GMS Hygiene and Infection Control最新文献

Introduction: Candidozyma (C.) auris (formerly Candida auris) is an emerging fungus posing a serious global health threat due to its multidrug resistance and difficulty in identification with standard laboratory methods. It causes severe illness in hospitalized patients, with risk factors including recent surgery, diabetes, and the use of broad-spectrum antibiotics and antifungals. Colonization of the respiratory tract, catheters, and skin with C. auris can lead to serious infections, particularly through central venous catheters, urinary catheters, and tracheostomy tubes, resulting in fungemia.

Case series: : We present a case series of five ICU patients with fungemia caused by C. auris. The cases emphasize the immune status, screening, and clinical manifestations of these patients. Antifungal susceptibility testing using broth microdilution was performed, and antifungals were administered based on sensitivity reports. Three patients showed improvement with appropriate therapy.

Conclusion: C. auris infections are increasing in prevalence and represent a significant burden to healthcare system and patients. Aggressive treatment and stringent infection control measures are essential to prevent the spread, multi-drug resistance, and mortality associated with C. auris. This study highlights the importance of effective treatment management, including the selection of antifungal agents and the implementation of robust infection control practices, to combat this emerging pathogen.

Introduction: Tuberculosis (TB) of the spine is the most common form of musculoskeletal TB, especially in developing countries, and may lead to serious complications if untreated. Early diagnosis, anti-tubercular therapy (ATT), and surgery when needed are key to effective management. Magnetic resonance imaging (MRI) is the most reliable tool for diagnosis, monitoring, and determining treatment duration. This study aims to evaluate the appropriate length of ATT and MRI's role in guiding therapy in spinal TB.

Methods: This 36-month prospective study included 100 spinal TB patients treated with standard ATT. Clinical, hematological, and MRI evaluations guided therapy duration. Biopsy confirmed diagnosis, and surgery was done when indicated. MRI healing was classified as complete, partial, or non-healed. ATT continued until MRI confirmed healing. Multidrug-resistant cases received second-line therapy.

Results: In a cohort of 100 spinal tuberculosis patients (mean age 23.5 years), 70% were female, and 88% had category-1 TB, with 12% exhibiting multidrug resistance. The thoracic spine was most affected (64%), followed by lumbar (30%) and cervical (6%) regions. Conservative treatment was administered to 78 patients, while 22 underwent surgery. Neurological deficits were present in 78% of cases. Diagnostic yields were highest with histopathology (50%), followed by GeneXpert (48%), smear microscopy (30%), and culture (28%). Inflammatory markers showed significant improvement: equivalent series resistance decreased from 34.95 to 13.1 mm/hr, and C-reactive protein from 32.4 to 6.3 mg/L over 12 months. MRI assessments revealed complete healing in 30% at 6 months and 80% at 12 months. By 18 months, recovery rates reached 89% clinically, 82% hematologically, and 88% radiologically.

Conclusion: Clinical recovery occurs first, but MRI is the most reliable tool for determining antitubercular therapy duration in spinal TB due to its accuracy in assessing disease resolution.

Introduction: Mold, which includes the components and metabolic products of mold fungi as well as other factors associated with moisture, such as yeasts, bacteria (actinobacteria) and mites, occurs indoors when there is increased moisture. In addition to known causes of damp/mold damage such as structural defects (including thermal bridges, rising damp, insufficient ventilation), water damage and incorrect ventilation and heating options, construction work plays an important role in hospitals and medical practices.

Methods: The AWMF S2k guideline "Medical clinical diagnostics for indoor mold exposure" was first published in 2016. Following a new systematic literature search, an updated version of this guideline was published in October 2023 with the cooperation of various medical disciplines and other experts. The guideline is intended to close the existing knowledge gap in terms of rational and efficient medical diagnosis in cases of indoor mold contamination. Recommendations are given on general and specific examination methods. Non-evidence-based diagnostic methods, some of which are still used in practice, are not recommended. Furthermore, treatment options for health problems and diseases caused by mold fungi are presented. It is explained why, in most cases, indoor measurements of molds, their components or metabolites are not required for medical evaluation.

Results: Individuals who are immunosuppressed (grade 2 and 3 of the immunosuppression grades according the Commission for Hospital Hygiene and Infection Prevention [KRINKO] at the Robert Koch Institute [RKI]), or are suffering from severe influenza, severe COVID-19, cystic fibrosis and uncontrolled bronchial asthma are at increased risk of exposure to mold fungi. For these patients, exposure to mold damage must be ruled out in the clinic and practice as well as in the home environment.

Conclusion: If, despite all precautionary measures, moisture/mold damage can be detected in the environment of these particularly vulnerable patients, it must be remediated immediately. Indoor measurements of mold exposure are not indicated for medical reasons. Rather, all measures that help to avoid moisture damage are crucial for prevention.

Background: Healthcare-associated infections (HAIs) caused by multidrug-resistant Pseudomonas aeruginosa (MDRPa) pose enormous challenges in healthcare. We examined the incidence and relative mortality rates of patients with MDRPa HAI compared to non-MDRPa HAI in southern China.

