Infection Prevention in Practice最新文献

Clean Hospitals Day 2025: The human factors of healthcare environmental hygiene 2025年清洁医院日：医疗环境卫生的人为因素

IF 1.9 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2025-12-01 DOI: 10.1016/j.infpip.2025.100486

Alexandra Peters , Martina Mocenic , Pierre Parneix , Brett G. Mitchell , Stephanie Dancer , David J. Weber

引用次数: 0

Diagnostic accuracy of point-of-care testing methods for SARS-CoV-2 detection in community quarantine and isolation settings 社区检疫和隔离环境中SARS-CoV-2检测的护理点检测方法诊断准确性

IF 1.9 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2025-11-17 DOI: 10.1016/j.infpip.2025.100496

Simon Ching Lam , Jing Jing Su , Shun Wa Tsang , Anna On Na Wong , Vivian Ching Man Pang , Jessie Yuk Seng Chung , Shun Chan , Rick Yiu Cho Kwan , Lorna Kwai Ping Suen

Reverse transcriptase polymerase chain reaction (RT-PCR) testing has been regarded as the gold standard for the diagnosis of coronavirus disease 2019 (COVID-19). In response to the sudden surge in cases that overwhelmed the healthcare system in Hong Kong, several point-of-care testing (POCT) methods have been developed for rapid COVID-19 screening. However, the diagnostic accuracy of these methods remains inadequately established.

COVID-19–positive patients and negative control subjects were recruited from a community isolation centre and individuals under home quarantine. Four nasal swab samples were collected by trained operators from each subject. Three swab samples were immediately tested using conventional COVID-19 rapid antigen test (RAT), fluorescence-based RAT (Fluorescent-RAT) and POCT quantitative polymerase chain reaction (qPCR). The fourth swab sample was submitted to a certified laboratory for standard RT-PCR analysis. The sensitivity and specificity of the three rapid testing methods were evaluated against the results obtained from the certified laboratory-based RT-PCR, which served as the reference standard.

The performance of the three diagnostic methods was assessed in 186 valid cases, which comprised 86 RT-PCR–confirmed positive cases and 100 negative cases. The participants' age ranged from 3 years to 94 years. The sensitivity of the Fluorescent-RAT (87.21%, 95% confidence interval [CI]:80.15%–94.27%) and the POCT qPCR (84.27%, 95% CI:76.71%–91.83%) was comparable and significantly higher than that of the conventional RAT (51.69%, 95% CI:41.30%–62.07%). All three methods demonstrated high specificity. The RAT and POCT qPCR exhibited 100% specificity (95% CI:100%), and the Fluorescent-RAT showed a specificity of 97.06% (95% CI:93.78%–100%).

This study demonstrated that the Fluorescent-RAT and POCT qPCR can serve as reliable alternatives to RT-PCR for COVID-19 diagnosis, offering improved performance compared with the conventional RAT.

逆转录聚合酶链反应（RT-PCR）检测被认为是诊断2019冠状病毒病（COVID-19）的金标准。为了应对突然激增的病例，使香港的医疗系统不堪重负，香港开发了几种即时检测（POCT）方法，用于快速筛查COVID-19。然而，这些方法的诊断准确性仍然不充分确定。从社区隔离中心招募covid -19阳性患者和阴性对照组以及居家隔离个体。由训练有素的操作人员从每个受试者中收集四份鼻拭子样本。采用常规的COVID-19快速抗原检测（RAT）、荧光检测（fluorescence- RAT）和POCT定量聚合酶链反应（qPCR）对3份拭子样本进行检测。第四个拭子样本被提交到认证实验室进行标准RT-PCR分析。将3种快速检测方法的灵敏度和特异性与作为参比标准的实验室RT-PCR检测结果进行比较。对186例有效病例进行了三种诊断方法的性能评估，其中86例rt - pcr确诊阳性，100例阴性。参与者的年龄从3岁到94岁不等。荧光-RAT（87.21%， 95%可信区间[CI]:80.15% ~ 94.27%）和POCT qPCR （84.27%, 95% CI:76.71% ~ 91.83%）的敏感性相当，且显著高于常规RAT （51.69%, 95% CI:41.30% ~ 62.07%）。三种方法均具有较高的特异性。RAT和POCT qPCR的特异性为100% (95% CI:100%)， fluorescence -RAT的特异性为97.06% （95% CI: 93.78%-100%）。本研究表明，荧光鼠和POCT qPCR可作为RT-PCR诊断COVID-19的可靠替代品，与传统的RAT相比，性能有所提高。

