Pub Date : 2022-03-01DOI: 10.1177/17571774211066774
Yetunde Ataiyero, Judith Dyson, Moira Graham
Background: Patients sometimes contract healthcare associated infections (HCAI) which are unrelated to their primary reasons for hospital admission. Surgical site infections are the most investigated and most recurrent type of HCAI in developing countries, affecting up to one-third of surgical patients.
Objective: This study aimed to assess and offer context to the hand hygiene resources available in a Nigerian teaching hospital through ward infrastructure survey, and to determine the hand hygiene compliance rate among surgical healthcare workers (HCWs) in a Nigerian teaching hospital through hand hygiene observations.
Methods: Ward infrastructure survey was conducted in the two adult surgical wards of the hospital using the World Health Organisation (WHO) hand hygiene ward infrastructure survey form. Hand hygiene observations were monitored over seven days in the surgical wards using a modified WHO hand hygiene observation form.
Results: Hand hygiene resources were insufficient, below the WHO recommended minimum standards. Seven hundred hand hygiene opportunities were captured. Using SPSS version 24.0, we conducted a descriptive analysis of audit results, and results were presented according to professional group, seniority and hand hygiene opportunities of the participants. Overall hand hygiene compliance was 29.1% and compliance was less than 40% across the three professional groups of doctors, nurses and healthcare assistants.
Conclusion: Hand hygiene compliance rates of the surgical HCWs are comparable to those in other Sub-Saharan African countries as well as in developed countries.
{"title":"An observational study of hand hygiene compliance of surgical healthcare workers in a Nigerian teaching hospital.","authors":"Yetunde Ataiyero, Judith Dyson, Moira Graham","doi":"10.1177/17571774211066774","DOIUrl":"https://doi.org/10.1177/17571774211066774","url":null,"abstract":"<p><strong>Background: </strong>Patients sometimes contract healthcare associated infections (HCAI) which are unrelated to their primary reasons for hospital admission. Surgical site infections are the most investigated and most recurrent type of HCAI in developing countries, affecting up to one-third of surgical patients.</p><p><strong>Objective: </strong>This study aimed to assess and offer context to the hand hygiene resources available in a Nigerian teaching hospital through ward infrastructure survey, and to determine the hand hygiene compliance rate among surgical healthcare workers (HCWs) in a Nigerian teaching hospital through hand hygiene observations.</p><p><strong>Methods: </strong>Ward infrastructure survey was conducted in the two adult surgical wards of the hospital using the World Health Organisation (WHO) hand hygiene ward infrastructure survey form. Hand hygiene observations were monitored over seven days in the surgical wards using a modified WHO hand hygiene observation form.</p><p><strong>Results: </strong>Hand hygiene resources were insufficient, below the WHO recommended minimum standards. Seven hundred hand hygiene opportunities were captured. Using SPSS version 24.0, we conducted a descriptive analysis of audit results, and results were presented according to professional group, seniority and hand hygiene opportunities of the participants. Overall hand hygiene compliance was 29.1% and compliance was less than 40% across the three professional groups of doctors, nurses and healthcare assistants.</p><p><strong>Conclusion: </strong>Hand hygiene compliance rates of the surgical HCWs are comparable to those in other Sub-Saharan African countries as well as in developed countries.</p>","PeriodicalId":16094,"journal":{"name":"Journal of Infection Prevention","volume":"23 2","pages":"59-66"},"PeriodicalIF":1.2,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8941592/pdf/10.1177_17571774211066774.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10868272","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-03-01DOI: 10.1177/17571774211066781
Stelios Iordanou
It is with great concern towatch theworldwide transformation of non-intensive care unit (ICU) into ICU facilities in a way to cope with the increased demand for ICUbeds for COVID-19 patients. Operating in an ICU requires well-trained professionals and well-established infection prevention and control (IPC), as well as antimicrobial stewardship practices by the healthcare professionals involved in patient care. Invasive devices that are often used in ICUs, such as endotracheal tubes, central vascular catheters, and urinary catheters, can potentially lead to device-associated healthcare-associated infections if IPC practices are not properly used. There is evidence that among COVID-19 patients, the most common type of infection seems to be device-associated. Ventilator-associated pneumonia (VAP) comes first, followed by bacteremia with sepsis and urinary tract infections (UTIs) (Nag and Kaur, 2021). In a retrospective study in China, more than 30% of COVID-19 patients acquired VAP, and 24% bacteremia (He et al., 2020). DA-HAIs are known to severely increase the mortality rate (Koch et al., 2015) especially if involving a resistant, multiresistant, or pan-resistant strain of bacteria. Despite the limited data, it is believed that at least half of the patients who died from COVID-19 had coinfection with super bacteria (Nag and Kaur, 2021). Our local unpublished data indicate a high colonization rate or/and high