Journal of Infection Prevention最新文献

Background: Hand hygiene is commonly regarded as being the single most important method in preventing various healthcare-associated infections which cause an estimated 37,000 deaths in Europe and 100,000 deaths in the United States annually. Despite this, infection prevention and control audits regularly demonstrate that staff are missing hand hygiene opportunities, and that personal protective equipment (PPE) is being used inappropriately, clearly highlighting that policies are not being conformed to.

Aim: The aim of this was to identify factors that facilitate and hinder staff in their compliance with hand hygiene and PPE standards and policies.

Methods: A mixed methods approach sequential explanatory design was used to investigate levels of compliance and staff identified barriers and facilitators. Quantitative data was obtained regarding COVID-19 cases, hand hygiene, and PPE compliance over a 10-month period in all inpatient wards (approximately 750 beds) across an acute Trust. Following a review of this data, two wards were selected. Four participants on each ward, covering various grades of staff, were interviewed to explore their perceptions of compliance (qualitative data), and a thematic analysis was conducted to determine themes of facilitators and barriers.

Results: When compared to COVID-19 cases, hand hygiene and PPE compliance showed a downward trend over the study period. Barriers and facilitators to compliance identified by staff were time, information, training, safety, and accessibility. Time was the most common theme, with compliance to policy being deemed as too time consuming.

Conclusion: Patient safety was identified as the most influential aspect on staff being compliant with time being the one aspect that would contribute most to non-compliance.

Background: Antibiotics are widely prescribed therapeutic agents in the paediatric population.

Aim/objective: This survey aims to describe an overview of antimicrobial stewardship (AMS) and the type of metrics used to monitor antibiotic consumption in paediatric wards in Malaysian public hospitals.

Methods: This research was conducted as a multicentre, quantitative research online survey in all Ministry of Health Malaysia hospitals with paediatric ward services. The survey respondents were the pharmacists in charge of either a paediatric ward or antibiotic consumption in each facility.

Results: Out of the 145 hospitals, only 99 with eligible facilities were shortlisted for the survey. Of the 99 hospitals identified in this survey, only 91 of the facilities responded. The result from the survey revealed that only six hospitals had a paediatric infectious disease (ID) specialist. Only 26 out of the 91 facilities that responded performed paediatric antibiotic monitoring. The survey showed that the type of metrics used to monitor antibiotic consumption varied. 46.2% (12/26) of paediatric monitored facilities were using defined daily dose (DDD), 23.1% (6/26) using days of therapy, 19.2% (5/26) using the number of vials, 15.4% (4/26) using the number of patients and 11.5% (3/26) using the length of therapy as their consumption metrics. Half (50%, 13/26) of the paediatric monitored facilities did not use any denominator for reporting while some facilities (38.5%, 10/26) used patient days.

Conclusion: Although 90% of the facilities practice AMS, in paediatrics, there appears to be no standardisation especially in antimicrobial consumption monitoring.

Background: Amid the SARS-CoV-2 pandemic, laboratories faced the challenge of maintaining diagnostic operations while adhering to infection prevention and control (IPC) guidelines. We investigated the impact of implementing rapid molecular testing of employees of a large medical laboratory to prevent workplace transmission.

Aim/objective: To evaluate if fast-track PCR diagnostics, alongside local infection control measures, could reduce internal transmission and workplace sickness absence.

Methods: Employees with respiratory symptoms, but testing negative for SARS-CoV-2, were allowed to work if clinically healthy. All included employees completed a questionnaire and underwent SARS-CoV-2 antibody testing post-pandemic. Data on sickness absence were retrieved from local human resources systems, and comparative analyses were conducted between the pre-pandemic and pandemic periods.

Findings/results: Of 153 participants, 84 (55%) reported having had COVID-19, with 12 (14%) suspecting workplace transmission. Six (4%) tested positive for SARS-CoV-2 IgG nucleocapsid despite no COVID-19 diagnosis. Among 101 (66%) reporting respiratory symptoms and negative SARS-CoV-2 tests, 80 (79%) were allowed to return to the workplace. Mean workplace sickness absence during the pandemic 2020 (3.74%) and 2021 (4.19%) was significant lower compared with sickness absence in the laboratory before the pandemic in 2019 (4.54%). No larger outbreaks in the laboratory were recorded.

