Journal of Infection Prevention最新文献

Background: Tuberculosis (TB) has become a public health problem among elderly in developing countries with the gradual increase in life expectancy.

Aim/objective: This study aimed to analyze the prognosis factors and chronological trends of TB in elderly in Southern Tunisia.

Methods: A retrospective study was conducted. All TB patients aged ≥60 years, recorded in the Center of TB Control between 1995 and 2016, were included. Chronological trends of TB were analyzed by calculating the correlation coefficient of Spearman (Rho). Multivariate analysis was done by binary logistic regression (Adjusted Odds ratio (AOR); CI; p) to determine the independent risk factors associated with unsuccessful outcome in elderly. A p value <0.05 was considered as statistically significant.

Results: Overall, 512 new elderly TB cases were notified between 1995 and 2016, with an average of 23.3 new cases/year. The mean TB incidence rate for elderly was 2.31/100,000 population/year. The case-fatality rate of 8.6%. Multivariate analysis showed that factors independently associated with unsuccessful outcome among elderly patients were age between 80 and 89 (AOR = 4.5; [95% CI: 2, 10.2]; p < 0.001), male gender (AOR = 2.2; [95% CI: 1.1, 4.4]; p = 0.026) and neuro-meningeal involvement (AOR = 4.6; [95% CI: 1.4, 14.8]; p = 0.011). The incidence of TB in elderly patients increased significantly from 0.95/100,000 population in 1995 to 2.17/100,000 population in 2016 (Rho = 0.48; p = 0.024).

Discussion: A better understanding of TB features in elderly and its chronological trends overtime would facilitate to put in place, in the national TB control program, strategies geared towards this group of people.

Backgound: Hepatitis B virus (HBV) infected persons often suffer stigma. Stigma can come from the society or be self-induced. This study assessed the gender differences and stigma experience of patients with HBV.

Methods: Prospective cross-sectional design with a qualitative element using a pretested interviewer administered questionnaire and an in-depth oral interview of HBV infected patients. Quantitative data obtained were entered into SPSS version 20 and analyzed using simple descriptive and inferential statistics, while content analysis was used for the qualitative data.

Results: Total of 242 respondents answered the quantitative questionnaire. There were 142(58.7%) males and 100 (41.3%) females; age range was 18-72 years with mean (SD) of 35.4(10.7) years. Overall stigma rate was 23.1%. Stigma resulted from a positive HBsAg test, and the experience was unaffected by other markers of HBV infection. Stigma was higher in the domain of disease transmission for both single and married respondents and was particularly higher among males than females. Stigma among females affected pre-marital engagements and also caused marital disharmony among married respondents. In-depth oral interview of 23 HBV infected respondents revealed that many exhibited self-stigma, had wrong knowledge of HBV infection modes, complications, and interpretation of HBV internet information which aggravated stigma reactions.

Conclusions: Stigma of HBV is high and majorly in the domain of disease transmission. It is higher in males than females. Enlightenment campaign targeting singles and married couples and HBV infection modes is advocated.

Introduction: Through routine respiratory samples surveillance among COVID-19 patients in the intensive care, three patients with aspergillus were identified in a newly opened general intensive care unit during the second wave of the pandemic.

Methodology: As no previous cases of aspergillus had occurred since the unit had opened. An urgent multidisciplinary outbreak meeting was held. The possible sources of aspergillus infection were explored. The multidisciplinary approach enabled stakeholders from different skills to discuss possible sources and management strategies. Environmental precipitants like air handling units were considered and the overall clinical practice was reviewed. Settle plates were placed around the unit to identify the source. Reports of recent water leaks were also investigated.

Results: Growth of aspergillus on a settle plate was identified the potential source above a nurse's station. This was the site of a historic water leak from the ceiling above, that resolved promptly and was not investigated further. Subsequent investigation above the ceiling tiles found pooling of water and mould due to a slow water leak from a pipe.

Conclusion: Water leaks in patient areas should be promptly notified to infection prevention. Detailed investigation to ascertain the actual cause of the leak and ensure any remedial work could be carried out swiftly. Outbreak meetings that include diverse people with various expertises (clinical and non-clinical) can enable prompt identification and resolution of contaminated areas to minimise risk to patients and staff. During challenging pandemic periods hospitals must not lose focus on other clusters and outbreaks occurring simultaneously.

Background: Healthcare-associated (HCA) SARS-CoV-2 infection is a significant contributor to the spread of the 2020 pandemic. Timely review of HCA cases is essential to identify learning to inform infection prevention and control (IPC) policies and organisational response.

Aim: To identify key areas for improvement through rapid investigation of HCA SARS-CoV-2 cases and to implement change.

Methods: Cases were identified based on date of first positive SARS-CoV-2 PCR sample in relation to date of hospital admission. Cases were reviewed using a structured gap analysis tool to identify key learning points. These were discussed in weekly multidisciplinary meetings to gain consensus on learning outcomes, level of harm incurred by the patient and required actions. Learning was then promptly fed back to individual teams and the organisation.

Findings: Of the 489 SARS-CoV-2 cases admitted between 10^th March and 23^rd June 2020, 114 suspected HCA cases (23.3%) were reviewed; 58/489 (11.8%) were ultimately deemed to be HCA. Five themes were identified: individual patient vulnerability, communication, IPC implementation, policy issues and organisational response. Adaptations to policies based on these reviews were completed within the course of the initial phase of the pandemic.