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引用次数: 0

Blood exposure accidents and associated risk factors among dental students in Rabat, Morocco: A cross-sectional study 血液暴露事故和相关的危险因素在牙科学生在拉巴特，摩洛哥：一项横断面研究

IF 1.9 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2025-11-13 DOI: 10.1016/j.infpip.2025.100498

L. Amminou, H. Soualem, S. Boukssim, S. Chbicheb

Objective

Blood exposure accidents (BEAs) are a major occupational hazard for dental students. Limited data exist on their prevalence and risk factors in Morocco.

Methods

A cross-sectional survey was conducted among 236 clinical-year dental students (4th–6th year) at the Faculty of Dental Medicine, Rabat. A structured, self-administered questionnaire assessed demographics, BEA history, and clinical practices. Chi-square tests and multivariable logistic regression identified independent risk factors.

Results

45.3% of participants reported at least one BEA, primarily from sharp instrument injuries (55.1%) or splashes onto mucous membranes (25.2%). Multivariate analysis showed that male gender was independently associated with higher risk (∼3.3×), with female students having lower odds of BEA (OR = 0.3, 95% CI: 0.18–0.86). Advanced academic year significantly increased risk (5th year: OR = 2.7, 95% CI: 1.2–6.2; 6th year: OR = 7.0, 95% CI: 3.1–15.3), while absence of procedural assistance also increased risk (OR = 0.1, 95% CI: 0.05–0.43 for assisted vs. non-assisted). Needle recapping practices showed no significant association.

Conclusion

BEAs are frequent among Moroccan dental students in Rabat, particularly in senior years and when procedures are unassisted. Targeted infection-control education, structured supervision, and national guidelines are needed to reduce occupational risks.

Trial registration

CERB 122-24.

目的血液暴露事故是牙科学生的主要职业危害。关于其在摩洛哥的流行情况和危险因素的数据有限。方法对拉巴特口腔医学院临床年级（4 ~ 6年级）236名学生进行横断面调查。一份结构化的、自我管理的问卷评估了人口统计学、BEA史和临床实践。结果45.3%的参与者报告至少有一次BEA，主要是锐器伤（55.1%）或溅到粘膜（25.2%）。多因素分析显示，男性与较高的BEA风险独立相关（~ 3.3×），而女性学生的BEA风险较低（OR = 0.3, 95% CI: 0.18-0.86）。高学年显著增加了风险（第5年：OR = 2.7, 95% CI: 1.2-6.2；第6年：OR = 7.0, 95% CI: 3.1-15.3），而缺乏程序性辅助也增加了风险（辅助与非辅助的OR = 0.1, 95% CI: 0.05-0.43）。缝针复盖没有明显的相关性。结论beas在拉巴特的摩洛哥牙科学生中很常见，特别是在高年级和无辅助手术时。需要有针对性的感染控制教育、有组织的监督和国家指南来降低职业风险。试验注册cerb 122-24。

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引用次数: 0

Comparison of bacterial contamination between disposable and cloth caps in an operating theatre setting 手术室一次性帽与布帽细菌污染比较

IF 1.9 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2025-11-08 DOI: 10.1016/j.infpip.2025.100497