Discussion: SARS-CoV-2 infections in the laboratory were mostly symptomatic and acquired outside the workplace. The combination of local IPC and rapid and frequent testing of employees facilitated an effective infection control and minimized workplace absence, maintain diagnostic operations.

Background: Antibiotic resistance represents a great concern worldwide with increasing related morbidity and mortality. Multidrug resistant microorganisms are going to be detected more and more frequently even in the community setting. Therefore, patients could be colonised even at the admission to the hospital.

Objective: The aim of this study is to evaluate colonisation at admission to an intensive care unit (ICU) and the acquisition of new colonisation during the ICU stay and the related risk factors. Secondly, healthcare-associated infections and surgical prophylaxis efficacy were also evaluated.

Methods: Retrospective observational study. All the patients admitted to the post-cardiosurgical ICU from 01 January to 30 June 2021 were enrolled. Colonisation was evaluated by rectal and nasal swab at admission or at the pre-hospitalisation visit and then every 7 days during the hospital stay.

Results: 80 out of 183 patients were colonised at admission, 46 by non-susceptible microorganisms (NSM). An antibiotic treatment in the previous 3 months was identified as risk factor for NSM colonisation. According to these isolates, about one third of the surgical prophylaxis could be ineffective. During the hospital stay, 36 patients acquired new colonisations; antibiotic treatment and length of hospital stay were recognised as risk factors. At least one (≥1) healthcare-associated infection (HAI) was detected in 54 patients (68 episodes); HAIs were significantly more frequent in the colonised patients. Moreover, in 35/68 HAIs aetiology was consistent with the colonisation.

Discussion: Knowing patients' colonisations could be fundamental to tailor antibiotic treatments and prophylaxis and to avoid NSM spread.

Background: The majority of antibiotics are prescribed in primary care. Urinary tract infections (UTIs) are the second most common reason for antibiotic prescribing in this sector. This study explores activities used by English Clinical Commissioning Groups (CCGs) to improve UTI prevention and management 2017-2022.

Methods: An online questionnaire was sent to CCG primary care chief nurses and medicines optimisation leads August-September 2022. Qualitative data was mapped to the Theoretical Domains Framework.

Results: Participant response rate was 14.1% (56/397), with representation from 29.2% (31/106) CCGs and across a range of roles. Education and training were the most reported intervention types, while changing the environment to facilitate behaviours was the least. Most interventions targeted general practice staff and patients, followed by care home staff, and residents and their families.The most reported success measures included reduction in antibiotic prescribing (54.5%, 97/178 interventions); positive stakeholder feedback (42.1%, 75/178); and increased adherence to diagnostic guidelines (32.6%, 58/178). 48.8% (20/41) stated their UTI activities had not been formally evaluated. Barriers and facilitators to intervention implementation included: availability of resources and time; staff collaboration; availability and accuracy of information; public and staff beliefs; systems and processes; and staff roles and responsibilities.

Conclusions: UTI interventions rolled out through English health authorities could be further improved through structures that increase capacity to effectively evaluate activities and share learning. Staff engagement and collaboration are key facilitators to implementation and should be leveraged in further initiatives, while support and guidance are provided to adapt initiatives to fit in the changing healthcare landscape.

Background: Infection prevention measures are crucial to prevent contamination among frontline healthcare workers (FL-HCWs) and non-frontline healthcare workers (NFL-HCWs). However, these measures can lead to skin lesions, potentially affecting their quality of life.

Objectives: Determine the prevalence of skin lesions caused by infection prevention measures and assess the impact of skin lesions on the quality of life.

Methods: A cross-sectional study was conducted, utilizing a self-administered questionnaire covering demographic and occupational information, self-reported skin lesions, and the Dermatology Life Quality Index (DLQI) for healthcare workers (HCWs) from three medical centres.