Conclusion: This approach enabled timely learning and implementation of control measures and policy development.

Background: The emergence of COVID-19 has been an ordeal for nurses worldwide. It is crucial to understand their experiences at the frontline, attempt to allay their concerns, and help inform future pandemic response capabilities.

Aims: To explore nurses' lived experiences at the frontline in order to identify and address their concerns and help enhance future responses to infectious disease outbreaks.

Methods: A qualitative study was carried out. Semi-structured interviews were conducted with 60 registered nurses who came to Hubei from different parts of China to care for patients with COVID-19. Interviews were audio-recorded and transcribed verbatim for thematic analysis.

Results: Six major themes emerged: emotional turmoil due to personal and professional concerns, quality issues with personal protective equipment and associated physical discomfort, witnessing and managing patient distress, readiness of emergency response mechanisms in the health system, collective community awareness and preparedness, and heightened professional pride and confidence in future epidemic control.

Discussion: Nurses were placed in challenging and unfamiliar situations to deal with unexpected and unpredictable events which caused considerable psychological and physical distress. Support in the form of government edicts, hospital management policies, community generosity and collegiality was highly welcomed by the nurses. Policy makers and managers should ensure that nurses are provided with the support and resources necessary for dealing with large-scale infectious disease outbreaks. Priority should be given to risk assessment, infection prevention and control, and patient and staff health and safety.

Background: The Department of Infection Control, at our University Hospital conducted contact tracing of COVID-19 positive patients and staff members at all hospitals in the North Denmark Region.

Aim: To describe the contact tracing performed during the COVID-19 pandemic in the Region and its outcomes.

Methods: Data from each contact tracing were collected prospectively during 14 May 2020-26 May 2021. Data included information about the index case (patient or hospital staff member), presentation (asymptomatic vs symptomatic), probable source of transmission (community-acquired or hospital-acquired), number of close contacts and if any of these were SARS-CoV-2 PCR-test positive.

Findings: 362 contact tracing were performed. A total of 573 COVID-19 positive cases were identified among 171 (30%) patients and 402 (70%) staff members. 192 (34%) of all cases were tested due to symptoms of COVID-19, whereas two-third were tested for other reasons including outbreak and systematic screening tests. A total of 1575 close contacts were identified, including 225 (14%) patients and 1350 (86%) staff members. 100 (6%) close contacts, including 24 patients and 76 staff members, were infected with SARS-CoV-2, of which 33 (43%) staff members was positive at day 0 i.e. the same day as being identified as close contacts.

Discussion: We found a three to one of close contacts to each index case, but only 6% became SARS-CoV-2 positive, with a surprisingly high number of those identified at day 0. Our data confirm that regular testing of patients and staff will identify asymptomatic carriers and thereby prevent new cases.

In April 2020, a coronavirus disease 2019 outbreak was identified among migrants/refugees in Greece. Overall, 155 of 450 hosted migrants and two of 46 employees were infected (attack rates: 34.4% and 4.3%, respectively). The mean age of infected migrants was 24.9 years (3 days-68 years). In addition, 177 community contacts were tested negative. Cases were cohorted in separate rooms from people tested negative. Surfaces were cleaned and disinfected daily. The implementation of measures for the containment of the outbreak was challenging due to language barriers and lack of space for cohorting. At that time, there was no official recommendation to the general population regarding the use of masks or other personal protective equipment. Extensive testing of vulnerable populations and building trust in order to report symptoms and comply with the recommendations are essential.

Background: Pulmonary tuberculosis (PTB) is a major health problem in Thailand. Delay in getting treatment is an important factor which may worsen the disease and increase TB transmission.

Objective: This study aimed to investigate the duration and predictors of patient delay among PTB patients in Northeast Thailand.

Methods: A cross-sectional study was undertaken using a structured questionnaire in nine districts in Nakhon Ratchasima Province from July to September 2018. The duration between the first symptom onset and the first visit to a health facility was determined, with a period of greater than 30 days defined as patient delay. Multiple logistic regression was used to identify predictors of the delay.

Results: 300 PTB patients participated in the survey, with patient delay identified in 39% of respondents. The median duration of the delay was 35 days among participants overall. Through multivariate analysis, primary education, upper secondary education, previous TB knowledge, TB recognition, TB stigmatisation, weight loss, self-treatment, the number of visits with health providers and using a motorcycle to travel to the hospital were significant predictors of patient delay.

Discussion: Knowledge needs to be provided to people to increase their recognition and minimise stigmatisation of TB. Education about TB screening needs to be revised and delivered to health providers to increase and improve TB detection processes.

Hand hygiene (HH) compliance among health-care workers has not satisfactorily improved despite multiple educative approaches. Between October 2019 and February 2020, we performed a self-evaluation test and a direct observation for the compliance of the 5 Moments for Hand Hygiene program advocated by the World Health Organization at two Japanese hospitals. Average percentages of self-evaluated HH compliance were as follows: (i) 76.9% for "Before touching a patient," (ii) 85.8% for "Before clean/aseptic procedures," (iii) 95.9% for "After body fluid exposure/risk," (iv) 84.0% for "After touching a patient," and (v) 69.2% for "After touching patient surroundings." On the other hand, actual HH compliance was 11.7% for "Before touching a patient" and 18.0% for "After touching a patient or patient surroundings." The present study demonstrated a big gap between self-evaluation and actual HH compliance among nurses working at hospitals, indicating the need of further providing the education in infection prevention.