Infection Prevention in Practice最新文献

A 4-year outbreak of MRSA ST72-MRSA-IV spa type t1597 in a surgical high dependency unit in Ireland linked to repeated healthcare worker recolonisation

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2024-11-15 DOI: 10.1016/j.infpip.2024.100421

Deirdre Brady , Grainne Brennan , Brian O'Connell , Ruth Buckley , Marie Brennan , Maria Lenehan , Jincy Jerry , Lars Nolke , Seyed Hossein Javadpour , Margaret M. Hannan , Breda Lynch , Maureen Lynch

Background

Patients undergoing cardiac surgery are identified as high risk for Staphylococcus aureus infection, including MRSA. An outbreak of MRSA was identified when two patients experienced MRSA infection concurrently in a cardiothoracic high dependency unit with uncommon detection of MRSA previously and an established screening programme.

Methods

An outbreak control team was convened and interventions applied including refresher training in hand and environmental hygiene, review of practice with regard to aseptic access of medical devices and consideration of antibiotic use in the unit. MRSA isolates were referred to the Irish National MRSA Reference Laboratory where spa typing assigned all isolates to t1597 and whole genome sequencing assigned them to multilocus sequence type ST72-MRSA-IV. Recovery of this strain from only this unit in Ireland and infrequent reporting in Europe prompted staff MRSA screening with two staff members found to harbour the outbreak strain. Despite successful decolonisation, recolonisation and further transmission to patients occurred.

Conclusions

In the clinical unit in which this outbreak occurred, the usual control measures to prevent spread of MRSA were in place. Recent Joint Healthcare Infection Society and Infection Prevention Society Guidance does not recommend routine staff screening for MRSA but does support its consideration in an outbreak of an unusual strain. In total, 9 patients and 2 staff were affected by this outbreak. There were 4 infections and 3 deaths. Sustained outbreak closure was necessary to protect certain national clinical programmes and was achievable only when colonised staff were no longer working in the unit.

{"title":"A 4-year outbreak of MRSA ST72-MRSA-IV spa type t1597 in a surgical high dependency unit in Ireland linked to repeated healthcare worker recolonisation","authors":"Deirdre Brady , Grainne Brennan , Brian O'Connell , Ruth Buckley , Marie Brennan , Maria Lenehan , Jincy Jerry , Lars Nolke , Seyed Hossein Javadpour , Margaret M. Hannan , Breda Lynch , Maureen Lynch","doi":"10.1016/j.infpip.2024.100421","DOIUrl":"10.1016/j.infpip.2024.100421","url":null,"abstract":"<div><h3>Background</h3><div>Patients undergoing cardiac surgery are identified as high risk for <em>Staphylococcus aureus</em> infection, including MRSA. An outbreak of MRSA was identified when two patients experienced MRSA infection concurrently in a cardiothoracic high dependency unit with uncommon detection of MRSA previously and an established screening programme.</div></div><div><h3>Methods</h3><div>An outbreak control team was convened and interventions applied including refresher training in hand and environmental hygiene, review of practice with regard to aseptic access of medical devices and consideration of antibiotic use in the unit. MRSA isolates were referred to the Irish National MRSA Reference Laboratory where <em>spa</em> typing assigned all isolates to t1597 and whole genome sequencing assigned them to multilocus sequence type ST72-MRSA-IV. Recovery of this strain from only this unit in Ireland and infrequent reporting in Europe prompted staff MRSA screening with two staff members found to harbour the outbreak strain. Despite successful decolonisation, recolonisation and further transmission to patients occurred.</div></div><div><h3>Conclusions</h3><div>In the clinical unit in which this outbreak occurred, the usual control measures to prevent spread of MRSA were in place. Recent Joint Healthcare Infection Society and Infection Prevention Society Guidance does not recommend routine staff screening for MRSA but does support its consideration in an outbreak of an unusual strain. In total, 9 patients and 2 staff were affected by this outbreak. There were 4 infections and 3 deaths. Sustained outbreak closure was necessary to protect certain national clinical programmes and was achievable only when colonised staff were no longer working in the unit.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 1","pages":"Article 100421"},"PeriodicalIF":1.8,"publicationDate":"2024-11-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142743991","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}

引用次数: 0

Pharmacist-led antimicrobial stewardship program in the treatment of Staphylococcus aureus bacteraemia in paediatric patients: a multivariate analysis 药剂师主导的抗菌药物管理计划在治疗儿科患者金黄色葡萄球菌菌血症中的应用：多变量分析

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2024-11-08 DOI: 10.1016/j.infpip.2024.100419

Stella Caroline Schenidt Bispo da Silva , Mariana Millan Fachi , Marinei Campos Ricieri , Fábio de Araújo Motta

Background

Care bundles are a recognised strategy to improve treatment. When managed through an Antimicrobial Stewardship Program (ASP) based on the pharmacist-led program model, care bundles can be an effective tool to guide decision making in clinical practice and to improve patient outcomes. This study aimed to evaluate the results of a pharmacist-led ASP which included a care bundle based on clinical outcomes of Staphylococcus aureus bacteraemia (SAB) in a paediatric hospital.

