2/1/2020, translating to 337 fewer NV-HAP cases. Following the US onset of the COVID-19 pandemic in February 2020, the NV-HAP IR increased by 25% (95% CI: 14-36) among Veterans without COVID-19 and 108% (95% CI: 178-245) among Veterans with COVID-19, resulting in an additional 50 NV-HAP cases and $5,042,900 in direct patient care costs 12-months post admission. DISCUSSION This increase in NV-HAP rates could be driven by elevated risk among Veterans with COVID-19, decreased prevention measures during extreme COVID-19 related system stress, and increased patient acuity among hospitalized Veterans during the first year of the pandemic. CONCLUSIONS Basic nursing preventive measures that are resilient to system stress are needed as well as population surveillance to rapidly identify changes in NV-HAP risk.
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Affiliation(s)
- Evan Carey
- Research and Development, Rocky Mountain Regional VA Medical Center, Aurora, CO; The VA Collaborative Evaluation Center (VACE), A Virtual Center Based at the Rocky Mountain Regional, Seattle, and Louis Stokes Cleveland VA Medical Centers, Aurora, Seattle and Cleveland, Colorado, Washington, Ohio; Department of Biostatistics and Informatics, Colorado School of Public Health, University of Colorado Anschutz Medical Campus.
| | - Hung-Yuan P Chen
- Research and Development, Rocky Mountain Regional VA Medical Center, Aurora, CO; The VA Collaborative Evaluation Center (VACE), A Virtual Center Based at the Rocky Mountain Regional, Seattle, and Louis Stokes Cleveland VA Medical Centers, Aurora, Seattle and Cleveland, Colorado, Washington, Ohio
| | - Dian Baker
- School of Nursing, California State University, Sacramento, CA
| | - Richard Blankenhorn
- Research and Development, Rocky Mountain Regional VA Medical Center, Aurora, CO; The VA Collaborative Evaluation Center (VACE), A Virtual Center Based at the Rocky Mountain Regional, Seattle, and Louis Stokes Cleveland VA Medical Centers, Aurora, Seattle and Cleveland, Colorado, Washington, Ohio
| | - Shannon Munro
- Department of Veterans Affairs Medical Center, Salem, VA
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Gurney H, White J, Sweeney J, Valyko A, Washer L. Evaluation of hospital-onset bloodstream infections compared to central line...associated bloodstream infections at an acute, tertiary care hospital. Am J Infect Control 2023; 51:1120-1123. [PMID: 37054893 DOI: 10.1016/j.ajic.2023.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 04/04/2023] [Accepted: 04/05/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Central line...associated bloodstream infection (CLABSI) is the current benchmark used in HAI (Hospital-associated infection) surveillance and effective interventions have greatly reduced the incidence in recent years. However, bloodstream infection (BSI) continues to be a major source of morbidity and mortality in hospitals. Hospital-onset bloodstream infection (HOBSI), which includes central and peripheral line surveillance, may be a more sensitive indicator of preventable BSI. Our objective is to assess the impact of a change to HOBSI surveillance by comparing the incidence of BSIs using the National Health care and Safety Network LabID and BSI definitions compared to CLABSI. METHODS Utilizing electronic medical charts, we determined if each blood culture met the HOBSI criteria according to the National Health care and Safety Network LabID and BSI definitions. We calculated the incidence rates (IRs) per 10,000 patient days for both definitions and compared them to the CLABSI rate per 10,000 patient days for the same period. RESULTS The IR of HOBSI using the LabID definition was 10.25. Using the BSI definition, we found an IR of 3.77. The IR of CLABSI for the same period was 1.84. CONCLUSIONS After excluding secondary BSIs, the HOBSI rate is still double that of the CLABSI rate. HOBSI surveillance is a more sensitive indicator of BSI than CLABSI, and thus a better target for monitoring effectiveness of interventions.
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Affiliation(s)
- Haley Gurney
- Department of Infection Prevention and Epidemiology, University of Michigan Health, Ann Arbor, MI.
| | - Jacqueline White
- Department of Infection Prevention and Epidemiology, University of Michigan Health, Ann Arbor, MI
| | - Jennifer Sweeney
- Department of Infection Prevention and Epidemiology, University of Michigan Health, Ann Arbor, MI
| | - Amanda Valyko
- Department of Infection Prevention and Epidemiology, University of Michigan Health, Ann Arbor, MI
| | - Laraine Washer
- Department of Infection Prevention and Epidemiology, University of Michigan Health, Ann Arbor, MI
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Pałka A, Kujawska A, Hareza DA, Gajda M, Wordliczek J, Jachowicz-Matczak E, Owsianka I, Żółtowska B, Chmielarczyk A, Romaniszyn D, I GM, Wójkowska-Mach J. Secondary bacterial infections & extensively drug-resistant bacteria among COVID-19 hospitalized patients at the University Hospital in Kraków. Ann Clin Microbiol Antimicrob 2023; 22:77. [PMID: 37620874 PMCID: PMC10463524 DOI: 10.1186/s12941-023-00625-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 07/29/2023] [Indexed: 08/26/2023] Open
Abstract
INTRODUCTION Healthcare-associated infections (HAI) and bacterial antimicrobial resistance posed a therapeutic risk during the coronavirus disease 2019 (COVID-19) pandemic. The aim of this study was to analyze the HAIs in COVID-19 patients in the Intensive Care Unit (ICU) and non-ICU at the University Hospital in Krakow (UHK) with an emphasis on the susceptibility of the most frequently isolated pathogens and the prevalence of extensively drug resistant (XDR) microorganisms. METHODS This laboratory-based study was carried out at the University Hospital in Krakow in the ICU and non-ICUs dedicated to COVID-19 patients between May 2021 and January 2022. All isolates of Klebsiella pneumoniae were analyzed using PFGE protocol. RESULTS 292 independent HAI cases were identified, with the predominance of urinary tract infections (UTI), especially in the non-ICU setting. The most common ICU syndrome was pneumonia (PNA). The prevalence of XDR organisms was 22.6% in the ICU and 14.8% in non-ICUs among all isolates. The incidence of carbapenem-resistant Enterobacteriaceae infection was 24.8 cases per 10,000 hospitalizations and the carbapenem-resistant A. baumannii infection incidence was 208.8 cases per 10,000 hospitalizations. The prevalence of XDR strains was highest in Acinetobacter spp, in PNA cases. The PFGE typing demonstrated that almost all XDR strains varied widely from each other. CONCLUSIONS In this study, there was a high incidence of HAI in COVID-19 patients, especially when compared to Western Europe and the United States. Similarly, the prevalence of XDR microorganisms, especially XDR-A.baumannii, was also high. PFGE did not confirm the horizontal spread of any organism strains.
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Affiliation(s)
- A Pałka
- Department of Microbiology, University Hospital in Krakow, ul. Jakubowskiego 2, 30-688, Kraków, Poland
| | - A Kujawska
- Department of Microbiology, University Hospital in Krakow, ul. Jakubowskiego 2, 30-688, Kraków, Poland
| | - D A Hareza
- Division of Infectious Diseases, Johns Hopkins School of Medicine, 1830 E Monument St, 4th Floor, Baltimore, MD, USA
| | - M Gajda
- Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, ul. Czysta 18, 31-121, Kraków, Poland
- Doctoral School of Medicine and Health Sciences, Jagiellonian University Medical College, ul. św. Anny 12, 31- 008, Kraków, Poland
| | - Jerzy Wordliczek
- Anesthesiology and Intensive Care Clinical Department, University Hospital in Krakow, ul. Jakubowskiego 2, 30- 688, Kraków, Poland
| | - E Jachowicz-Matczak
- Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, ul. Czysta 18, 31-121, Kraków, Poland
| | - I Owsianka
- Doctoral School of Medicine and Health Sciences, Jagiellonian University Medical College, ul. św. Anny 12, 31- 008, Kraków, Poland
| | - B Żółtowska
- Department of Microbiology, University Hospital in Krakow, ul. Jakubowskiego 2, 30-688, Kraków, Poland
| | - A Chmielarczyk
- Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, ul. Czysta 18, 31-121, Kraków, Poland
| | - D Romaniszyn
- Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, ul. Czysta 18, 31-121, Kraków, Poland
| | - Gregorczyk-Maga I
- Institute of Dentistry, Faculty of Medicine, Jagiellonian University Medical College, ul. Montelupich 4, 31-155, Kraków, Poland
| | - J Wójkowska-Mach
- Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, ul. Czysta 18, 31-121, Kraków, Poland.
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13
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Fakhreddine S, Fawaz M, Hassanein S, Al Khatib A. Prevalence and mortality rate of healthcare-associated infections among COVID-19 patients: a retrospective cohort community-based approach. Front Public Health 2023; 11:1235636. [PMID: 37637822 PMCID: PMC10449454 DOI: 10.3389/fpubh.2023.1235636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 07/24/2023] [Indexed: 08/29/2023] Open
Abstract
Background The prevalence of HAI among COVID-19 patients ranged between 4.8% and 42.8% with the highest occurrence observed in critically ill patients. The present study aimed to evaluate the clinical features of HAI in severe and critical COVID-19 patients, their microbiological characteristics, and the attributable risk factors. Methods This is an analytical observational, retrospective single-center, cohort study that included 723 patients with severe-critical COVID-19 admitted to Saint George Hospital between September 2020 and February 2021. Data collection included demographic variables (sex, age), comorbidities, laboratory findings, HAI types and agents, COVID-19 treatment modalities, hospitalization settings, length of stay, and mortality rate. Data was analyzed using SPSS version 25. Results The prevalence of patients developing HAI was 7.3% (53 of 723). Five types of nosocomial bacterial infections were tracked noting ventilator-associated pneumonia (41.26%), catheter-associated urinary tract infection (28.6%), hospital-acquired pneumonia (17.44%), catheter-related bloodstream infection (6.35%), and bloodstream infection (6.35%). Binary logistic analysis showed that HAI are statistically affected by four factors noting patients' age (p = 0.039), Length of Stay (p < 0.001), BIPAP (p = 0.019), and mechanical ventilation (p < 0.001). The risk of having HAI increases 3.930 times in case of mechanical ventilation, 2.366 times in case of BIPAP, 1.148 times when the LOS increases 1 day, and 1.029 times when the age is higher with 1 year. Conclusion Since the prevalence of HAI is high among severe and critical COVID-19 patients, it is important to prepare a treatment with diagnostic, preventative, and control measures for this infection.
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Affiliation(s)
- Soha Fakhreddine
- Department of Infectious Diseases, Saint-Georges Hospital, Hadat, Lebanon
- Department of Nursing, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Mirna Fawaz
- Department of Nursing, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
| | - Salwa Hassanein
- Department of Nursing, Faculty of Health Sciences, Almoosa College, Al Ahsa, Saudi Arabia
- Department of Community Health Nursing, Cairo University, Cairo, Egypt
| | - Alissar Al Khatib
- Department of Nursing, Faculty of Health Sciences, Beirut Arab University, Beirut, Lebanon
- Department of Nursing, Faculty of Health Sciences, Almoosa College, Al Ahsa, Saudi Arabia
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14
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Brachio SS, Gu W, Saiman L. Next Steps for Health Care-Associated Infections in the Neonatal Intensive Care Unit. Clin Perinatol 2023; 50:381-397. [PMID: 37201987 DOI: 10.1016/j.clp.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
We discuss the burden of health care-associated infections (HAIs) in the neonatal ICU and the role of quality improvement (QI) in infection prevention and control. We examine specific QI opportunities and approaches to prevent HAIs caused by Staphylococcus aureus , multidrug-resistant gram-negative pathogens, Candida species, and respiratory viruses, and to prevent central line-associated bloodstream infections (CLABSIs) and surgical site infections. We explore the emerging recognition that many hospital-onset bacteremia episodes are not CLABSIs. Finally, we describe the core tenets of QI, including engagement with multidisciplinary teams and families, data transparency, accountability, and the impact of larger collaborative efforts to reduce HAIs.