Methods: A hospital-wide longitudinal cohort study was conducted using prospectively collected surveillance data from 2018 to 2021. Poisson regression was applied to estimate incidence rate ratios (IRRs). Propensity-score matching and competing risks regression analysis (Fine-Gray model) were employed to estimate subdistribution hazard ratios (sHRs) for in-hospital mortality comparing MDRPa to non-MDRPa infections.

Results: Among 562 patients studied (mean age 58 years, 74% male, in-hospital mortality 13.7%), 278 (49%) had an MDRPa HAI and 284 (51%) a non-MDRPa HAI. The incidence rate of MDRPa HAIs increased over time (mean monthly IRR: 1.016, 95% CI: 1.007-1.024). No significant difference in 14-day in-hospital mortality between MDRPa and non-MDRPa HAIs were detected in the propensity-matched doubly-robust analysis (adjusted sHR: 1.07, 95% CI: 0.52-2.19). However, MDRPa HAI was associated with a lower probability of 14-day discharge alive (adjusted sHR: 0.44, 95% CI: 0.31-0.63), resulting in longer hospital stays.

Conclusions: The study provided real-world evidence of the clinical burden of MDRPa HAIs in China, highlighting their rising incidence and direct effect on prolonging hospitalisation. The findings underscore the need for antimicrobial stewardship interventions to ensure timely de-escalation and optimised antibiotic therapy.

Background: The preoperative application of skin antiseptics can be performed conventionally with sterile forceps and a sterile gauze swab or with a ready-made single-use applicator. Since the latter is more ecologically than the conventional procedure, an investigation into whether the application method influences the antiseptic efficacy is warranted.

Method: The comparison was performed on the upper arm (low density of sebaceous glands) and forehead (high density of sebaceous glands) of volunteers according to test method 13 of the Association for Applied Hygiene for the certification of skin antiseptics in Germany. The antiseptic, 70% v/v propan-2-ol +2% w/v chlorhexidine digluconate (P/CHG), was applied either with the applicator, with forceps, or by gentle wetting without rub-in. After rub-in or wetting, samples were taken from the application area with sterile swabs, transferred into tryptic soy broth and plated onto tryptic soy agar. The reduction of the skin flora was calculated based on the number of colony forming units before and after antisepsis application. Additionally, the formulation P/CHG was compared with the reference standard 70% v/v propan-2-ol (P) for testing skin antiseptics in Germany.

Results: There was no difference in antiseptic efficacy between the use of applicator or forceps. However, if the skin was only gentle wetted with the antiseptic, the efficacy was significantly lower than after rub-in with the applicator or forceps.In one trial, the antiseptic P/CHG tended to be more effective or, in another trial, was statistically significantly more effective than P when tested on skin with few sebaceous glands.

Discussion: The results underline the necessity of thoroughly rubbing-in the antiseptic for preoperative skin antisepsis instead of merely wetting the skin. The literature confirms the higher efficacy of the P/CHG antiseptic compared to P (the reference for testing skin antiseptics in Germany), based on the criterion of rate of surgical site infections (SSI).

Conclusion: According to the GRADE (Grading of Recommendations Assessment, Development and Evaluation)-based classification of evidence, the results presented here are of "high evidence". Thus, for preoperative skin antisepsis, P/CHG is to be used instead of alcohol-based formulations lacking CHG, due to the sustained efficacy of CHG. As the efficacy of applying the antiseptic with forceps and gauze swab or with single-use applicator does not differ on skin with few or many sebaceous glands, the single-use applicator should be preferred due to the guaranteed standardization of application, the time savings compared to the conventional method, and more favorable economic and ecological sustainability.

Aim: Healthcare-associated infections are largely preventable and pose a substantial burden on society. The most effective way to control infection is to ensure optimal hand hygiene. This cross-sectional study aimed to evaluate hand hygiene (HH) beliefs, practices, and importance levels among healthcare-professional students.

Methods: Students of Kutahya Health Sciences University, Faculty of Medicine, Faculty of Dentistry, Faculty of Health, and Vocational Schools of Health Services were included in this questionnaire-based study. The questionnaire contained a total of 45 items. The first nine included demographic information; the other items were divided into three subgroups: hand hygiene belief scale (HBS), hand hygiene practice inventory (HHPI), and hand hygiene importance scale (HIS). The questionnaire used a 5-point Likert scale ranging from strongly disagree to strongly agree.

Results: A total of 884 participants (695 female, 189 male) with a mean age of 20.2±2.61(17-49) completed the survey by answering all questions. The mean total scale score of all participants was 145.7±17.89. The mean HBS score was 67.7±10.91, mean HHPI score was 64.7±8.98, and the mean HIS score was 13.4±2.25. It was determined that females and individuals under 20 years old had higher scores than males and participants > 20 years of age, and students in the medical and health sciences departments scored higher than students in vocational schools and the faculty of dentistry.

Conclusions: This study determined that students' belief, practice, and importance levels regarding the necessity of HH were high and that age, gender, and university department affected HH compliance.