S. Kenny , K. Kuan , A. Walsh , S.F. FitzGerald

引用次数: 0

Determinants of hand hygiene compliance among healthcare workers in public and private hospitals of Addis Ababa, Ethiopia 埃塞俄比亚亚的斯亚贝巴公立和私立医院医护人员手部卫生依从性的决定因素

IF 1.9 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2025-11-05 DOI: 10.1016/j.infpip.2025.100488

A. Melaku , T. Admasu , A. Ambelu

Introduction

Hand hygiene is crucial for preventing hospital-acquired infections (HAIs), but compliance and resource availability still fall short in developing countries. This study examined hand hygiene compliance and its determinants among healthcare workers in selected hospitals in Addis Ababa, Ethiopia.

Methods

A mixed-methods, cross-sectional study was conducted in both public and private hospitals from December 2024 to January 2025, involving 506 healthcare workers across 19 hospitals. Twenty in-depth interviews were conducted with healthcare workers. Kobo Toolbox was used for quantitative data collection, and SPSS was used for analysis. Binary and multi-nomial logistic regression identified determinants of hand hygiene compliance (P<0.05). Thematic analysis was used to analyse qualitative data.

Results

Hand hygiene compliance showed a disparity: self-reported compliance was 71% (54.7% in public hospitals vs 87.3% in private hospitals), while observed compliance was much lower at 20.4% (11% public vs 29.8% private). Infrastructural assessment found that 79.2% of hospitals had handwashing sinks (70.9% public vs 98.6% private), 16% of which were non-functional (24.7% public vs 1.3% private). Additionally, 49.4% of hospitals lacked running water (66.8% public vs 8.6% private), and 54.6% lacked soap (79.5% public vs 9.8% private). Compliance was significantly associated with availability of a functional sink [adjusted odds ratio (AOR) 2.29, 95% confidence interval (CI) 1.17–4.51], touch-free taps (AOR 3.39, 95% CI 1.6–7.17), soap (AOR 2.11, 95% CI 1.05–4.25), training (AOR 2.39, 95% CI 1.43–4.00), and a hand hygiene protocol (AOR 7.50, 95% CI 2.84–19.81). The main barriers to compliance were infrastructural deficits, glove dependency, low risk perception, and insufficient institutional prioritization.

Conclusion

Hand hygiene compliance and material provision in hospitals in Addis Ababa are low, with a notable disparity between public and private hospitals. As the presence of infrastructure alone does not ensure compliance, the availability of a functional sink with water and soap at the point of care (or alcohol-based hand rub), regular hygiene training, adequate WASH funding, and strong institutional commitment are essential.

手部卫生对于预防医院获得性感染至关重要，但在发展中国家，遵守卫生要求和资源供应仍然不足。本研究考察了埃塞俄比亚亚的斯亚贝巴选定医院的卫生保健工作者的手卫生依从性及其决定因素。方法采用混合方法，于2024年12月至2025年1月在公立和私立医院进行横断面研究，涉及19家医院的506名医护人员。对医护人员进行了20次深度访谈。采用Kobo Toolbox进行定量数据收集，采用SPSS进行分析。二元和多元逻辑回归确定了手卫生依从性的决定因素（P<0.05）。采用专题分析对定性数据进行分析。结果口腔卫生依从性存在差异：自我报告的依从性为71%（公立医院为54.7%，私立医院为87.3%），而观察到的依从性为20.4%（公立医院为11%，私立医院为29.8%）。基础设施评估发现，79.2%的医院有洗手槽（70.9%的公立医院对98.6%的私立医院），其中16%的医院没有功能（24.7%的公立医院对1.3%的私立医院）。此外，49.4%的医院没有自来水（66.8%的公立医院比8.6%的私立医院），54.6%的医院没有肥皂（79.5%的公立医院比9.8%的私立医院）。依从性与功能水槽的可用性显著相关[调整优势比（AOR） 2.29, 95%可信区间（CI） 1.17-4.51]、免触水龙头（AOR 3.39, 95% CI 1.6-7.17）、肥皂（AOR 2.11, 95% CI 1.05-4.25）、训练（AOR 2.39, 95% CI 1.43-4.00）和手卫生方案（AOR 7.50, 95% CI 2.84-19.81）。合规的主要障碍是基础设施缺陷、手套依赖、低风险认知和机构优先级不足。结论亚的斯亚贝巴市医院的手卫生依从性和用品供应较低，公立医院与私立医院之间存在显著差异。由于仅有基础设施并不能确保遵守规定，因此必须在护理点提供带水和肥皂（或含酒精的洗手液）的功能性洗涤槽、定期的卫生培训、充足的讲卫生资金以及强有力的机构承诺。

