Infection Prevention in Practice最新文献_第10页

Re-purposed drive-through vaccination set-up for Mpox, New York Metropolitan Area 纽约大都会区重新设计的免下车麻疹疫苗接种装置

Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2023-11-01 DOI: 10.1016/j.infpip.2023.100316

Marina Keller, Vishnu Chaturvedi, Rebecca Glassman, Donald S. Chen, Marc El-Khoury, Mary Dundas, Nicholas Feola, Varghese Thankachen, Marie Yezzo, Keri Tone, Justin Williams, Renee Garrick

引用次数: 1

Description and results of a new method for assessing real-life performance of a UV-C disinfection robot 一种评估UV-C消毒机器人实际性能的新方法的描述和结果

Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2023-11-01 DOI: 10.1016/j.infpip.2023.100322

Michael Rodgers, Suzan Cremers, Edmée Bowles

Background

Due to the disadvantages of manual disinfection of patient rooms, mobile disinfection robots using ultraviolet C (UV–C) radiation are increasingly being used. Assessing their in situ effectiveness remains challenging.

Aim

This study describes a new method to prove adequate in situ disinfection (≥5-log reduction in bacterial load), and uses this method to assess the efficacy of a mobile disinfection robot using UV-C radiation.

Methods

Agar plates serving as proxies for smooth surfaces in patient rooms were inoculated with bacterial suspension and placed on various surfaces in a patient room. After irradiation by an automated mobile UV-C robot, reduction in colony growth was determined by comparing the irradiated plates to a reference series of non-irradiated plates, enabling the evaluation of whether an adequate reduction in colony-forming units (CFU's) of ≥5-log was reached on these irradiated surfaces.

Findings

The new technique described here proved a successful method for demonstrating an in situ ≥5-log reduction in CFU's for five different bacterial pathogens. Of the 32 plates placed on UV-accessible surfaces, 31 showed an adequate reduction in CFU's of ≥5-log. One plate could not be assessed.

Conclusion

Inoculated agar plates placed in patient rooms before irradiation and subsequently compared to a reference series can be used to assess in situ efficacy of mobile disinfection robots using UV-C radiation. Our findings support the idea that UV-C robots, used adjunctively to conventional manual washing and disinfection, may achieve adequate bacterial load reduction on UV-accessible smooth surfaces in patient rooms for a selected subset of pathogens.

由于人工消毒病房的缺点，使用紫外线C (UV-C)辐射的移动消毒机器人越来越多地被使用。评估它们的原位有效性仍然具有挑战性。目的本研究描述了一种新的方法来证明充分的原位消毒(细菌负荷减少≥5对数)，并利用该方法评估了使用UV-C辐射的移动消毒机器人的效果。方法用细菌悬浮液接种sagar平板，作为病房表面光滑的代表，放置在病房的不同表面上。在自动移动UV-C机器人照射后，通过将辐照板与参考系列未辐照板进行比较来确定菌落生长的减少，从而评估这些辐照表面是否达到了≥5-log的菌落形成单位(CFU)的充分减少。研究结果:本文描述的新技术证明了一种成功的方法，可以证明五种不同细菌病原体的CFU原位降低≥5对数。在放置在紫外线可及表面的32个板中，31个显示CFU的充分降低≥5-log。一个盘子无法评估。结论在照射前将接种过的琼脂平板放置于病房，并与参考系列进行比较，可用于评估移动消毒机器人使用UV-C辐射的原位效果。我们的研究结果支持这样一种观点，即UV-C机器人作为传统人工洗涤和消毒的辅助工具，可以在病房中紫外线可及的光滑表面上达到足够的细菌负荷减少，以清除选定的病原体子集。

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引用次数: 0

Effects of data-driven feedback on nurses' and physicians' hand hygiene in hospitals – a non-resource-intensive intervention in real-life clinical practice 数据驱动反馈对医院护士和医生手部卫生的影响——在现实临床实践中的非资源密集型干预

Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2023-10-31 DOI: 10.1016/j.infpip.2023.100321

Anne-Mette Iversen , Marco Bo Hansen , Svend Ellermann-Eriksen

Background

Hand hygiene (HH) by healthcare workers (HCWs) is one of the most important measures to prevent hospital-acquired infections. However, HCWs struggle to adhere to HH guidelines. We aimed to investigate the effect of a non-resource intensive intervention with group and individual feedback on HCWs HH in a real-life clinical practice during the COVID-19 pandemic.

