Infection Control and Hospital Epidemiology最新文献

Objective: To deconstruct the multiple levels of risk factors for Clostridioides difficile infection, using multilevel models (MLMs) accounting for patient movement.

Study design and setting: Case-control study of patients hospitalized in three acute care Delaware hospitals, December 2019-December 2023.

Patients: Cases were patients aged ≥18 years who tested positive for hospital-onset C. difficile infection. Controls were patients aged ≥18 years hospitalized more than 72 hours, who did not test positive for C. difficile infection.

Methods: Hierarchical and cross-classified MLMs were used to calculate odds of C. difficile infection based on patient-level risk factors and to evaluate the variation in odds of infection attributable to environmental risk factors using the hospital unit(s) a patient was assigned to during hospitalization.

Results: Our study included 1,223 patients (249 cases, 974 controls). In both models, greater odds of infection were associated with antibiotic exposure [adjusted odds ratio (aOR) = 11.20, 95% confidence interval (CI) = 7.19, 17.40; aOR = 12.80, 95% CI = 8.46, 19.40 for hierarchical and cross-classified models respectively] and health insurance (aOR = 1.74, 95% CI = 1.12, 2.68; aOR = 1.62, 95% CI = 1.03, 2.53; public vs. private). Median odds ratios (MOR) for both models indicated greater relevance of between-unit heterogeneity in the outcome than health insurance but less than antibiotic exposure (MOR = 1.83, 95% CI = 1.56, 2.30 and 2.71 95% CI = 2.10, 4.06).

Conclusion: Using multilevel methods accounting for patient movement, we found that while antibiotic use is the most important risk factor in patients that developed C. difficile infection, environmental risk factors are additionally important and should be considered in research involving hospitalized patients and healthcare-associated infections.

Objective: To explore the impact of an immersive virtual reality (VR) training module on infection prevention and control (IPC) knowledge and attitudes of healthcare personnel (HCP) and to demonstrate the use of VR for performance assessment in cleaning and disinfection of portable medical equipment (PME).

Design: Quasi-experimental study.

Setting: Two academic medical centers and three long-term care facilities.

Participants: HCP in clinical roles were recruited.

Methods: Pilot sites trained participants on an immersive VR training module on PME cleaning and disinfection. Participants completed the VR module and pre- and post-knowledge and attitude assessment surveys, including a post-survey on the user experience of the VR module. Performance data were collected from the head-mounted displays (HMD) on the duration of the VR session, and participant performance including in-module task completion, hand hygiene compliance, PME disinfection percentage, and in-module quiz performance. Statistical significance and effect size were calculated using paired sample t-tests and Cohen's D for pre- and post-survey results. HMD data were analyzed using descriptive statistics.

Results: A total of 60 participants were recruited; 54 were included for analysis, with improvements in knowledge and attitudes post-training. Participant user experience was rated 50.19/55. HMD data demonstrated: 22-minute mean module duration, mean of 2.15/28 tasks not completed, mean of 2.56 missed hand hygiene opportunities, and 54% PME mean disinfection percentage, and varied performance on in-module quizzes.

Conclusions: Immersive VR training may be effective in improving HCP knowledge and attitudes in IPC concepts. Performance data collected through VR training can evaluate learner performance and be used to target training for improvement.

An outbreak of emm92/ST82 Streptococcus pyogenes was detected through prospective genomic surveillance at a military treatment facility. Twenty-one of twenty-six patients had confirmed epidemiological links to grappling sports. One case resulted from household transmission. The benefits of routine surveillance extend beyond the hospital environment enabling the detection of community-driven transmission.

This anonymous survey of hospitalists and acute care nurses evaluated awareness of peripheral intravenous catheters (PIVC) presence and decision-making regarding PIVC insertion, maintenance, and removal. Nurses were most aware of PIVC presence and regarded as best to make decisions about PIVC, yet <50% of respondents felt nurses should remove PIVC without an order.

Objective: Cardiovascular surgeries can be lifesaving, but mediastinitis following these procedures results in increased morbidity and mortality. We sought to increase the number of days between cases of mediastinitis at our institution from an average of 58 to greater than 223 days, the upper control limit of our baseline data.

Design: Quality improvement initiative.

Setting: Freestanding pediatric hospital.

Methods: We convened a multidisciplinary team to identify potential interventions. As many infections were not captured by the Solutions for Patient Safety definition, we monitored mediastinitis cases using the Society of Thoracic Surgeons definition. Our outcome measure was cases of mediastinitis. Plan-Do-Study-Act cycles were completed within our operating rooms (ORs) and cardiac care unit (CCU). We tracked measures on statistical process control charts and with descriptive statistics.

Results: From a baseline of 58 days, our hospital has gone over 450 days without a case of mediastinitis. No special causes were noted in our balancing measures. All process measures showed improvement.

Conclusions: A series of OR- and CCU-based interventions significantly increased the amount of time between our cases of mediastinitis. This work highlights the importance of engaging both OR and postoperative stakeholders in proactive mediastinitis prevention work.

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.