Infection Control and Hospital Epidemiology最新文献

Objective: In Staphylococcus aureus the qacA/B and smr genes have been associated with elevated MICs to antiseptics with such organisms often termed antiseptic tolerant S. aureus (ATSA). The impact of repeated healthcare or antiseptic exposure on colonization with ATSA is uncertain.

Design: Prospective longitudinal cohort study.

Setting/participants: The high-risk cohort included children with a new diagnosis of malignancy recruited from a pediatric oncology clinic. The low-risk cohort were otherwise healthy children enrolled from general pediatrics clinics.

Methods: Subjects had anterior nares and axillary cultures collected at 3-month intervals for one year. Identified S. aureus isolates underwent PCR for qacA/B and smr. The primary outcome was colonization with ATSA at least once during study follow-up. Logistic regression models were utilized to adjust for confounding across cohorts.

Results: 226 subjects were evaluable for the primary outcome. It was noted that 93.5% of high-risk subjects reported regularly using chlorhexidine gluconate (CHG) antiseptic products. Colonization with ATSA was found in 15.5% of subjects. In univariable analyses, subjects in the low-risk cohort more frequently had ATSA colonization; following adjustment for confounders, the rates of overall ATSA colonization were similar in the high- and low-risk cohorts. Only 2 subjects had colonization with an ATSA strain at more than one encounter.

Conclusions: Pediatric oncology patients do not experience higher rates of ATSA colonization than healthy children. In addition, ATSA colonization is transient relative to strains negative for smr/qacA/B. These findings suggest that repeated use of infection prevention strategies including CHG do not predispose to colonization with ATSA in the ambulatory setting.

In test-negative study of residents exposed to viral respiratory infection (VRI), odds of VRI (excluding SARS-CoV-2) was higher with shared room (OR = 2.28, 95% CI, 1.53-3.40) and shared adjoining washroom (OR = 1.65, 95% CI, 1.03-2.64) than neighboring rooms. Measures recommended for exposed residents in shared rooms should be considered for shared washrooms.

In Antimicrobial Stewardship and Infection Prevention and Control, programmatic goals often strive to achieve clinical benefit by practice change in the direction of doing less. Practically, this may include reducing the number of tests ordered, encouraging shorter and more narrow courses of antimicrobials, or discontinuing practices that are no longer contextually appropriate. Because promoting practice change in the direction of doing less is a critical aspect of day-to-day operations in Antimicrobial Stewardship and Infection Prevention and Control, the goals of this Society for Healthcare Epidemiology Research Committee White Paper are to provide a roadmap and framework for leveraging principles of implementation and de-implementation science in day-to-day practice. Part II of this series focuses on some practical case studies, including real-world examples of applied de-implementation science to promote discontinuation of practices that are ineffective, overused, or no longer effective.

Objective: Antimicrobial resistance (AMR) is a global health challenge, highlighting the need for antibiotic stewardship policies. We evaluated the impact of the National Action Plan to Contain Antimicrobial Resistance (2022-2025) on antibiotic use among primary healthcare institutions (PHIs) in Central China.

Design: A segmented interrupted time-series analysis from January 2021 to December 2023.

Methods: We collected data from 1510 PHIs, by region, types of healthcare institutions and medication type, assessing antibiotic consumption using defined daily doses per 1000 inhabitants per day and the quality by the percentage of broad-spectrum antibiotics.

Results: Post-intervention, antibiotic consumption declined by -35.96% (95%CI: -49.34 to -22.57), and the proportion of broad-spectrum antibiotic use decreased by -41.97% (-61.74 to -22.20). Consumption dropped significantly in both moderately developed areas and underdeveloped areas, while highly developed areas saw the largest reduction in broad-spectrum antibiotic use. Rural PHIs also showed notable declines in both overall antibiotic consumption and broad-spectrum usage.

Conclusions: The policy was associated with a reduction in antibiotic use across PHIs, though regional disparities in its implementation suggest uneven benefits.

Background: The utility of routine environmental sampling to monitor the airborne fungal load (AFL) in healthcare settings is uncertain.

Methods: AFL was measured by monthly cultures at a tertiary-care pediatric hospital from November 2018 through October 2023 on eleven units caring for patients at risk for invasive mold infection (IMI). Surveillance for healthcare-associated IMI was conducted for all patients in the healthcare system using locally developed definitions for possible, probable, and definite hospital-onset infections. Poisson regression was used to analyze the association between AFL and monthly IMI rates.