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引用次数: 0

Evaluation of hand hygiene implementation in hospitals in the post-war Tigray region of Ethiopia, using the WHO Hand Hygiene Self-Assessment Framework 使用世卫组织手卫生自我评估框架，评价战后埃塞俄比亚提格雷地区医院的手卫生实施情况

IF 1.9 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2025-10-31 DOI: 10.1016/j.infpip.2025.100490

Akeza Awealom Asgedom , Bente Elisabeth Moen , Ana Lorena Ruano

Background

Healthcare-associated infections are a major cause of morbidity and mortality among health personnel worldwide. The World Health Organization's (WHO) multi-modal hand hygiene tool has shown inadequate hand hygiene levels in various sub-Saharan countries. We have applied it here to describe the hand hygiene level in public health facilities in Tigray, Ethiopia.

Methods

A cross-sectional study was conducted from June to July 2024 in all accessible public health facilities. An interview-based WHO hand hygiene self-assessment framework (HHSAF) tool was used for data collection. Descriptive analyses and independent t-test were used to analyse data.

Results

A total of 33 facilities (two referral, 10 general, and 21 primary hospitals) from six accessible zones of Tigray participated in the survey. The mean age of the respondents was 35 years (SD: 8) with a mean service duration of nine years (SD: 7). Most respondents were infection prevention and control (IPC) focal persons (66.7%), followed by chief executive officers (9.1%). The overall HHSAF score was 126 (range: 15–318), indicating a basic hand hygiene level. Seventeen facilities (51.5%) had inadequate hand hygiene levels, 13 (39.4%) had basic hand hygiene level, three (9.1%) had an intermediate hand hygiene level, and none had an advanced hand hygiene level.

Conclusions

Hand hygiene levels were unsatisfactory in post-war Tigray and were limited across all zones and types of facility, posing an increased risk of infection for healthcare personnel. Improvements in hand hygiene practices and IPC capacity building are essential to prevent healthcare-associated infections. Longitudinal research on hand hygiene level monitoring is recommended.

背景：卫生保健相关感染是全世界卫生人员发病和死亡的主要原因。世界卫生组织（世卫组织）的多模式手卫生工具显示，撒哈拉以南非洲各国的手卫生水平不足。我们在这里应用它来描述埃塞俄比亚提格雷公共卫生设施的手部卫生水平。方法采用横断面研究方法，于2024年6 - 7月在所有可达的公共卫生机构进行调查。采用基于访谈的世卫组织手卫生自我评估框架（HHSAF）工具收集数据。采用描述性分析和独立t检验对数据进行分析。结果来自提格雷6个可通达区的33家医院（2家转诊医院、10家综合医院和21家基层医院）参与了调查。受访者的平均年龄为35岁（SD: 8），平均服务时间为9年（SD: 7）。受访者中感染预防和控制（IPC）联络人最多（66.7%），其次是首席执行官（9.1%）。总体HHSAF得分为126（范围：15-318），表示基本的手卫生水平。手卫生不达标17家（51.5%），基本手卫生13家（39.4%），中级手卫生3家（9.1%），高级手卫生0家。结论提格雷战后卫生水平不理想，所有区域和设施类型的卫生水平有限，增加了卫生保健人员的感染风险。改善手部卫生习惯和IPC能力建设对于预防卫生保健相关感染至关重要。建议对手卫生水平监测进行纵向研究。