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Affiliation(s)
- Sandhya S Brachio
- Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH17, New York, NY 10032, USA.
| | - Wendi Gu
- Division of Neonatology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH17, New York, NY 10032, USA
| | - Lisa Saiman
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, 622 West 168th Street, PH1-470, New York, NY 10032, USA; Department of Infection Prevention and Control, NewYork-Presbyterian Hospital, New York, NY, USA
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15
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Nasiri N, Mangolian Shahrbabaki P, Sharifi A, Ghasemzadeh I, Khalili M, Karamoozian A, Khalooei A, Haghdoost A, Sharifi H. Barriers and Problems in Implementing Health-Associated Infections Surveillance Systems in Iran: A Qualitative Study. Med J Islam Repub Iran 2023; 37:57. [PMID: 37457414 PMCID: PMC10349358 DOI: 10.47176/mjiri.37.57] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Indexed: 07/18/2023] Open
Abstract
Background Healthcare-associated infections (HAIs) are among the most critical challenges for patients and healthcare providers. To achieve the goals of the surveillance system, it is necessary to identify its barriers and problems. This study aimed to identify the barriers and problems of the surveillance system for HAIs. Methods This qualitative study was conducted using the content analysis method to investigate the challenges of this surveillance system from the perspective of 18 infection control nurses from hospitals in different cities of Iran with work experience of 1 to 15 years. Data were collected through semi-structured interviews and analyzed using the Lundman and Graneheim qualitative content analysis method. Results In this study, we found 2 categories and 7 subcategories. Two categories were barriers related to human resources and organizational barriers to infection control. The 7 subcategories included weakness of medical staff in adherence to health principles, obstacles related to patients, high workload and insufficient motivation, lack of staff knowledge, lack of human resources, functional and logistical weaknesses, and weaknesses in the surveillance system. Conclusion To reduce problems and improve HAIs reporting, the HAIs surveillance system needs the support of health system officials and managers. This administrative and support focus can establish the framework for removing and lowering other barriers, such as the number of reported cases, physician and staff noncooperation, and the prevalence of HAIs. It can also bring HAIs cases closer to reality.
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Affiliation(s)
- Naser Nasiri
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV
Surveillance, Institute for Futures Studies in Health, Kerman University of Medical
Sciences, Kerman, Iran
| | | | - Ali Sharifi
- Department of Ophthalmology, Shafa Hospital, Afzalipour School of Medicine,
Kerman University of Medical Sciences, Kerman, Iran
| | - Iman Ghasemzadeh
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV
Surveillance, Institute for Futures Studies in Health, Kerman University of Medical
Sciences, Kerman, Iran
| | - Malahat Khalili
- The Michael G. DeGroote Institute for Pain Research and Care, McMaster
University, Hamilton, Ontario, Canada
| | - Ali Karamoozian
- Modeling in Health Research Center, Institute for Futures Studies in Health,
Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Khalooei
- Social Determinants of Health Research Center, Institute for Futures Studies in
Health, Kerman University of Medical Sciences, Kerman, Iran
| | - AliAkbar Haghdoost
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV
Surveillance, Institute for Futures Studies in Health, Kerman University of Medical
Sciences, Kerman, Iran
| | - Hamid Sharifi
- HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV
Surveillance, Institute for Futures Studies in Health, Kerman University of Medical
Sciences, Kerman, Iran
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Iwona GM, Anna P, Mateusz F, Michal K, Anna K, Paweł M, Estera JM, Dorota R, Agnieszka C, Barbara Ż, Jadwiga WM. Impact of tooth brushing on oral bacteriota and health care-associated infections among ventilated COVID-19 patients: an intervention study. Antimicrob Resist Infect Control 2023; 12:17. [PMID: 36890608 PMCID: PMC9992909 DOI: 10.1186/s13756-023-01218-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/15/2023] [Indexed: 03/10/2023] Open
Abstract
BACKGROUND Up to 48% of ventilated coronavirus disease 2019 (COVID-19) patients develop ventilator-associated pneumonia (VAP) during hospitalization in an ICU. Dysbiotic oral microbiota can colonize the lower respiratory tract and lead to VAP. It is recommended to introduce oral care strategies in the ICU to prevent VAP. In this study, we observed the impact of an oral hygienic protocol with tooth brushing on cultivable oral bacteriota, the incidence of HAI and patient safety among mechanically ventilated COVID-19 patients in an ICU setting. METHODS In this prospective cohort study, we recruited 56 adult COVID-19 patients who qualified for mechanical ventilation. Patients were divided into 2 groups depending on the oral care procedure: standard and extended oral procedures with tooth brushing. Oral bacteriota samples were taken first within 36 h and after 7 days of intubation. Microorganisms were identified by MALDI/TOF mass spectrometry. bacterial health care-associated infection (HAI) cases were retrospectively analyzed by etiology. A PFGE study was performed for Klebsiella pneumoniae to check for clonal spreading of strains from oral bacteriota samples and HAI cases. RESULTS We observed significant dysbiosis and a decrease in cultivable oral bacteriota diversity, with a high frequency of potentially pathogenic species, including Acinetobacter baumannii and K. pneumoniae. The HAI incidence rate was high (55.2/1000 patient-days), most commonly of K. pneumoniae and A. baumannii etiologies, which correlated with the presence of A. baumannii and K. pneumoniae in the oral samples. Strains isolated from VAP cases were the same as oral isolates in 8 cases. The procedure with tooth brushing led to less frequent identification of A. baumannii in oral samples (55.6% vs. 5.3%, p = 0.001); however, it did not decrease the incidence of HAIs. CONCLUSIONS Dysbiotic oral bacteriota is an important source of respiratory pathogens. The introduction of tooth brushing in oral hygiene protocols in an ICU setting was effective in decreasing the extent of oral bacteriota dysbiosis; however, it did not reduce the risk of HAIs or mortality. TRIAL REGISTRATION 1072.6120.333.2020.
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Affiliation(s)
- Gregorczyk-Maga Iwona
- Institute of Dentistry, Faculty of Medicine, Jagiellonian University Medical College, Ul. Montelupich 4, 31-155, Kraków, Poland
| | - Pałka Anna
- Microbiology Unit, University Hospital, Ul. Jakubowskiego 2, 30-688, Kraków, Poland
| | - Fiema Mateusz
- Department of Endocrinology, University Hospital, Ul. Jakubowskiego 2, 30-688, Kraków, Poland
| | - Kania Michal
- Doctoral School of Medicine and Health Sciences, Jagiellonian University Medical College, Ul. św. Anny 12, 31-008, Kraków, Poland. .,Chair of Metabolic Diseases, Faculty of Medicine, Jagiellonian University Medical College, Ul. Jakubowskiego 2, 30-688, Kraków, Poland.
| | - Kujawska Anna
- Microbiology Unit, University Hospital, Ul. Jakubowskiego 2, 30-688, Kraków, Poland
| | - Maga Paweł
- Chair of Angiology, Faculty of Medicine, Jagiellonian University Medical College, Ul. Jakubowskiego 2, 30-688, Kraków, Poland
| | - Jachowicz-Matczak Estera
- Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18, 31-121, Kraków, Poland
| | - Romaniszyn Dorota
- Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18, 31-121, Kraków, Poland
| | - Chmielarczyk Agnieszka
- Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18, 31-121, Kraków, Poland
| | - Żółtowska Barbara
- Center for Innovative Therapy, Clinical Research Coordination Center, University Hospital, Ul. Jakubowskiego 2, 30-688, Kraków, Poland
| | - Wójkowska-Mach Jadwiga
- Chair of Microbiology, Faculty of Medicine, Jagiellonian University Medical College, Czysta 18, 31-121, Kraków, Poland
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Żebrowska M, Strohmaier S, Westgarth C, Huttenhower C, Erber AC, Haghayegh S, Eliassen AH, Huang T, Laden F, Hart JE, Rosner B, Kawachi I, Chavarro JE, Okereke OI, Schernhammer ES. Relationship between pet ownership and risk of high depressive symptoms in adolescence and young adulthood. J Affect Disord 2023; 323:554-561. [PMID: 36464093 PMCID: PMC9839520 DOI: 10.1016/j.jad.2022.11.070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/25/2022] [Accepted: 11/20/2022] [Indexed: 12/05/2022]
Abstract
BACKGROUND Only few longitudinal studies with high risk of bias have examined relationship between pets and adolescents' mental health. METHODS Our prospective cohort study followed depression-free US adolescents aged 12-18, enrolled in the Growing Up Today Study from pet ownership assessment in 1999 to possible occurrence of high depressive symptoms defined based on the McKnight Risk Factor Survey between 2001 and 2003. Propensity-score-adjusted odds ratios (ORs) and 95 % confidence intervals (CIs) were estimated using generalized estimating equation models. RESULTS Among 9631 adolescents [42.4 % male, mean age 14.9 years (SD 1.6)], we found no association between pet ownership and risk of high depressive symptoms (ORany_pet = 1.14; 95%CI, 0.95-1.38). Stratified analyses revealed no evidence of effect modification by sex, but effect modification by maternal history of depression (depressed mothers ORany_pet = 0.83; 95 % CI: 0.58-1.19, non-depressed mothers ORany_pet = 1.27; 95 % CI: 1.02-1.58; Pintx = 0.03), which differed further by children's sex. Effects were more pronounced among children with a history of childhood abuse (ORany_pet = 0.41 (0.14-1.15); Pintx ≤0.03). No major differences by type of pet owned were observed in any of these analyses. LIMITATIONS Our sample is predominantly white and all are offspring of nurses with a similar academic background which could affect generalizability. CONCLUSIONS Overall, we found no association between pet ownership and depression during adolescence, however subgroup analyses indicated some individuals may benefit from a pet. Future longitudinal studies with more detailed exposure assessments, including pet attachment are needed to further explore the potential of human-animal interaction on mental health.
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Affiliation(s)
- Magdalena Żebrowska
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Susanne Strohmaier
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Carri Westgarth
- Department of Livestock and One Health, Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Liverpool, UK
| | - Curtis Huttenhower
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Astrid C Erber
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Shahab Haghayegh
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - A Heather Eliassen
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Tianyi Huang
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Francine Laden
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Jaime E Hart
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Bernard Rosner
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Ichiro Kawachi
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Jorge E Chavarro
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Olivia I Okereke
- Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Eva S Schernhammer
- Department of Epidemiology, Center for Public Health, Medical University of Vienna, Vienna, Austria; Channing Division of Network Medicine, Department of Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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18
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Dadon M, Chedid K, Martin ET, Shaul I, Greiver O, Katz I, Saadon H, Alfaro M, Hod L, Shorbaje A, Braslavsky-Siag A, Moscovici S, Kaye KS, Marchaim D. The impact of bedside wipes in multi-patient rooms: a prospective, crossover trial evaluating infections and survival. J Hosp Infect 2023; 134:50-56. [PMID: 36754289 DOI: 10.1016/j.jhin.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 11/16/2022] [Accepted: 11/21/2022] [Indexed: 02/10/2023]
Abstract
BACKGROUND Multidrug-resistant organisms (MDROs) are prevalent on high-touch surfaces in multi-patient rooms. AIM To quantify the impact of hanging single-use cleaning/disinfecting wipes next to each bed. Pre-specified outcomes were: (1) hospital-acquired infections (HAIs), (2) cleaning frequency, (3) MDRO room contamination, (4) new MDRO acquisitions, and (5) mortality. METHODS Clustered randomized crossover trial at Shamir Medical Center, Israel (October 2016 to January 2018). Clusters were randomly assigned to use for cleaning either single-use quaternary ammonium wipes (Clinell) or standard practices (reusable cloths and buckets with bleach). Six-month intervention periods were implemented in alternating sequence, separated by a washout period. Five high-touch surfaces were monitored by fluorescent markers. Study outcomes were compared between periods using generalized estimating equations, Poisson regression, and Cox proportional hazards models. FINDINGS Overall, 7725 patients were included (47,670 person-days), 3793 patients in rooms with intervention cleaning and 3932 patients in rooms with standard practices. During the intervention, there was no significant difference in HAI rates (incidence rate ratio: 1.6; 95% confidence interval (CI): 0.7-3.5; P = 0.3). However, in intervention rooms, the frequency of environmental cleaning was higher (odds ratio: 3.73; 95% CI: 2.0-7.1; P < 0.0001), MDRO environmental contamination rate was insignificantly lower (odds ratio: 0.7; 95% CI: 0.5-1.0; P = 0.06), new MDRO acquisition rate was lower (hazard ratio: 0.4; 95% CI: 0.2-1.0; P = 0.04), and in-hospital mortality rate was lower (incidence rate ratio: 0.8; 95% CI: 0.7-1.0; P = 0.03). CONCLUSION Hanging single-use cleaning/disinfecting wipes next to each bed did not affect the HAI rates but did improve the frequency of cleaning, reduce MDRO environmental contamination, and was associated with reduced incidence of new MDRO acquisitions and reduced mortality. This is a feasible, recommended practice to improve patient outcomes in multi-patient rooms.
