Infection Control and Hospital Epidemiology最新文献

We evaluated one of the first secure large language models approved for protected health information, for identifying central line-associated bloodstream infections (CLABSIs) using real clinical notes. Despite no pretraining, the model demonstrated rapid assessment and high sensitivity for CLABSI identification. Performance would improve with access to more patient data.

A 54-question survey about System Healthcare Infection Prevention Programs (SHIPPs) was sent out to SHEA Research Network participants in August 2023. Thirty-eight United States-based institutions responded (38/93, 41%), of which 23 have SHIPPs. We found heterogeneity in the structure, staffing, and resources for system infection prevention (IP) programs.

Background: Universal masking within healthcare settings was adopted to combat the spread of coronavirus disease 2019 (COVID-19). In addition to mitigating the risk for Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection, it also had an added benefit of preventing the nosocomial transmission of other respiratory viral diseases.

Objective: This study examines the impact of the masking intervention on nosocomial respiratory viral infections (RVI) in vulnerable sub-populations of people with cancer at a tertiary care hospital.

Design: Interrupted time series analysis.

Methods: We reviewed non-SARS-CoV-2 nosocomial RVI between January 1, 2017 and December 31, 2023 and compared its quarterly trends before (January 2017 to March 2020) and after (April 2020 to December 2023) the universal masking intervention was implemented.

Results: Prior to the masking policy, there was no significant change in the quarterly rate of non-SARS-CoV-2 nosocomial RVI (baseline trend: P = 0.662). Crude infection rates decreased from 5.6% preintervention to 4.3% after the masking policy was implemented (P < 0.001). Quarterly trends continued to steadily decline post-intervention (β = -0.10, SE = 0.04, P < 0.007).

Conclusions: Our results suggest that universal face masking is associated with reduced non-SARS-CoV-2 nosocomial RVI, providing further evidence to support the continued use of face masks in healthcare settings to protect the health of immunocompromised patients.

Objective: This study quantified the burden of hospital-onset bacteremia and fungemia (HOB) among cancer and transplant patients compared to other patients.

Methods: A retrospective cross-sectional study used data from 41 hospitals between October 2015 and June 2019. Hospitalizations were segmented into categories using diagnosis-related groups (DRG): myeloproliferative (MP) cancer, solid tumor cancer, transplant, and non-cancer/non-transplant ("reference group"). To quantify the association between DRG and HOB, multivariable adjusted Poisson regression models were fit. Analyses were stratified by length of stay (LOS).

Results: Of 645,315 patients, 59% were female and the majority 41 years of age or older (76%). Hospitalizations with MP cancer and transplant demonstrated higher HOB burden compared to the reference group, regardless of LOS category. For all hospitalizations, the >30 days LOS category had a higher burden of HOB. The median time to reportable HOB was within 30 days regardless of duration of hospitalization (reference, 8 days; solid tumor cancer, 8 days; transplant, 12 days; MP cancer, 13 days).

Conclusion: MP cancer and transplant patients had a higher burden of HOB compared to other hospitalized patients regardless of LOS. Whether these infections are preventable should be further evaluated to inform quality metrics involving reportable bacteremia and fungemia.

A Nebraska statewide webinar series was initiated during the coronavirus disease 2019 (COVID-19) pandemic for long-term care (LTC) and acute care/outpatient (AC) facilities. An impact survey was completed by 48 of 96 AC and 109 of 429 LTC facilities. The majority reported increased regulatory awareness (AC: 65%, LTC: 54%) and updated COVID-19 (AC: 61%, LTC: 69%) and general infection prevention (AC: 61%, LTC: 60%) policies.

Background: Infection control guidelines for cystic fibrosis (CF) stress cleaning of environmental surfaces and patientcare equipment in CF clinics. This multicenter study measured cleanliness of frequently touched surfaces in CF clinics using an ATP bioluminescence assay to assess the effectiveness of cleaning/disinfection and the impact of feedback.

Methods: Eight surfaces were tested across 19 clinics (10 pediatric, 9 adult) over 5 rounds of testing. Rounds 1 and 2 served as uncleaned baseline, and Round 3 occurring after routine cleaning. Rounds 4 and 5 were performed after feedback provided to staff and measured after cleaning. Pass rates defined as <250 relative light units were the primary outcome.