Methods

A retrospective cohort study with multivariate analysis was conducted in a paediatric hospital in Brazil. The study comprised 120 paediatric patients with a positive blood culture for S. aureus with occurred between 2014 and 2021 and clinical and laboratory results consistent with infection. The study was classified into two periods: pre-intervention (n=44) and intervention (n=76). A pharmacist-led ASP program with a care bundle was established during the intervention period 2017–2021. The primary outcome assessed was the impact on clinical outcomes, including infection-related mortality and 90-day reinfection rate, both being considered therapeutic failure.

Results

The multivariate analysis demonstrated that the following variables had an impact on primary outcome: infant patients [Odds ratio (OR) 12.998, P=0.044]; use of more than three antimicrobial treatment regimens [OR 0.006, P=0.017]; intervention period [OR 0.060, P=0.034]; bundle item 1 – follow-up blood culture [OR 18.953, P=0.049]; bundle item 2 – early source control [OR 0.002, P=0.018]; bundle item 4 – de-escalation to oxacillin for methicillin-sensitive S. aureus [OR 0.041, P=0.046].

Conclusions

The pharmacist-led ASP model showed an increase in adherence to the care bundle between the two study periods, with reduced probability of a negative outcome. Furthermore, risk factors for S. aureus bacteraemia were identified that may inform management and contribute to better patient outcomes in the paediatric population.

背景护理捆绑是一种公认的改善治疗的策略。如果通过基于药剂师主导计划模式的抗菌药物管理计划（ASP）进行管理，护理捆绑可成为指导临床实践决策和改善患者预后的有效工具。本研究旨在评估以药剂师为主导的 ASP 的效果，其中包括基于儿科医院金黄色葡萄球菌菌血症（SAB）临床疗效的护理包。研究对象包括 120 名金黄色葡萄球菌血培养呈阳性的儿科患者，这些患者的病程在 2014 年至 2021 年之间，临床和实验室结果与感染相符。研究分为两个阶段：干预前（44 人）和干预（76 人）。在 2017-2021 年干预期间，建立了一个由药剂师主导的 ASP 计划，并配备了护理包。评估的主要结果是对临床结果的影响，包括感染相关死亡率和90天再感染率，两者均被视为治疗失败。结果多变量分析表明，以下变量对主要结果有影响：婴儿患者[Odds ratio (OR) 12.998, P=0.044]；使用三种以上抗菌药物治疗方案[OR 0.006, P=0.017]；干预期[OR 0.060，P=0.034]；捆绑项目 1--随访血培养[OR 18.953，P=0.049]；捆绑项目 2--早期源头控制[OR 0.002，P=0.018]；捆绑项目 4--对甲氧西林敏感的 S.结论以药剂师为主导的 ASP 模型显示，在两个研究期间，护理捆绑包的依从性有所提高，出现负面结果的概率有所降低。此外，还发现了金黄色葡萄球菌菌血症的风险因素，这些因素可为儿科患者的管理提供参考，并有助于改善患者的预后。

{"title":"Pharmacist-led antimicrobial stewardship program in the treatment of Staphylococcus aureus bacteraemia in paediatric patients: a multivariate analysis","authors":"Stella Caroline Schenidt Bispo da Silva , Mariana Millan Fachi , Marinei Campos Ricieri , Fábio de Araújo Motta","doi":"10.1016/j.infpip.2024.100419","DOIUrl":"10.1016/j.infpip.2024.100419","url":null,"abstract":"<div><h3>Background</h3><div>Care bundles are a recognised strategy to improve treatment. When managed through an Antimicrobial Stewardship Program (ASP) based on the pharmacist-led program model, care bundles can be an effective tool to guide decision making in clinical practice and to improve patient outcomes. This study aimed to evaluate the results of a pharmacist-led ASP which included a care bundle based on clinical outcomes of <em>Staphylococcus aureus</em> bacteraemia (SAB) in a paediatric hospital.</div></div><div><h3>Methods</h3><div>A retrospective cohort study with multivariate analysis was conducted in a paediatric hospital in Brazil. The study comprised 120 paediatric patients with a positive blood culture for <em>S. aureus</em> with occurred between 2014 and 2021 and clinical and laboratory results consistent with infection. The study was classified into two periods: pre-intervention (n=44) and intervention (n=76). A pharmacist-led ASP program with a care bundle was established during the intervention period 2017–2021. The primary outcome assessed was the impact on clinical outcomes, including infection-related mortality and 90-day reinfection rate, both being considered therapeutic failure.</div></div><div><h3>Results</h3><div>The multivariate analysis demonstrated that the following variables had an impact on primary outcome: infant patients [Odds ratio (OR) 12.998, <em>P</em>=0.044]; use of more than three antimicrobial treatment regimens [OR 0.006, <em>P</em>=0.017]; intervention period [OR 0.060, <em>P</em>=0.034]; bundle item 1 – follow-up blood culture [OR 18.953, <em>P</em>=0.049]; bundle item 2 – early source control [OR 0.002, <em>P</em>=0.018]; bundle item 4 – de-escalation to oxacillin for methicillin-sensitive <em>S. aureus</em> [OR 0.041, <em>P</em>=0.046].</div></div><div><h3>Conclusions</h3><div>The pharmacist-led ASP model showed an increase in adherence to the care bundle between the two study periods, with reduced probability of a negative outcome. Furthermore, risk factors for <em>S. aureus</em> bacteraemia were identified that may inform management and contribute to better patient outcomes in the paediatric population.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"6 4","pages":"Article 100419"},"PeriodicalIF":1.8,"publicationDate":"2024-11-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142707064","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}