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Affiliation(s)
- M Dadon
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - K Chedid
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - E T Martin
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - I Shaul
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Greiver
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - I Katz
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - H Saadon
- Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel
| | - M Alfaro
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - L Hod
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - A Shorbaje
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - S Moscovici
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - K S Kaye
- Division of Allergy, Immunology and Infectious Diseases, Robert Wood Johnson Medical School, NJ, USA
| | - D Marchaim
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin, Israel.
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Damico V, Murano L, Margosio V, Ripamonti C. Co-infections among COVID-19 adult patients admitted to intensive care units: results from a retrospective study. Ann Ig 2023; 35:49-60. [PMID: 35195240 DOI: 10.7416/ai.2022.2515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Co-infection rates increase in patients admitted to the Intensive Care Units. The aim of this study was to examine the Healthcare Associated Infections in critically ill adult patients infected with SARS-CoV-2. METHODS A retrospective observational study in adults with confirmed SARS-CoV-2 infection requiring intensive care unit admission was performed. From February 2020 to September 2021, healthcare records from a total of 118 patients were evaluated. RESULTS In the study period, 39 patients were diagnosed with at least 1 Healthcare Associated Infection (33.1%). The co-infection/co-colonisation rate >48 hours after admission was 29.0 per 1,000 person/days (95 % CI 19.1-33.9). A total of 94 isolates were identified, the most common being Klebsiella spp, Clostridium difficile, Acinetobacter baumanii and Enterococcus spp. Associated outcomes for Healthcare Associated Infections have been identified: age >64 years (p= .003), length of Intensive Care Unit stay> 7 days (p= .002), Type 2 Diabetes mellitus (p= .019), cardiovascular disease (p= .021), inserted central venous catheter (p= .014), intubation (p< .001), APACHE II score >25 (p< .001), mechanical ventilation 48 hours (p= .003), and inserted urinary catheter (p= .002). The overall fatality rate of patients included in the study was 41.5% (n= 49), and it was found to be significantly higher in patients who acquired a Healthcare Associated Infection (n=26/39, 66.7%) compared to those who did not acquire it (n= 23/79, 29.1%) (OR= 4.87; 95% CI = 2.14-11.10; p< .001). CONCLUSIONS Our study showed high rates of Healthcare Associated Infections in critically ill adults with COVID-19. Associated factors for Healthcare Associated Infections acquisition and fatality in Intensive Care Units patients were identified as a good reason for a revision of existing infection control policies.
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Affiliation(s)
- V Damico
- Local Health and Social Authority, Province of Lecco, Italy
| | - L Murano
- Sanitary Assistance Residency "Madonna della Neve" Onlus, Premana, LC, Italy
| | - V Margosio
- Local Health and Social Authority, Province of Lecco, Italy
| | - C Ripamonti
- Local Health and Social Authority, Province of Lecco, Italy
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20
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Wright JR, Ly TT, Cromwell KB, Brislawn CJ, Chen See JR, Anderson SLC, Pellegrino J, Peachey L, Walls CY, Lloyd CM, Jones OY, Lawrence MW, Bess JA, Wall AC, Shope AJ, Lamendella R. Assessment of a novel continuous cleaning device using metatranscriptomics in diverse hospital environments. Front Med Technol 2023; 5:1015507. [PMID: 36935775 PMCID: PMC10020724 DOI: 10.3389/fmedt.2023.1015507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2022] [Accepted: 02/17/2023] [Indexed: 03/06/2023] Open
Abstract
Introduction Despite routine implementation of cleaning and disinfection practices in clinical healthcare settings, high-touch environmental surfaces and contaminated equipment often serve as reservoirs for the transmission of pathogens associated with healthcare-associated infections (HAIs). Methods The current study involved the analysis of high-touch surface swabs using a metatranscriptomic sequencing workflow (CSI-Dx™) to assess the efficacy of cleanSURFACES® technology in decreasing microbial burden by limiting re-contamination. This is a non-human single center study conducted in the Emergency Department (ED) and on an inpatient Oncology Ward of Walter Reed National Military Medical Center that have followed hygienic practices during the COVID-19 pandemic environment. Results Although there was no difference in observed microbial richness (two-tailed Wilcoxon test with Holm correction, P > 0.05), beta diversity findings identified shifts in microbial community structure between surfaces from baseline and post-intervention timepoints (Day 1, Day 7, Day 14, and Day 28). Biomarker and regression analyses identified significant reductions in annotated transcripts for various clinically relevant microorganisms' post-intervention, coagulase-negative staphylococci and Malassezia restricta, at ED and Oncology ward, respectively. Additionally, post-intervention samples predominantly consisted of Proteobacteria and to a lesser extent skin commensals and endogenous environmental microorganisms in both departments. Discussion Findings support the value of cleanSURFACES®, when coupled with routine disinfection practices, to effectively impact on the composition of active microbial communities found on high-touch surfaces in two different patient care areas of the hospital (one outpatient and one inpatient) with unique demands and patient-centered practices.
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Affiliation(s)
- Justin R Wright
- Contamination Source Identification, LLC., Huntingdon, PA, United States
| | - Truc T Ly
- Contamination Source Identification, LLC., Huntingdon, PA, United States
| | - Karen B Cromwell
- Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Colin J Brislawn
- Contamination Source Identification, LLC., Huntingdon, PA, United States
| | - Jeremy R Chen See
- Contamination Source Identification, LLC., Huntingdon, PA, United States
| | | | - Jordan Pellegrino
- Contamination Source Identification, LLC., Huntingdon, PA, United States
| | - Logan Peachey
- Contamination Source Identification, LLC., Huntingdon, PA, United States
| | - Christine Y Walls
- Contamination Source Identification, LLC., Huntingdon, PA, United States
| | - Charise M Lloyd
- Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Olcay Y Jones
- Walter Reed National Military Medical Center, Bethesda, MD, United States
| | - Matthew W Lawrence
- Walter Reed National Military Medical Center, Bethesda, MD, United States
| | | | | | - Alexander J Shope
- Contamination Source Identification, LLC., Huntingdon, PA, United States
- AIONX, Hershey, PA, United States
| | - Regina Lamendella
- Contamination Source Identification, LLC., Huntingdon, PA, United States
- Correspondence: Regina Lamendella
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21
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Lai L, Rouphael N, Xu Y, Kabbani S, Beck A, Sherman A, Anderson EJ, Bellamy A, Weiss J, Cross K, Mulligan MJ. An Oil-in-Water adjuvant significantly increased influenza A/H7N9 split virus Vaccine-Induced circulating follicular helper T (cT FH) cells and antibody responses. Vaccine 2022; 40:7065-7072. [PMID: 36273986 DOI: 10.1016/j.vaccine.2022.09.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 04/09/2022] [Accepted: 09/12/2022] [Indexed: 11/15/2022]
Abstract
BACKGROUND Unadjuvanted A/H7N9 vaccines are poorly immunogenic. The immune response is improved with the addition of MF59, an oil-in-water adjuvant. However, the cellular immunologic responses of MF59-adjuvanted A/H7N9 vaccine are not fully understood. METHODS 37 participants were vaccinated with 2 doses of 2013 influenza A/H7N9 vaccine (at Days 1 and 21) with or without MF59 and enrolled in an immunology substudy. Responses were assessed at multiple timepoints (Days 0, 8, 21, 29, and 42) for hemagglutination inhibition (HAI) and neutralizing antibody (Neut) assays, memory B cell responses by enzyme-linked ImmunoSpot; circulating follicular helper T cells (cTFH) and CD4 + T cells by intracellular cytokine staining. RESULTS MF59-adjuvanted influenza A/H7N9 vaccine induced significantly higher hemagglutination inhibition (HAI) and neutralizing antibody (Neut) responses when compared to unadjuvanted vaccine. The adjuvanted vaccine elicited significantly higher levels of Inducible T-cell Co-Stimulator (ICOS) expression by CXCR3+CXCR5+CD4+ cTFH cells, compared to unadjuvanted vaccine. The magnitude of increase in cTFH cells (from baseline to Day 8) and in IL-21 expressing CD154+CD4+ T cells (from baseline to Days 8 and 21) correlated with HAI (at Day 29) and Neut antibody (at Days 8 and 29) titers. The increase in frequency of IL-21 expressing CD154+CD4+T cells (from baseline to Day 21) correlated with memory B cell frequency (at Day 42). CONCLUSION cTFH activation is associated with HAI and Neut responses in recipients of MF59-adjuvanted influenza A/H7N9 vaccine relative to unadjuvanted vaccine. Future studies should focus on optimizing the cTFH response and use cTFH as an early biomarker of serological response to vaccination. This trial was registered at clinicaltrials.gov, trial number NCT01938742.
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Affiliation(s)
- Lilin Lai
- Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University, 500, Irvin Court, Decatur GA 30030
| | - Nadine Rouphael
- Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University, 500, Irvin Court, Decatur GA 30030.
| | - Yongxian Xu
- Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University, 500, Irvin Court, Decatur GA 30030
| | - Sarah Kabbani
- Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University, 500, Irvin Court, Decatur GA 30030
| | - Allison Beck
- Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University, 500, Irvin Court, Decatur GA 30030
| | - Amy Sherman
- Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University, 500, Irvin Court, Decatur GA 30030
| | - Evan J Anderson
- Departments of Pediatrics and Medicine, Emory University School of Medicine and Children's Healthcare of Atlanta, 2015 Uppergate
| | - Abbie Bellamy
- EMMES Corporation, 401, North Washington Street, Suite 700, Rockville, MD 20850, USA
| | - Julia Weiss
- EMMES Corporation, 401, North Washington Street, Suite 700, Rockville, MD 20850, USA
| | - Kaitlyn Cross
- EMMES Corporation, 401, North Washington Street, Suite 700, Rockville, MD 20850, USA
| | - Mark J Mulligan
- Hope Clinic of the Emory Vaccine Center, Division of Infectious Diseases, Department of Medicine, Emory University, 500, Irvin Court, Decatur GA 30030
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Wardal E, Żabicka D, Hryniewicz W, Sadowy E. VanA-Enterococcus faecalis in Poland: hospital population clonal structure and vanA mobilome. Eur J Clin Microbiol Infect Dis 2022; 41:1245-1261. [PMID: 36057762 PMCID: PMC9489580 DOI: 10.1007/s10096-022-04479-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Accepted: 07/18/2022] [Indexed: 11/03/2022]
Abstract
The aim of our study was to characterize the epidemiological situation concerning nosocomial vancomycin-resistant Enterococcus faecalis of VanA-phenotype (VREfs-VanA) in Poland by investigating their clonal relationships and the vanA-associated mobilome. One-hundred twenty-five clinical isolates of VREfs-VanA collected between 2004 and 2016 were studied by phenotypic assays, multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE), PCR detection of plasmid-specific genes, and Tn1546 structure and localization mapping. Selected isolates were subjected to PFGE-S1, Southern hybridization, genomic sequencing and conjugation experiments. The majority of isolates (97.6%) belonged to clonal complexes CC2 and CC87 of E. faecalis. All isolates were resistant to vancomycin and teicoplanin, and resistance to ciprofloxacin and aminoglycosides (high level) was very prevalent in this group. VanA phenotype was associated with 16 types of Tn1546, carrying insertion sequences IS1216, ISEfa4, IS1251 and IS1542, located on repUS1pVEF1, rep1pIP501, rep2pRE25, rep9pAD1/pTEF2/pCF10 and rep6pS86 replicons. The most common Tn1546 B- and BB-type transposons, harbouring one or two copies of IS1216, were inserted between rep18ap200B and repUS1pVEF1 genes and located on ~ 20 kb and 150-200 kb plasmids. VREfs-VanA in Poland represent a polyclonal group, indicating a number of acquisitions of the vanA determinant. The repUS1pVEF1-vanA plasmids, unique for Poland, were the main factor beyond the acquisition of vancomycin resistance by E. faecalis, circulating in Polish hospitals.