Methods

In 2021, an 11-month prospective, interventional study was conducted in two inpatient departments at a Danish university hospital. An automated hand hygiene monitoring system (Sani Nudge™) was used to collect data. HH opportunities and alcohol-based hand rub events were measured. Data were provided as HH compliance (HHC) rates. We compared HHC across 1) a baseline period, 2) an intervention period with weekly feedback in groups, followed by 3) an intervention period with weekly individual feedback on emails, and 4) a follow-up period.

Results

We analyzed data from physicians (N=65) and nurses (N=109). In total, 231,022 hygiene opportunities were analyzed. Overall, we observed no significant effect of feedback, regardless of whether it was provided to the group or individuals. We found a trend toward a higher HHC in staff restrooms than in medication rooms and patient rooms. The lowest HHC was found in patient rooms.

Conclusions

The automated hand hygiene monitoring system enabled assessment of the interventions. We found no significant effect of group or individual feedback at the two departments. However, other factors may have influenced the results during the pandemic, such as time constraints, workplace culture, and the degree of leadership support.

卫生保健工作者(HCWs)的手部卫生(HH)是预防医院获得性感染的最重要措施之一。然而，卫生保健工作者很难遵守卫生保健指导方针。我们的目的是在COVID-19大流行期间的现实临床实践中，调查非资源密集型干预与群体和个人反馈对医护人员HH的影响。方法2021年，在丹麦一家大学医院的两个住院部进行了一项为期11个月的前瞻性介入研究。使用自动手卫生监测系统(Sani Nudge™)收集数据。测量HH机会和基于酒精的搓手事件。数据为HH依从性(HHC)率。我们比较了1)基线期，2)干预期每周小组反馈，3)干预期每周个人电子邮件反馈，4)随访期。结果我们分析了来自内科医生(N=65)和护士(N=109)的资料。总共分析了231,022个卫生机会。总的来说，我们观察到反馈没有显著的效果，不管它是提供给群体还是个人。我们发现，员工休息室的HHC含量高于医务室和病房。最低的HHC出现在病房。结论手卫生自动监测系统可对干预措施进行评估。我们发现团体或个人反馈在两个部门没有显著的效果。然而，在大流行期间，其他因素可能影响了结果，例如时间限制、工作场所文化和领导支持程度。

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引用次数: 0

The ongoing challenge of ventilator-associated pneumonia: epidemiology, prevention, and risk factors for mortality in a secondary care hospital intensive care unit 呼吸机相关性肺炎的持续挑战:二级医院重症监护病房的流行病学、预防和死亡危险因素

Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2023-10-31 DOI: 10.1016/j.infpip.2023.100320

Cihan Semet

Background

Ventilator-associated pneumonia (VAP) is a leading cause of morbidity and mortality among intensive care unit infections. Despite various preventive measures, the incidence of VAP remains high.

Aims

This study aimed to explore the epidemiology and risk factors for VAP associated mortality in a secondary care hospital, comparing outcomes before and after implementing a VAP prevention bundle.

Methods

This retrospective study was conducted from July 1, 2021, to June 30, 2023, at a secondary care hospital. Patients over 18 years old who underwent mechanical ventilation for more than 48 hours were included. The study compared the incidence, microbiological etiology, and outcomes of VAP before and after implementing the VAP prevention bundle and analyzed risk factors for mortality from VAP.

Results

A total of 83 patients diagnosed with VAP were included. Despite concerted efforts to implement the VAP prevention bundle, there was no significant decrease in the VAP rate per 1000 ventilator days, early-onset VAP, secondary bloodstream infections, acute respiratory distress syndrome, and 30-day mortality. The microbiological etiology of VAP remained consistent between the two periods. A decrease in lymphocyte count and albumin level were identified as independent risk factors for 30-day mortality.

Conclusions

Concerted efforts to implement a VAP prevention bundle did not significantly reduce the incidence or improve outcomes of VAP in this secondary care hospital setting. The microbiological etiology remained unchanged. Monitoring lymphocyte count and albumin level may help identify patients at high mortality risk. Further research is needed to develop more effective VAP prevention and management strategies.