{"title":"Evaluation of hand hygiene implementation in hospitals in the post-war Tigray region of Ethiopia, using the WHO Hand Hygiene Self-Assessment Framework","authors":"Akeza Awealom Asgedom , Bente Elisabeth Moen , Ana Lorena Ruano","doi":"10.1016/j.infpip.2025.100490","DOIUrl":"10.1016/j.infpip.2025.100490","url":null,"abstract":"<div><h3>Background</h3><div>Healthcare-associated infections are a major cause of morbidity and mortality among health personnel worldwide. The World Health Organization's (WHO) multi-modal hand hygiene tool has shown inadequate hand hygiene levels in various sub-Saharan countries. We have applied it here to describe the hand hygiene level in public health facilities in Tigray, Ethiopia.</div></div><div><h3>Methods</h3><div>A cross-sectional study was conducted from June to July 2024 in all accessible public health facilities. An interview-based WHO hand hygiene self-assessment framework (HHSAF) tool was used for data collection. Descriptive analyses and independent <em>t</em>-test were used to analyse data.</div></div><div><h3>Results</h3><div>A total of 33 facilities (two referral, 10 general, and 21 primary hospitals) from six accessible zones of Tigray participated in the survey. The mean age of the respondents was 35 years (SD: 8) with a mean service duration of nine years (SD: 7). Most respondents were infection prevention and control (IPC) focal persons (66.7%), followed by chief executive officers (9.1%). The overall HHSAF score was 126 (range: 15–318), indicating a basic hand hygiene level. Seventeen facilities (51.5%) had inadequate hand hygiene levels, 13 (39.4%) had basic hand hygiene level, three (9.1%) had an intermediate hand hygiene level, and none had an advanced hand hygiene level.</div></div><div><h3>Conclusions</h3><div>Hand hygiene levels were unsatisfactory in post-war Tigray and were limited across all zones and types of facility, posing an increased risk of infection for healthcare personnel. Improvements in hand hygiene practices and IPC capacity building are essential to prevent healthcare-associated infections. Longitudinal research on hand hygiene level monitoring is recommended.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 4","pages":"Article 100490"},"PeriodicalIF":1.9,"publicationDate":"2025-10-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"145568215","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}

引用次数: 0

Impact of a nudge-based intervention on hand soap usage in a Japanese Hospital: interrupted time series analysis 日本一家医院轻推干预对洗手液使用的影响：中断时间序列分析

IF 1.9 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2025-10-27 DOI: 10.1016/j.infpip.2025.100494

Tetsuji Morishita , Masayoshi Monji , Masao Kuwabara , Shin Lee , Makoto Hayashi , Hisashi Tsurumi , Hidetoshi Matsunami

Background

This study aimed to evaluate the effectiveness of nudge-based messages on hand soap usage in a Japanese hospital setting.

Methods

Interrupted time series analysis was conducted using monthly hand soap usage data from April 2022 to March 2024. The following nudge messages were placed in restrooms: “Are your neighbors washing their hands with soap?” (men) and “Water does not disinfect; soap works!” (women). A generalized least squares model with harmonic terms was used to analyze the data, accounting for seasonality and autocorrelation.

Results

The intervention was associated with an immediate increase of 147.85 units/month in hand soap usage (95% confidence interval [CI]: 61.87–233.83; P = 0.003). However, usage gradually decreased by 11.47 units/month thereafter (95% CI: –27.10 to 4.15; P = 0.166). Sensitivity analysis using Poisson regression confirmed the robustness of these findings. The intervention was associated with a 38.5% increase in hand soap usage (incidence rate ratio [IRR] = 1.385, 95% CI: 1.265–1.515, P < 0.001), but there was a subsequent 1.9% monthly decrease (IRR = 0.981, 95% CI: 0.965–0.997, P = 0.019).

