Infection Control and Hospital Epidemiology最新文献

To evaluate ultraviolet-C (UV-C) disinfection, we interviewed 34 personnel at 22 Veterans Affairs (VA) hospitals. Barriers included safety concerns, patient volumes, staffing, and costs. Facilitators included education and interprofessional communication. An implementation toolkit, interprofessional collaboration, and leadership support could optimize UV-C integration into VA infection prevention.

Background: Hospital sink drains are recognized reservoirs for gram-negative bacteria (GNB). This study evaluates the efficacy of a sink drain disinfection strategy using hydrogen peroxide-based foam, mechanical cleaning, and drain cover replacement in reducing GNB bioburden in a neonatal intensive care unit (NICU).

Methods: We conducted a prospective cohort study of 30 NICU room sinks comparing three interventions: (1) foam disinfection alone (n = 5), (2) foam with mechanical cleaning (n = 5), and (3) foam with drain cover replacement (n = 5), and (4) foam, mechanical cleaning, and drain cover replacement (n = 5), to controls (no intervention, n = 10). Samples from sink drains, faucets, counters, basins, and drain covers were collected at baseline (Day 0) and post-intervention (Days 1, 3, 5, and 7). Bacterial colony counts were analyzed using linear regression models.

Results: At baseline, sink drains and drain covers had the highest bioburden (total GNB mean ln-CFU: 15.4 and 16.4), with Pseudomonas aeruginosa (33%) and Stenotrophomonas maltophilia (39%) as predominant isolates. The intervention combining foam, mechanical cleaning, and drain cover replacement achieved the greatest bioburden reduction on Day 1 in drains (mean ln-CFU reduction = 11.0, 95% CI: 6.4, 16.0, p < 0.001) and covers (mean reduction = 14.0, 95% CI: 8.7, 19.0, p < 0.001), with sustained effects through Day 7. Recolonization to ∼50% of baseline was evident by Day 5 in both sites.

Conclusions: Physical bioburden removal improved the effect of a foaming disinfectant in reducing GNB. However, recolonization occurred by day 5.

Objective: Investigate the increased incidence of Mycobacterium chelonae positive respiratory cultures in hospitalized patients.

Design: Apply the Healthcare-Associated Links in Transmission of Nontuberculous Mycobacteria (HALT NTM) toolkit to an outbreak investigation of M. chelonae.

Setting: Quaternary-care pediatric hospital and medical center in the United States with a recently opened LEED-certified critical care tower.

Patients: Adult and pediatric patients with M. chelonae positive respiratory cultures between June 2022 and January 2024.

Methods: An epidemiological investigation involving clinical and laboratory practices, water management, building construction and renovation projects. Environmental sampling of air vents, water sources and endoscope reprocessing equipment was performed. M. chelonae isolates recovered from patients and the environment were analyzed using whole genome sequencing and compared for relatedness.

Results: Three clusters of matching environmental and patient isolates were identified. The most common environmental source of M. chelonae was ice/water dispensers with 40% positivity of sampled units. The critical care tower's water system performance and metrics were suboptimal, leading to four physical remediation activities along with a hyperchlorination treatment.

Conclusions: Recent and ongoing construction along with the implementation of a LEED-certified, low-flow water system in a new critical care tower provided enhanced opportunities for M. chelonae exposure at point of use locations such as ice/water dispensers. More national infection prevention and control guidance is needed to address the infection risks from water sustainability efforts and construction activities in healthcare facilities.

Objective and design: Therapies provided in nontraditional settings or by individuals without knowledge of core principles of infection prevention and control (IPC) may place consumers at risk of adverse events. We summarize findings from our recent consultation experiences in the Division of Healthcare Quality Promotion (DHQP) at the Centers for Disease Control and Prevention (CDC) to help identify targets for prevention efforts and enhanced consumer protections.

Methods: We reviewed records of DHQP consultations with state, local, or territorial health officials conducted from 2016 to 2023 to identify investigations involving nontraditional therapies or settings in the United States. Information collected included type of procedure or therapy, type of setting, pathogens involved, number of affected individuals, and types of IPC issues identified.

