GMS Hygiene and Infection Control最新文献

Background: The COVID-19 pandemic era had witnessed an upsurge of healthcare-associated infections (HAI) in COVID intensive care units (ICUs), which can be reduced by following proper hand hygiene (HH) practice. Performing HH auditing in COVID ICUs and providing timely feedback to the stake holders is crucial to reduce HAIs.

Methods: From July 2021 to December 2021, HH auditing was conducted in COVID ICUs. Hand hygiene (HH) complete adherence rate (HHCAR), HH partial adherence rate (HHPAR) and HH total adherence rate (HHTAR) were analysed. Profession-specific HHTAR and moment-specific HHTAR (for each WHO moment) were also calculated.

Results: HHCAR, HHPAR and HHTAR were found to be 47%, 19% and 66%, respectively. There was a significant increase in the monthly HHTAR from 62.2% to 72.2% (p<.001). The profession-specific hand-hygiene adherence rate (HHAR) was found to be highest among nurses (67%), and the moment-specific HHAR of WHO-moments 2 (90%) and 3 (94.8%) had the highest HH adherence.

Conclusions: Auditing HH and providing timely feedback significantly improved HH adherence. The greatest need now is to regularly conduct HH auditing in COVID locations of all healthcare facilities to reduce the HAI rate among the COVID-19 infected patients in ICUs.

Background: The major heatwave in Europe in August 2003 resulted in 70,000 excess deaths. In Frankfurt am Main, a city with 767,000 inhabitants in the south-west of Germany, around 200 more people died in August 2003 than expected. Soon afterwards, the city introduced adaptation measures to prevent heat-related health problems and subsequently established further mitigation measures to limit climate change. Frankfurt is rated as being one of the cities in Germany to have implemented the best climate adaptation and mitigation measures. This study addressed the following questions: is there already a downward trend in mortality from heat and can this be attributed to the measures taken?

Materials and methods: The age-standardized mortality rate (ASR) was calculated for the months of June to August and for calendar weeks 23 to 34 of the individual years on the basis of population data and deaths of the inhabitants of Frankfurt am Main for the years 2000 to 2023. This was related to the meteorological data from the Frankfurt measuring station of the German National Meteorological Service. For four different heat exposure indicators (heat days, days in heat weeks, days in heatwaves and days with heat warnings), the incidence rate (death cases per 1 million person days) (IR) was calculated for days with and without exposure, and the incidence rate difference and the incidence rate ratio (IRR) were estimated to compare days with vs days without exposure.

Results: Over the years, the mean daily temperatures tended to increase, and the standardized mortality rate decreased. An increase in ASR was observed during heatwaves up to 2015, but no longer in the later ones. In the summer of 2003, the incidence rate was 16.0 (95% confidence interval (CI) 12.2-19.9) per 1 million person days greater on heat days than on days not classified as heat days, and the corresponding incidence rate ratio was 1.64 (95% CI 1.48-1.82). Although the weather data for the summers of 2018 and 2022 were comparable with the record-breaking heat summer of 2003, the incidence rate differences (2018: 3.8, 95% CI 0.9-6.7; 2022: 2.3, 95% CI -0.3-4.9) and the IRR (2018: 1.20, 95% CI 1.05-1.37; 2022: 1.12, 95% CI 0.99-1.26) were considerably lower. Similar results were also obtained when comparing mortality in heat weeks and heatwaves as well as on days with heat warnings.

Discussion: In summary, our study in Frankfurt am Main not only showed a decrease in heat-related mortality in the population as a whole over the years, but also a decrease in excess mortality during various heat periods (day, week, wave, warning), especially in comparison with the years with very high heat stress and drought (2003, 2018 and 2022). However, whether this development represents success of the intensive prevention measures that have been implemented in the city for years or merely describes a general trend cannot be ans

Introduction: In Germany, hospitals, rehabilitation facilities and outpatient surgery facilities are required by law to perform antibiotic-consumption surveillance. Established IT programs are available for recording the defined daily doses. These do not exist for long-term care facilities (LTCFs). Antibiotic stewardship is also recommended for LTCFs. In view of the lack of IT solutions for consumption surveillance, this study investigated whether point prevalence studies could be a suitable basis for a data-based antibiotic stewardship program in LTCFs.

Method: In May 2023, 18 elderly-care facilities in Berlin, Germany, participated in a point prevalence survey on antibiotic consumption according to the established HALT (healthcare-associated infections in long-term care facilities) method. The number of residents present and their risk factors (including the use of catheters and antibiotic therapy) were recorded. The results were compared with comparable data from previous surveys in LTCFs in Berlin, Germany as well as with the HALT data for Europe as a whole and for Germany.