背景:呼吸机相关性肺炎(VAP)是重症监护病房感染中发病率和死亡率的主要原因。尽管采取了各种预防措施，VAP的发病率仍然很高。目的:本研究旨在探讨二级护理医院VAP相关死亡率的流行病学和危险因素，比较实施VAP预防方案前后的结果。方法回顾性研究于2021年7月1日至2023年6月30日在一家二级护理医院进行。患者年龄超过18岁，机械通气时间超过48小时。该研究比较了实施VAP预防措施前后VAP的发病率、微生物病因学和结局，并分析了VAP死亡的危险因素。结果共纳入83例VAP患者。尽管采取了协调一致的措施来实施VAP预防措施，但每1000个呼吸机日的VAP率、早发性VAP、继发性血流感染、急性呼吸窘迫综合征和30天死亡率没有显著下降。VAP的微生物病因学在两个时期保持一致。淋巴细胞计数和白蛋白水平下降被确定为30天死亡率的独立危险因素。结论:在二级护理医院，实施VAP预防措施并没有显著降低VAP的发生率或改善VAP的预后。微生物病因学保持不变。监测淋巴细胞计数和白蛋白水平可能有助于确定高死亡风险的患者。需要进一步研究以制定更有效的VAP预防和管理策略。

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引用次数: 0

Clinical and microbiological evaluation of ventilator-associated pneumonia in an intensive care unit in Vietnam 越南重症监护病房呼吸机相关肺炎的临床和微生物学评估

Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2023-10-30 DOI: 10.1016/j.infpip.2023.100318

Kayoko Hayakawa , Nguyen Gia Binh , Dao Xuan Co , Pham The Thach , Pham Thi Phuong Thuy , Ngo Quy Chau , Mai Lan Huong , Do Van Thanh , Doan Mai Phuong , Tohru Miyoshi-Akiyama , Maki Nagashima , Norio Ohmagari

Background

The increasing incidence of multidrug-resistant Gram-negative bacteria causing ventilator-associated pneumonia (VAP) is a global concern. A better understanding of the epidemiology of VAP in Southeast Asia is essential to optimise treatments and patient outcomes.

Methods

VAP epidemiology in an intensive care unit in Vietnam was investigated. A prospective cohort study was conducted. Patients who were ventilated for >48 hours, diagnosed with VAP, and had a positive respiratory culture between October 2015 and March 2017 were included. Whole-genome sequencing (WGS) was performed on Acinetobacter baumannii isolates.

Results

We identified 125 patients (137 episodes) with VAP from 1,699 admissions. Twelve patients had 2 VAP episodes. The median age was 60 years (interquartile range: 48–70), and 68.8% of patients were male. Diabetes mellitus was the most frequent comorbidity (N=35, 28%). Acinetobacter baumannii was most frequently isolated in the first VAP episode (N=84, 67.2%) and was multiply resistant to meropenem, levofloxacin, and amikacin. The 30-day mortality rate was 55.2% (N=69) and higher in patients infected with A. baumannii (N=52, 65%). WGS results suggested a complex spread of multiple clones.

Conclusions

In an intensive care unit in Vietnam, VAP due to A. baumannii had a high mortality rate, and A. baumannii and K. pneumoniae were multidrug resistant, with carbapenem resistance of 97% and 70%, respectively.

多药耐药革兰氏阴性菌引起呼吸机相关性肺炎(VAP)的发病率不断上升，这是一个全球关注的问题。更好地了解东南亚VAP的流行病学对于优化治疗和患者预后至关重要。方法对越南某重症监护病房的svap流行病学进行调查。进行了一项前瞻性队列研究。纳入2015年10月至2017年3月期间通气48小时、诊断为VAP且呼吸培养阳性的患者。对鲍曼不动杆菌分离株进行全基因组测序。结果:我们从1,699例入院患者中确定了125例(137次发作)VAP。12例患者有2次VAP发作。中位年龄为60岁(四分位数范围:48 ~ 70岁)，68.8%的患者为男性。糖尿病是最常见的合并症(N=35, 28%)。鲍曼不动杆菌在第一次VAP发作时最常见(N=84, 67.2%)，对美罗培南、左氧氟沙星和阿米卡星多重耐药。感染鲍曼不动杆菌的患者30天死亡率为55.2% (N=69)，而感染鲍曼不动杆菌的患者30天死亡率更高(N=52, 65%)。WGS结果表明，多个无性系存在复杂的传播。结论在越南某重症监护病房，鲍曼不动杆菌引起的VAP死亡率较高，鲍曼不动杆菌和肺炎克雷伯菌均为多药耐药，碳青霉烯类耐药率分别为97%和70%。