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Affiliation(s)
- Ewa Wardal
- Department of Molecular Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland
| | - Dorota Żabicka
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland
| | - Waleria Hryniewicz
- Department of Epidemiology and Clinical Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland
| | - Ewa Sadowy
- Department of Molecular Microbiology, National Medicines Institute, Chełmska 30/34, 00-725, Warsaw, Poland.
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23
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Akinbobola AB, Osunla AC, Bello OM, Ajayi OA. Study of the persistence of selected Gram-negative bacteria pathogens of healthcare-associated infections on hospital fabrics. Am J Infect Control 2022; 50:755-757. [PMID: 34883159 DOI: 10.1016/j.ajic.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/25/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND The ability of healthcare associate infection (HAI) pathogens to persist on fomites is crucial to their transmission within the healthcare setting, this study evaluated the persistence of 3 common HAI pathogens on fabrics materials commonly used in healthcare settings. METHODS Persistence of bacteria species on fabric was investigate by inoculating standardized inoculum prepared from the clinical isolates of Pseudomonas aeruginosa, Escherichia coli and Acinetobacter baumannii on sterile swatches of 100% cotton, microfiber and polyester. Viable bacteria persisting on the inoculated fabrics were evaluated immediate after inoculation and subsequently at 96-hour interval for 32 days using the drop plate technique. The effect of moisture on the persistence of the studied bacteria isolates was also evaluated. RESULTS Between 3 and 6 log reduction in the viability of the inoculated bacteria cells were observed after 32 days of inoculation on fabrics. Generally, lower viable cells were recovered from the microfiber fabrics compared to others, while higher viable cells were recovered from wet fabrics compared to the dry fabrics in this study. DISCUSSION AND CONCLUSIONS This study demonstrated that HAI bacteria pathogens can persist for more than a month on hospital fabrics, and that their persistence can be enhanced by moisture.
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Affiliation(s)
- Ayorinde B Akinbobola
- Department of Microbiology, Adekunle Ajasin University, Akungba-Akoko, Ondo State, Nigeria.
| | - Ayodeji C Osunla
- Department of Microbiology, Adekunle Ajasin University, Akungba-Akoko, Ondo State, Nigeria
| | - Oluyemi M Bello
- Department of Microbiology, Adekunle Ajasin University, Akungba-Akoko, Ondo State, Nigeria
| | - Olajide A Ajayi
- Department of Microbiology, Adekunle Ajasin University, Akungba-Akoko, Ondo State, Nigeria; Centre for Infectious Disease Control and Drug Development (CIDCDD), Adekunle Ajasin University Akungba-Akoko, Ondo State, Nigeria
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24
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Prigitano A, Perrone PM, Esposto MC, Carnevali D, De Nard F, Grimoldi L, Principi N, Cogliati M, Castaldi S, Romanò L. ICU ENVIRONMENTAL SURFACES ARE A RESERVOIR OF FUNGI: SPECIES DISTRIBUTION IN NORTHERN ITALY. J Hosp Infect 2022; 123:74-79. [PMID: 35181398 DOI: 10.1016/j.jhin.2022.02.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/08/2022] [Accepted: 02/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Preventing and reducing nosocomial infections is a public health goal. Concern about healthcare-associated fungal infections has increased in recent years, due to the emergence and spread of new pathogens, increasing antifungal resistance and outbreaks in hospital settings. AIM This study investigated the presence of medically-relevant fungal species on environmental surfaces in 12 intensive care units of 8 hospitals in Milan, Italy. METHODS Environmental samplings, using contact plates on surfaces near bed stations and medical workstations, were conducted between November 2019 and January 2020. Fungi isolated were identified and some were tested in vitro for antifungal susceptibility. FINDINGS A total of 401 environmental samples were collected from 61 bed stations and 17 medical workstations. Positive samples were found in all hospitals except one, with positivity rates ranging from 4% to 24.2%. Filamentous fungi were found mainly on infusion pumps (23.2%) and patient tables (21.2%), whereas yeasts were mainly on computers (25%) and floors (10.9%). Fungi were isolated from 12% of total samples. Filamentous fungi, mainly Aspergillus fumigatus, grew in 70.8% of positive samples, and yeasts in 27.1%, mainly Candida parapsilosis (42.8%) and C. glabrata (28.6%). Fungi were detected both near patients' beds and on surfaces at workstations, indicating potential for environment-to-patient, patient-to-patient and healthcare workers-to-patient transmission CONCLUSIONS: This study highlights that surveillance in hospital settings through environmental sampling may be an important component of fungal infection prevention.
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Affiliation(s)
- Anna Prigitano
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Pier Mario Perrone
- Post Graduate School of Public Health, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Maria Carmela Esposto
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Davide Carnevali
- Post Graduate School of Public Health, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Francesca De Nard
- Post Graduate School of Public Health, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; ATS, Agenzia di Tutela della Salute della Città Metropolitana di Milano, Milan, Italy
| | - Ludovico Grimoldi
- Post Graduate School of Public Health, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Niccolò Principi
- Post Graduate School of Public Health, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Massimo Cogliati
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Silvana Castaldi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy; Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Luisa Romanò
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.
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25
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Holmes K, Moinuddin M, Steinfeld S. Developing valid test bank of surveillance case study scenarios for inter-rater reliability. Am J Infect Control 2022; 50:960-962. [PMID: 35158010 DOI: 10.1016/j.ajic.2022.02.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 02/05/2022] [Accepted: 02/07/2022] [Indexed: 11/01/2022]
Abstract
Case studies are utilized for training on National Healthcare Safety Network (NHSN) healthcare associated infection surveillance definitions. Item discrimination and item analysis were applied to case studies to identify questions that most accurately assess infection preventionists (IPs) application of surveillance definitions.
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26
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Castelli A, Norville P, Kiernan M, Maillard JY, Evans SL. Review of decontamination protocols for shared non-critical objects in 35 policies of UK NHS Acute Care Organisations. J Hosp Infect 2021; 120:65-72. [PMID: 34767870 DOI: 10.1016/j.jhin.2021.10.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 10/28/2021] [Accepted: 10/30/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Decontamination of non-critical objects shared by patients is key in reducing HAIs, but it is a complex process that needs precise guidance from UK NHS Acute Care Organisations (ACOs). AIM To review the indications given by NHS ACOs' policies regarding the decontamination of shared non-critical devices. METHODS Detailed lists of decontamination protocols for shared non-critical objects were retrieved from cleaning, disinfection, and decontamination policies of 35 NHS ACOs. Three parameters were considered for each object: decontamination method, decontamination frequency and person responsible for decontamination. FINDINGS 1279 decontamination protocols regarding 283 different shared non-critical objects were retrieved. 689 (54%) did not indicate the person responsible for decontamination, while only 425 (33%), were complete, giving indications for all three parameters analysed. Only 2.5% (32/1279) decontamination protocols were complete and identical in two policies. In policies where cleaning represented the major decontamination method, chemical disinfection was rarely mentioned and vice versa. A general agreement among policies can be found for four main decontamination methods (detergent and water, detergent wipes, disinfectant wipes, use of disposable items), two decontamination frequencies (between events, daily) and two responsible person designations (nurses, domestic staff). CONCLUSIONS Decontamination protocol policies for shared non-critical objects had some similarities but did not concur on how each individual object should be decontaminated. The lack of clear indications regarding the person responsible for the decontamination process put at risk the ability of policies to serve as guidance.
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Affiliation(s)
- Andrea Castelli
- School of Engineering, Cardiff University, Cardiff, Wales, UK; School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK; Fellows Research Centre, GAMA Healthcare Ltd., Halifax, UK
| | - Phillip Norville
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK; Fellows Research Centre, GAMA Healthcare Ltd., Halifax, UK
| | - Martin Kiernan
- Fellows Research Centre, GAMA Healthcare Ltd., Halifax, UK; School of Nursing and Midwifery, University of Newcastle, Ourimbah, New South Wales, Australia; Richard Wells Research Centre, University of West London, Brentford, UK
| | - Jean-Yves Maillard
- School of Pharmacy and Pharmaceutical Sciences, Cardiff University, Cardiff, Wales, UK.
| | - Sam L Evans
- School of Engineering, Cardiff University, Cardiff, Wales, UK.
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27
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Levi Y, Ben-David D, Estrin I, Saadon H, Krocker M, Goldstein L, Klafter D, Zilberman-Itskovich S, Marchaim D. The Impact of Differences in Surveillance Definitions of Hospital Acquired Urinary Tract Infections (HAUTI). Antibiotics (Basel) 2021; 10:antibiotics10101262. [PMID: 34680842 PMCID: PMC8532618 DOI: 10.3390/antibiotics10101262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 10/14/2021] [Accepted: 10/15/2021] [Indexed: 11/17/2022] Open
Abstract
Hospital-acquired urinary tract infections (HAUTI) are common and most cases are related to catheters (CAUTI). HAUTI and CAUTI surveillance is mandatory in many countries as a measure to reduce the incidence of infections and appropriately direct the allocation of preventable resources. The surveillance criteria issued by the Israeli Ministry of Health (IMOH), differ somewhat from that of the U.S. Centers for Disease Control and Prevention (CDC). Our study aims were to query and quantify the impact of these differences. In a retrospective cohort study conducted at Shamir Medical Center, for calendar year 2017, the surveillance criteria of both IMOH and CDC were applied on 644 patient-unique adults with “positive” urine cultures (per similar definitions). The incidence of HAUTI per IMOH was significantly higher compared to CDC (1.24/1000 vs. 1.02/1000 patient-days, p = 0.02), with no impact on hospitalization’s outcomes. The agreement rate between methods was high for CAUTI (92%), but much lower for all HAUTI (83%). The major error rate, i.e., patients diagnosed with HAUTI per IMOH but had no UTI per CDC, was 31%. To conclude, in order for surveillance to reflect the relative situation and direct allocation of preventable resources based on scientific literature, the process should be uniform worldwide.
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Affiliation(s)
- Yossef Levi
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel; (Y.L.); (D.B.-D.); (S.Z.-I.)
| | - Debby Ben-David
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel; (Y.L.); (D.B.-D.); (S.Z.-I.)
- Unit of Infection Control, Wolfson Medical Center, Holon 5822012, Israel
| | - Inna Estrin
- Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin 7030000, Israel; (I.E.); (H.S.); (M.K.); (L.G.); (D.K.)
| | - Hodaya Saadon
- Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin 7030000, Israel; (I.E.); (H.S.); (M.K.); (L.G.); (D.K.)
| | - Maya Krocker
- Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin 7030000, Israel; (I.E.); (H.S.); (M.K.); (L.G.); (D.K.)
| | - Lili Goldstein
- Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin 7030000, Israel; (I.E.); (H.S.); (M.K.); (L.G.); (D.K.)
| | - Dan Klafter
- Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin 7030000, Israel; (I.E.); (H.S.); (M.K.); (L.G.); (D.K.)
| | - Shani Zilberman-Itskovich
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel; (Y.L.); (D.B.-D.); (S.Z.-I.)
- Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin 7030000, Israel; (I.E.); (H.S.); (M.K.); (L.G.); (D.K.)
| | - Dror Marchaim
- Sackler School of Medicine, Tel-Aviv University, Tel-Aviv 6997801, Israel; (Y.L.); (D.B.-D.); (S.Z.-I.)
- Unit of Infection Control, Shamir (Assaf Harofeh) Medical Center, Zerifin 7030000, Israel; (I.E.); (H.S.); (M.K.); (L.G.); (D.K.)
- Correspondence: ; Tel.: +972-8-977-9049; Fax: +972-8-977-9043
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28
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Walji SD, Bruder MR, Aucoin MG. Virus matrix interference on assessment of virucidal activity of high-touch surfaces designed to prevent hospital-acquired infections. Antimicrob Resist Infect Control 2021; 10:133. [PMID: 34507617 PMCID: PMC8431935 DOI: 10.1186/s13756-021-01001-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 08/27/2021] [Indexed: 12/24/2022] Open
Abstract
Objectives/purpose High-touch surfaces are a critical reservoir in the spread of nosocomial infections. Although disinfection and infection control protocols are well developed, they lack the ability to passively reduce the pathogenic load of high-touch surfaces. Copper and its alloys have been suggested as a surface that exhibit continuous biocidal effects. Antimicrobial studies on these surfaces are prevalent, while virucidal studies are not as well explored. The goal of this study was to first determine the virucidal activity of a copper–nickel–zinc alloy and to then examine the effect of soiling and virus preparation on virucidal activity. Methods A baculovirus vector was used as an easily quantifiable model of an infectious enveloped animal cell virus. Droplets containing virus were deposited on surfaces and allowed to stay wet using humidity control or were dried onto the surface. Virus was then recovered from the surface and assayed for infectivity. To examine how the composition of the droplet affected the survival of the virus, 3 different soiling conditions were tested. The first two were recommended by the United States Environmental Protection Agency and the third consisted of cell debris resulting from virus amplification. Results A copper–nickel–zinc alloy was shown to have strong virucidal effects for an enveloped virus. Copper, nickel, and zinc ions were all shown to leach from the alloy surface and are the likely cause of virucidal activity by this surface. Virucidal activity was achieved under moderate soiling but lost under high soiling generated by routine virus amplification procedures. The surface was able to repeatably inactivate dried virus droplets under moderate soiling conditions, but unable to do so for virus droplets kept wet using high humidity. Conclusion Ion leaching was associated with virucidal activity in both wet and dried virus conditions. Soiling protected the virus by quenching metal ions, and not by inhibiting leaching. The composition of the solution containing virus plays a critical role in evaluating the virucidal activity of surfaces and surface coatings.
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Affiliation(s)
- Sadru-Dean Walji
- Department of Chemical Engineering, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada
| | - Mark R Bruder
- Department of Chemical Engineering, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada
| | - Marc G Aucoin
- Department of Chemical Engineering, University of Waterloo, 200 University Ave West, Waterloo, ON, N2L 3G1, Canada.
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Chen See J, Ly T, Shope A, Bess J, Wall A, Komanduri S, Goldman J, Anderson S, McLimans CJ, Brislawn CJ, Tokarev V, Wright JR, Lamendella R. A Metatranscriptomics Survey of Microbial Diversity on Surfaces Post-Intervention of cleanSURFACES® Technology in an Intensive Care Unit. Front Cell Infect Microbiol 2021; 11:705593. [PMID: 34354962 PMCID: PMC8330600 DOI: 10.3389/fcimb.2021.705593] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 07/05/2021] [Indexed: 12/16/2022] Open
Abstract
Hospital-acquired infections (HAIs) pose a serious threat to patients, and hospitals spend billions of dollars each year to reduce and treat these infections. Many HAIs are due to contamination from workers’ hands and contact with high-touch surfaces. Therefore, we set out to test the efficacy of a new preventative technology, AIONX® Antimicrobial Technologies, Inc’s cleanSURFACES®, which is designed to complement daily chemical cleaning events by continuously preventing re-colonization of surfaces. To that end, we swabbed surfaces before (Baseline) and after (Post) application of the cleanSURFACES® at various time points (Day 1, Day 7, Day 14, and Day 28). To circumvent limitations associated with culture-based and 16S rRNA gene amplicon sequencing methodologies, these surface swabs were processed using metatranscriptomic (RNA) analysis to allow for comprehensive taxonomic resolution and the detection of active microorganisms. Overall, there was a significant (P < 0.05) global reduction of microbial diversity in Post-intervention samples. Additionally, Post sample microbial communities clustered together much more closely than Baseline samples based on pairwise distances calculated with the weighted Jaccard distance metric, suggesting a defined shift after product application. This shift was characterized by a general depletion of several microbes among Post samples, with multiple phyla also being reduced over the duration of the study. Notably, specific clinically relevant microbes, including Staphylococcus aureus, Clostridioides difficile and Streptococcus spp., were depleted Post-intervention. Taken together, these findings suggest that chemical cleaning events used jointly with cleanSURFACES® have the potential to reduce colonization of surfaces by a wide variety of microbes, including many clinically relevant pathogens.
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Affiliation(s)
- Jeremy Chen See
- Contamination Source Identification, Huntingdon, PA, United States
| | - Truc Ly
- Contamination Source Identification, Huntingdon, PA, United States
| | - Alexander Shope
- Contamination Source Identification, Huntingdon, PA, United States.,AIONX, Hershey, PA, United States
| | | | - Art Wall
- Nextflex, San Jose, CA, United States
| | | | | | - Samantha Anderson
- Contamination Source Identification, Huntingdon, PA, United States.,Department of Biology, Juniata College, Huntingdon, PA, United States
| | - Christopher J McLimans
- Contamination Source Identification, Huntingdon, PA, United States.,Department of Biology, Juniata College, Huntingdon, PA, United States
| | - Colin J Brislawn
- Contamination Source Identification, Huntingdon, PA, United States
| | - Vasily Tokarev
- Contamination Source Identification, Huntingdon, PA, United States.,Department of Biology, Juniata College, Huntingdon, PA, United States
| | - Justin R Wright
- Contamination Source Identification, Huntingdon, PA, United States
| | - Regina Lamendella
- Contamination Source Identification, Huntingdon, PA, United States.,Department of Biology, Juniata College, Huntingdon, PA, United States
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30
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Snyder RL, White KA, Glowicz JB, Novosad SA, Soda EA, Hsu S, Kuhar DT, Cochran RL. Gaps in infection prevention practices for catheter-associated urinary tract infections and central line-associated bloodstream infections as identified by the Targeted Assessment for Prevention Strategy. Am J Infect Control 2021; 49:874-8. [PMID: 33493538 DOI: 10.1016/j.ajic.2021.01.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/19/2021] [Accepted: 01/19/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND Catheter-associated urinary tract infections (CAUTI) and central line-associated bloodstream infections (CLABSI) represent a substantial portion of health care-associated infections (HAIs) reported in the United States. The Targeted Assessment for Prevention Strategy is a quality improvement framework to reduce health care-associated infections. Data from the Targeted Assessment for Prevention Facility Assessments were used to determine common infection prevention gaps for CAUTI and CLABSI. METHODS Data from 2,044 CAUTI and 1,680 CLABSI assessments were included in the analysis. Items were defined as potential gaps if ≥33% respondents answered Unknown, ≥33% No, or ≥50% No or Unknown or Never, Rarely, Sometimes, or Unknown to questions pertaining to those areas. Review of response frequencies and stratification by respondent role were performed to highlight opportunities for improvement. RESULTS Across CAUTI and CLABSI assessments, lack of physician champions (<35% Yes) and nurse champions (<55% Yes), along with lack of awareness of competency assessments, audits, and feedback were reported. Lack of practices to facilitate timely removal of urinary catheters were identified for CAUTI and issues with select device insertion practices, such as maintaining aseptic technique, were perceived as areas for improvement for CLABSI. CONCLUSIONS These data suggest common gaps in critical components of infection prevention and control programs. The identification of these gaps has the potential to inform targeted CAUTI and CLABSI prevention efforts.
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31
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Ceylan G, Topal S, Turgut N, Ozdamar N, Oruc Y, Agin H, Devrim I. Assessment of potential differences between pre-filled and manually prepared syringe use during vascular access device management in a pediatric intensive care unit. J Vasc Access 2021; 23:885-889. [PMID: 33983076 DOI: 10.1177/11297298211015500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Central line-associated bloodstream infection is one of the four primary health-care-associated infections applicable to pediatric intensive care units defined by The Centers for Disease Control and Prevention. According to current guidelines, it is essential to flush vascular access devices before each infusion to assess catheter function and prevent catheter-related complications. OBJECTIVE This prospective trial aimed to assess the potential differences between pre-filled and manually prepared saline syringe use during vascular access device management in a pediatric intensive care unit. METHODS Volunteered registered pediatric intensive care unit nurses were asked to implement the flushing solution to an extension line of a central venous catheter in vitro. After the randomization process with opaque sealed envelopes, they have started either with manual preparation or used sterile pre-filled saline syringes. Sterile application steps forms were used for monitoring the manual preparation of saline syringes versus the pre-filled saline syringes phase. Each volunteer repeated the steps for 3, 5, and 10 mL syringe volumes with the manually prepared and pre-filled saline syringes. After completing the procedures, failed steps and durations were transferred into a database to be analyzed by a blinded investigator. RESULTS A total of 41 nurses volunteered and 123 forms for three attempts per one nurse were filled for each group. In the manual preparation group, the number of at least one failure in the necessary steps was 89 (72.3%) and the same number in the pre-filled syringe group was 6 (4.9%), and significantly lower in the pre-filled saline syringe group (p < 0.001). The overall time for preparing to flush was 86.0 ± 22.3 s (ranging from 46 to 173 s) for manual prepared syringes and 35.2 ± 9.4 s (ranging from 18 to 100 s) (p < 0.001) for pre-filled saline syringes. CONCLUSION Our results demonstrate that the risk for breaking the aseptic no-touch technic was higher in the manual preparation group. We have also demonstrated that the flushing time was shorter with pre-filled syringes compared to manually prepared ones, which may contribute to decreasing the workload of the nurses and may increase the quality of care in the intensive care units. The use of pre-filled saline syringes may decrease the central line-associated bloodstream infections incidence and may increase the quality of care by saving extra time in the pediatric intensive care unit.
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Affiliation(s)
- Gokhan Ceylan
- Department of Pediatric Intensive Care Unit, Dr. Behcet Uz Children's Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Sevgi Topal
- Department of Pediatric Intensive Care Unit, Dr. Behcet Uz Children's Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Nuriye Turgut
- Department of Pediatric Intensive Care Unit, Dr. Behcet Uz Children's Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Nihal Ozdamar
- Department of Pediatric Intensive Care Unit, Dr. Behcet Uz Children's Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Yeliz Oruc
- Infections Control Committee, Dr. Behcet Uz Children's Disease, and Surgery Training and Research Hospital, Izmir, Turkey
| | - Hasan Agin
- Department of Pediatric Intensive Care Unit, Dr. Behcet Uz Children's Disease and Surgery Training and Research Hospital, Izmir, Turkey
| | - Ilker Devrim
- Department of Pediatric Infectious Diseases, Dr. Behcet Uz Children's Disease and Surgery Training and Research Hospital, Izmir, Turkey
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Sexton DJ, Bentz ML, Welsh RM, Derado G, Furin W, Rose LJ, Noble-Wang J, Pacilli M, McPherson TD, Black S, Kemble SK, Herzegh O, Ahmad A, Forsberg K, Jackson B, Litvintseva AP. Positive correlation between Candida auris skin-colonization burden and environmental contamination at a ventilator-capable skilled nursing facility in Chicago. Clin Infect Dis 2021; 73:1142-1148. [PMID: 33978150 PMCID: PMC8492228 DOI: 10.1093/cid/ciab327] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Candida auris is an emerging multidrug-resistant yeast that contaminates healthcare environments causing healthcare-associated outbreaks. The mechanisms facilitating contamination are not established. METHODS C. auris was quantified in residents' bilateral axillary/inguinal composite skin swabs and environmental samples during a point-prevalence survey at a ventilator-capable skilled-nursing facility (vSNF A) with documented high colonization prevalence. Environmental samples were collected from all doorknobs, windowsills and handrails of each bed in 12 rooms. C. auris concentrations were measured using culture and C. auris-specific qPCR. The relationship between C. auris concentrations in residents' swabs and associated environmental samples were evaluated using Kendall's tau-b (τb) correlation coefficient. RESULTS C. auris was detected in 70 /100 tested environmental samples and 31/ 57 tested resident skin swabs. The mean C. auris concentration in skin swabs was 1.22 x 10 5 cells/mL by culture and 1.08 x 10 6 cells/mL by qPCR. C. auris was detected on all handrails of beds occupied by colonized residents, as well as 10/24 doorknobs and 9/12 windowsills. A positive correlation was identified between the concentrations of C. auris in skin swabs and associated handrail samples based on culture (τb = 0.54, p = 0.0004) and qPCR (τb = 0.66, p = 3.83e -6). Two uncolonized residents resided in beds contaminated with C. auris. CONCLUSIONS Colonized residents can have high C. auris burdens on their skin, which was positively related with contamination of their surrounding healthcare environment. These findings underscore the importance of hand hygiene, transmission-based precautions, and particularly environmental disinfection in preventing spread in healthcare facilities.