Results: On the day of the survey, 2040 residents were present, 7.7% of whom bore a urinary catheter and 0.5% a vascular catheter. 0.2% of the residents had a port access, 0.4% a dialysis catheter and one resident (0.05%) a tracheostoma. Twenty-seven (1.3%) residents were receiving an antibiotic on the day of the survey. Of these, 29.6% had a urinary tract catheter. 63.0% of the antibiotics were given for a urinary tract infection, 14.8% for a respiratory tract infection and 11.1% for a wound/soft tissue infection. The overall prevalence of antibiotics was in the range of previous surveys from Germany (1.2-2.4%) and significantly lower than in the Europe-wide HALT survey overall (4.3-4.5%).

Discussion: The survey showed low use of antibiotics in the LTCFs in comparison with Europe-wide surveys. The time required was less than 2 hours for a 100-bed facility. Until appropriate IT programs to determine the defined daily doses are also available for LTCFs, such easy-to-perform and standardized point-prevalence surveys - if repeated several times a year - can be a suitable method for recording the use of antibiotics in nursing homes for the elderly.

Background: In summer 2023, mandatory reporting of respiratory syncytial virus (RSV) by name was introduced in Germany. The stated objectives were: to improve the database to prevent overburdening of the healthcare system, to implement targeted, early investigation and action by local health authorities to prevent further spread, and to assess vaccines after the expected approval of RSV vaccination.

Methods: These objectives are examined against the background of data from mandatory reporting of RSV in the German federal state of Saxony, which has been required since 2002, and the data from the ARE (acute respiratory diseases) survey in Germany, considering the basic legal requirements and options of the Infection Protection Act, the requirements of the EU Commission for the collection of data on infectious diseases and the recommendations by experts of the European Centre for Disease Prevention and Control (ECDC), the options for individual or general preventive measures by the health authorities and previous experience with the evaluation options of the reported data (especially regarding the effectiveness of vaccinations).

Results and discussion: An extrapolation of the previously reported data from Saxony to the whole of Germany shows that over 100,000 reports per year must be expected (more than the reports of both rota and noroviruses together). Neither the requirements of the EU Commission nor the views of an expert group of the ECDC recommend mandatory RSV reporting. Mandatory reporting by name is also not appropriate from a legal perspective. A sentinel, which is also better suited to assessing vaccinations, would be more appropriate to avoid unnecessarily overburdening the health authorities. In addition, initial experience with wastewater sentinels for RSV has shown that they may be used to record local and regional RSV infections - albeit without information on the severity of the disease and thus the burden on the healthcare system.Against this background, mandatory reporting of RSV does not appear to be appropriate. Instead, the existing sentinels should be continued and further expanded, possibly supplemented by RSV wastewater monitoring.

Background: Patients are hospitalized for extended periods, particularly in intensive care units (ICUs). As a result, the saturation probe (pulse oximeter) remains attached for an extended period and microorganisms can grow in the wet environment. If the pulse oximeters are not reprocessed, cross-infection may occur. The literature contains several studies in which gloves were used for the measurement while various SpO₂ (peripheral arterial oxygen saturation) measurements were compared with each other. However, such comparisons have yet to be made with the results of arterial blood gas SpO₂ measurements by pulse oximeter, considered as the gold standard. The present study aimed to compare arterial blood gas values with the fingertip saturation measurement performed by having adult patients wear gloves of different colors, one after the other, on their fingers and determining the effect of the differently colored gloves (transparent, white, black, light blue) on saturation values.

Methods: The study was conducted on 54 patients in an ICU. Intra-arterial blood gas SpO₂ results were measured. Oxygen saturation was measured while the patient 1. did not wear gloves and 2. sequentially wore a series of gloves of different colors. Paired t-test, correlation analysis, and Bland Altman charts were used to evaluate the results.

Results: The mean SpO₂% value of the participants' intra-arterial blood gas measurements was 97.76±2.04. The mean SpO₂% value obtained from the measurements of the fingers with a transparent glove was 0.43 points lower than the mean SpO₂% value of the intra-arterial blood gas measurements (t=0.986, p=0.61). The mean SpO₂% value obtained from the measurements of the fingers with a white glove was 0.93 points lower than the mean SpO₂% value of the intra-arterial blood gas measurements (t=1.157, p=0.093).

Conclusion: Of the measurements performed with a glove, the mean SpO₂% value obtained from the measurements of the fingers with a transparent glove was more consistent with the mean SpO₂% value of the intra-arterial blood gas measurements than measurement of the fingers without a glove.

In addition to emissions harmful to the environment, a significant amount of waste is generated in hospitals. In recognition of the fact that medical devices (MDs) contain valuable raw materials, such as rare earth elements, other metals, and high-quality plastics, a recycling concept has been developed. The project was examined for safety and feasibility from a hygiene point of view with sustainability in mind in order to create a reference solution for other areas as applicable. The recycling process begins when the MDs accumulate in the surgical facility and are separated into recyclable and disposable parts. The recyclable parts are subjected to wipe disinfection and collected in closed boxes until they are taken away, while the non-recyclable parts are sent for disposal. The recyclable waste, including the transport boxes, is steam-disinfected in a fractionated vacuum process before recycling. The waste is then recycled, and the emptied transport boxes are made available for re-collection by the surgical facility. The analysis of the overall recycling process shows that infectious risks both for the employees who collect, transport, and recycle the MDs and for the environment are neglectable.