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引用次数: 0

Coronavirus disease 2019 (COVID-19) impact on central-line-associated bloodstream infections (CLABSI): a systematic review 2019冠状病毒病（新冠肺炎）对中枢相关血流感染（CLABSI）的影响：一项系统综述。

Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2023-10-13 DOI: 10.1016/j.infpip.2023.100313

Giovanni Satta , Timothy M. Rawson , Luke S.P. Moore

Introduction

Central line-associated bloodstream infections (CLABSI) are an important clinical and public health issue, impacted by the purported increase in healthcare-associated infections (including CLABSI) during the COVID-19 pandemic. This review evaluates the impact of COVID-19 on CLABSI at a global level, to determine risk factors, effective preventive measures and microbiological epidemiology.

Methods

A systematic literature review was performed using a PECO framework, with COVID-19 infection as the exposure measure and CLABSI rates as the main outcome of interest, pre- and during the pandemic.

Results

Overall, most studies (17 of N=21) found a significant increase in CLABSI incidence/rates during the pandemic. Four studies showed a reduction (N=1) or no increase (N=3). High workload, redeployment, and ‘overwhelmed’ healthcare staff were recurrent risk-factor themes, likely to have negatively influenced basic infection control practices, including compliance with hand hygiene and line care bundles. Microbiological epidemiology was also impacted, with an increase in enterococcal infections and other pathogens.

Conclusion

The COVID-19 pandemic significantly impacted CLABSI incidence/rates. Observations from the different studies highlight significant gaps in healthcare associated infections (HCAI) knowledge and practice during the pandemic, and the importance of identifying preventive measures effective in reducing CLABSI, essential to health system resilience for future pandemics. Central to this are changes to CLABSI surveillance, as reporting is not mandatory in many healthcare systems. An audit tool combined with regular assessments of the compliance with infection control measures and line care bundles also remains an essential step in the prevention of CLABSI.

简介：中心线相关血流感染（CLABSI）是一个重要的临床和公共卫生问题，受新冠肺炎大流行期间据称的健康护理相关感染（包括CLABSI在内）增加的影响。本综述评估了新冠肺炎在全球范围内对CLABSI的影响，以确定风险因素、有效的预防措施和微生物流行病学。方法：使用PECO框架进行系统的文献回顾，以新冠肺炎感染为暴露指标，CLBSI率为感兴趣的主要结果，包括大流行前和大流行期间。结果：总体而言，大多数研究（21项研究中有17项）发现，在疫情期间，CLBSI的发病率/发病率显著增加。四项研究显示减少（N=1）或没有增加（N=3）。高工作量、重新部署和医护人员“不堪重负”是反复出现的风险因素主题，可能对基本的感染控制实践产生了负面影响，包括遵守手部卫生和一线护理包。微生物流行病学也受到影响，肠球菌感染和其他病原体增加。结论：新冠肺炎大流行显著影响CLBSI的发病率。不同研究的观察结果突出了疫情期间医疗保健相关感染（HCAI）知识和实践的重大差距，以及确定有效减少CLBSI的预防措施的重要性，这对卫生系统应对未来疫情至关重要。这方面的核心是CLBSI监测的变化，因为在许多医疗保健系统中，报告不是强制性的。审计工具与对感染控制措施和一线护理包合规性的定期评估相结合，仍然是预防CLBSI的重要步骤。

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引用次数: 0

An observational study on carbapenem-resistant Enterobacterales (CRE) colonisation and subsequent risk of infection in an adult intensive care unit (ICU) at a tertiary care hospital in India 一项关于印度一家三级护理医院成人重症监护室（ICU）耐碳青霉烯肠杆菌（CRE）定植和随后感染风险的观察性研究。

Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2023-09-30 DOI: 10.1016/j.infpip.2023.100312

Kirtika Sharma, Vibhor Tak, Vijaya Lakshmi Nag, Pradeep Kumar Bhatia, Nikhil Kothari

Background

Carbapenem-resistant Enterobacterales (CRE) are a global health problem with a growing prevalence. India has a high prevalence of CRE. CRE infections are difficult to treat, and are associated with significant morbidity and mortality. Colonisation is generally a prerequisite for infection and the prevention of CRE colonisation is key to the prevention of CRE infection.

