Infection Control and Hospital Epidemiology最新文献

We surveyed SHEA Research Network institutions in the U.S. to characterize penicillin allergy delabeling practices. Although most institutions reported active delabeling programs, we found substantial variability in these initiatives. Reported barriers included minimal electronic health record (EHR) integration and time constraints. Expanding non-allergist-led programs and EHR integration are critical to optimizing and advancing delabeling.

Background: Hospital sinks are reservoirs for epidemiologically important pathogens (EIPs), yet practical, effective strategies for sustained decontamination are lacking.

Methods: We conducted a randomized controlled trial of 30 in-room sinks (15 intervention, 15 control) in a newly renovated hospital unit to evaluate the efficacy of a hydrogen peroxide/peracetic acid foamed disinfectant in reducing sink contamination. Intervention sinks received foamed disinfectant to sink drains three times weekly; control sinks underwent standard daily surface cleaning. Weekly sampling was performed from three sink locations (top surface, tail pipe, P-trap) over 35 weeks. The primary outcome was sink conversion events (SCEs), defined as first detection of ≥1 EIP, defined as Pseudomonas aeruginosa, Stenotrophomonas spp., or Acinetobacter spp., and ESBL-producing or carbapenem-resistant Enterobacterales, in previously negative sinks.

Results: A total of 2880 samples were collected. All sinks were negative at baseline for study pathogens. Nearly all sinks (29/30) experienced an SCE during the study period. However, only 44 (9%) intervention sink samples were positive for EIPs, compared to 270 (47%) in control sinks (p < 0.00001). EIPs were recovered from 4% versus 24% of P-traps and 4% versus 39% of tail pipes; sink top/handle contamination was rare and similar (3% vs 4%). The most frequent EIPs were Acinetobacter spp. and Stenotrophomonas spp. Intervention sinks experienced a delayed time to SCE (p = 0.0001). Items were stored on/in sinks in 93% of observations.

Conclusion: Regular application of a foamed disinfectant reduced and delayed EIP contamination in renovated hospital sinks. Foam-based protocols may help mitigate environmental reservoirs of multidrug-resistant organisms.

Background: Surgical site infections (SSIs) are among the most common postoperative complications in colorectal surgery, and associate with increased morbidity, prolonged recovery, and higher healthcare costs. Most studies combine all SSI categories, potentially overestimating economic burden due to higher severity of organ/space infections. The specific cost impact of incisional SSIs-superficial and deep infections-remains underexplored, despite its prevention potential. This study aimed to evaluate hospital costs associated with incisional SSIs following colorectal resection.

Methods: A retrospective cohort study was conducted at a tertiary oncologic center, including patients who underwent surgical resection for primary neoplasms of the colon, rectum, or anal canal between 2018 and 2023. Patients with incisional SSIs were matched 1:1 to controls without SSI using propensity scores based on demographic and surgical variables. Total hospital costs within 60 days postoperatively were analyzed using real-world, institution-specific cost data. Multivariate regression was used to identify independent cost predictors.

Results: Among 985 eligible patients, 176 (17.9%) developed an incisional SSI. After matching, 346 patients (173 pairs) were included in the cost analysis. Mean hospital costs were significantly higher in the SSI group (€6,065.93 vs €5,089.97; P < 0.001), primarily due to prolonged hospitalization and increased outpatient care use (medical and nursing consultations). Incisional SSI was an independent predictor of higher costs, along with open surgery, comorbidities and stoma presence.

Conclusions: Incisional SSIs associated with higher hospital costs after colorectal surgery. These findings support the implementation of targeted SSI prevention strategies to reduce complications and optimize healthcare resource use.

Objective: This study outlines the investigation into an outbreak of Mycobacterium fortuitum infections involving 17 cases undergoing hip or knee surgeries at two ambulatory surgery centers (ASCs) in Tennessee from January 2023 to November 2024. Notably, the outbreak could not be attributed to contaminated water sources, which are typically associated with non-tuberculous mycobacteria (NTM) outbreaks, presenting a unique challenge.

Methods: Outbreak investigation steps included Infection Prevention (IP) assessments, case-control study, environmental sampling, whole genome sequencing, and a healthcare personnel (HCP) exposure questionnaire.

Results: IP assessment highlighted several concerns, including no formal facility water management program (WMP), a lack of dedicated IP personnel and certified sterile processing staff, the absence of a formalized system for tracking surgical site infections, and a notable gap in understanding the requirements for reporting diseases. The case-control findings revealed a significant association between the presence of a surgical technologist in the operating room during the procedures and the occurrence of NTM infections, indicated by an odds ratio of 55.77 (95% CI [3.16-985.44]; P = 0.0097). Thirteen clinical isolates collected at one ASC and three additional isolates collected at a second ASC were highly related by whole genome sequencing.

Conclusion: The study further elucidates valuable insights gained from the outbreak response, including the gaps in surveillance within the ambulatory surgical setting and systematic collection of cultures from environmental sources. It emphasizes the importance of thorough vetting, onboarding, continuing education, and practice monitoring for HCP.