Results: Of 1500 consultations, we identified 30 (2%) involving nontraditional therapies or settings. Therapies were performed for esthetic reasons, general wellness, or as treatment for pain. Infectious pathogens were identified in the blood, joint fluid, and skin and soft tissue, and included viruses, bacteria, and fungi. Investigations revealed breaches in injection safety, medical device reprocessing, medication preparation and handling, and environmental disinfection. Over 7000 consumers received notification regarding potential exposure to an infectious pathogen.

Conclusions: This summary highlights the potential infectious risks to consumers posed by nontraditional therapies, which may have unproven benefits and poorly defined risks. With continued expansion of nontraditional therapies and settings, consumers will benefit from education, training, and oversight of those who provide therapies in these settings.

The publication rate of abstracts presented at a conference can provide some insight into its academic quality, although it is hardly the sole metric. We evaluated 351 SHEA Spring Conference abstracts; 49.9% were published. Findings demonstrate the strong academic output of SHEA conferences.

Background: Shorter antibiotic courses and transition to oral therapy for uncomplicated gram-negative bloodstream infections (GN-BSI) are evidence-supported yet remain challenging to implement. Here we report our experience with a GN-BSI antimicrobial stewardship (AS) quality improvement initiative in a large health system.

Methods: We implemented two sequential AS interventions in adult patients hospitalized with uncomplicated GN-BSI: (1) mandatory AS review of patients discharging on intravenous (IV) antibiotics ("OPAT review") and (2) a clinical guideline informing oral antibiotic transition and duration, in our 22-hospital system. We evaluated the initiative from January 2018 to September 2024. Pre- and postimplementation rates of (1) IV antibiotics at discharge and (2) total length of antibiotic therapy were calculated across the following periods: preintervention, after OPAT review, and after guideline implementation. Secondary outcomes included duration <10 days, oral antibiotic prescribing, and guideline-recommended dosing.

Results: 3,231 patients (preintervention: 666, postOPAT review: 1,357, postguideline: 1,208) were included. We observed decreases in IV antibiotics at discharge (22.7% preintervention, 10.7% postOPAT review, and 9.2% postguideline, p < 0.001) and median length of treatment (13.5 days preintervention to 10.7 days postguideline, p < 0.001). We also observed improvement in durations <10 days (19.1% vs 45%, p < 0.001), oral antibiotic prescriptions, and appropriate dosing (2.8% vs 33.5%, p < 0.001), but no difference in rates of BSI recurrence, mortality, or C. difficile infection.

Conclusion: After implementing GN-BSI-focused AS initiatives in our large health system, we observed a shift toward more frequent oral rather than IV antibiotics at discharge, and shorter overall antibiotic durations, without obvious changes in adverse outcomes.

We characterized antibiotic prescribing for outpatient telemedicine visits among a large cohort of pediatric, adult, and older adult populations during 2021. Opportunities exist for improving antibiotic prescribing in outpatient telemedicine, especially for respiratory conditions and among rural and older adult populations.

Objective: Assess knowledge, attitudes, and practices for control of Candidozyma auris among healthcare providers in long-term acute care hospitals (LTACHs).

Design: Mixed methods; quantitative survey, followed by qualitative focus groups.

Setting: Two LTACHs with endemic spread of C. auris in the Chicago, Illinois region.

Participants: Convenience sample of frontline healthcare providers.

Results: Fifty-three quantitative surveys were completed, and 21 individuals participated in qualitative focus groups. Survey participants were 92% female, 43% nurses, and 60% had >10 years of experience in their current role. They reported awareness of high-priority healthcare-associated multidrug-resistant pathogens, including C. auris (86%). Most participants agreed that C. auris is a national problem (74%), but only 56% agreed it was a problem in their own hospital. Barriers to C. auris prevention identified in the survey included understaffing (63%), lack of training (52%), lack of coworker accountability (48%), and lack of adequate time for task completion (49% for self, 48% for coworkers). Focus groups included 10 nurses, 5 patient care technicians, 3 secretaries, and 3 therapists. Focus groups highlighted the importance of enforcement and monitoring of prevention measures and the need for additional education. When asked how to improve infection prevention at their hospital, participants identified themes of education, improvements in enforcement and monitoring of prevention measures, staff support, and improvements in visual communication and healthcare design.

Conclusions: In this cohort of frontline LTACH healthcare providers, we identified multiple barriers to C. auris containment and elicited potential solutions. These insights suggest targets for future interventions to improve C. auris control.