Background and objective: Hand antisepsis one of the most important strategies for preventing transmission of drug-resistant microorganisms and healthcare-associated infections. Overt observation of hand antisepsis in healthcare settings is currently considered the gold standard for monitoring its adherence rate. However, a major limitation of this method is the "Hawthorne effect", wherein health staff who know they are being assessed may alter their behavior. In this survey, we aimed to compare the overt and covert methods of observation of hand hygiene.

Method: This cross-sectional descriptive-analytic study was conducted over six months in the intensive care units (ICUs) of Namazi Teaching Hospital in Shiraz. The study population comprised ICU staff, including nurses, physicians (specialists and residents), and other healthcare workers (HCWs) in direct contact with patients. Convenience sampling was used. Hand antisepsis adherence was assessed through both overt (open) and covert (hidden) observations across different work shifts. Data was collected using the "WHO Hand Hygiene Observation Checklist" and analyzed in SPSS 18 using descriptive statistics and the chi-squared test.

Results: The findings revealed that in a total of 9 ICUs (including 4 surgical, 2 medical, and 3 general ICUs) with over 90 active beds, 776 opportunities were observed through overt observation and 1,780 opportunities through covert observation. Overall, hand antisepsis adherence was 58.4% in overt observation and 60.3% in covert observation (p=0.352, RR=0.96). A significant difference was found in adherence rates among certain professional groups and specific hand antisepsis opportunities.

Discussion and conclusion: No significant difference was found in hand antisepsis adherence between overt and covert observation methods, suggesting that both approaches are suitable to assess the in health care centers. It is essential to institutionalize hand antisepsis as an occupational culture in healthcare settings. Raising awareness among healthcare teams about the severe consequences of hospital-acquired infections can provide the necessary motivation for consistent and proper hand antisepsis practices.

Background: Post-treatment apical periodontitis and postoperative pain remain critical challenges in endodontics, with success often relying on effective intracanal medications to control microbial infection, reduce inflammation, and promote tissue healing. Recent advances in medication formulations and techniques have expanded the options for managing these conditions, necessitating a systematic review of their efficacy. Thus, this review evaluated the effectiveness of various intracanal medications, including calcium hydroxide (CH), triple antibiotic paste with diclofenac potassium (TAPC), nano-based formulations, and Ledermix paste, in reducing microbial load, controlling inflammation, and alleviating postoperative pain in endodontic treatment.

Method: Relevant studies were reviewed to assess the antimicrobial efficacy, pain management outcomes, and healing potential of different intracanal medications. The studies utilized various methodologies, including randomized controlled trials and retrospective analyses, with outcome measures such as bacterial reduction, levels of inflammatory mediators, pain scores, and imaging-based assessments of lesion healing.

Results: CH demonstrated significant microbial reduction (up to 99.5%), decreased inflammatory mediators (IL-1β, TNF-α), and enhanced tissue healing, making it a reliable choice for managing apical periodontitis. TAPC showed superior pain relief compared to CH due to its dual antibacterial and anti-inflammatory action, significantly reducing pain within 48 hours. Nano-based formulations, including nano-silver and nano-CH, provided enhanced pain relief and effective microbial control while maintaining safety and reliability. Ledermix paste emerged as the most effective for rapid pain reduction in cases of acute apical periodontitis, highlighting the importance of corticosteroids and antibiotics. Advanced imaging modalities, such as cone-beam computed tomography (CBCT), facilitated accurate diagnosis and monitoring of periapical healing, demonstrating a high healing rate (76%) for large lesions treated nonsurgical.

Conclusion: This review confirms the efficacy of traditional calcium hydroxide and highlights the advantages of innovative formulations such as TAPC, nanoparticles, and Ledermix paste in improving treatment outcomes. Rapid pain relief, effective microbial control, and enhanced healing underscore their potential for routine clinical use. The findings also emphasize the importance of advanced imaging and individualized treatment planning. Further research is warranted to optimize medication protocols and explore the long-term implications of emerging formulations.

Quaternary ammonium compounds (QACs) account for approximately 35% of the U.S. disinfectant market, but mounting concerns about their links to occupational asthma, reproductive toxicity, and antimicrobial resistance as well as their allergic potential have driven increased adoption of non-QAC chemical disinfectants, which comprise the remaining 65% of the market. This review critically examines the health, environmental, and material compatibility profiles of these non-QAC agents, including alcohols, chlorine compounds, hydrogen peroxide, peracetic acid, and phenolics. While many of these agents reduce certain risks associated with QACs, they present new challenges such as respiratory irritation, corrosiveness, systemic toxicity, and ecological persistence. Hydrogen peroxide and peracetic acid show favorable biodegradability but may impair wastewater systems or damage sensitive equipment. Among emerging technologies, ultraviolet-C (UV-C) disinfection stands out for its high antimicrobial efficacy, absence of chemical residues, and strong environmental profile. A risk-balanced, evidence-based approach to disinfectant selection is essential, and greater integration of UV-C and other non-chemical technologies may support safer and more sustainable infection control practices.