Infection Control and Hospital Epidemiology最新文献

In LA County, contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus require 7.3 million gowns annually generating 506 tons of plastic waste and 1.73 million kilograms of carbon dioxide equivalents, which cause the loss of 4.07 disability-adjusted life-years. Unintended consequences of gown use necessitates exploration of infection prevention alternatives.

Rapid molecular testing for antimicrobial resistance (AR) provides an indication of resistance faster than phenotypic antimicrobial susceptibility testing. We summarize the adoption of molecular testing for AR among US acute care hospitals and discuss the potential impact on National Healthcare Safety Network's surveillance for AR.

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) carriage in post-acute care hospitals (PACH) reflects both importation of colonized patients and within-PACH transmission. We studied within-PACH transmission by examining the sameness of CRAB clusters, as identified by Fourier-transform infrared (FTIR) spectroscopy.

Methods: We conducted a point-prevalence survey in 55 wards in 18 Israeli PACH in 2021. Patients (n = 1,733) were screened for CRAB, and 461 isolates from 357 patients underwent FTIR typing (IR Biotyper, Bruker). We assigned each patient isolate to its cluster and paired each patient-cluster combination with every other patient-cluster combination. We examined the relationship between physical proximity of pairs (n = 75,047) and FTIR cluster sameness using generalized estimating equation logistic regression. To estimate within-ward transmission, we compared proportions of cluster sameness within wards versus between institutions.

Results: The 461 CRAB isolates formed 23 FTIR clusters. Compared to being in different institutions, being in the same ward was associated with significantly higher odds of sharing the same cluster (odds ratio: 3.6, p < 0.001). Odds ratios were highest for patients in the same room (6.2) or adjacent rooms (6.1) (p < 0.001 for both). Based on same-cluster pairs we estimated that 70% of prevalent CRAB cases resulted from within-ward transmission.

Conclusions: CRAB strain similarity was strongly associated with spatial proximity within PACH wards, indicating that within-ward transmission is an important contributor to CRAB carriage prevalence. Similar risk in same and adjacent rooms suggests transmission via shared staff or equipment. Ward-level infection control interventions are warranted to interrupt spread.

Background: Respiratory virus transmission in healthcare settings is not well understood. To investigate the transmission dynamics of common healthcare-associated respiratory virus infections, we performed retrospective whole genome sequencing (WGS) surveillance at three teaching hospitals.

Methods: From January 2, 2018, to January 4, 2020, nasal swab specimens positive for rhinovirus, influenza virus, human metapneumovirus (HMPV), or respiratory syncytial virus (RSV) from patients hospitalized for ≥3 days were sequenced. High-quality genomes were assessed for genetic relatedness using ≤3 single nucleotide polymorphisms (SNPs) as a cutoff, except for rhinovirus (≤10 SNPs). Patient health records were reviewed for genetically related clusters to identify epidemiological connections.

Results: We collected 436 viral specimens from 359 patients: rhinovirus (n = 291), influenza virus (n = 50), RSV (n = 48), and HMPV (n = 47). Of these, 42%% (152/359 patients) were from a pediatric hospital, and 58% were from adult hospitals. WGS was performed on 61.2% (178/291) rhinovirus, 78% (39/50) influenza virus, 90% (43/48) RSV, and all HMPV specimens. Among high-quality genomes, we identified 14 genetically related clusters involving 36 patients (range: 2-5 patients per cluster). We identified common epidemiological links for 53% (19/36) of clustered patients; 63% (12/19) of patients had same-unit stays, 26% (5/19) had overlapping hospital stays, and 11% (2/19) shared common providers. On average, genetically related clusters spanned 16 days (range: 0 - 55 days).

Conclusion: WGS offered new insights into respiratory virus transmission dynamics. These advancements could potentially improve infection prevention and control strategies, leading to enhanced patient safety and healthcare outcomes.

National Healthcare Safety Network developed a hospital-onset bacteremia (HOB) reporting module which may be used for Centers for Medicare and Medicaid Services (CMS)-reimbursement in the future. This retrospective study compared CMS-reported, HOB, and Overlap events. There were twice as many HOB as CMS events, but >40% of HOB were due to infections that lack defined infection prevention practices.

Objective: To assess preparedness for Candida auris in Canadian hospitals.

Design: Cross-sectional survey.

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

Methods: In June 2024, surveys were e-mailed to the infection prevention and control departments of 109 CNISP hospitals and their 33 microbiology laboratories. The surveys assessed policies for patient screening/management and laboratory processes supporting C. auris transmission prevention. Results were compared to a similar 2018 survey.

Results: All 109 hospitals and 32/33 laboratories responded. Most hospitals had policies for admission screening (80%, 87/109) and policies/defined plans for post-exposure screening (95%, 104/109). Policy presence increased from 18% to 73% in 56 hospitals completing both 2018 and 2024 surveys (P < 0.001). Among hospitals with admission screening policies, 69% (60/87) screened for recent out-of-country hospitalization. All but one hospital implemented transmission-based precautions for cases; 70% (76/109) continued precautions indefinitely. Overall, 94% (99/105; excluding hospitals with exclusively private rooms) and 55% (60/109) of hospitals screened roommates and wardmates, respectively. Frequency and timing of screening and policies regarding precautions for exposed patients varied. All hospitals used axilla and groin swabs, at minimum, for screening. Most (81%, 26/32) laboratories identified all clinically significant Candida isolates to species level, increasing from 48% to 85% (P < 0.001) in the 27 laboratories completing both 2018 and 2024 surveys. Twenty-four laboratories (75%) had standard operating procedures for processing screening specimens; 96% (23/24) used direct plating onto chromogenic agar.

Conclusions: Despite progress in C. auris preparedness, areas for improvement remain. Variability in practice may be related to evidence gaps and resource constraints.

After implementation of a molecular syndromic panel for infectious diarrhea, a significantly greater proportion of C. difficile results were classified as colonization rather than infection compared to the pre-implementation period. Routine C. difficile reporting from multiplex panels should be re-evaluated to minimize diagnostic uncertainty in some patients.