Journal of Infection Prevention最新文献

Background: Hospital Infection Prevention and Control Teams (IPCTs) provide clinical cover during weekdays with on call support at weekends. We report the results of a 6-month pilot of extending infection prevention and control nursing (IPCN) clinical cover to weekends at one National Health Service trust in the United Kingdom.

Methods: We examined daily episodes of infection prevention and control (IPC) clinical advice given before and during the pilot of extended IPCN to weekends. Stakeholders rated the value, impact, and their awareness of the new extended IPCN cover.

Results: Episodes of clinical advice given were more evenly distributed across the weeks during the pilot. Advantages for infection management, patient flow, and clinical workload were seen.

Conclusions: IPCN clinical cover at weekends is feasible and valued by stakeholders.

Background: Effective health communication is crucial for achieving positive population health outcomes. This is important for infection prevention and control (IPC), which relies on widespread public compliance to be effective. Whilst social media (SM) platforms disseminate health information, there is conflicting evidence to suggest their influence on compliance with public health guidelines.

Objective: To appraise the available evidence and determine the extent to which social media exposure contributes to public compliance with IPC measures.

Methods: A systematic protocol based on the MOOSE and PRISMA guidelines was followed. Observational studies were identified through systematic searches of four electronic databases and a hand search. Following data extraction, eligible studies were quality assessed, and the findings were integrated using narrative synthesis.

Findings: 15 studies were included. The studies located presented heterogeneous designs and findings. A weak positive association was identified, with 60% of the studies observing a positive association between social media and compliance with IPC measures. 26.7% identified a negative correlation, and 13.3% identified no correlation. Several factors were identified to mediate the relationship, including knowledge and conspiracy beliefs.

Discussion: This systematic review identified a weak positive correlation between exposure to social media and public compliance with recommended IPC measures, suggesting that social media should be utilised in future IPC related communication strategies. Social media provides a cost-effective, publicly accessible platform to disseminate accurate information, and neutralise misinformation. Recommendations are made for further research to reduce the uncertainty created by the identification of heterogenous studies.

Background: The Infection Prevention Societies Competency Framework is a detailed tool that recognises the multi factorial work of Infection Prevention and Control Teams. This work often takes place in complex, chaotic and busy environments where non-compliance with policies, procedures and guidelines is endemic. As reductions in Healthcare Associated Infection became a health service priority the tone of Infection Prevention and Control (IPC) became increasingly uncompromising and punitive. This can create conflict between IPC professionals and clinicians who may take a different view as to the reasons for sub optimum practice. If unresolved, this can create a tension that has a negative impact on working relationships and ultimately patient outcomes.

Concepts and context: Emotional Intelligence, that ability to recognise, understand and manage our own emotions and recognise, understand and influence the emotions of others, is not something, hitherto, that has been headlined as an attribute for individuals working in IPC. Individuals with higher level of Emotional Intelligence show a greater capacity for learning, deal with pressure more effectively, communicate in interesting and assertive ways and recognise the strengths and weaknesses of others. Overall, the trend is that they are more productive and satisfied in the workplace.

Conclusion: Emotional Intelligence should be a much sought after trait in IPC as this will better equip a post holder to deliver challenging IPC programmes. When appointing to an IPC team, the candidates Emotional Intelligence should be considered and then developed through a process of education and reflection.

Objectives: Antimicrobial resistance poses a major public health threat. Despite Indian retail sector antibiotic consumption per capita increasing by approximately 22% between 2008 and 2016, empirical studies that examine policy or behavioural interventions addressing antibiotic misuse in primary healthcare are scarce. Our study aimed to assess perceptions of interventions and gaps in policy and practice with respect to outpatient antibiotic misuse in India.

Methods: We conducted 23 semi-structured, in-depth interviews with a variety of key informants with diverse backgrounds in academia, non-government organisations, policy, advocacy, pharmacy, medicine and others. Data were charted into a framework matrix and analysed using a hybrid, inductive and deductive thematic analysis. Themes were analysed and organised according to the socio-ecological model at various levels ranging from the individual to the enabling environment.

Results: Key informants largely focused on the importance of adopting a structural perspective to addressing socio-ecological drivers of antibiotic misuse. There was a recognition that educational interventions targeting individual or interpersonal interactions were largely ineffective, and policy interventions should incorporate behavioural nudge interventions, improve the healthcare infrastructure and embrace task shifting to rectify staffing disparities in rural areas.

Conclusions: Prescription behaviour is perceived to be governed by structural issues of access and limitations in public health infrastructure that create an enabling environment for antibiotic overuse. Interventions should move beyond a clinical and individual focus on behaviour change with respect to antimicrobial resistance and aim for structural alignment between existing disease specific programs and between the informal and formal sector of healthcare delivery in India.

Background: The use of point-of-care testing (POCT) for influenza is not routine in many hospitals in the United Kngdom and testing is currently by laboratory-based polymerase chain reaction (PCR) tests. This review aims to evaluate patients who were tested positive for influenza in the last winter season and project if future POCT usage at initial point of patient assessment could assist in better utilisation of healthcare resources.

Methods: Retrospective review in a district general hospital without POCT facility for influenza. Medical records of patients who tested positive for influenza during a 4-month period from 1 October 2019 to 31 January 2020 in the paediatric department were reviewed and analysed.

Results: Thirty patients had laboratory-confirmed cases of influenza of which 63% (n = 19) were admitted to the ward. 56% of patients were not isolated at first instance on admission and 50% (n = 9) of admitted patients did not require inpatient management which totalled up to 224 h length of stay in ward.