DA-HAIs prevalence among these patients. Antimicrobial stewardship principles are another important aspect of patient care that seems to be neglected during the pandemic (Huttner et al., 2020). Bacterial infections require antimicrobials. However, distinguishing the bacterial from a viral infection is often difficult. A large proportion of COVID-19 patients, that are in the need of ICU hospitalization, present fever, cough, and radiological infiltrates, which lead to the decision of prescribing antibiotics despite the viral disease origin. It is well evidenced that the misuse of antibiotics increases resistance (Llor and Bjerrum, 2014) leading to superinfections. When ICU beds are increasing, non-trained staff recruitment is unavoidable. Additionally, the extreme environmental pressure forces staff to exhaustion. Non-well-trained staff in combination with exhaustion, increased patient disease severity, the extended length of ICU, older patient ages, and misuse of antibiotics can potentially be a lethal combination. ICUs are farmore than equipment and staff. Training the staff, establishing IPC, and antimicrobial stewardship practices take more time than that it required to transform a non-ICU facility into an ICU. Therefore, rushed decisions may severely compromise patient safety in terms of DA-HAIs and superinfections.
{"title":"The transformation of non-ICU into ICU facilities may compromise patient safety in terms of infections.","authors":"Stelios Iordanou","doi":"10.1177/17571774211066781","DOIUrl":"https://doi.org/10.1177/17571774211066781","url":null,"abstract":"It is with great concern towatch theworldwide transformation of non-intensive care unit (ICU) into ICU facilities in a way to cope with the increased demand for ICUbeds for COVID-19 patients. Operating in an ICU requires well-trained professionals and well-established infection prevention and control (IPC), as well as antimicrobial stewardship practices by the healthcare professionals involved in patient care. Invasive devices that are often used in ICUs, such as endotracheal tubes, central vascular catheters, and urinary catheters, can potentially lead to device-associated healthcare-associated infections if IPC practices are not properly used. There is evidence that among COVID-19 patients, the most common type of infection seems to be device-associated. Ventilator-associated pneumonia (VAP) comes first, followed by bacteremia with sepsis and urinary tract infections (UTIs) (Nag and Kaur, 2021). In a retrospective study in China, more than 30% of COVID-19 patients acquired VAP, and 24% bacteremia (He et al., 2020). DA-HAIs are known to severely increase the mortality rate (Koch et al., 2015) especially if involving a resistant, multiresistant, or pan-resistant strain of bacteria. Despite the limited data, it is believed that at least half of the patients who died from COVID-19 had coinfection with super bacteria (Nag and Kaur, 2021). Our local unpublished data indicate a high colonization rate or/and high DA-HAIs prevalence among these patients. Antimicrobial stewardship principles are another important aspect of patient care that seems to be neglected during the pandemic (Huttner et al., 2020). Bacterial infections require antimicrobials. However, distinguishing the bacterial from a viral infection is often difficult. A large proportion of COVID-19 patients, that are in the need of ICU hospitalization, present fever, cough, and radiological infiltrates, which lead to the decision of prescribing antibiotics despite the viral disease origin. It is well evidenced that the misuse of antibiotics increases resistance (Llor and Bjerrum, 2014) leading to superinfections. When ICU beds are increasing, non-trained staff recruitment is unavoidable. Additionally, the extreme environmental pressure forces staff to exhaustion. Non-well-trained staff in combination with exhaustion, increased patient disease severity, the extended length of ICU, older patient ages, and misuse of antibiotics can potentially be a lethal combination. ICUs are farmore than equipment and staff. Training the staff, establishing IPC, and antimicrobial stewardship practices take more time than that it required to transform a non-ICU facility into an ICU. Therefore, rushed decisions may severely compromise patient safety in terms of DA-HAIs and superinfections.","PeriodicalId":16094,"journal":{"name":"Journal of Infection Prevention","volume":"23 2","pages":"79-80"},"PeriodicalIF":1.2,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8941590/pdf/10.1177_17571774211066781.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10868271","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-22DOI: 10.1177/17571774211060418
Tochi Joy Okwor, Josephine G Gatua, C. Umeokonkwo, S. Abah, I. Ike, A. Ogunniyi, O. Ipadeola, Timothy A Attah, H. Assad, Jerome Dooga, A. Olayinka, J. Abubakar, J. Oladejo, O. Aderinola, C. Eneh, E. Ilori, Priscilla Ibekwe, C. Ochu, C. Ihekweazu