Results: 78 cases of IMI were identified during the period of AFL monitoring. Of these, 51 infections were classified as healthcare-associated probable or proven IMI and were tested for association with AFL measurements. There was not a significant facility-wide association between the average monthly AFL and the overall IMI rate. On units where hematology/oncology patients were treated, however, an increase in average monthly local AFL for opportunistic fungal pathogens of 1 CFU/m³ was associated with a 1.48-fold increase in the IMI rate for these patients (95% CI 1.00-2.19, P = .05). The AFL for Aspergillus species on these units showed a particularly strong association with the hematology/oncology IMI rate (15.9-fold elevation for an increase of 1 CFU/m³ [95% CI 2.8-90.7, P = .002]). Neither hematology/oncology nor facility-wide IMI rates showed comparable associations with changes of the AFL in outdoor air.

Conclusions: Regular monitoring of AFL on targeted hospital units may identify periods when hematology/oncology patients are at increased risk for IMI.

De-implementation of established practices is a common challenge in infection prevention and antimicrobial stewardship and a necessary part of the life cycle of healthcare quality improvement programs. Promoting de-implementation of ineffective antimicrobial use and increasingly of low-value diagnostic testing are cornerstones of stewardship practice. Principles of de-implementation science and the interplay of implementation and de-implementation are discussed in part I of this Society for Healthcare Epidemiology of America White Paper Series.In this second part of the series, we discuss a process for applying principles of de-implementation science in infection prevention and stewardship and then review some real-world examples and case studies, including a national blood culture shortage, contact precautions, and surgical and dental prophylaxis. We use these examples to demonstrate how barriers and facilitators can be mapped to evidence-informed implementation/de-implementation strategies to promote efforts to reduce low-value, ineffective, or out-of-date practices. These real-world examples highlight the need for infection prevention and stewardship programs to adapt to changing evidence, contexts, and conditions. Although barriers to practice change are often a bit different, de-implementation can sometimes be thought of as the implementation of a new program-but the new program aims to stop rather than start doing something.As the saying goes, sometimes less really is more. Medicine and public health have a strong action bias and a strong aversion to risk and uncertainty. Although our best intentions may point us to implementing more interventions, often, the best medicine instead dictates that we do less, or nothing at all. Leveraging principles of de-implementation science can help move healthcare in the right direction when interventions are low-value, ineffective, or no longer needed.

In an observational study, healthcare personnel often entered contact precautions rooms without contacting patients or the environment. An approach requiring gloves and gowns based on actual contacts rather than for all room entries would reduce personal protective equipment donning and doffing time, cost, and carbon footprint by more than half.

Objective: To describe trends in the prevalence of healthcare-associated infections (HAIs) and antibiotic-resistant organisms (AROs) in Canadian acute-care hospitals.

Design: Repeated point prevalence surveys.

Setting: Canadian Nosocomial Infection Surveillance Program (CNISP) hospitals.

Methods: Trained infection control professionals reviewed medical records of eligible adult patients and applied standardized definitions to collect demographic data and information on HAIs, AROs, and additional precautions from 39 to 62 hospitals in 2002, 2009, 2017, and 2024.

Results: The prevalence of adult patients with at least one HAI increased from 10.4% (95% CI: 9.6%-11.2%) in 2002 to 12.4% (95% CI: 11.7%-13.2%) in 2009, declined to 8.4% (95% CI: 7.8%-9.0%) in 2017, and stabilized in 2024 (8.1%, 95% CI: 7.6%-8.6%) despite 3.1% of HAIs being due to SARS-CoV-2. Between 2017 and 2024, there were increases in bloodstream infections (1.0% to 1.5%, p = 0.002), viral respiratory infections (VRI) (0.3% to 0.6%, p < 0.001), and in the prevalence of patients on additional precautions for carbapenemase-producing organisms (0.1% to 1.7%, p < 0.001) and VRIs (2.1% to 3.6%, p < 0.001). In 2024, AROs were responsible for 6.6% of infections. One-third of HAIs were device-associated, and the prevalence of central line-associated bloodstream infections (CLABSIs) doubled from 0.4% in 2017 to 0.7% in 2024, p = 0.02.

Conclusions: A point prevalence survey performed in Canada in 2024 following the COVID-19 pandemic identified a stable prevalence of HAIs and AROs despite the inclusion of SARS-CoV-2. Concerning trends were observed including the increased prevalence of certain HAIs such as CLABSIs and VRIs highlighting the need for ongoing efforts in hospital infection prevention.