Conclusions

These findings suggest that nudge-based interventions can be effective in promoting hand hygiene in Japanese health-care settings, but the effect may wane over time.

本研究旨在评估日本医院环境中轻推信息对洗手液使用的有效性。方法对2022年4月至2024年3月每月洗手液使用数据进行中断时间序列分析。洗手间里贴着这样的提示信息：“你的邻居用肥皂洗手吗？”（男人）和“水不消毒；soap工作!”(女性)。采用调和项广义最小二乘模型对数据进行分析，考虑了季节性和自相关性。结果干预与立即增加147.85单位/月的洗手液使用量相关（95%可信区间[CI]: 61.87-233.83; P = 0.003）。然而，此后使用量逐渐减少11.47个单位/月（95% CI: -27.10至4.15;P = 0.166）。使用泊松回归的敏感性分析证实了这些发现的稳健性。干预与洗手液使用率增加38.5%相关（发病率比[IRR] = 1.385, 95% CI: 1.265-1.515, P < 0.001），但随后每月下降1.9% （IRR = 0.981, 95% CI: 0.965-0.997, P = 0.019）。这些发现表明，在日本卫生保健机构中，以轻推为基础的干预措施可以有效地促进手卫生，但效果可能会随着时间的推移而减弱。

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引用次数: 0

Implementation of a peripheral intravenous catheter bundle to reduce phlebitis and hospital-onset Staphylococcus aureus bacteremia: A quality improvement project 实施外周静脉导管束以减少静脉炎和院内发生的金黄色葡萄球菌菌血症：一项质量改进项目

IF 1.9 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2025-10-27 DOI: 10.1016/j.infpip.2025.100495

Jie Li , Maria Theresa Cabahug , Tuodi Wu , Hairu Chai , Rongyan An , Nicole Shu Ning Teoh , Liang Fang Yu , Zaleha binte Alias , Shi Yun Foo , Suhailah binte Nasir , Wenyi Seow , Philomena Liew , Thean Yen Tan

Background

Peripheral intravenous catheters (PIVCs) are widely used in hospitals and account for up to one-third of hospital-onset Staphylococcus aureus bacteremia (HO-SAB) cases.

Local Problem

In response to increasing HO-SAB, a quality improvement initiative was launched to reduce PIVC-related phlebitis and HO-SAB.

Methods

An evidence-based bundle for peripheral intravenous catheter (PIVC) insertion and care was developed, focusing on four key components: hand hygiene, aseptic technique during insertion, daily monitoring and timely removal of PIVCs, and optimization of maintenance care. The bundle was piloted in two wards using the Model for Improvement, which led to a reduction in phlebitis rates. The same PIVC bundle was subsequently implemented in a phased manner across the hospital, with the implementation process guided by Kotter's 8-step model of change to ensure effective and sustainable adoption.

Interventions

Interventions involved staff education, daily PIVC checks, process and outcome monitoring with feedback, ongoing ward engagement, and hospital-wide awareness campaigns. Key implementation measures included bundle compliance, phlebitis rates, and PIVC-related HO-SAB.

Results

Phlebitis rates in pilot wards declined from 7% to 1–2%, with comparable reductions observed after hospital-wide implementation. PIVC-related HO-SAB rates decreased from 0.61 (pre-implementation) to 0.26 episodes per 10,000 patient-days.

Conclusions

Overall, the structured care bundle significantly reduced phlebitis and was associated with lower PIVC-related HO-SAB rates.