In a retrospective cohort of 6363 neonates admitted to three NICUs, there was no reduction in Staphylococcus aureus acquisition when comparing pre- and post-pandemic incidence rates. While additional infection prevention practices introduced during the pandemic helped prevent SARS-CoV-2 transmission, these practices may not have reduced S. aureus transmission to infants.

This single-center retrospective analysis evaluated the yield of blood cultures in patients with febrile neutropenia during a supply shortage. The detection rate of true bacteremia was observed to increase with the number of sets obtained, although this increase was not statistically significant. Findings support limiting repeat cultures within 48 hours.

Objective: To evaluate the impact of implementation of a conditional reflex urine culturing strategy on urine culture rates, antimicrobial use, and clinical outcomes in hospitalized adults.

Design: Pre-post quasi-experimental study.

Setting: Emergency departments and inpatient units within a large, integrated healthcare system in Northeast Ohio, comprising 10 medical centers.

Patients: Adult patients with a urine culture ordered from June 1, 2018, to May 31, 2023.

Methods: A system-wide intervention was implemented on June 1, 2020, requiring urinalysis (UA) with pyuria findings to trigger a urine culture order. We compared urine culture rates, antimicrobial use (measured by days of therapy [DOT] and days of antimicrobial spectrum coverage [DASC]), and clinical outcomes between pre-and post-intervention periods.

Results: The intervention resulted in an 85.4% reduction in urine culture rates (0.54 vs 3.71 per 100 patient days). Antimicrobial use decreased, with DOT per 100 patient days dropping by 11.5% and DASC/DOT by 16.1%. No significant differences were observed in Clostridioides difficile infection rate, subsequent bloodstream infections with urinary pathogens, or mortality between pre- and post-intervention groups.

Conclusions: A conditional reflex urine culturing strategy implemented as part of a diagnostic stewardship framework reduced urine culture and antimicrobial use without adverse clinical outcomes. This highlights the potential of diagnostic stewardship to optimize antimicrobial use in hospitalized adults.

Objective: To determine the rate of healthcare personnel (HCP) glove or gown contamination with methicillin-resistant Staphylococcus aureus (MRSA) and to estimate which patient care interactions and HCP roles are associated with greater contamination.

Design: Multicenter cohort study.

Setting: Five Veterans Affairs medical centers in the United States.

Patients and participants: Patients with a positive MRSA clinical or surveillance culture within the past 7 days were enrolled. Five HCP in the room were observed for each patient. After completion of tasks and prior to room exit, HCP gloves and gowns were cultured separately.

Results: We enrolled 799 patients and obtained 3,832 glove and gown cultures. Contamination of HCP gloves or gown with MRSA occurred 713 of 3,832 (18.6%) of the time, while 589 of 3,832 (15.4%) of interactions resulted in contamination of gloves, and 319 of 3,831 (8.3%) of interactions resulted in contamination of gowns. The gloves and gowns of physical therapists and occupational therapists were most frequently contaminated. Any interactions that involved touching the patient resulted in glove or gown contamination in 622 of 2,901 (21.4%) of observations, while touching only the environment resulted contamination in 91 of 931 (9.8%) of observations. Rates of glove or gown contamination were similar in the intensive care unit (ICU) and non-ICU.

Conclusions: Contamination of HCP gloves and gowns with MRSA occurs frequently when caring for Veteran patients particularly when there is direct patient contact. Hospitals may consider optimizing contact precautions by using fewer precautions for low-risk interactions and more precautions for high-risk interactions.

Objective: Using the Modified Rhyme Test in accordance with the National Institute for Occupational Safety and Health (NIOSH) protocol, we assessed the communication performance for both speech intelligibility and hearing acuity in bearded healthcare workers (HCWs) wearing a N95/P2 respirator with an under-mask elastic band beard cover.

Design and setting: A prospective simulation study conducted at the respiratory fit test center of the Royal Melbourne Hospital.

Participants: Bearded HCWs who required respiratory protection and could not shave for medical, cultural, or religious reasons.

Results: The overall performance rating score was 91.3% and 99.8% for speech intelligibility and hearing acuity respectively. There was a reduction in the percentage of correct words perceived by a panel of trained listeners when bearded HCWs were speaking while wearing the N95/P2 respirator/elastic band combination compared to the uncovered beard condition (84.5% vs. 92.9%, p = 0.011). However, no significant difference was found in the perception of medical phrases between these two conditions. In the hearing assessment, there were no differences found in hearing correct single words or medical phrases between the two conditions.

Conclusions: This study demonstrates that when bearded HCWs wore the N95/P2 respirator/elastic band combination, their speech intelligibility and hearing acuity greatly exceeded the NIOSH standard of 70% in the Modified Rhyme Test. This finding is crucial for ensuring effective communication among bearded HCWs, thereby supporting both respiratory protection and operational efficiency in healthcare settings.

We evaluated the impact of silencing penicillin cross-reactivity alerts on perioperative antibiotic prescribing and surgical site infections (SSIs) in 6 hospitals using an interrupted time series analysis. Silencing the alerts minimally increased cefazolin prescribing among penicillin allergy labeled patients (sensitivity analysis only; P = 0.03) and had no influence on SSIs (P = 0.32).