Background Infection prevention and control (IPC) activities play a large role in preventing the transmission of SARS-CoV-2 in healthcare settings. This study describes the state of IPC preparedness within health facilities in Nigeria during the early phase of coronavirus disease (COVID-19) pandemic. Methods We carried out a cross sectional study of health facilities across Nigeria using a COVID-19 IPC checklist adapted from the U.S Centers for Disease Control and Prevention. The IPC aspects assessed were the existence of IPC committee and teams with terms of reference and workplans, IPC training, availability of personal protective equipment and having systems in place for screening, isolation and notification of COVID-19 patients. Existence of the assessed aspects was regarded as preparedness in that aspect. Results In total, 461 health facilities comprising, 350 (75.9%) private and 111 (24.1%) public health facilities participated. Only 19 (4.1%) health facilities were COVID-19 treatment centres with 68% of these being public health facilities. Public health facilities were better prepared in the areas of IPC programme with 69.7% of them having an IPC focal point versus 32.3% of private facilities. More public facilities (59.6%) had an IPC workplan versus 26.8% of private facilities. Neither the public nor the private facilities were adequately prepared for triaging, screening, and notifying suspected cases, as well as having trained staff and equipment to implement triaging. Conclusions The results highlight the need for government, organisations and policymakers to establish conducive IPC structures to reduce the risk of COVID-19 transmission in healthcare settings.
{"title":"An assessment of infection prevention and control preparedness of healthcare facilities in Nigeria in the early phase of the COVID-19 pandemic (February–May 2020)","authors":"Tochi Joy Okwor, Josephine G Gatua, C. Umeokonkwo, S. Abah, I. Ike, A. Ogunniyi, O. Ipadeola, Timothy A Attah, H. Assad, Jerome Dooga, A. Olayinka, J. Abubakar, J. Oladejo, O. Aderinola, C. Eneh, E. Ilori, Priscilla Ibekwe, C. Ochu, C. Ihekweazu","doi":"10.1177/17571774211060418","DOIUrl":"https://doi.org/10.1177/17571774211060418","url":null,"abstract":"Background Infection prevention and control (IPC) activities play a large role in preventing the transmission of SARS-CoV-2 in healthcare settings. This study describes the state of IPC preparedness within health facilities in Nigeria during the early phase of coronavirus disease (COVID-19) pandemic. Methods We carried out a cross sectional study of health facilities across Nigeria using a COVID-19 IPC checklist adapted from the U.S Centers for Disease Control and Prevention. The IPC aspects assessed were the existence of IPC committee and teams with terms of reference and workplans, IPC training, availability of personal protective equipment and having systems in place for screening, isolation and notification of COVID-19 patients. Existence of the assessed aspects was regarded as preparedness in that aspect. Results In total, 461 health facilities comprising, 350 (75.9%) private and 111 (24.1%) public health facilities participated. Only 19 (4.1%) health facilities were COVID-19 treatment centres with 68% of these being public health facilities. Public health facilities were better prepared in the areas of IPC programme with 69.7% of them having an IPC focal point versus 32.3% of private facilities. More public facilities (59.6%) had an IPC workplan versus 26.8% of private facilities. Neither the public nor the private facilities were adequately prepared for triaging, screening, and notifying suspected cases, as well as having trained staff and equipment to implement triaging. Conclusions The results highlight the need for government, organisations and policymakers to establish conducive IPC structures to reduce the risk of COVID-19 transmission in healthcare settings.","PeriodicalId":16094,"journal":{"name":"Journal of Infection Prevention","volume":"5 1","pages":"101 - 107"},"PeriodicalIF":1.2,"publicationDate":"2022-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89594877","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-22DOI: 10.1177/17571774211060394
Sophie A. Rutter, Marc Bonne, C. Stones, C. Macduff
Background Handwashing is a key strategy for reducing the spread of infection but hand hygiene practises are often poor. Pre-testing messages prior to a campaign is expensive and time consuming. Objective This study investigates (1) emotional reactions to handwashing messages based on four different theoretical constructs (Knowledge of Risk, Comfort, Disgust and Social Norms), (2) how images may influence emotional reactions and (3) the influence of emotion, images and theoretical construct on handwashing motivation. Methods A novel methodology was employed whereby FaceReader, software that automatically analyses emotions, was used to identify reactions to handwashing messages. Thirty-one participants from The University of Sheffield were recruited for this laboratory study. Results Most participants did not react strongly to any message and emotional reactions were similar for messages from different theoretical constructs. Adding images to text messages intensified some emotional reactions, particularly Happy and Disgusted for the two messages from the Disgust theoretical perspective. Moreover, participants thought that messages that used images were 1.8 times more likely to encourage handwashing. Knowledge of Risk messages (most encouraging) were 2.9 times more likely to be selected as encouraging handwashing than Comfort messages (least encouraging). An increase in the Disgusted emotion was also associated with an increase in encouragement. Discussion This study suggests that handwashing messages should be designed to exploit emotional reactions but more research is needed to understand how to design messages for these reactions. Whether disgust is as important post Covid-19 requires future investigation. FaceReader can be usefully and inexpensively employed to pre-test handwashing messages.