Objectives

To determine the prevalence of CRE colonisation and subsequent infections in an adult intensive care unit (ICU) in India.

Methods

We conducted a prospective observational study in which perirectal swabs were obtained along with relevant clinical details of consenting adult patients upon ICU admission between January 2019 and August 2020. Rectal screening was performed using MacConkey agar plates with ertapenem disks and further identification was performed using conventional microbiological techniques. Ertapenem minimum inhibitory concentration (MIC) was determined using an epsillometer (E) test. The modified carbapenem inactivation (mCIM) test and EDTA carbapenem inactivation test (eCIM) were performed to confirm carbapenem resistance using the Clinical Laboratory Standards Institute (CLSI) 2020 guidelines.

Results

192 ICU patients were screened for CRE. 37 patients were found to be colonised with CRE. Klebsiella pneumoniae (N=25; 67.6%) was the most frequent CRE isolate, followed by Escherichia coli (N=11; 29.7%) and one Enterobacter species (N=1; 2.7%). 89.2% (33/37) patients developed CRE infection. Pneumonia was the most common CRE infection identified in 12/33 (36.4%) patients.during the hospital stay. The median duration of hospital stay was longer (17 days) for CRE colonised compared to CRE non-colonised patients (9 days) (P<0.001). Death occurred in 27 % (N=10/37) of CRE-colonised patients during the hospital admission.

Conclusion

CRE colonisation is associated with high risk of subsequent CRE infection and longer ICU and hospital admission.

背景：碳青霉烯类耐药肠杆菌（CRE）是一个全球性的健康问题，其发病率越来越高。印度CRE的患病率很高。CRE感染很难治疗，并且与显著的发病率和死亡率相关。定植通常是感染的先决条件，预防CRE定植是预防CRE感染的关键。目的：确定印度成人重症监护室（ICU）CRE定植和随后感染的流行率。方法：我们进行了一项前瞻性观察性研究，在该研究中，获得了2019年1月至2020年8月入住ICU时同意的成年患者的直肠周围拭子以及相关临床细节。使用带有厄他培南圆盘的MacConkey琼脂平板进行直肠筛查，并使用常规微生物学技术进行进一步鉴定。使用epsillometer（E）试验测定额尔坦最小抑制浓度（MIC）。使用临床实验室标准研究所（CLSI）2020指南进行改良碳青霉烯失活（mCIM）试验和EDTA碳青霉烯灭活试验（eCIM），以确认碳青霉烯耐药性。结果：对192例ICU患者进行CRE筛查。发现37例患者被CRE定植。肺炎克雷伯菌（N=25；67.6%）是最常见的CRE分离株，其次是大肠杆菌（N=11；29.7%）和一种肠杆菌（N=1；2.7%）。89.2%（33/37）的患者出现CRE感染。在住院期间，肺炎是最常见的CRE感染，在12/33（36.4%）患者中发现。入院期间，CRE定植患者的中位住院时间（17天）比CRE非定植患者（9天）更长（PN=10/37）。结论：CRE定植与随后CRE感染的高风险以及更长的ICU和住院时间有关。

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引用次数: 0

Evaluation of the impact before and after the application of an antimicrobial stewardship program at Dong Thap General Hospital, Vietnam, from 2017 to 2021 2017年至2021年越南Dong Thap总医院应用抗菌药物管理计划前后的影响评估

Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2023-09-23 DOI: 10.1016/j.infpip.2023.100311

Hai-Yen Nguyen-Thi , Tran Viet Bui , Hong-Nguyen Tran-Thi , Anh Dang Minh Le , Bao Dang Gia Nguyen , Hong-Nhung Tran-Thi , Thien Nguyen , Nguyen Dang Tu Le

Background

Vietnam has one of the highest rates of antibiotic resistance in Asia. In 2020, the Vietnam Minister of Health introduced new legislation for the implementation of an antimicrobial stewardship program (ASP). The evidence for the effectiveness of ASP in small hospitals and hospitals located in provinces was limited compared with larger-scale and central city hospitals.