Results: Out of the 190 FL-HCWs and 199 NFL-HCWs surveyed, 37.2% reported skin lesions. Female and FL-HCWs exhibited a higher occurrence of skin lesions. Prolonged use of masks was significantly associated with facial skin lesions. While the use of personal protective equipment and hand hygiene had little to no effect on the Dermatology Life Quality Index (DLQI) for 80.7% of healthcare workers (HCWs) with skin lesions, those with facial skin lesions, papules, or a history of any skin lesions, as well as those who more frequently washed their hands, showed a more altered DLQI.

Conclusions: FL-HCWs had more skin symptoms than NFL-HCWs, but these issues were generally not severe and had minimal impact on overall quality of life.

Background: Hand hygiene is a crucial measure for preventing the spread of healthcare-associated infections. While healthcare workers receive emphasis, hospital visitor hand hygiene compliance is limited.

Aim: To investigate hand hygiene compliance among hospital visitors.

Methods: A comprehensive search of four databases (PubMed, Embase, Scopus, ScienceDirect) and a hand search were performed from inception to October 2023. Observational studies in hospital settings were included if estimates for adult hospital visitors' observation were reported. Joanna Briggs Institute critical appraisal checklist was used to assess the risk of bias in the included studies. Meta-analysis was conducted using STATA software version 17 to estimate a weighted pooled compliance rate with a 95% confidence interval.

Results: 17 studies were included in this study. The pooled hand hygiene compliance among hospital visitors was 37% (95% CI: 25 - 49). Subgroup analysis revealed that in low-middle-income countries, covert observation, ICU and various ward studies, longer observation durations, measuring hand hygiene at entrance and exit points, and smaller sample sizes were all associated with higher visitor hand hygiene compliance rates.

Discussion: The visitor hand hygiene compliance rate was notably low, much lower than that reported for doctors and nurses. This significant difference highlights the urgent need for focused attention and interventions to improve visitor hand hygiene practices.

Healthcare-associated infections (HAIs) are an increasing concern and educational programmes may increase healthcare professionals' adherence to infection prevention and control (IPC) guidelines. However, despite evidence regarding the effectiveness of peer-to-peer educational programmes, to our knowledge, no studies have been conducted in non-hospital settings. A post-intervention pilot study based on peer-to-peer meetings on HAI topics in home care and nursing homes was conducted. A survey was administered to eligible nurses willing to participate, collecting socio-demographic data, the perceived effectiveness and quality of the programme, and the topics for future meetings. Twelve 'Pills of Prevention' seminars were held, enrolling 115 nurses and nursing aides. Of the 115 participants, 81 (70.4%) were eligible and 31 (38.2%) completed the survey. Participants found tangible changes in the clinical settings mostly at the individual level, with bundles/checklists delivered during the meetings mostly being used in everyday practice. Regarding the perceived quality, the overall satisfaction with the programme was high due to the opportunity to 'freely share own opinions' and the 'appropriateness of selected topics'. 'Bundles/checklists' were seen as the most interesting topics to prioritize in the future among home care nurses, while HAIs in COVID-19 patients were the least. A community-based peer-to-peer programme, still neglected in terms of HAIs' continuing education strategies, is appreciated and may produce benefits both at the individual and the group level.

Background: Healthcare-associated infections are strictly related to healthcare practices. A head nurse stimulates and motivates nurses, boosts nurses' job performance and satisfaction, and can influence adverse event development.

Aim: To explore the relationship between healthcare-associated infections and head nurse leadership style.

Methods: A systematic review was conducted. The search was conducted from 1973 until March 2022 on PubMed, Cochrane Library, Scopus, CINAHL, Web of Science, Embase, and APA PsycInfo databases. The review followed the Joanna Briggs Institute Manual for Evidence Synthesis and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A thematic synthesis and critical appraisal of the included studies have been conducted.

Results: Eight articles were included in this review. Head nurses' leadership, supported by the organization, can positively influence the job performance and job satisfaction of nurses by reducing infection rates associated with vascular access and urinary catheters.

Discussion: Authentic and transformational nurse leadership styles can foster targeted interventions and improvements tailored to preventing and controlling healthcare-associated infections. Even if there is limited evidence, the results support that the occurrence of infections can be reduced by leadership strategies implemented by head nurses.