引用次数: 0

Feasibility of hand disinfection in paediatric advanced life support (PALS): A simulation study 儿科高级生命支持（PALS）中手部消毒的可行性：模拟研究

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2024-11-07 DOI: 10.1016/j.infpip.2024.100418

Michael Bentele , Stefanie Bentele , Nicolas Reinoso-Schiller , Simone Scheithauer , Stefan Bushuven

Background

Hand disinfection is often omitted during emergencies because it may delay life-saving treatments. As healthcare-associated infections significantly worsen patient outcomes, the categorical omission of hand disinfection in emergencies should be re-evaluated. Real-world observations on this subject tentatively indicate compliance rates of <10%. In an adult simulation study, we have previously shown that proper hand disinfection without delaying patient care is feasible in >50% of scenarios. However, no comparable data have been published regarding emergencies in infants or children.

Aim

This observational study aimed to assess the feasibility of hand disinfection in simulated paediatric patients requiring advanced life support (PALS).

Methods

We observed 32 simulations of life-threatening conditions. Two observers counted all possible moments for administering hand hygiene, according to the World Health Organization protocol, and assessed them for time-neutral feasibility.

Results

In the 32 scenarios, the feasibility of hand disinfection for all WHO moments ranged from 78.3 to 100%. Of all 573 hand disinfection moments, 552 (96.3%) were deemed feasible.

Altogether 208 (36.3%) occurred before aseptic tasks. Of these, 187 (89.9%) were considered feasible. Hand disinfection for WHO-2 moments feasibility showed to be at least 50% in the cases. A total of 189 (90.9%) of all WHO-2 hand disinfections were applied by the role of the “iv-manager”. Scenarios with shockable rhythms and peri-arrest showed higher feasibility ratios than those without.

Conclusions

The categorical omission of hand disinfection in PALS seems to be no longer acceptable or appropriate. The feasibility of hand hygiene should be re-evaluated in real-world scenarios.

背景由于手部消毒可能会延误挽救生命的治疗，因此在紧急情况下往往会省略手部消毒。由于医疗相关感染会严重恶化患者的预后，因此应重新评估在紧急情况下绝对不进行手部消毒的做法。对这一问题的实际观察初步表明，符合率为 10%。我们曾在一项成人模拟研究中表明，在不耽误患者护理的情况下进行适当的手部消毒在 50%的情况下是可行的。这项观察性研究旨在评估在需要高级生命支持（PALS）的模拟儿科患者中进行手部消毒的可行性。两名观察员根据世界卫生组织的规程统计了所有可能的手部卫生实施时刻，并对其进行了时间中立可行性评估。结果在 32 个场景中，世界卫生组织所有时刻的手部消毒可行性从 78.3% 到 100% 不等。在所有 573 个手消毒时刻中，有 552 个（96.3%）被认为是可行的，其中有 208 个（36.3%）发生在无菌任务之前。其中 187 次（89.9%）被认为是可行的。WHO-2时刻的手部消毒可行性至少为50%。在所有 WHO-2 手部消毒中，共有 189 次（90.9%）是由 "输液管理者 "进行的。有可电击节律和围休克的场景比没有可电击节律和围休克的场景显示出更高的可行性比率。手部卫生的可行性应在实际场景中重新评估。

{"title":"Feasibility of hand disinfection in paediatric advanced life support (PALS): A simulation study","authors":"Michael Bentele , Stefanie Bentele , Nicolas Reinoso-Schiller , Simone Scheithauer , Stefan Bushuven","doi":"10.1016/j.infpip.2024.100418","DOIUrl":"10.1016/j.infpip.2024.100418","url":null,"abstract":"<div><h3>Background</h3><div>Hand disinfection is often omitted during emergencies because it may delay life-saving treatments. As healthcare-associated infections significantly worsen patient outcomes, the categorical omission of hand disinfection in emergencies should be re-evaluated. Real-world observations on this subject tentatively indicate compliance rates of <10%. In an adult simulation study, we have previously shown that proper hand disinfection without delaying patient care is feasible in >50% of scenarios. However, no comparable data have been published regarding emergencies in infants or children.</div></div><div><h3>Aim</h3><div>This observational study aimed to assess the feasibility of hand disinfection in simulated paediatric patients requiring advanced life support (PALS).</div></div><div><h3>Methods</h3><div>We observed 32 simulations of life-threatening conditions. Two observers counted all possible moments for administering hand hygiene, according to the World Health Organization protocol, and assessed them for time-neutral feasibility.</div></div><div><h3>Results</h3><div>In the 32 scenarios, the feasibility of hand disinfection for all WHO moments ranged from 78.3 to 100%. Of all 573 hand disinfection moments, 552 (96.3%) were deemed feasible.</div><div>Altogether 208 (36.3%) occurred before aseptic tasks. Of these, 187 (89.9%) were considered feasible. Hand disinfection for WHO-2 moments feasibility showed to be at least 50% in the cases. A total of 189 (90.9%) of all WHO-2 hand disinfections were applied by the role of the “iv-manager”. Scenarios with shockable rhythms and peri-arrest showed higher feasibility ratios than those without.</div></div><div><h3>Conclusions</h3><div>The categorical omission of hand disinfection in PALS seems to be no longer acceptable or appropriate. The feasibility of hand hygiene should be re-evaluated in real-world scenarios.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 1","pages":"Article 100418"},"PeriodicalIF":1.8,"publicationDate":"2024-11-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142703912","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}