Aim

Evaluation of the impact before and after the introduction of an antimicrobial stewardship program at Dong Thap General Hospital, from 2017 to 2021.

Methods

Retrospective data was collected from June 2017 to June 2021. The impact of the ASP on changes in antibiotic use and the clinical outcome associated with the implementation of the ASP was evaluated using autoregressive integrated moving average modelling of controlled interrupted time-series analysis.

Results

There was a significant and sustained decrease in antibiotic consumption level (step change) in 2 indicators, DOT/1000PD (129.55; P<0.01) and LOT/1000PD (99.95, P<0.01), immediately after the ASP intervention. There were no statistically significant changes identified in terms of consumption with DDD/1000PD, or in the clinical outcomes. The results showed no statistically significant change in consumption trend (ramps) in all evaluated indicators. No statistically significant changes in consumption levels and trends were observed in the control group.

Conclusion

The ASP implemented in Dong Thap General Hospital from 2017 to 2021 showed a considerable influence on antibiotic consumption as indicated by the DOT/1000 PD and LOT/1000 PD during the initial stages. Moreover, controlling antibiotic consumption did not negatively impact patient outcomes.

越南是亚洲抗生素耐药性最高的国家之一。2020年，越南卫生部长提出了实施抗微生物药物管理规划(ASP)的新立法。与大型医院和中心城市医院相比，小型医院和省级医院ASP有效性的证据有限。目的评估2017年至2021年东塔综合医院引入抗菌药物管理方案前后的影响。方法回顾性收集2017年6月至2021年6月的数据。ASP对抗生素使用变化的影响，以及与ASP实施相关的临床结果，采用控制中断时间序列分析的自回归综合移动平均模型进行评估。结果2项指标DOT/1000PD (129.55;P<0.01)和LOT/1000PD (99.95, P<0.01)。在DDD/1000PD的消耗方面，或在临床结果方面，没有统计学上显著的变化。结果显示，所有评价指标的消费趋势(斜坡)没有统计学上的显著变化。在对照组中，消费水平和趋势没有统计学上的显著变化。结论2017 - 2021年实施的ASP对前期DOT/1000 PD和LOT/1000 PD的抗生素用量有较大影响。此外，控制抗生素的使用对患者的预后没有负面影响。

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引用次数: 0

Risk factors of carbapenemase-producing Enterobacterales acquisition among adult intensive care unit patients at a Kentucky Academic Medical Center 肯塔基学术医学中心重症监护病房成人患者中产碳青霉烯酶肠杆菌获得的危险因素

Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2023-09-09 DOI: 10.1016/j.infpip.2023.100310

Jason Eric Wilson , Wayne Sanderson , Philip M. Westgate , Kathleen Winter , Derek Forster

Background

Acquisition of carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) are associated with negative health outcomes. Our adult intensive care unit (ICU) population has experienced low levels of CP-CRE acquisition; however, specific risk factors for this population at our medical facility have not been studied.

Aims

To identify risk factors of CP-CRE acquisition and describe CP-CRE epidemiology among adult ICU patients at our medical facility.

Methods

A retrospective cohort study was performed at a Kentucky Academic Medical Center. Surveillance specimens were collected at admission and weekly thereafter to identify CP-CRE colonization. Clinical data were extracted from patient medical records. Cases were defined as those who tested positive for CP-CRE on ICU admission day 3 or greater. Risk of CP-CRE acquisition was calculated using Modified Poisson regression.