外周静脉导管（pivc）在医院广泛使用，占医院发病金黄色葡萄球菌菌血症（HO-SAB）病例的三分之一。当地问题为应对越来越多的HO-SAB，开展了一项质量改进倡议，以减少pivc相关的静脉炎和HO-SAB。方法以手卫生、置管过程中的无菌技术、静脉导管的日常监测和及时拔出、维持护理的优化为重点，构建静脉导管置入与护理循证指南。使用改进模式在两个病房进行了捆绑试验，从而降低了静脉炎的发生率。随后在整个医院分阶段实施了相同的PIVC捆绑包，实施过程由Kotter的8步变化模型指导，以确保有效和可持续的采用。干预措施包括员工教育、每日PIVC检查、过程和结果的反馈监测、持续的病房参与以及全医院的意识宣传活动。关键实施措施包括束依从性、静脉炎率和与pivc相关的HO-SAB。结果试点病房的静脉炎率从7%下降到1-2%，在全院范围内实施后也有类似的下降。pivc相关的HO-SAB发生率从0.61例（实施前）降至0.26例/ 10,000患者日。结论：总体而言，结构化护理包显著减少了静脉炎，并与较低的pivc相关HO-SAB发生率相关。

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引用次数: 0

Carbapenem-Resistant Klebsiella pneumoniae outbreak in the Intensive Care Unit of a cancer centre 耐碳青霉烯肺炎克雷伯菌在癌症中心重症监护病房爆发

IF 1.9 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2025-10-21 DOI: 10.1016/j.infpip.2025.100493

Yuying Pang , Yan Hu , Jiaoyang Zhu , Zhaoxia Liu , Youquan Zhou , Xiumei Yang , Yifan Peng , Min Zhao

Background

We describe an outbreak of carbapenem-resistant Klebsiella pneumoniae (CRKP) nosocomial infection in the intensive care unit (ICU) of a cancer hospital. We evaluate the containment measures implemented and provide evidence-based recommendations for improving CRKP infection prevention and control strategies.

Methods

Between June and July 2023, a comprehensive epidemiological investigation was conducted, including environmental hygiene surveillance and targeted infection control interventions. These measures focused on patients with CRKP nosocomial infections in the ICU, and their effectiveness was systematically evaluated.

Results

A total of 22 CRKP strains were identified in 14 patients(including one transferred from another hospital), with 13 nosocomial infections. Five patients had infections at multiple sites. The nosocomial infection rate was 8.1%, representing a statistically significant increase compared to the same period in previous years. Environmental surveillance detected CRKP contamination on the hands of two doctors (8.7% detection rate) and on various surfaces (8% detection rate), particularly shared equipment, bed unit surfaces, and sanitary ware. Following the implementation of control measures, the spread was effectively contained.

Conclusions

Key factors contributing to transmission likely included delayed identification of infected patients, inadequate enforcement of isolation protocols, and suboptimal environmental cleaning and disinfection. Early detection, strict isolation measures, and thorough environmental cleaning are essential for effective prevention and control of CRKP in the ICU setting.

背景：我们描述了一家癌症医院重症监护病房（ICU）爆发的碳青霉烯耐药肺炎克雷伯菌（CRKP）医院感染。我们对实施的遏制措施进行评估，并为改进CRKP感染预防和控制策略提供循证建议。方法于2023年6 - 7月开展流行病学调查，包括环境卫生监测和有针对性的感染控制措施。这些措施主要针对ICU的CRKP医院感染患者，并对其有效性进行系统评价。结果14例患者（包括1例外院转诊患者）共检出22株CRKP，院内感染13例。5名患者有多处感染。医院感染率为8.1%，与往年同期相比有显著上升。环境监测在两名医生的手上（检出率为8.7%）和各种表面（检出率为8%），特别是共用设备、床单位表面和卫生洁具上检测到CRKP污染。实施防控措施后，疫情传播得到有效遏制。结论导致传播的关键因素可能包括感染患者的识别延迟、隔离方案的执行不力以及环境清洁和消毒不理想。在ICU环境中，早期发现、严格隔离措施和彻底的环境清洁是有效预防和控制CRKP的必要条件。

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引用次数: 0

Retrospective cohort study of Gram-negative bacteraemia shows transmission of hypervirulent Klebsiella pneumoniae in a UK Intensive Care Unit during the Covid-19 pandemic 革兰氏阴性菌血症的回顾性队列研究显示，在Covid-19大流行期间，英国重症监护病房中出现了高致病性肺炎克雷伯菌的传播