引用次数: 0

Reassessing the need for scheduled replacement of short term central venous catheters: A narrative comprehensive review 重新评估定期更换短期中心静脉导管的必要性：全面回顾性叙述

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2024-11-07 DOI: 10.1016/j.infpip.2024.100420

Regev Cohen

Central venous catheters (CVCs) are essential in modern healthcare but are associated with significant risks, particularly catheter-related bloodstream infections (CRBSIs). Current guidelines do not recommend routine replacement of CVCs based on time alone. However, recent evidence challenges this recommendation. A comprehensive literature review was conducted, focusing on studies exploring the risk-factors of short-term, non-hemodialysis CVCs, that were published in the last two decades while including seminal older works for context. The guidelines regarding scheduled CVC-replacement are not based on sufficiently convincing data. Current literature establishes the significance of CVC-duration as a major risk-factor for CRBSI occurrence, especially after 9–14 days of catheter-dwelling. The daily CRBSI risk is probably not constant, and the cumulative risk may reach high rates after 9–14 days, especially for femoral and jugular insertions compared to the subclavian site, suggesting potential benefits of scheduled CVC replacement, especially for non-subclavian catheters.

中心静脉导管 (CVC) 是现代医疗保健中不可或缺的设备，但也存在很大的风险，尤其是与导管相关的血流感染 (CRBSI)。目前的指南不建议仅根据时间来常规更换 CVC。然而，最近的证据对这一建议提出了质疑。我们进行了一次全面的文献综述，重点关注过去二十年中发表的探讨短期非血液透析用 CVC 风险因素的研究，同时纳入了一些具有开创性的旧文献以作为参考。关于定期更换 CVC 的指导原则并没有以足够令人信服的数据为基础。目前的文献证实，CVC 的持续时间是 CRBSI 发生的主要风险因素，尤其是在导管留置 9-14 天之后。每天发生 CRBSI 的风险可能并不恒定，9-14 天后累积风险可能会达到很高的水平，尤其是与锁骨下部位相比，股骨和颈静脉插入部位的风险更高，这表明定期更换 CVC（尤其是非锁骨下导管）具有潜在的益处。

引用次数: 0

Rapid implementation of a clinical decision-support workflow during the national blood culture bottle shortage 在全国血液培养瓶短缺期间快速实施临床决策支持工作流程

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2024-11-02 DOI: 10.1016/j.infpip.2024.100417

Saira Butt , Amy B. Kressel , Brian L. Haines , Katherine Merrill , Amber M. Ryan , Kenneth C. Gavina , Bree Weaver , Michael Kays , Molly Tieman , Margaret Muciarelli , Phillip Clapham

Background

The United States Food and Drug Administration recently announced a national blood culture (BC) bottle shortage; the exact date of restoration is still being determined.

Aim

Implement a workflow to mitigate the BC bottle shortage at our hospital.

Methods

We created the following clinical decision support workflow in electronic medical record to help mitigate BC bottle use: (a) limit to two BC in 24 hours, (b) only repeat BC if 72 hours have passed from the prior sets, (c) do not repeat BC for coagulase-negative Staphylococcus bacteremia when considered a contaminant (i.e., no implanted vascular device), (d) do not repeat BC for Streptococcus bacteremia, (e) do not repeat cultures for Gram-negative rod bacteremia unless an unknown source, immunosuppression, or clinical worsening.

Findings

Post implementation, our weekly average BC bottle use decreased to 29.5%.

Conclusion

Within three weeks of the BC bottle shortage announcement, we successfully deployed evidence-based BC restrictions in the electronic medical record (EMR), reducing our BC orders by 29.5%. We encourage others to consider and potentially replicate our workflow to contribute to diagnostic stewardship.

背景美国食品和药物管理局最近宣布全国性血液培养（BC）瓶短缺；具体恢复日期仍在确定中。方法我们在电子病历中创建了以下临床决策支持工作流程，以帮助减少 BC 瓶的使用：(a) 限制在 24 小时内进行两次 BC，(b) 只有在距离上一次 BC 已过去 72 小时时才重复 BC，(c) 如果认为凝固酶阴性葡萄球菌菌血症是污染物（即：没有植入血管装置），则不重复 BC、结论在 BC 瓶短缺公告发布后的三周内，我们成功地在电子病历 (EMR) 中部署了循证 BC 限制，将 BC 订单减少了 29.5%。我们鼓励其他人考虑并有可能复制我们的工作流程，为诊断监管做出贡献。