{"title":"Using FaceReader to explore the potential for harnessing emotional reactions to motivate hand hygiene","authors":"Sophie A. Rutter, Marc Bonne, C. Stones, C. Macduff","doi":"10.1177/17571774211060394","DOIUrl":"https://doi.org/10.1177/17571774211060394","url":null,"abstract":"Background Handwashing is a key strategy for reducing the spread of infection but hand hygiene practises are often poor. Pre-testing messages prior to a campaign is expensive and time consuming. Objective This study investigates (1) emotional reactions to handwashing messages based on four different theoretical constructs (Knowledge of Risk, Comfort, Disgust and Social Norms), (2) how images may influence emotional reactions and (3) the influence of emotion, images and theoretical construct on handwashing motivation. Methods A novel methodology was employed whereby FaceReader, software that automatically analyses emotions, was used to identify reactions to handwashing messages. Thirty-one participants from The University of Sheffield were recruited for this laboratory study. Results Most participants did not react strongly to any message and emotional reactions were similar for messages from different theoretical constructs. Adding images to text messages intensified some emotional reactions, particularly Happy and Disgusted for the two messages from the Disgust theoretical perspective. Moreover, participants thought that messages that used images were 1.8 times more likely to encourage handwashing. Knowledge of Risk messages (most encouraging) were 2.9 times more likely to be selected as encouraging handwashing than Comfort messages (least encouraging). An increase in the Disgusted emotion was also associated with an increase in encouragement. Discussion This study suggests that handwashing messages should be designed to exploit emotional reactions but more research is needed to understand how to design messages for these reactions. Whether disgust is as important post Covid-19 requires future investigation. FaceReader can be usefully and inexpensively employed to pre-test handwashing messages.","PeriodicalId":16094,"journal":{"name":"Journal of Infection Prevention","volume":"190 1","pages":"87 - 92"},"PeriodicalIF":1.2,"publicationDate":"2022-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90270528","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-21DOI: 10.1177/17571774211066773
Nicholas Whitcomb, Maureen Monteleone, P. Johansen, Mark Matthews, P. Aucoin, Donald Burt, W. Whitcomb
In the spring of 2020, COVID-19 spread rapidly through a long-term care facility in Massachusetts. 74 (of 134 total) residents tested positive, with 72 testing positive in the first three weeks of the outbreak. Fatigue, anorexia, myalgia, and confusion were the most common symptoms. 21 residents (28%) testing positive subsequently died.