Aim: SARS-CoV-2 hospital clusters are a challenge for healthcare systems. There is an increased risk of infection for both healthcare workers (HCWs) and patients; cluster countermeasures are also a drain on resources for the wards affected. We analysed to which extent characteristics and dynamics of SARS-CoV-2 clusters varied throughout the pandemic at a German university hospital.

Methods: Patient and/or HCW clusters from 10/2020 to 04/2022 were included in the study and grouped by virus variant into i.) clusters comprised of the presumably predominant wild-type, Alpha or Delta (WAD) SARS-COV-2 variants, and ii.) clusters comprised predominantly of Omicron subtype cases. The two groups were compared for specific characteristics and dynamics.

Results: Forty-two SARS-CoV-2 clusters and 528 cases were analysed. Twenty-one clusters and 297 cases were attributed to the WAD and 21 clusters and 231 cases to the Omicron group. There were no significant differences in median size (8 vs. 8 cases, p=0.94) or median duration (14 vs. 12 days; p=0.48), nor in the percentage of HCWs involved (46.8% vs. 50.2%; p=0.48). Patients in the WAD group were older (median 75 vs. 68 years of age; p≤0.05). The median time from cluster onset to case onset was significantly shorter for the Omicron group (median 6 vs. 11 days; p≤0.05).

Conclusions: Omicron clusters exhibited a more rapid dynamic, forcing all parties involved to adapt to the increased workload. Compared to excessive community case counts, constant Omicron cluster-affiliated case counts and stable cluster characteristics suggest an improved compliance with IPC countermeasures.

Artificial intelligence (AI) and robotics have emerged as game-changing technologies with the potential to revolutionize the healthcare industry. In the context of hospitals, their integration holds the promise of not only improving patient care but also driving competitive advantage and fostering sustainable development. This review paper aims to explore and evaluate the impact of AI and robotics applications on attaining competitive advantage and promoting sustainable development in hospitals, examines the current landscape of AI and robotics adoption in healthcare settings and delve into their specific applications within hospitals, including AI-assisted diagnosis, robotic surgery, patient monitoring, and data analytics. A key finding is the insufficient use of KI to date in terms of promoting sustainable development in hospitals. Furthermore, attempts to analyze the potential benefits and challenges associated with these technologies in terms of enhancing patient outcomes, operational efficiency, cost savings, and differentiation from competitors. Drawing upon a comprehensive review of the existing literature and case studies, this paper provides valuable insights into the transformative potential of AI and robotics in hospitals.

Caries is a multifactorial disease that involves a majority of the pediatric population. If not diagnosed and treated, it can lead to severe consequences affecting the permanent dentition. The objective of this study was to assess the prevalence of oral foci of infection in a multispeciality hospital during the pandemic in Chennai, South India. The majority of the patients examined had caries.

Introduction: Despite a recent increase in the representation of female authors in scientific literature, a significant gap persists concerning the inclusion of women in research. This necessitates the analysis of published literature from a gender perspective. This study aimed to provide gender distribution in authorship in the 100 most-cited articles on food-borne pathogen outbreaks from 1990 to 2020.

Methods: Bibliometric analysis was conducted using the Scopus database. Two reviewers were selected to search the database. We included the 100 most-cited articles on foodborne outbreak investigations. The analysis was conducted using Statistical Package for Social Sciences (SPSS) version 26 and Microsoft Excel version 2016. The citation data, including total citations, citations per year, and representation of women as first and senior authors, was analyzed in terms of frequencies, mean, median, and interquartile range. The correlation between journal impact factor and the representation of women in high-impact factor journals was determined. A p-value of <0.05 was considered significant.

Results: Most of the top-cited articles were published between 2001 and 2010 (n=47). The top 3 most-cited articles were from the USA. Of the total 100 articles, women were the first and last authors in 46% and 28% of the articles, respectively, reflecting a significant gender gap. However, the proportion of females as principal investigators gradually increased from 25% (n=10/30) to 52% (n=24/47) during the period 2001-2010 and to 92% (n=12/13) during 2011-2020. The USA had the highest number of included articles (n=48), and women were principal authors in 56% (n=27) of them. The lowest representation of women was observed in Austria, Denmark, Japan, Netherlands, New Zealand, Nigeria, Portugal, and the United Kingdom.

Conclusion: Women are under-represented in published literature on food-borne pathogen outbreaks. Although the representation of women as principal authors has recently increased, disparities still exist at the senior-author level, calling for women's advancement in academic science.