GMS Hygiene and Infection Control最新文献

Background: Occupational acquisition of hepatitis C virus (HCV) among healthcare workers (HCWs) has markedly declined in high-income countries, largely due to improved infection control measures and safety-engineered devices. However, the risk of HCV transmission from HCWs to patients remains insufficiently characterized.

Methods: We conducted a systematic review of studies reporting serological evidence of HCV transmission from infected HCWs to patients. Following PRISMA guidelines, we searched MEDLINE, Scopus, and Cochrane databases for publications up to July 2025.

Results: Of 192 studies identified, 24 from eight countries met inclusion criteria. In total, 27 HCWs were implicated as potential sources, and 54,622 patients were tested for HCV RNA. Seventy-six transmissions were confirmed by RNA sequencing; 369 were classified as probable and 15 as possible. Direct provider-to-patient transmission was documented in 18 studies, 12 of which involved exposure-prone procedures (EPP), yielding a mean transmission rate of 0.47% (62/13,224; 95% CI 0.036-0.061%). Viral load data were reported for only eight transmitting HCWs, all with ≥2×10⁵ IU/mL, while no measurements were available for the remaining 19. Given the rarity of direct transmission and the absence of validated HCV RNA thresholds, national guidelines (UK, Germany, the Netherlands, Belgium, France, Switzerland, USA) differ considerably regarding restrictions or monitoring of infected HCWs performing EPP. Indirect HCV transmission associated with diversion of opiates and injection-safety breaches by HCWs addicted to morphine accounted for an even higher risk, with a mean rate of 0.94% (389/41,398; 95% CI 0.85-1.04%).

Conclusions: Evidence on HCW-to-patient HCV transmission remains limited and provides only weak guidance for national prevention policies. Indirect transmission through unsafe practices by opioid diversion has emerged as the predominant pathway, underscoring the need for real-time monitoring, tamper-resistant systems, and strict adherence to infection prevention measures in healthcare settings.

As hygiene and infection control take center stage in modern healthcare, it is crucial to remember the struggle of a pioneer who championed these principles long before they were widely accepted. Ignaz Philipp Semmelweis is often regarded as the "Pioneer of Hand Hygiene," the "Father of Infection Control", and the "Protector of Motherhood" for his transformative approach in combating childbed fever. These titles only touch the surface of his broader legacy as a researcher and public health hero. Although he received limited recognition during his lifetime, Semmelweis's posthumous legacy has laid the foundation for infection control and evidence-based medical practices. His enduring legacy is a powerful reminder of the importance of scientific inquiry and its lasting impact on public health.

Human metapneumovirus (hMPV), first identified in 2001, has increasingly been recognized as a significant cause of acute respiratory tract infections worldwide. Although often overshadowed by respiratory syncytial virus (RSV) and influenza, hMPV contributes substantially to the global burden of respiratory disease, particularly among young children, older adults, and immunocompromised populations. The COVID-19 pandemic further altered the epidemiology of respiratory viruses, disrupting established seasonal patterns and creating immunity gaps that have fueled unusual hMPV outbreaks in recent years. Despite its clinical relevance, hMPV remains underdiagnosed due to limited awareness, restricted access to reliable diagnostic tools, and frequent co-infections that obscure its contribution to disease severity. Currently, no licensed antivirals or vaccines exist, leaving supportive care as the only treatment option. Ongoing research into monoclonal antibodies, vaccine candidates, and combined RSV-hMPV preventive strategies offers promise but remains in early stages. In the context of global interconnectedness and the demonstrated capacity of respiratory viruses to cause widespread disruption, hMPV raises important concerns as a potential emerging public health threat. While unlikely to cause pandemic-scale disruption, hMPV's endemic circulation and disproportionate impact on vulnerable populations warrant its recognition as an emerging threat demanding proactive public health intervention and sustained investment in prevention strategies. This review examines hMPV's evolving role as a public health threat in the post-COVID-19 landscape, where altered epidemiological patterns and increased surveillance have highlighted its underappreciated impact.