{"title":"A COVID-19 outbreak in a long-term care facility in Massachusetts: Rapidity and extent of spread, resident symptoms, and mortality","authors":"Nicholas Whitcomb, Maureen Monteleone, P. Johansen, Mark Matthews, P. Aucoin, Donald Burt, W. Whitcomb","doi":"10.1177/17571774211066773","DOIUrl":"https://doi.org/10.1177/17571774211066773","url":null,"abstract":"In the spring of 2020, COVID-19 spread rapidly through a long-term care facility in Massachusetts. 74 (of 134 total) residents tested positive, with 72 testing positive in the first three weeks of the outbreak. Fatigue, anorexia, myalgia, and confusion were the most common symptoms. 21 residents (28%) testing positive subsequently died.","PeriodicalId":16094,"journal":{"name":"Journal of Infection Prevention","volume":"38 1","pages":"125 - 127"},"PeriodicalIF":1.2,"publicationDate":"2022-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73840397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-18DOI: 10.1177/17571774211066786
M. Dekker, R. V. Mansfeld, C. Vandenbroucke-Grauls, Tessa E Lauret, Bernadette Cfm Schutijser, M. D. de Bruijne, I. Jongerden
Background Infection control link nurses (ICLN) disseminate knowledge on infection prevention topics to their peers. Little is known about how they succeed and thereby contribute to infection prevention in daily practise. Aim To explore the experiences of infection control link nurses regarding their role in acute care hospitals and identify perceived facilitators and best practices. Methods We conducted a qualitative study with semi-structured individual and focus group interviews with ICLN. The effect of COVID-19 on the ICLN role was added as a topic in focus group interviews during the pandemic. Results Twenty-six ICLN working in acute care hospitals were interviewed. ICLN perceived their role as to identify, monitor, facilitate and inform their colleagues on infection prevention topics related to their ward. Their experiences vary from feeling challenged and wonder how to get started, to feeling confident and taking initiatives that lead to ward-based improvements. When inspired by each other and supported by infection control practitioners or managers, ICLN feel empowered to initiate more activities to improve practice. During the COVID-19 pandemic, ICLN felt their responsibilities were magnified. When transferred to another ward, the focus on the ICLN role seemed dispersed. Discussion Empowered ICLN adjust and operationalize infection prevention policies to fit the conditions of their specific wards and provide practical instructions and feedback to their peers which enable better compliance to infection prevention policies. Support and inspiration from other ICLN, infection control practitioners and management contribute to this empowerment and consequently to taking impactful initiatives to improve practice.
{"title":"Role perception of infection control link nurses; a multi-centre qualitative study","authors":"M. Dekker, R. V. Mansfeld, C. Vandenbroucke-Grauls, Tessa E Lauret, Bernadette Cfm Schutijser, M. D. de Bruijne, I. Jongerden","doi":"10.1177/17571774211066786","DOIUrl":"https://doi.org/10.1177/17571774211066786","url":null,"abstract":"Background Infection control link nurses (ICLN) disseminate knowledge on infection prevention topics to their peers. Little is known about how they succeed and thereby contribute to infection prevention in daily practise. Aim To explore the experiences of infection control link nurses regarding their role in acute care hospitals and identify perceived facilitators and best practices. Methods We conducted a qualitative study with semi-structured individual and focus group interviews with ICLN. The effect of COVID-19 on the ICLN role was added as a topic in focus group interviews during the pandemic. Results Twenty-six ICLN working in acute care hospitals were interviewed. ICLN perceived their role as to identify, monitor, facilitate and inform their colleagues on infection prevention topics related to their ward. Their experiences vary from feeling challenged and wonder how to get started, to feeling confident and taking initiatives that lead to ward-based improvements. When inspired by each other and supported by infection control practitioners or managers, ICLN feel empowered to initiate more activities to improve practice. During the COVID-19 pandemic, ICLN felt their responsibilities were magnified. When transferred to another ward, the focus on the ICLN role seemed dispersed. Discussion Empowered ICLN adjust and operationalize infection prevention policies to fit the conditions of their specific wards and provide practical instructions and feedback to their peers which enable better compliance to infection prevention policies. Support and inspiration from other ICLN, infection control practitioners and management contribute to this empowerment and consequently to taking impactful initiatives to improve practice.","PeriodicalId":16094,"journal":{"name":"Journal of Infection Prevention","volume":"17 1","pages":"93 - 100"},"PeriodicalIF":1.2,"publicationDate":"2022-02-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87190853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-02-15DOI: 10.1177/17571774211060417
M. Frödin, L. Ahlstrom, B. Gillespie, C. Rogmark, B. Nellgård, E. Wikström, Annette Erichsen Andersson
Background Urinary catheter (UC)–associated infections are one of the most common preventable healthcare-associated infections (HAIs) and they frequently occur in older, frail populations. Aim The study aim was to describe the incidence of UC-associated infection in elderly patients undergoing hip fracture surgery after implementing a preventive care bundle. Methods A longitudinal prospective study using a before-and-after design. The bundle was theory driven and involved the co-creation of a standard operational procedure, education and practical training sessions. Prospectively collected registry data were analysed. Univariable statistics and multivariable logistic regressions were used for analyses. Results 2,408 patients with an acute hip fracture were included into the study. There was an overall reduction in UC catheter associated-associated urinary tract infections, from 18.5% (n = 75/406) over time to 4.2% (n = 27/647). When adjusting for all identified confounders, patients in phase 4 were 74% less likely to contract an UC-associated infection (OR, 0.26; 95% CI, 0.15–0.45, p < 0.0001). Discussion Bundled interventions can reduce UC-associated infections substantially, even in elderly frail patients. Partnership and co-creation as implementation strategies appear to be promising in the fight against HAI.