Conclusions: Routine POCT for influenza can potentially improve management of patients presenting with respiratory symptoms and allocation of healthcare resources. We recommend its use to be introduced in diagnostic pathways for acute respiratory illness in the paediatric population in the next winter season in all hospitals.

Asymptomatic and pre-symptomatic staff and residents likely contribute to widespread transmission of COVID-19 in long-term care settings. Here, we describe the successful containment of a COVID-19 outbreak on one floor of a 163-bed Veterans Affairs (VA) Community Living Center (CLC). Testing using nasopharyngeal swabs with a rapid turn-around-time identified 3 of 28 (11%) residents and 2 of 41 (5%) healthcare personnel (HCP) with COVID-19. Both HCP likely worked on the floor while pre-symptomatic. When one HCP reported a cough to the secondary (employee) screening clinic, she was erroneously advised to work. Protocols to limit the risk for HCP to import COVID-19 were reinforced with Community Living Center staff as well as with personnel in secondary screening. Further, the CLC implemented an expanded screening tool that assessed residents for typical and atypical symptoms of COVID-19. No further cases of COVID-19 were detected on the CLC floor in the subsequent 6 weeks. Swift recognition and response helped contain the outbreak and prevent further COVID-19 infections among other residents and staff.

Background: Infection prevention and control (IPC) practices against COVID-19 should be adopted by healthcare workers (HCWs) at their workplaces to protect themselves, their patients, and their families from infection.

Purpose: This study aimed to describe the relationship between the healthcare-related COVID-19 infection prevention measures adopted by HCWs and their SARS-CoV-2 seropositivity.

Research design: This cross-sectional study was conducted during the second and third COVID-19 waves in Egypt.

Study sample: The study included 416 unvaccinated HCWs from 39 hospitals in Egypt.

Data collection: Sociodemographic data, as well as COVID-19 IPC measures done at work, and protective measures performed by their healthcare facilities were collected. SARS-CoV-2 spike protein antibodies were measured by ELISA.

Results: 58.2% of participants were seropositive for SARS-CoV-2. Among the previously undiagnosed HCWs, 125/271 (46.1%) were seropositive. Predictors of seropositivity were rural residence (aOR = 5.096; 95% CI: 1.583-16.403, p = 0.006), previous COVID-19 infection (aOR = 4.848, 95% CI: 2.933-8.015, p = 0.000), and examining 10-20 suspected COVID-19 patients daily (aOR = 2.329; 95% CI: 1.331-4.077, p = 0.003. Reporting low satisfaction (25-50%) with infection control implementation, working more than 40 h per week, reporting to "sometimes abiding by hand hygiene" compared to those who reported to "always" adhere to hand hygiene and shorter duration of hand washing (<20 s) were associated with significantly higher odds of seropositivity.

Conclusions: Poor infection control measures and the high workload of HCWs (longer working hours and examining more patients) were modifiable risk factors for SARS-CoV-2 seropositivity among HCWs. Hand hygiene was better among HCWs working in urban versus rural areas.

Background: Bronchoscopy is generally a safe and efficient procedure. However, the risk of cross-contamination with reusable flexible bronchoscopes (RFB) has been detected in several outbreaks worldwide.

Aim: To estimate the average cross-contamination rate of patient-ready RFBs based on available published data.

Methods: We performed a systematic literature review in PubMed and Embase to investigate the cross-contamination rate of RFB. Included studies identified indicator organisms or colony forming units (CFU) levels, and total number of samples >10. The Contamination threshold was defined according to the European Society of Gastrointestinal Endoscopy and European Society of Gastrointestinal Endoscopy Nurse and Associates (ESGE-ESGENA) guidelines. To calculate the total contamination rate, a random effects model was applied. Heterogeneity was analysed via a Q-test and illustrated in a forest plot. Publication bias was analysed via the Egger's regression test and illustrated in a funnel plot.

Results: Eight studies fulfilled our inclusion criteria. The random effects model included 2169 samples and 149 events (positive tests). The total RFB cross-contamination rate was 8.69% ± 1.86 (standard division [SD]) (95% confidence interval [CI]: 5.06-12.33%). The result showed significant heterogeneity of 90% and publication bias.

Discussion: Significant heterogeneity and publication bias is likely associated with varying methodology and aversion towards publishing negative findings, respectively. Based on the cross-contamination rate an infection control paradigm shift is needed to ensure patient safety. We recommend to follow the Spaulding classification and classify RFBs as critical items. Accordingly, infection control measures such as obligatory surveillance, and implementing single-use alternatives must be considered where feasible.

Background: Evidence linking the role of ventilation systems in transmission of infection to patients in intensive care units has increased in recent years.

Aims: This research-based commentary set out to identify the historical aspect of intensive care unit design, current problems and some potential solutions with respect to ventilation systems.

Methods: Databases and open source information was used to obtain data on the historical aspects and current guidance in ICU, and the authors experiences have been used to suggest potential solutions to ventilation problems in ICU.

Findings: The authors found a number of problems with ventilation in ICU to which there has not been a cohesive response in terms of guidance to support users and designers. The resultant void permits new projects to proceed with suboptimal and designs which place patients and staff at risk.

Discussion: The NHS is now at the start of major new investments in healthcare facilities in England and this together with the end of the antibiotic era mandates new guidance to address these major concerns.