Background and purpose: Healthcare-associated infections (HAIs) continue to be a leading cause of morbidity, mortality, and increased healthcare costs worldwide. Despite advances in infection prevention, the burden of HAIs remains high, exacerbated by the rise of antimicrobial resistance (AMR) and the growing complexity of patient care. Effective prevention strategies are critical to reducing HAI rates and improving patient outcomes. This review aims to highlight the clinical significance of HAIs, explore their impact on patient safety, and underscore the necessity for robust surveillance and infection control (IC) programs across healthcare settings.

Results: The study found that HAIs continue to affect a significant proportion of hospitalized patients, with invasive devices and antimicrobial-resistant pathogens being key contributors. Surveillance systems, when combined with targeted IC protocols and continuous staff education, can reduce HAI incidence and improve patient safety. Moreover, the implementation of antimicrobial stewardship programs and proper hygiene practices along with emerging technologies plays a pivotal role in curbing the spread of resistant organisms.

Conclusion: Healthcare systems must prioritize HAI prevention to safeguard patient safety, reduce treatment costs, and combat the growing threat of AMR.

Introduction: Ultrasonic scaling has transformed periodontal therapy, delivering effective plaque and calculus removal. However, it also introduces risks through the generation of aerosols and splatter, which can transmit infectious agents. This review evaluates strategies to mitigate aerosol contamination in modern dental practice.

Results: Pre-, intra-, and post procedural measures can significantly minimize contamination. Adequate ventilation, appropriate coolant selection, and preprocedural mouthrinses limit aerosol generation. Personal protective equipment reduces exposure, while high-volume evacuators (HVEs) effectively capture aerosols. After the procedure, thorough instrument reprocessing and surface disinfection, along with the use of high-efficiency particulate air filters (HEPA) and UV irradiation, are essential for air decontamination.

Conclusion: Ongoing research continues to enhance control protocols. Implementing these measures effectively safeguards both patients and dental personnel, particularly in light of respiratory infections such as flu.

Objective: Central line-associated bloodstream infections (CLABSIs) are life-threatening complications in critically ill patients, necessitating early identification for timely intervention. This study evaluates the predictive performance of Systemic Inflammatory Response Index (SIRI), a novel composite marker derived from routine blood counts, for early prediction of CLABSI within first two calendar days following central venous catheter (CVC) insertion.

Method: In this observational study at a tertiary ICU, 234 adults with CVCs for over two days were classified as CLABSI-positive or negative per CDC/NHSN criteria. SIRI was calculated using the formula (neutrophils×monocytes/lymphocytes) based on day 2 complete blood counts. Logistic regression and receiver operating characteristic (ROC) curve analysis was done to determine diagnostic performance.

Results: CLABSI was diagnosed in 39 patients. Median SIRI values were significantly higher in CLABSI group (37.3 vs. 12.0; p<0.001). In univariate logistic regression, SIRI emerged as an independent predictor of CLABSI (OR=1.0097; 95% CI: 1.001-1.018; p=0.015). ROC analysis demonstrated a moderate discriminative power with AUROC=0.72 (95% CI: 0.64-0.80). At optimal threshold, SIRI achieved 84.6% sensitivity, 52.8% specificity, 58.1% accuracy, 26.4% positive predictive value (PPV) and a notably high negative predictive value (NPV) of 94.5%, supporting its value as an early rule-out marker for CLABSI.

Conclusion: SIRI, derived from routine complete blood counts, shows strong potential as a non-invasive, early screening marker for CLABSI. Its high sensitivity and NPV support its use for early rule-out, especially in settings lacking rapid diagnostics. Further prospective validation is warranted.