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Affiliation(s)
- D Joseph Sexton
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Meghan L Bentz
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Rory M Welsh
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Gordana Derado
- Division of Foodborne, Waterborne, and Environmental Diseases, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - William Furin
- Clinical and Environmental Microbiology Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Laura J Rose
- Clinical and Environmental Microbiology Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Judith Noble-Wang
- Clinical and Environmental Microbiology Branch, Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | - Tristan D McPherson
- Chicago Department of Public Health, Chicago, IL, USA.,Epidemic Intelligence Service, Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | | | | | - Owen Herzegh
- Enhanced Capacity Surge Laboratory, Reagent and Diagnostic Services Branch, Division of Scientific Resources, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) Centers for Disease Control & Prevention (CDC), Atlanta, GA, USA
| | - Ausaf Ahmad
- Enhanced Capacity Surge Laboratory, Reagent and Diagnostic Services Branch, Division of Scientific Resources, National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) Centers for Disease Control & Prevention (CDC), Atlanta, GA, USA
| | - Kaitlin Forsberg
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Brendan Jackson
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Trautner BW, Morgan DJ. Imprecision Medicine: Challenges in Diagnosis, Treatment, and Measuring Quality for Catheter-Associated Urinary Tract Infection. Clin Infect Dis 2021; 71:e520-e522. [PMID: 32324234 DOI: 10.1093/cid/ciaa467] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Accepted: 04/21/2020] [Indexed: 01/19/2023] Open
Abstract
We question the reliability of the vague symptoms that most commonly define catheter-associated urinary tract infection (CAUTI) and encourage further examination of whether the current CAUTI definition reflects a true infection. While diagnosing CAUTI using the current surveillance definition, physicians may be missing a number of nonurinary etiologies for fever, prematurely diagnosing urinary tract infection, and prescribing unnecessary antibiotics. We believe it is time to reconsider the quality metric of CAUTI. By doing so, we can improve antibiotic use and quality of patient care.
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Affiliation(s)
- Barbara W Trautner
- Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.,Section of Health Services Research, Departments of Medicine and Surgery, Baylor College of Medicine, Houston, Texas, USA
| | - Daniel J Morgan
- Veterans Affairs Maryland Health Care System, Baltimore, Maryland, USA.,Division of Genomic Epidemiology and Clinical Outcomes, Department of Epidemiology and Public Health, University of Maryland, Baltimore, Baltimore, Maryland, USA
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34
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Clancy C, Delungahawatta T, Dunne CP. Hand-hygiene-related clinical trials reported between 2014 and 2020: a comprehensive systematic review. J Hosp Infect 2021; 111:6-26. [PMID: 33744382 DOI: 10.1016/j.jhin.2021.03.007] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 03/08/2021] [Accepted: 03/08/2021] [Indexed: 12/11/2022]
Abstract
Background There is general consensus that hand hygiene is the most effective way to prevent healthcare-associated infections. However, low rates of compliance amongst healthcare workers have been reported globally. The coronavirus disease 2019 pandemic has further emphasized the need for global improvement in hand hygiene compliance by healthcare workers. Aim This comprehensive systematic review provides an up-to-date compilation of clinical trials, reported between 2014 and 2020, assessing hand hygiene interventions in order to inform healthcare leaders and practitioners regarding approaches to reduce healthcare-associated infections using hand hygiene. Methods CINAHL, Cochrane, EMbase, Medline, PubMed and Web of Science databases were searched for clinical trials published between March 2014 and December 2020 on the topic of hand hygiene compliance among healthcare workers. In total, 332 papers were identified from these searches, of which 57 studies met the inclusion criteria. Findings Forty-five of the 57 studies (79%) included in this review were conducted in Asia, Europe and the USA. The large majority of these clinical trials were conducted in acute care facilities, including hospital wards and intensive care facilities. Nurses represented the largest group of healthcare workers studied (44 studies, 77%), followed by physicians (41 studies, 72%). Thirty-six studies (63%) adopted the World Health Organization's multi-modal framework or a variation of this framework, and many of them recorded hand hygiene opportunities at each of the ‘Five Moments’. However, recording of hand hygiene technique was not common. Conclusion Both single intervention and multi-modal hand hygiene strategies can achieve modest-to-moderate improvements in hand hygiene compliance among healthcare workers.
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Yang J, Huang X, Zhang J, Fan R, Zhao W, Han T, Duan K, Li X, Zeng P, Deng J, Zhang J, Yang X. Sex-specific differences of humoral immunity and transcriptome diversification in older adults vaccinated with inactivated quadrivalent influenza vaccines. Aging (Albany NY) 2021; 13:9801-9819. [PMID: 33744852 PMCID: PMC8064175 DOI: 10.18632/aging.202733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 02/16/2021] [Indexed: 11/25/2022]
Abstract
Clinical data showed sex variability in the immune response to influenza vaccination, this study aimed to investigate differentially expressed genes (DEGs) that contribute to sex-bias immunity to quadrivalent inactivated influenza vaccines (QIVs) in the elderly. 60 healthy adults aged 60-80 yrs were vaccinated with QIVs, and gene expression was analyzed before and after vaccination. The humoral immunity was analyzed by HAI assay, and the correlation of gene expression patterns of two sex groups with humoral immunity was analyzed. The DEGs involved in type I interferon signaling pathway and complement activation of classical pathway were upregulated within 3 days in females. At Day 28, the immune response showed a male-bias pattern associated with the regulation of protein processing and complement activation of classical pathway. A list of DEGs associated with variant responses to influenza vaccination between females and males were identified by biology-driven clustering. Old females have a greater immune response to QIVs but a rapid antibody decline, while old males have the advantages to sustain a durable response. In addition, we identified genes that may contribute to the sex variations toward influenza vaccination in the aged. Our findings highlight the importance of developing personalized seasonal influenza vaccines.
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Affiliation(s)
- Jing Yang
- National Institute of Engineering Technology Research in Combination Vaccine, Wuhan 430207, Hubei Province, China.,Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, Hubei Province, China
| | - Xiaoyuan Huang
- National Institute of Engineering Technology Research in Combination Vaccine, Wuhan 430207, Hubei Province, China.,Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, Hubei Province, China
| | - Jiayou Zhang
- National Institute of Engineering Technology Research in Combination Vaccine, Wuhan 430207, Hubei Province, China.,Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, Hubei Province, China
| | - Renfeng Fan
- Guangdong Province Institute of Biological Products and Materia Medica, Guangzhou 510440, Guangdong Province, China
| | - Wei Zhao
- National Institute of Engineering Technology Research in Combination Vaccine, Wuhan 430207, Hubei Province, China.,Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, Hubei Province, China
| | - Tian Han
- National Institute of Engineering Technology Research in Combination Vaccine, Wuhan 430207, Hubei Province, China.,Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, Hubei Province, China
| | - Kai Duan
- National Institute of Engineering Technology Research in Combination Vaccine, Wuhan 430207, Hubei Province, China.,Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, Hubei Province, China
| | - Xinguo Li
- National Institute of Engineering Technology Research in Combination Vaccine, Wuhan 430207, Hubei Province, China.,Wuhan Institute of Biological Products Co., Ltd., Wuhan 430207, Hubei Province, China
| | - Peiyu Zeng
- Gaozhou Center for Disease Control and Prevention, Maoming 525200, Guangdong Province, China
| | - Jinglong Deng
- Gaozhou Center for Disease Control and Prevention, Maoming 525200, Guangdong Province, China
| | - Jikai Zhang
- Guangdong Province Institute of Biological Products and Materia Medica, Guangzhou 510440, Guangdong Province, China
| | - Xiaoming Yang
- National Institute of Engineering Technology Research in Combination Vaccine, Wuhan 430207, Hubei Province, China.,China Biotechnology Co., Ltd., Peking 100029, China
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Walker BS, Sutton TL, Eil RL, Korngold EK, Kolbeck KJ, Billingsley KG, Mayo SC. Conventional hepatic arterial anatomy? Novel findings and insights of a multi-disciplinary hepatic arterial infusion pump program. Am J Surg 2021; 221:1188-1194. [PMID: 33685717 DOI: 10.1016/j.amjsurg.2021.02.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2020] [Revised: 02/14/2021] [Accepted: 02/22/2021] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Variant hepatic arterial anatomy (vHAA) is thought to occur in 20-30% of patients. Hepatic arterial infusion (HAI) pump placement for liver cancers requires thorough hepatic artery dissection; we sought to compare vHAA identified during pump placement with established dogma. METHODS Between 2016 and 2020, n = 30 patients received a HAI pump. Intra-operatively identified vHAA was characterized and compared with published data. RESULTS vHAA was identified in 60% (n = 18) of patients, significantly higher than 19% (3671 of 19013) in the largest published series (P < 0.001). The most common variations were accessory left (n = 12; 40%) and replaced right (n = 6; 20%) hepatic arteries; six (20%) had ≥2 variants. Pre-operative imaging correctly identified 67% of variant hepatic arteries. DISCUSSION Meticulous operative dissection of the hepatic arterial tree reveals vHAA not captured by imaging or cadaveric dissection. vHAA likely has a higher prevalence than previously reported and should be addressed to optimize therapeutic efficacy of HAI pump therapy.
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Affiliation(s)
- Brett S Walker
- Oregon Heath & Science University (OHSU), Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA
| | - Thomas L Sutton
- Oregon Heath & Science University (OHSU), Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA
| | - Robert L Eil
- Oregon Heath & Science University (OHSU), Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA; The Knight Cancer Institute at OHSU, Portland, OR, 97239, USA
| | - Elena K Korngold
- OHSU, Department of Diagnostic Radiology, Section of Body Imaging, Portland, OR, 97239, USA
| | - Kenneth J Kolbeck
- OHSU, Charles T. Dotter Department of Interventional Radiology, Portland, OR, 97239, USA
| | - Kevin G Billingsley
- Oregon Heath & Science University (OHSU), Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA; The Knight Cancer Institute at OHSU, Portland, OR, 97239, USA
| | - Skye C Mayo
- Oregon Heath & Science University (OHSU), Department of Surgery, Division of Surgical Oncology, Portland, OR, 97239, USA; The Knight Cancer Institute at OHSU, Portland, OR, 97239, USA.