{"title":"Effectiveness of implementing a preventive urinary catheter care bundle in hip fracture patients","authors":"M. Frödin, L. Ahlstrom, B. Gillespie, C. Rogmark, B. Nellgård, E. Wikström, Annette Erichsen Andersson","doi":"10.1177/17571774211060417","DOIUrl":"https://doi.org/10.1177/17571774211060417","url":null,"abstract":"Background Urinary catheter (UC)–associated infections are one of the most common preventable healthcare-associated infections (HAIs) and they frequently occur in older, frail populations. Aim The study aim was to describe the incidence of UC-associated infection in elderly patients undergoing hip fracture surgery after implementing a preventive care bundle. Methods A longitudinal prospective study using a before-and-after design. The bundle was theory driven and involved the co-creation of a standard operational procedure, education and practical training sessions. Prospectively collected registry data were analysed. Univariable statistics and multivariable logistic regressions were used for analyses. Results 2,408 patients with an acute hip fracture were included into the study. There was an overall reduction in UC catheter associated-associated urinary tract infections, from 18.5% (n = 75/406) over time to 4.2% (n = 27/647). When adjusting for all identified confounders, patients in phase 4 were 74% less likely to contract an UC-associated infection (OR, 0.26; 95% CI, 0.15–0.45, p < 0.0001). Discussion Bundled interventions can reduce UC-associated infections substantially, even in elderly frail patients. Partnership and co-creation as implementation strategies appear to be promising in the fight against HAI.","PeriodicalId":16094,"journal":{"name":"Journal of Infection Prevention","volume":"65 1","pages":"41 - 48"},"PeriodicalIF":1.2,"publicationDate":"2022-02-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"90290635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.1177/17571774211035559
Behroz Mahdavi Poor, Jalil Rashedi, Mohammad Asgharzadeh
Cryptosporidiosis is caused by Cryptosporidium ssp., an emerging human pathogen. It is one of the most common causes of diarrheal infection in highand low-income countries. Cryptosporidium in healthy people causes self-limiting diarrhoea. This opportunistic parasite often affects children and adults with immune deficiency failures, such as those with HIV/AIDS and malnourished individuals. In these groups, the infection causes severe, chronic and devastating diarrhoea that may lead to life-threatening complications. In addition, the loss of the small intestine microvillus border can lead to malabsorption in patients with diarrhoea (Tzipori and Ward, 2002). Malnutrition is the most important cause of immunodeficiency in children in low-income countries. It affects the child’s immune system and alters the physicochemical characteristics of the intestine; therefore, it causes a significant increase in the pathogenesis of Cryptosporidium. In children suffering from malnutrition, the frequent diarrhoea caused by Cryptosporidium is long-lasting and more severe in comparison with healthy children (Gendrel et al., 2003). Malnutrition increases the susceptibility to cryptosporidiosis, which in turn intensifies the malnutrition. Consequently, a vicious cycle is created that can threaten the patient’s life (Costa et al., 2011). A prospective study in Haitian children aged < 2 years showed that children with acute cryptosporidiosis usually suffered from malnutrition, including vitamin A deficiency. These children often were not breastfed, since breastfeeding plays a protective role against Cryptosporidium infection (Kirkpatrick et al., 2002). Another prospective study of malnourished children in Dhaka denoted that cryptosporidial diarrhoea was significantly more prevalent among children aged 2–5 years (Mondal et al., 2009). Nowadays, Nitazoxanide is the drug of choice in cryptosporidial infection. It is an effective drug for cryptosporidial diarrhoea in immunocompetent people, but in the absence of adequate immune response, especially those with HIV or malnourished children, Nitazoxanide will not be able to eradicate the infection (Costa et al., 2011). In fact, an effective antiparasitic drug is not available for severely malnourished children, so the improvement of nutrition and hydration along with antiparasitic therapy are necessary to treat cryptosporidiosis in children (Costa et al., 2011; Kirkpatrick et al., 2002; Mondal et al., 2009). Clearly, the infection with Cryptosporidium has an adverse effect on the growth and cognitive development of children, which manifest itself more seriously in malnourished children (Kirkpatrick et al., 2002). Thus, it is necessary to monitor children for cryptosporidial infection, especially in malnourished children to avoid adverse effects of the infection on their growth and health.
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