{"title":"Rapid implementation of a clinical decision-support workflow during the national blood culture bottle shortage","authors":"Saira Butt , Amy B. Kressel , Brian L. Haines , Katherine Merrill , Amber M. Ryan , Kenneth C. Gavina , Bree Weaver , Michael Kays , Molly Tieman , Margaret Muciarelli , Phillip Clapham","doi":"10.1016/j.infpip.2024.100417","DOIUrl":"10.1016/j.infpip.2024.100417","url":null,"abstract":"<div><h3>Background</h3><div>The United States Food and Drug Administration recently announced a national blood culture (BC) bottle shortage; the exact date of restoration is still being determined.</div></div><div><h3>Aim</h3><div>Implement a workflow to mitigate the BC bottle shortage at our hospital.</div></div><div><h3>Methods</h3><div>We created the following clinical decision support workflow in electronic medical record to help mitigate BC bottle use: (a) limit to two BC in 24 hours, (b) only repeat BC if 72 hours have passed from the prior sets, (c) do not repeat BC for coagulase-negative <em>Staphylococcus</em> bacteremia when considered a contaminant (i.e., no implanted vascular device), (d) do not repeat BC for <em>Streptococcus</em> bacteremia, (e) do not repeat cultures for Gram-negative rod bacteremia unless an unknown source, immunosuppression, or clinical worsening.</div></div><div><h3>Findings</h3><div>Post implementation, our weekly average BC bottle use decreased to 29.5%.</div></div><div><h3>Conclusion</h3><div>Within three weeks of the BC bottle shortage announcement, we successfully deployed evidence-based BC restrictions in the electronic medical record (EMR), reducing our BC orders by 29.5%. We encourage others to consider and potentially replicate our workflow to contribute to diagnostic stewardship.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"6 4","pages":"Article 100417"},"PeriodicalIF":1.8,"publicationDate":"2024-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653380","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}

引用次数: 0

Status of infection prevention and control in Cameroon healthcare facilities: lessons learned from the WHO COVID-19 scorecard tool under the hierarchy of control model 喀麦隆医疗机构的感染预防和控制现状：从世卫组织 COVID-19 计分卡工具中汲取的分级控制模式的经验教训

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2024-10-28 DOI: 10.1016/j.infpip.2024.100407

Boris Arnaud Kouomogne Nteungue , Erick Tandi , Chanceline Bilounga Ndongo , Tania Bissouma-Ledjou , Alphonse Acho , Jeffrey Campbell , Dieudonnée Reine Ndougou , Reverien Habimana , Ambomo Sylvie Myriam , Bertolt Brecht Kouam Nteungue , Oyono Yannick , Louis Joss Bitang , Georges Alain Etoundi Mballa , Yap Boum

Background

Infection prevention and control (IPC) helps prevent disease transmission in healthcare facilities. There is a dearth of information on the implementation of IPC during the COVID-19 outbreak in Cameroon using the recommended WHO COVID-19 IPC scorecard tool. The present study assessed healthcare facilities' compliance to IPC by continuous assessments, with an evaluation of the tool using the hierarchy of control theory.

Methods

This cross-sectional study was conducted in the 10 administrative regions of Cameroon by evaluating healthcare facilities prioritized by the Ministry of Public Health as high-risk facilities between March 2020 and November 2023. Comparisons were made regarding the facilities' ownership, level and status.

Results

2,188 assessments from 1,358 healthcare facilities were collected. The median IPC scores at each evaluation were between the intermediate and advanced level, with a bias linked with decreasing selection of facilities. However, only 172 (13%) healthcare facilities achieved advanced IPC score (≥75%). Higher IPC scores were found in hospitals (p<0.001) and in private facilities (p=0.02). Predictors of good IPC compliance were hospital (OR=3.7, CI: 1.4–9.8) and private facility (OR=2.3, CI: 1.6–3.3). The tool met the five domains of the hierarchy of control model.

Conclusion

Repeated IPC assessments using recommended tools contribute to a better compliance of IPC by healthcare facilities in resources constrained settings.

背景感染预防与控制（IPC）有助于防止疾病在医疗机构中传播。关于喀麦隆在 COVID-19 爆发期间使用世界卫生组织推荐的 COVID-19 IPC 计分卡工具实施 IPC 的情况，目前还缺乏相关信息。这项横断面研究在喀麦隆的 10 个行政区进行，对公共卫生部在 2020 年 3 月至 2023 年 11 月期间优先考虑的高风险医疗机构进行了评估。结果收集了来自 1,358 家医疗机构的 2,188 份评估报告。每次评估的 IPC 得分中位数介于中级和高级之间，其中的偏差与设施选择的减少有关。然而，只有 172 家（13%）医疗机构达到了 IPC 高级水平（≥75%）。医院（p<0.001）和私营机构（p=0.02）的 IPC 得分更高。医院（OR=3.7，CI：1.4-9.8）和私营机构（OR=2.3，CI：1.6-3.3）是IPC符合性良好的预测因素。结论在资源有限的环境中，使用推荐工具重复进行 IPC 评估有助于医疗机构更好地遵守 IPC。