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Abstract
IntroductionThe number of patients and clinical conditions treated in home healthcare (HHC) is increasing. Care in home settings presents many challenges, including healthcare-associated infections (HAI). Currently, in Belgium, data and guidelines on the topic are lacking.AimTo develop a definition of HAI in HHC and investigate associated risk factors and recommendations for infection prevention and control (IPC).MethodsThe study included three components: a scoping literature review, in-depth interviews with individuals involved in HHC and a two-round Delphi survey to reach consensus among key informants on the previous steps' results.ResultsThe literature review included 47 publications. We conducted 21 in-depth interviews. The Delphi survey's two rounds had 21 and 23 participants, respectively. No standard definition was broadly accepted or known. Evidence on associated risk factors was impacted by methodological limitations and recommendations were inconsistent. Agreement was reached on defining HAI in HHC as any infection specifically linked with providing care that develops in a patient receiving HHC from a professional healthcare worker and occurs ≥ 48 hours after starting HHC. Risk factors were hand hygiene, untrained patients and caregivers, patients' hygiene and presence and management of invasive devices. Agreed recommendations were to adapt and standardise existing IPC guidelines to HHC and to perform a national point prevalence study to measure the burden of HAI in HHC.ConclusionsThis study offers an overview of available evidence and field knowledge of HAI in HHC. It provides a framework for a prevalence study, future monitoring policies and guidelines on IPC in Belgium.
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Affiliation(s)
- Ana Hoxha
- European Programme for Intervention Epidemiology Training (EPIET), European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Els Duysburgh
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
| | - Laure Mortgat
- Department of Epidemiology and Public Health, Sciensano, Brussels, Belgium
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Bower CW, Fridkin DW, Wolford HM, Slayton RB, Kubes JN, Jacob JT, Ray SM, Fridkin SK. Evaluating Movement of Patients With Carbapenem-resistant Enterobacteriaceae Infections in the Greater Atlanta Metropolitan Area Using Social Network Analysis. Clin Infect Dis 2021; 70:75-81. [PMID: 30809636 DOI: 10.1093/cid/ciz154] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/20/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Carbapenem-resistant Enterobacteriaceae (CRE) are an urgent threat with potential for rapid spread. We evaluated the role of Medicare patient movement between facilities to model the spread of CRE within a region. METHODS Through population-based CRE surveillance in the 8-county Atlanta (GA) metropolitan area, all Escherichia coli, Enterobacter spp., or Klebsiella spp. resistant to ≥1 carbapenem were reported from residents. CRE was attributed to a facility based on timing of culture and facility exposures. Centrality metrics were calculated from 2016 Medicare data and compared to CRE-transfer derived centrality metrics by Spearman correlation. RESULTS During 2016, 283 incident CRE cases with concurrent or prior year facility stays were identified; cases were attributed mostly to acute care hospitals (ACHs; 141, 50%) and skilled nursing facilities (SNFs; 113, 40%), and less frequently to long-term acute care hospitals (LTACHs; 29, 10%). Attribution was widespread, originating at 17 of 20 ACHs (85%), 7 of 8 (88%) LTACHs, but only 35 of 65 (54%) SNFs. Betweenness of Medicare patient transfers strongly correlated with betweenness of CRE case-transfer data in ACHs (r = 0.75; P < .01) and LTACHs (r = 0.77; P = .03), but not in SNFs (r = 0.02; P = 0.85). We noted 6 SNFs with high CRE-derived betweenness but low Medicare-derived betweenness. CONCLUSIONS CRE infections originate from almost all ACHs and half of SNFs. We identified a subset of SNFs central to the CRE transfer network but not the Medicare transfer network; other factors may explain CRE patient movement in these facilities.
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Affiliation(s)
- Chris W Bower
- Georgia Emerging Infections Program, Atlanta, Georgia.,Atlanta Veterans Affairs Medical Center, Decatur, Atlanta, Georgia.,Atlanta Research and Education Foundation, Atlanta, Georgia
| | - Daniel W Fridkin
- Georgia Emerging Infections Program, Atlanta, Georgia.,Atlanta Veterans Affairs Medical Center, Decatur, Atlanta, Georgia.,Atlanta Research and Education Foundation, Atlanta, Georgia
| | - Hannah M Wolford
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rachel B Slayton
- Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julianne N Kubes
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Jesse T Jacob
- Georgia Emerging Infections Program, Atlanta, Georgia.,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Susan M Ray
- Georgia Emerging Infections Program, Atlanta, Georgia.,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
| | - Scott K Fridkin
- Georgia Emerging Infections Program, Atlanta, Georgia.,Atlanta Veterans Affairs Medical Center, Decatur, Atlanta, Georgia.,Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia
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Assariparambil AR, Nayak SG, Sugunan A, Mukhopadhyay C, Shankar R, Devi ES, George A. Structure, staffing, and factors affecting infection control nurses: Hospital based exploratory survey- A study protocol. J Adv Nurs 2020; 77:1062-1069. [PMID: 33222280 DOI: 10.1111/jan.14658] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/04/2020] [Accepted: 10/19/2020] [Indexed: 11/28/2022]
Abstract
AIM The overall aim of the study is to develop a module for the structure, staffing, job responsibilities, training and workflow for the hospital Infection Control Department. DESIGN An exploratory research design in two phases. Phase 1: Hospital based exploratory survey design. Phase 2: Delphi technique with Focus Group Discussion. METHOD Data will be collected through interviewing Infection Control Nurses (ICNs) or infection control in-charge using Infection Prevention and Control Assessment Framework (IPCAF) released by World Health Organization (WHO) in the first phase and Delphi technique in the second phase to determine the problems and solutions for the concerns pertaining to the ICNs. The study is funded by Indian Council of Medical Research from 15 October 2019 for 3 years duration. DISCUSSION Healthcare Associated Infection (HAI) affects the care quality of millions of people around the globe. Many researchers have explored the evidence for causes and measures to contain infection. However, there are hardly few researches from the perspective to structure, staffing pattern and factors affecting ICNs. As staffing is considered as a vital component in infection prevention, there is a necessity for optimization to reduce the global burden related to HAI. IMPACT This protocol on Structure, staffing, and factors affecting ICN will provide insight into developing strategy, policy or educational module for the ICNs across the country. TRIAL REGISTRATION The trial is registered with Central Trial Registry of India (CTRI) with reference ID: CTRI/2020/07/026286.
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Affiliation(s)
| | - Shalini G Nayak
- Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Aswin Sugunan
- Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Chiranjay Mukhopadhyay
- Department of Microbiology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Ravi Shankar
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Elsa Sanatombi Devi
- Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
| | - Anice George
- Manipal College of Nursing, Manipal Academy of Higher Education, Manipal, India
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Garzotto F, Comoretto RI, Ostermann M, Nalesso F, Gregori D, Bonavina MG, Zanardo G, Meneghesso G. Preventing infectious diseases in Intensive Care Unit by medical devices remote control: Lessons from COVID-19. J Crit Care 2020; 61:119-124. [PMID: 33157307 PMCID: PMC7588313 DOI: 10.1016/j.jcrc.2020.10.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 10/14/2020] [Accepted: 10/14/2020] [Indexed: 12/21/2022]
Abstract
The management of COVID-19 patients in the ICUs requires several and prolonged life-support systems (mechanical ventilation, continuous infusions of medications and nutrition, renal replacement therapy). Parameters have to be entered continuously into the device user interface by healthcare personnel according to the dynamic clinical condition. This leads to an increased risk of cross-contamination, use of personal protective equipment and the need for stringent and demanding protocols. Cables and tubing extensions have been utilized to make certain devices usable outside the patient's room but at the cost of introducing further hazards. Remote control of these devices decreases the frequency of unnecessary interventions and reduces the risk of exposure for both patients and healthcare personnel. healthcare-associated Infections (including respiratory viral and bacterial infections) are increasing especially in high-risk areas such as ICUs the management of critically ill patients requires several and prolonged life-support devices (ventilators, extracorporeal circuits, infusion pumps) increasing the risk of cross-contamination by aerosol, infected organic fluids or direct contact remote control of these devices, from a separated control-room, reduces unnecessary personnel biohazard exposure and contacts for both patients and healthcare workers bidirectional communication with medical equipment has potential to prevent contamination of patients and medical staff by limiting the spread of infections and allows for time and cost saving due to the reduced need of PPE
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Affiliation(s)
- Francesco Garzotto
- Health Directorate Unit, Veneto Institute of Oncology IOV- IRCCS, 64 Via Gattamelata, Padova 35128, Italy; Department of Cardiac Thoracic Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy.
| | - Rosanna Irene Comoretto
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Marlies Ostermann
- Department of Critical Care, King's College London, Guy's & St. Thomas' Hospital, London, UK
| | - Federico Nalesso
- Department of Medicine, Nephrology, Dialysis and Transplantation Unit, University of Padova, Padova, Italy
| | - Dario Gregori
- Department of Cardiac Thoracic Vascular Sciences and Public Health, Unit of Biostatistics, Epidemiology and Public Health, University of Padova, Padova, Italy
| | - Maria Giuseppina Bonavina
- Health Directorate Unit, Veneto Institute of Oncology IOV- IRCCS, 64 Via Gattamelata, Padova 35128, Italy
| | - Giorgio Zanardo
- Intensive Care Unit, Veneto Institute of Oncology IOV-IRCCS, 16/Z Via dei Carpani, 31033, Castelfranco Veneto, Italy
| | - Gaudenzio Meneghesso
- Department of Information Engineering, University of Padova. 6/B Via Gradenigo, Padova 35131, Italy
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Strnad BS, Ludwig DR, Gilcrease-Garcia B, Fraum TJ, Shetty AS, Doyle MBM, Mellnick VM. Contemporary Imaging of the Surgically Placed Hepatic Arterial Infusion Chemotherapy Pump. AJR Am J Roentgenol 2021; 217:633-43. [PMID: 33025806 DOI: 10.2214/AJR.20.24437] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Hepatic arterial infusion (HAI) of chemotherapy is a locoregional treatment strategy for hepatic malignancy involving placement of a surgically implanted pump or percutaneous port-catheter device into a branch of the hepatic artery. HAI has been used for metastatic colorectal cancer for decades but has recently attracted new attention because of its potential impact on survival, when combined with systemic therapy, in patients presenting with unresectable hepatic disease. Although various HAI device-related complications have been described, little attention has been given to their appearance on imaging. Radiologists are uniquely positioned to identify these complications given that patients receiving HAI therapy typically undergo frequent imaging and may have complications that are delayed or clinically unsuspected. Therefore, this article reviews the multimodality imaging considerations of surgically implanted HAI devices. The role of imaging in routine perioperative assessment, including the normal postoperative appearance of the device, is described. The imaging findings of potential complications, including pump pocket complications, catheter or arterial complications, and toxic or ischemic complications, are presented, with a focus on CT. Familiarity with the device and its complications will aid radiologists in playing an important role in the treatment of patients undergoing HAI therapy.
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Walji SD, Aucoin MG. A critical evaluation of current protocols for self-sterilizing surfaces designed to reduce viral nosocomial infections. Am J Infect Control 2020; 48:1255-1260. [PMID: 32204920 DOI: 10.1016/j.ajic.2020.02.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 02/18/2020] [Accepted: 02/18/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Biocidal high-touch surfaces contact surfaces can be used to help reduce healthcare-acquired infections (HAIs). While the bactericidal protocols are well developed, there remains high variability in the methods used to evaluate the virucidal properties of such surfaces. This paper seeks to identify the most commonly used methods and critically evaluate the strengths of each method by comparing tests from standard testing organisations and related bactericidal protocols. METHODS Three databases and grey literature were queried using a key-word search for relevant articles. Articles were selected if they met the criteria of virucidal properties of self-sterilizing surfaces designed to prevent HAIs. Of the resulting 177 articles, 38 met the inclusion criteria. RESULTS The resulting papers varied greatly in their testing methods and recommendations. Further, no standard test adequately meets the needs for specifically testing virucidal properties of self-sterilizing surfaces. CONCLUSIONS Studies have shown that temperature and humidity can affect the performance of virucidal touch-surfaces, but no standard protocols were found to test these factors.