Results: Of the 750 tests performed, 72% of surfaces passed at baseline, and 79%, 83%, and 85% of surfaces passed in Rounds 3, 4, and 5, respectively. The overall pass-rate was significantly higher in adult compared to pediatric clinics (86% vs 71%; P < 0.001). In pediatric clinics, blood pressure equipment and computer keyboards in the pulmonary function lab consistently passed, but the exam room patient/visitor chairs consistently failed in all rounds. In adult clinics blood pressure equipment, keyboards in exam rooms and exam tables passed in all rounds and no surface consistently failed.

Conclusion: We demonstrate the feasibility of an ATP bioluminescence assay to measure cleanliness of patient care equipment and surfaces in CF clinics. Pass rates improved after cleaning and feedback for certain surfaces. We found that surfaces are more challenging to keep clean in clinics taking care of younger patients.

Objective: Assess healthcare workers' (HCW) attitudes toward universal masking, and gowns and gloves used as part of transmission-based precautions.

Design: Cross-sectional survey.

Setting: Academic, tertiary care medical center in Baltimore, Maryland.

Participants: HCW who work in patient care areas and have contact with patients.

Methods: In May 2023, a 15-question web-based survey was distributed by the hospital's communications team via email. The survey contained questions to assess HCW perceptions of universal masking policies prior to the availability of COVID-19 vaccines and at the time of the survey, and the use of gowns and gloves for transmission-based precautions. Descriptive statistics were used to summarize data. Differences in agreement with universal masking over time, level of agreement with gown and glove policies, and with all PPE types across respondent characteristics were assessed.

Results: 257 eligible respondents completed the survey. Nurses and patient care technicians (43%) and providers (17%) were the most commonly reported roles. Agreement with universal mask use decreased from 84% early in the pandemic to 55% at the time of the survey. 70% and 72% of HCW agreed masks protect themselves and others, respectively. 63% expressed any level of annoyance with mask wearing, the most often due to communication challenges or physical discomfort. 75% agreed with gown use for antibiotic-resistant bacteria compared with 90% for glove use.

Conclusions: The majority of HCW agree with the use of PPE to prevent pathogen transmission in the healthcare setting. Agreement with universal mask use for patient care shifted during the COVID-19 pandemic.

Objective: To compare the effectiveness of universal admission testing (UAT) and risk-based testing (RBT) in preventing nosocomial coronavirus disease 2019 (COVID-19) after the implementation of strict infection control measures.

Design: Retrospective multicenter cohort study.

Setting: Five community hospitals in Japan.

Patients: 14,028 adult patients admitted emergently from June 1, 2022, to January 31, 2023.

Methods: We calculated crude incidence density rates of community-acquired COVID-19 (positive test ≤4 days postadmission), hospital-acquired COVID-19 (positive test ≥8 days postadmission), total postadmission COVID-19 (all cases of positive test postadmission), and primary cases (sporadic and index cases). A generalized estimating equation model was used to adjust for local incidence (new COVID-19 patients per 100,000 population), single-bed room proportion, and admission proportion of patients older than 65 years.

Results: The weekly local incidence in the study areas was less than 1,800 per 100,000 population (1.8%). Two hospitals implemented RBT and 3 implemented UAT. The median admission testing rate was higher in the UAT group than in the RBT group (95% vs 55%; difference 45.2%, 95% CI, 40.3%-48.8%). Crude and adjusted analyses revealed no significant associations between incidence density rates (IRR; >1 indicates higher incidence with UAT) and admission strategies for any of the outcomes: community-acquired cases (adjusted IRR = 1.23; 95% CI, 0.46-3.31), hospital-acquired cases (1.46; 0.80-2.66), total postadmission COVID-19 (1.22; 0.79-1.87), and primary cases (0.81; 0.59-1.12).

Conclusions: Compared with risk-based testing, universal admission testing may have limited additional benefits in preventing nosocomial COVID-19 transmission during a period of low-moderate local incidence.