{"title":"Status of infection prevention and control in Cameroon healthcare facilities: lessons learned from the WHO COVID-19 scorecard tool under the hierarchy of control model","authors":"Boris Arnaud Kouomogne Nteungue , Erick Tandi , Chanceline Bilounga Ndongo , Tania Bissouma-Ledjou , Alphonse Acho , Jeffrey Campbell , Dieudonnée Reine Ndougou , Reverien Habimana , Ambomo Sylvie Myriam , Bertolt Brecht Kouam Nteungue , Oyono Yannick , Louis Joss Bitang , Georges Alain Etoundi Mballa , Yap Boum","doi":"10.1016/j.infpip.2024.100407","DOIUrl":"10.1016/j.infpip.2024.100407","url":null,"abstract":"<div><h3>Background</h3><div>Infection prevention and control (IPC) helps prevent disease transmission in healthcare facilities. There is a dearth of information on the implementation of IPC during the COVID-19 outbreak in Cameroon using the recommended WHO COVID-19 IPC scorecard tool. The present study assessed healthcare facilities' compliance to IPC by continuous assessments, with an evaluation of the tool using the hierarchy of control theory.</div></div><div><h3>Methods</h3><div>This cross-sectional study was conducted in the 10 administrative regions of Cameroon by evaluating healthcare facilities prioritized by the Ministry of Public Health as high-risk facilities between March 2020 and November 2023. Comparisons were made regarding the facilities' ownership, level and status.</div></div><div><h3>Results</h3><div>2,188 assessments from 1,358 healthcare facilities were collected. The median IPC scores at each evaluation were between the intermediate and advanced level, with a bias linked with decreasing selection of facilities. However, only 172 (13%) healthcare facilities achieved advanced IPC score (≥75%). Higher IPC scores were found in hospitals (p<0.001) and in private facilities (p=0.02). Predictors of good IPC compliance were hospital (OR=3.7, CI: 1.4–9.8) and private facility (OR=2.3, CI: 1.6–3.3). The tool met the five domains of the hierarchy of control model.</div></div><div><h3>Conclusion</h3><div>Repeated IPC assessments using recommended tools contribute to a better compliance of IPC by healthcare facilities in resources constrained settings.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"6 4","pages":"Article 100407"},"PeriodicalIF":1.8,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653377","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}

引用次数: 0

Low prevalence of borderline oxacillin resistant Staphylococcus aureus (BORSA) in a tertiary care hospital in South Carolina 南卡罗来纳州一家三级护理医院中耐受奥沙西林的金黄色葡萄球菌（BORSA）的低流行率

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2024-10-28 DOI: 10.1016/j.infpip.2024.100414

Connor Horne , Gabrielle DiMattia , Nicholas Perkins , Prerana Roth

Prompt treatment for Staphylococcus aureus bloodstream infections is often dependent on known diagnostic testing modalities to differentiate between methicillin-susceptible S. aureus (MSSA) and methicillin-resistant S. aureus (MRSA). Borderline-oxacillin resistant S. aureus (BORSA), a rare, non-mecA mediated phenotype, has unclear resistance mechanisms but potentially significant consequences as it is frequently misidentified as MSSA but behaves more like MRSA. A retrospective analysis was performed of MSSA bloodstream infections to determine the prevalence of BORSA. Our institution found BORSA prevalence of 0.1%, consistent with literature. Though prevalence is low, due to unclear mechanisms and unreliable detection methods, BORSA may pose a therapeutic and epidemiological threat.

金黄色葡萄球菌血流感染的及时治疗通常取决于已知的诊断检测方法，以区分甲氧西林敏感金黄色葡萄球菌（MSSA）和耐甲氧西林金黄色葡萄球菌（MRSA）。耐边界奥沙西林金黄色葡萄球菌（BORSA）是一种罕见的、非mecA介导的表型，其耐药机制尚不清楚，但可能会产生重大影响，因为它经常被误认为是MSSA，但表现得更像MRSA。我们对 MSSA 血流感染进行了回顾性分析，以确定 BORSA 的流行率。我院发现 BORSA 感染率为 0.1%，与文献报道一致。虽然流行率较低，但由于机制不明确和检测方法不可靠，BORSA 可能会对治疗和流行病学构成威胁。

引用次数: 0

Use of ICD-9-CM coding for identifying antibiotic prescriptions during hospitalization: a Delphi consensus model 使用 ICD-9-CM 编码识别住院期间的抗生素处方：德尔菲共识模型

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2024-10-28 DOI: 10.1016/j.infpip.2024.100416

Agnese Comelli , Camilla Genovese , Giulia Renisi , Luigia Scudeller , Martina Zanforlini , Giulia Macaluso , Arianna Mazzone , Antonio Muscatello , Giorgio Bozzi , Alessia Zoncada , Angelo Pan , Marianna Rossi , Paolo Bonfanti , Stefania Chiappetta , Salvatore Casari , Marco Ripa , Antonella Castagna , Liana Signorini , Francesco Castelli , Margherita Chiamenti , Alessandra Bandera

A Delphi consensus-seeking procedure was conducted to validate a list of ICD-9-CM codes that could help identify hospital admissions in which antimicrobials are more likely to be prescribed. The panel agreed to include 2967 codes out of 16229 (18.28%). Such codes could support AMS strategies by large-scale monitoring of drug consumption.

