GMS Hygiene and Infection Control最新文献

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.

Introduction: The regeneration of oral tissues, including periodontal ligaments, alveolar bone, and soft tissues, remains a major challenge in dentistry and maxillofacial surgery. Traditional approaches, such as grafting and guided tissue regeneration, are limited by donor site morbidity, immune responses, and surgical complexities. Injectable hydrogels have emerged as promising biomaterials due to their ability to deliver cells, growth factors, and bioactive molecules directly to injury sites in a minimally invasive manner. Their adjustable properties and ability to mimic the extracellular matrix make them ideal for promoting tissue repair and regeneration. This review evaluates the literature on injectable hydrogels in oral tissue regeneration, with a focus on their composition, mechanism of action, and clinical applications.

Methods: A systematic search was conducted across PubMed, Scopus, Web of Science, and Google Scholar for studies published between 2000 and 2024, following PRISMA guidelines.

Results: Thirty (30) studies met the inclusion criteria, with five selected for detailed analysis. The findings highlight the regenerative potential of hydrogels composed of natural polymers, e.g., collagen, alginate, and hyaluronic acid, synthetic polymers, e.g., polyethylene glycol PEG, and polycaprolactone, as well as poly(lactic-co-glycolic)acid. Advanced hydrogel formulations, including self-healing, thermosensitive, and bioactive hydrogels, demonstrate enhanced biocompatibility, mechanical properties, and controlled drug delivery.

Conclusion: Despite their potential, challenges such as long-term stability, clinical translation, and standardization in hydrogel formulations remain. Further research is required to optimize hydrogel-based therapies for widespread clinical use in oral and periodontal tissue regeneration.

Introduction: Fusobacterium (F.) nucleatum, a Gram-negative anaerobic bacterium, has been implicated in both periodontal disease and oral squamous cell carcinoma (OSCC). This review aims to evaluate the levels of F. nucleatum in patients with periodontal disease and OSCC, exploring its potential role in the pathogenesis.

Methods: A comprehensive literature search was conducted across multiple databases, identifying studies that measured F. nucleatum levels in periodontal disease and OSCC tissues.

Results: A higher prevalence of F. nucleatum exists in both periodontal disease and OSCC tissues compared to healthy controls.

Conclusion: It appears that there is a link between infection with F. nucleatum and the development of these oral diseases. Further research is warranted to elucidate the mechanisms underlying this association and to explore potential therapeutic interventions targeting F. nucleatum.

Aim: Washing is a multistep process and a critical step in the sterilization of reusable instruments used in surgery. The complexity of the design of some types of instruments, such as those with a lumen, is a major challenge, both in terms of cleaning and of checking their cleanliness.The aim of this study was to validate a new approach to compare washing methods of reusable instruments with internal lumen. This approach was then tested to compare six methods for washing reamers.

Methods: The proposed method was based on detection by Soiltest^®, a commercially available soiling test, using ninhydrin in a spectrophotometric approach at 570 nm. To increase the sampling yield of conventional swabbing, we used new wash brushes for each sampling.

Results: Soiltest^® results were linearly quantified with a quantitative and reproducible method. The equation of calibration curve was Y=0.2043X-0.03489, the coefficient of determination was 0.9926, and the slope was significantly different from zero (p<0.0001, F-test). The optimal cleaning method for reamers was a combination of chemical detergents, manual cleaning ensuring that no obstruction is present in the instrument, and mechanical washing in a washer-disinfector with a system of continuous irrigation of the lumen of the instrument.

Conclusion: This study validated a new approach to evaluate the cleanliness of critical reusable surgical instruments with lumen based on the detection of protein residues using Soiltest^®, by means of a colorimetric method using ninhydrin.