Hand hygiene is essential to prevent the transmission of pathogens between healthcare workers (HCWs) and patients. Launched in 2019, Pulpe'Friction is a declarative audit that provides a quick assessment of hand hygiene in healthcare facilities. This audit consists of interviewing HCWs and patients. Some facilities performed a second audit after the first one, as well as a sufficient period of implementation of actions. The question was, did these facilities improve in terms of hand hygiene practices and informating the patients? In two stable cohorts of French medical-facility wards, this study aimed to assess whether there was an improvement in reported and observed alcohol based hand rub (ABHR) practices and in the proportion of patients informed about hand hygiene when two audits were conducted consecutively. A first cohort of 416 wards from 130 facilities was constituted including 5,521 HCWs interviewed during the first audit and 5,383 HCWs during the second audit. A second cohort of 139 wards from 62 facilities was formed including 2,090 patients interviewed during the first audit and 1,726 patients during the second audit. A significant improvement was observed in self-reported alcohol hand rub practices by HCWs before and after contact with the patient, and after contact with the patient's immediate environment. Significantly, more patients declared they received information about when to perform hand hygiene during the second audit. To conclude, the wards in which two audits were performed significantly improved their reported practices. The pulpe'friction method is not only useful to evaluate reported practices and barriers, it also offers a simple way to evaluate the impact of the actions implemented in a ward.

Introduction: In recent years, diagnostic stewardship has gained importance worldwide as part of antibiotic stewardship and infection control programs. However, the specific involvement of infection control (IC) teams in this area has not been studied.

Method: A volunteer survey of participants at the 2024 Freiburg Conference on Infection Prevention and Therapy was conducted to assess attitudes and practices regarding diagnostic stewardship.

Results: The majority of the 182 participants worked in German hospitals with established IC-committees (91.2%), antibiotic stewardship teams (43.4%), and laboratory commissions (24.7%).For sepsis diagnosis, at least two pairs of blood cultures are usually taken, which is in line with the guidelines; 14.3% use the "six-pack" rule (three pairs), and 28.6% take all cultures from one puncture site. For many clinical tests -except of stool tests and C-reactive protein - less than 50% rated their use as "appropriate", indicating a need for improvement. Interleukin 6 and beta-D-glucan are rarely used.Strategies such as reflex tests and cascade reporting are only used occasionally and are viewed with scepticism in some cases. Screening for methicillin resistant Staphylococcus aureus and Vancomycin resistant enterococci was rated as "appropriate" by over 60%, while screening for multidrug-resistant Gram-negative bacteria was rated as such by 50%. In the area of IC, 32.4% reported inadequate sampling of surfaces and 33.2% of staff hands.

Discussion: Subjective assessments and a heterogeneous participant structure limit the survey, and subgroup analyses are not possible due to the small number of cases. However, the results show chances for education and integration of IC teams in diagnostic stewardship programs.

Aim: Comparative inactivation studies with the murine norovirus (MNV) and different test substances showed considerable different results between test laboratories. To decipher the underlying mechanisms of this observation, different virus pools (virus suspensions) of the MNV were analysed in two independent laboratories by performing inactivation tests with i. a. various alcoholic formulations and different culture media.

Methods: Virucidal activity of different test formulations (propan-2-ol, propan-1-ol, ethanol, aldehydes and peracetic acid) against MNV has been tested in the quantitative suspension test according to EN 14476:2019.

Results: Results of the inactivation studies with MNV varied greatly depending on the cell culture medium and its additives used. In particular, the addition of HEPES to the medium in the course of virus propagation led to a strong decrease in the virus inactivation, when this virus pool was used in the approach with an alcoholic formulation.

Conclusion: The use of different cell culture media with individual supplements can have a major impact on the results of inactivation studies with MNV. Therefore, harmonized protocols of viral inactivation test should be developed that describe the same cell culture conditions.

This review examines physical environmental influences and their potential effect on human health. The factors discussed are noise (effect of sound), the physical effect of particulate matter (fine dust, particulate matter PM10, PM2.5, ultrafine particles UFP), various types of radiation (electromagnetic fields, radioactivity) and climate (especially heat). In order to identify hazard potentials, it is necessary to know the route of exposure and the mode of action. Environmental epidemiology studies help to illustrate the health consequences for the population. The limitations of the studies must also be considered.