为了验证有助于确定哪些住院病例更有可能被处方抗菌药物的 ICD-9-CM 代码列表，我们采用了德尔菲法（Delphi）寻求共识的程序。专家小组同意将 16229 个代码中的 2967 个代码（18.28%）纳入其中。这些代码可以通过大规模监测药物消耗来支持 AMS 战略。

引用次数: 0

Effect of the implementation of infection prevention measures by an infection prevention link physician in trauma and orthopaedic surgery on hygiene-relevant processes and nosocomial infections 创伤和矫形外科感染预防联系医生实施感染预防措施对卫生相关流程和院内感染的影响

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2024-10-26 DOI: 10.1016/j.infpip.2024.100415

Meike M. Neuwirth , Benedikt Marche , Jerome Defosse , Frauke Mattner , Robin Otchwemah

Background

The German Infection Protection Act and KRINKO recommend nominating one authorized medical specialist in every medical department as an infection prevention link physician (PLP). Detailed evidence on the contribution of PLPs to reducing infection rates is not available in Germany.

Aim

The "HygArzt"-study investigated whether, and to what extent, a PLP in orthopaedics/trauma surgery is able to improve hand hygiene adherence (HHA), process steps of dressing change, nosocomial infection (NI) and surgical site infection (SSI) rates by implementing an infection prevention bundle (IPB).

Methods

In consideration of a literature review on infection prevention measures in orthopaedics/trauma surgery and existing departmental hygiene standards, supported by the responsible infection control specialist, an IPB was developed by an interdisciplinary team and implemented by a PLP. The effects of IPB on NI, SSI, and HHA were determined in a pre-post study design on three trauma surgery/orthopaedic wards of a university hospital.

Findings

In pre-post comparison HHA was significantly increased, and NI rates were reduced significantly. The greatest increase in adherence occurred in the pre-indications "Before touching a patient" (pre: 37.3%; post: 73.0%), "Before clean/aseptic procedure" (pre: 34.2%; post: 75.5%) and "Before surgery" (pre: 9.7%; post: 57.0%). The analysis of NI and SSI rates (NI: p=0.03; SSI: p=0.01; relative risk (RR) of 0.53 in each case) revealed rate reductions.

Conclusion

The implementation of an IPB by a PLP led to an optimisation of processes and to a reduction of SSIs and NIs. PLPs seem to have the potential for targeted, group-specific implementation of complex IPBs.

背景德国《感染防护法》和 KRINKO 建议在每个医疗部门指定一名经授权的医学专家作为感染预防联系医生（PLP）。目的 "HygArzt "研究调查了骨科/创伤外科的感染预防联系医生（PLP）是否能够通过实施感染预防捆绑包（IPB）来改善手部卫生依从性（HHA）、换药流程步骤、院内感染（NI）和手术部位感染（SSI）率，以及改善的程度。方法根据有关骨科/创伤外科感染预防措施的文献综述和现有的科室卫生标准，在负责感染控制专家的支持下，由跨学科团队制定了一套 IPB，并由一名 PLP 负责实施。在一家大学医院的三个创伤外科/骨科病房中，采用前后对比研究设计确定了 IPB 对 NI、SSI 和 HHA 的影响。在 "接触病人前"（前：37.3%；后：73.0%）、"清洁/无菌操作前"（前：34.2%；后：75.5%）和 "手术前"（前：9.7%；后：57.0%）这几项前指示中，遵守率的提高幅度最大。对 NI 和 SSI 感染率的分析（NI：p=0.03；SSI：p=0.01；相对风险 (RR) 均为 0.53）显示感染率有所下降。PLP似乎有可能有针对性地针对特定群体实施复杂的IPB。

{"title":"Effect of the implementation of infection prevention measures by an infection prevention link physician in trauma and orthopaedic surgery on hygiene-relevant processes and nosocomial infections","authors":"Meike M. Neuwirth , Benedikt Marche , Jerome Defosse , Frauke Mattner , Robin Otchwemah","doi":"10.1016/j.infpip.2024.100415","DOIUrl":"10.1016/j.infpip.2024.100415","url":null,"abstract":"<div><h3>Background</h3><div>The German Infection Protection Act and KRINKO recommend nominating one authorized medical specialist in every medical department as an infection prevention link physician (PLP). Detailed evidence on the contribution of PLPs to reducing infection rates is not available in Germany.</div></div><div><h3>Aim</h3><div>The \"HygArzt\"-study investigated whether, and to what extent, a PLP in orthopaedics/trauma surgery is able to improve hand hygiene adherence (HHA), process steps of dressing change, nosocomial infection (NI) and surgical site infection (SSI) rates by implementing an infection prevention bundle (IPB).</div></div><div><h3>Methods</h3><div>In consideration of a literature review on infection prevention measures in orthopaedics/trauma surgery and existing departmental hygiene standards, supported by the responsible infection control specialist, an IPB was developed by an interdisciplinary team and implemented by a PLP. The effects of IPB on NI, SSI, and HHA were determined in a pre-post study design on three trauma surgery/orthopaedic wards of a university hospital.</div></div><div><h3>Findings</h3><div>In pre-post comparison HHA was significantly increased, and NI rates were reduced significantly. The greatest increase in adherence occurred in the pre-indications \"Before touching a patient\" (pre: 37.3%; post: 73.0%), \"Before clean/aseptic procedure\" (pre: 34.2%; post: 75.5%) and \"Before surgery\" (pre: 9.7%; post: 57.0%). The analysis of NI and SSI rates (NI: <em>p</em>=0.03; SSI: <em>p</em>=0.01; relative risk (RR) of 0.53 in each case) revealed rate reductions.</div></div><div><h3>Conclusion</h3><div>The implementation of an IPB by a PLP led to an optimisation of processes and to a reduction of SSIs and NIs. PLPs seem to have the potential for targeted, group-specific implementation of complex IPBs.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"6 4","pages":"Article 100415"},"PeriodicalIF":1.8,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653376","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}