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Abstract
Purpose of Review Surveillance of communicable diseases is essential in all countries to prevent and control infections, to detect outbreaks and also to see the effects of interventions. The data should be reliable, and collection, analysis and feedback as well as the action based on this data should be fast. In this article, author discusses the limitations the Low Middle income Countries (LMICs) have in implementing disease surveillance and some suggestions for improvement. Recent Findings Integrated Disease Surveillance and Response (IDSR) has been implemented successfully through most of the countries in Africa though they belong to low or LMIC. Major barriers for surveillance of Healthcare Associated Infections in LMICs are non-availability of adequate number of healthcare personnel such as infection control personnel as well as not having an integrated healthcare system with an effective data flow. For some infections, not having proper diagnostic facilities is a major obstacle. An important capacity limitation in clinical laboratories of LMICs is identification of antimicrobial resistant organisms as well as other pathogens to species level. This affects the surveillance of infections and antimicrobial resistance. Summary Use of modern technology, capacity building including the human resources as well as the laboratory capacity in healthcare setting, improving data communication methods, are the main recommendations made. Education and training of healthcare staff as well as educating the general public to change the attitudes of people is another aspect that we need to concentrate.
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Stanton RA, McAllister G, Daniels JB, Breaker E, Vlachos N, Gable P, Moulton-Meissner H, Halpin AL. Development and Application of a Core Genome Multilocus Sequence Typing Scheme for the Health Care-Associated Pathogen Pseudomonas aeruginosa. J Clin Microbiol 2020; 58:e00214-20. [PMID: 32493782 DOI: 10.1128/JCM.00214-20] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/28/2020] [Indexed: 12/11/2022] Open
Abstract
Pseudomonas aeruginosa is an opportunistic human pathogen that frequently causes health care-associated infections (HAIs). Due to its metabolic diversity and ability to form biofilms, this Gram-negative nonfermenting bacterium can persist in the health care environment, which can lead to prolonged HAI outbreaks. We describe the creation of a core genome multilocus sequence typing (cgMLST) scheme to provide a stable platform for the rapid comparison of P. aeruginosa isolates using whole-genome sequencing (WGS) data. We used a diverse set of 58 complete P. aeruginosa genomes to curate a set of 4,440 core genes found in each isolate, representing ∼64% of the average genome size. We then expanded the alleles for each gene using 1,991 contig-level genome sequences. The scheme was used to analyze genomes from four historical HAI outbreaks to compare the phylogenies generated using cgMLST to those of other means (traditional MLST, pulsed-field gel electrophoresis [PFGE], and single-nucleotide variant [SNV] analysis). The cgMLST scheme provides sufficient resolution for analyzing individual outbreaks, as well as the stability for comparisons across a variety of isolates encountered in surveillance studies, making it a valuable tool for the rapid analysis of P. aeruginosa genomes.
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45
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Smits G, Stabell Benn C, Whittle H, van Binnendijk R, Aaby P, van der Klis F. Maternal Measles Antibodies and Their Influence on All-cause Mortality Following Measles Vaccination: An Alternative to Measure Very Low Maternal Antibody Levels. Clin Infect Dis 2020; 68:1758-1760. [PMID: 30329030 DOI: 10.1093/cid/ciy900] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Accepted: 10/15/2018] [Indexed: 01/08/2023] Open
Abstract
It was previously shown by hemagglutination inhibition that measles vaccination in the presence of maternal measles antibodies was associated with reduced all-cause mortality. We confirmed this serological association using a multiplexed immunoassay as a sensitive alternative and estimated a threshold concentration (28.7 mIU/mL) that correlates with lower all-cause mortality (P = .02).
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Affiliation(s)
- Gaby Smits
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Christine Stabell Benn
- Research Center for Vitamins and Vaccines, Bandim Health Project, Statens Serum Institut, Copenhagen.,OPEN, Institute of Clinical Research, and DIAS, University of Southern Denmark/Odense University Hospital, Denmark
| | - Hilton Whittle
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine, United Kingdom
| | - Rob van Binnendijk
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
| | - Peter Aaby
- Projécto de Saúde Bandim, INDEPTH Network, Bissau, Guinea-Bissau
| | - Fiona van der Klis
- Centre for Immunology of Infectious Diseases and Vaccines, National Institute of Public Health and the Environment, Bilthoven, The Netherlands
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Fedorov AY, Zhirnov OP. [Method for evaluating the neuraminidase activity of receptordestroying enzyme (RDE) compounds using the influenza virus.]. Vopr Virusol 2020; 65:113-118. [PMID: 32515567 DOI: 10.36233/0507-4088-2020-65-2-113-118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 03/31/2020] [Indexed: 11/05/2022]
Abstract
INTRODUCTION The classic hemagglutination inhibition reaction (RTGA) is used to determine the level of antiviral antibodies in human and animal serum specimens. During the performance of RTGA the tested sera must be treated with a receptor-destroying enzyme (RDE) to remove serum glycans that degrade the accuracy of the RTGA results. To optimize the amounts of RDE compounds used, it is necessary to know their real neuraminidase activity. This article describes a simple and economical method for testing the neuraminidase activity of receptordestroying compounds using standard reagents and laboratory equipment. Aims of investigation. Design of an improved simple and convenient method for evaluating the neuramin1idase activity using the flu virus. MATERIAL AND METHODS Here, we propose a convenient method for evaluating the activity of neuraminidase by double-fold dilution procedure with human or animal erythrocytes followed by hemagglutination assay with influenza A virus. RESULTS AND DISCUSSION The method is based on the ability of neuraminidase to hydrolyze sialic acid residues on the cell surface of erythrocytes, that deprives red blood cells to be agglutinated with the flu virus, since these sialic glycans provide virus attachment and hemagglutination. CONCLUSION The designed method allows the accurate measurement of the receptor-destroying (neuraminidase) activity of RDE compounds and the comparison of the compounds with each other. This test is necessary to optimize the RTGA protocol when monitoring blood sera of animals and humans after influenza infection and/or Acute Respiratory diseases (ARD). The designed method can be included in the guidelines of regulations for the RTGA protocol, which is used in different laboratories to monitor the epidemic process of influenza and ARD infections.
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Affiliation(s)
- A Y Fedorov
- D.I. Ivanovsky Institute of Virology, National Research Centre for Epidemiology and Microbiology named after the honorary academician N.F. Gamaleya, Moscow, 123098, Russia.,I.M. Sechenov First Moscow State Medical University, Moscow, 119991, Russia
| | - O P Zhirnov
- D.I. Ivanovsky Institute of Virology, National Research Centre for Epidemiology and Microbiology named after the honorary academician N.F. Gamaleya, Moscow, 123098, Russia.,Russian-German Academy of Medical and Biotechnological Sciences, Skolkovo Innovation Center, Moscow, 121205, Russia
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Sposato KA. Non-ventilator health care-associated pneumonia (NV-HAP): The infection preventionist's role in identifying NV-HAP. Am J Infect Control 2020; 48:A3-A6. [PMID: 32331563 DOI: 10.1016/j.ajic.2020.03.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 03/02/2020] [Indexed: 11/18/2022]
Abstract
One of the fundamental challenges in nonventilator health care-associated pneumonia (NV-HAP) surveillance is identifying cases and standardizing surveillance protocols. This section highlights clinical pneumonia definitions and current surveillance definitions, as well as the difficulty in case finding methodologies. In addition, we review current microbiology and molecular testing methods. Further, we explore future opportunities to leverage the electronic health care record in attempt to identify a reliable less burdensome data identification and collection methodology. Finally, we highlight the importance of a collaborative approach to prevention of NV- HAP, as well as strategies to assist the IP with facilitating interdisciplinary communication and uptake of evidence-based implementation strategies.
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Ribas RM, Campos PA, Brito CS, Gontijo-Filho PP. Coronavirus Disease 2019 (COVID-19) and healthcare-associated infections: Emerging and future challenges for public health in Brazil. Travel Med Infect Dis 2020; 37:101675. [PMID: 32305631 DOI: 10.1016/j.tmaid.2020.101675] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Revised: 04/10/2020] [Accepted: 04/14/2020] [Indexed: 01/28/2023]
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Kaier K, Wolkewitz M, Hehn P, Mutters NT, Heister T. The impact of hospital-acquired infections on the patient-level reimbursement-cost relationship in a DRG-based hospital payment system. Int J Health Econ Manag 2020; 20:1-11. [PMID: 31165960 DOI: 10.1007/s10754-019-09267-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 05/28/2019] [Indexed: 06/09/2023]
Abstract
Hospital-acquired infections (HAIs) are a common complication in inpatient care. We investigate the incentives to prevent HAIs under the German DRG-based reimbursement system. We analyze the relationship between resource use and reimbursements for HAI in 188,731 patient records from the University Medical Center Freiburg (2011-2014), comparing cases to appropriate non-HAI controls. Resource use is approximated using national standardized costing system data. Reimbursements are the actual payments to hospitals under the G-DRG system. Timing of HAI exposure, cost-clustering within main diagnoses and risk-adjustment are considered. The reimbursement-cost difference of HAI patients is negative (approximately - €4000). While controls on average also have a negative reimbursement-cost difference (approximately - €2000), HAI significantly increase this difference after controlling for confounding and timing of infection (- 1500, p < 0.01). HAIs caused by vancomycin-resistant Enterococci have the most unfavorable reimbursement-cost difference (- €10,800), significantly higher (- €9100, p < 0.05) than controls. Among infection types, pneumonia is associated with highest losses (- €8400 and - €5700 compared with controls, p < 0.05), while cost-reimbursement relationship for Clostridium difficile-associated diarrhea is comparatively balanced (- €3200 and - €500 compared to controls, p = 0.198). From the hospital administration's perspective, it is not the additional costs of HAIs, but rather the cost-reimbursement relationship which guides decisions. Costs exceeding reimbursements for HAI may increase infection prevention and control efforts and can be used to show their cost-effectiveness from the hospital perspective.
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Affiliation(s)
- Klaus Kaier
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany.
| | - Martin Wolkewitz
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany
| | - Philip Hehn
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany
| | - Nico T Mutters
- Institute for Infection Prevention and Hospital Epidemiology, Faculty of Medicine, Medical Center - University of Freiburg, Breisacher Straße 115 b, 79106, Freiburg, Germany
| | - Thomas Heister
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Stefan-Meier-Str. 26, 79104, Freiburg, Germany
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White KA, Soe MM, Osborn A, Walling C, Fike LV, Gould CV, Kuhar DT, Edwards JR, Cochran RL. Implementation of the Targeted Assessment for Prevention Strategy in a healthcare system to reduce Clostridioides difficile infection rates. Infect Control Hosp Epidemiol 2020; 41:295-301. [PMID: 31928537 DOI: 10.1017/ice.2019.358] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND Prevention of Clostridioides difficile infection (CDI) is a national priority and may be facilitated by deployment of the Targeted Assessment for Prevention (TAP) Strategy, a quality improvement framework providing a focused approach to infection prevention. This article describes the process and outcomes of TAP Strategy implementation for CDI prevention in a healthcare system. METHODS Hospital A was identified based on CDI surveillance data indicating an excess burden of infections above the national goal; hospitals B and C participated as part of systemwide deployment. TAP facility assessments were administered to staff to identify infection control gaps and inform CDI prevention interventions. Retrospective analysis was performed using negative-binomial, interrupted time series (ITS) regression to assess overall effect of targeted CDI prevention efforts. Analysis included hospital-onset, laboratory-identified C. difficile event data for 18 months before and after implementation of the TAP facility assessments. RESULTS The systemwide monthly CDI rate significantly decreased at the intervention (β2, -44%; P = .017), and the postintervention CDI rate trend showed a sustained decrease (β1 + β3; -12% per month; P = .008). At an individual hospital level, the CDI rate trend significantly decreased in the postintervention period at hospital A only (β1 + β3, -26% per month; P = .003). CONCLUSIONS This project demonstrates TAP Strategy implementation in a healthcare system, yielding significant decrease in the laboratory-identified C. difficile rate trend in the postintervention period at the system level and in hospital A. This project highlights the potential benefit of directing prevention efforts to facilities with the highest burden of excess infections to more efficiently reduce CDI rates.
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