IF 1.9 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2025-10-20 DOI: 10.1016/j.infpip.2025.100492

Rachel Bousfield , Ruth Kappeler , Sumita Pai , Olly Allen , Kathy Randall , Jacqueline Keane , Stephen Baker

Background

The National incidence of bloodstream infection (BSI) caused by Klebsiella Pneumoniae increased during the Covid-19 pandemic in the United Kingdom, whilst we observed an increase in BSI caused by Gram-negative bacteria in our adult Intensive Care Unit (ICU).

Methods

We audited all Gram-negative bacterial BSIs between 13^th April 2020 and 25^th December 2021 in our ICU. In total, 41 organisms underwent antimicrobial susceptibility testing and genome sequencing. Notable organisms isolated included 16 Klebsiella spp., 4 E. coli, and 4 Pseudomonas spp.

Results

Overall, we observed a low prevalence of multi-drug resistant (MDR) organisms causing BSI on our unit. A fifth (4/20) of E. coli and Klebsiella spp. isolates carried ESBL or AmpC genes and a single P. monteilli carried the IMP-1 gene. At least 3/16 (19%) BSI with Klebsiella spp. were likely associated with transmission between patients in nearby beds. These transmission events were associated with two hypervirulent K. pneumoniae (ST412 and ST86) and a K. aerogenes ∗002b. Half of all K. pneumoniae associated with BSI were hypervirulent, having K2 or K57 capsule type and the presence of iuc, iro, Rmp genes.

Discussion

Hypervirulent K. pneumoniae is an emerging problem, capable of causing a severe, disseminated infection. We suggest risk factors for transmission may include shared equipment, environmental and PPE contamination, and failure of effective hand hygiene. With COVID-19 infection endemic, if SARS-CoV-2 patients require cohort nursing in bays with sessional use gowns, we recommend these are short-sleeved, to facilitate effective hand hygiene. We argue strict Infection Control policy, including enhanced cleaning, is critical to reduce transmission of hypervirulent K. pneumoniae and advocate for enhanced national surveillance systems.

背景：在英国Covid-19大流行期间，由肺炎克雷伯菌引起的全国血液感染（BSI）发生率增加，同时我们观察到成人重症监护病房（ICU）由革兰氏阴性菌引起的BSI发生率增加。方法对2020年4月13日至2021年12月25日ICU中所有革兰氏阴性细菌性脑损伤患者进行审计。共有41种微生物进行了抗菌药敏试验和基因组测序。检出的主要病原菌包括16株克雷伯氏菌、4株大肠杆菌和4株假单胞菌。结果总体而言，我们观察到引起BSI的多重耐药（MDR）病原菌的发生率较低。1 / 5（4/20）的大肠杆菌和克雷伯氏菌分离株携带ESBL或AmpC基因，1株蒙氏杆菌携带IMP-1基因。至少3/16（19%）感染克雷伯氏菌的BSI可能与附近病床患者之间的传播有关。这些传播事件与两种高毒力肺炎克雷伯菌（ST412和ST86）和一种产气克雷伯菌∗002b有关。与BSI相关的所有肺炎克雷伯菌中有一半是高毒力的，具有K2或K57胶囊型，并且存在iuc， iro， Rmp基因。高毒力肺炎克雷伯菌是一个新出现的问题，能够引起严重的播散性感染。我们建议传播的风险因素可能包括共用设备、环境和个人防护用品污染以及没有有效的手部卫生。在COVID-19流行感染的情况下，如果SARS-CoV-2患者需要在穿罩衣的隔间里进行队列护理，我们建议穿短袖罩衣，以促进有效的手部卫生。我们认为严格的感染控制政策，包括加强清洁，对于减少高毒力肺炎克雷伯菌的传播至关重要，并主张加强国家监测系统。

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