引用次数: 0

Is there an association between colonisation of vancomycin resistant Enterococci, methicillin resistant Staphylococcus Aureus, or Clostridiodes Difficile and mortality in sepsis? 耐万古霉素肠球菌、耐甲氧西林金黄色葡萄球菌或艰难梭菌的定植与败血症死亡率之间是否存在关联？

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2024-10-26 DOI: 10.1016/j.infpip.2024.100413

Matthew JG. Sigakis , Joseph Posluszny , Michael D. Maile , Elizabeth S. Jewell , Milo Engoren

Background

To determine if colonisation with drug resistant organisms is associated with worse outcomes in patients who subsequently develop sepsis.

Methods

Retrospective study of patients with sepsis employing logistic regression and linear regression to determine the independent association of colonisation with adverse outcomes.

Results

Mortality was higher in patients colonized with VRE [501 of 1937 (26%) v. 1052 of 5624 (19%) non-VRE colonised patients, difference 7% (95% confidence interval (5,9%), p<0.001] and MRSA [168 of 708 (24%) v 1342 of 6804 (20%) non-MRSA colonised patients, difference 4% (1,7%), p = 0.014]. CDiff colonisation was not associated with increased mortality [153 of 757 (21%) v 762 of 7432 (18%), difference 3% (0,6%), p=0.052]. After multivariable logistic regression, VRE colonisation remained associated with increased hospital mortality [odds ratio = 1.273, 95% confidence interval (1.099, 1.475), p = 0.001]. VRE colonisation was also associated with subsequent receipt of mechanical ventilation [odds ratio = 1.179, 95% confidence interval (1.043, 1.334), p = 0.009] and with receipt of renal replacement therapy (RRT) [OR = 1.36 (1.11, 1.66), p = 0.003].

Conclusions

We found that VRE colonisation, but not MRSA or C. diff colonisation, was associated with increased hospital mortality in septic patients.

方法对脓毒症患者进行回顾性研究，采用逻辑回归和线性回归确定定植与不良预后的独立关联。结果VRE定植患者的死亡率较高[1937例患者中的501例（26%）v. 5624例非VRE定植患者中的1052例（19%），差异为7%（95%置信区间（5,9%），p<0.001）]，MRSA定植患者的死亡率较高[708例患者中的168例（24%）v. 6804例非MRSA定植患者中的1342例（20%），差异为4%（1,7%），p = 0.014]。CDiff 定植与死亡率增加无关[757 例中的 153 例（21%）v 7432 例中的 762 例（18%），差异为 3% (0,6%)，P=0.052]。多变量逻辑回归后，VRE 定植仍与住院死亡率增加相关[几率比 = 1.273，95% 置信区间 (1.099, 1.475)，p = 0.001]。VRE 定植还与随后接受机械通气[几率比 = 1.179，95% 置信区间 (1.043，1.334)，p = 0.009]和接受肾脏替代治疗 (RRT) [OR = 1.36 (1.11，1.66)，p = 0.003]有关。

{"title":"Is there an association between colonisation of vancomycin resistant Enterococci, methicillin resistant Staphylococcus Aureus, or Clostridiodes Difficile and mortality in sepsis?","authors":"Matthew JG. Sigakis , Joseph Posluszny , Michael D. Maile , Elizabeth S. Jewell , Milo Engoren","doi":"10.1016/j.infpip.2024.100413","DOIUrl":"10.1016/j.infpip.2024.100413","url":null,"abstract":"<div><h3>Background</h3><div>To determine if colonisation with drug resistant organisms is associated with worse outcomes in patients who subsequently develop sepsis.</div></div><div><h3>Methods</h3><div>Retrospective study of patients with sepsis employing logistic regression and linear regression to determine the independent association of colonisation with adverse outcomes.</div></div><div><h3>Results</h3><div>Mortality was higher in patients colonized with VRE [501 of 1937 (26%) v. 1052 of 5624 (19%) non-VRE colonised patients, difference 7% (95% confidence interval (5,9%), p<0.001] and MRSA [168 of 708 (24%) v 1342 of 6804 (20%) non-MRSA colonised patients, difference 4% (1,7%), p = 0.014]. CDiff colonisation was not associated with increased mortality [153 of 757 (21%) v 762 of 7432 (18%), difference 3% (0,6%), p=0.052]. After multivariable logistic regression, VRE colonisation remained associated with increased hospital mortality [odds ratio = 1.273, 95% confidence interval (1.099, 1.475), p = 0.001]. VRE colonisation was also associated with subsequent receipt of mechanical ventilation [odds ratio = 1.179, 95% confidence interval (1.043, 1.334), p = 0.009] and with receipt of renal replacement therapy (RRT) [OR = 1.36 (1.11, 1.66), p = 0.003].</div></div><div><h3>Conclusions</h3><div>We found that VRE colonisation, but not MRSA or C. diff colonisation, was associated with increased hospital mortality in septic patients.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"6 4","pages":"Article 100413"},"PeriodicalIF":1.8,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142653378","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}

引用次数: 0