Findings

Independent risk factors of CP-CRE acquisition included administration of enteral tube feeds (risk ratio [RR], 4.46; 95% confidence interval [CI], 1.74–11.43); diagnosis of Clostridioides difficile enterocolitis (RR, 3.51; 95% CI, 1.27–9.68), pressure ulcer (RR, 3.48; 95% CI, 1.91–6.36), and morbid obesity (RR, 2.10; 95% CI, 1.12–3.95); having a drainage tube (RR, 2.63; 95% CI, 1.38–4.98); admission to a medical ICU (RR, 2.39; 95% CI, 1.32–4.35); 90-day use of a carbapenem (RR, 2.27; 95% CI, 1.21–4.26); and dialysis procedure (RR, 2.22; 95% CI, 1.15–4.27).

Conclusion

Most CP-CRE risk factors were associated with alteration of colon microbiota and/or invasive procedures/devices. These results will assist in creating a more targeted CP-CRE active surveillance system and highlight areas for infection prevention intervention.

背景获得产生碳青霉烯酶的碳青霉烯耐药肠杆菌（CP-CRE）与负面健康结果有关。我们的成人重症监护室（ICU）人群经历了低水平的CP-CRE获取；然而，在我们的医疗机构中，这一人群的具体风险因素尚未得到研究。目的确定CP-CRE获得的危险因素，并描述我们医疗机构成年ICU患者的CP-CRE流行病学。方法在肯塔基州学术医学中心进行回顾性队列研究。入院时和入院后每周采集监测标本，以确定CP-CRE定植。临床数据是从患者医疗记录中提取的。病例被定义为在ICU入院第3天或更长时间CP-CRE检测呈阳性的患者。CP-CRE获得的风险使用修正泊松回归进行计算。发现获得CP-CRE的独立风险因素包括给予肠管喂养（风险比[RR]，4.46；95%置信区间[CI]，1.74-11.43）；艰难梭菌性小肠结肠炎的诊断（RR，3.51；95%CI，1.27-9.68）、压疮（RR，3.48；95%可信区间，1.91-6.36）和病态肥胖（RR，2.10；95%置信区间，1.12–3.95）；具有引流管（RR，2.63；95%CI，1.38–4.98）；进入医疗ICU（RR，2.39；95%CI，1.32–4.35）；碳青霉烯类药物使用90天（RR，2.27；95%CI，1.21–4.26）；和透析程序（RR，2.22；95%CI，1.15-4.27）。结论大多数CP-CRE危险因素与结肠微生物群和/或侵入性程序/设备的改变有关。这些结果将有助于建立一个更有针对性的CP-CRE主动监测系统，并突出感染预防干预领域。

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引用次数: 0

Contamination dynamics of personal protective equipment (PPE) by SARS-CoV-2 RNA in a makeshift hospital with COVID-19 positive occupants 某方舱医院SARS-CoV-2 RNA对个人防护装备的污染动态

Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2023-09-09 DOI: 10.1016/j.infpip.2023.100309

Tingting Xia , Shi Shi , Jinyan Yang , Dan Sun , Jijiang Suo , Huihui Kuang , Nana Sun , Hongyan Hu , Jinhan Xiao , Zhongqiang Yan

Background

Personal protective equipment (PPE) helps protect healthcare workers (HCWs) from infection and prevents cross-contamination. Knowledge of the contamination dynamics of PPE during the management of COVID-19 patients in a makeshift hospital is limited.

Aim

To describe the rate of SARS-CoV-2 contamination in PPE and to assess the change of contamination at different time points.

Methods

HCWs were followed up for up to 4 hours with hourly collection of swab samples from PPE surfaces in a makeshift COVID-19 hospital setting. Swabs were tested using quantitative reverse transcription polymerase chain reaction (RT-qPCR) for SARS-CoV-2 RNA.

Results

SARS-CoV-2 was detected on 50.9% of the 1620 swabbed samples from 9 different sites of full-body PPE worn by HCWs. The proportion of sites contaminated with SARS-CoV-2 RNA varied from 10.6% to 95.6%. Viral RNA was most frequently detected from the sole of the outer foot cover (95.6%) and least frequently on the face shield (10.6%). The median Ct values among positive samples were 34.20 (IQR, 32.61–35.22) and 34.05 (IQR, 32.20–35.39) for ORF1ab and N genes, respectively. The highest rate of contamination with SARS-CoV-2 RNA for the PPE swab samples was found after 3 hours of use. The positive rate of outer surface of HEPA filters from air supply device was 82.1% during the full capacity period of the makeshift hospital.

Conclusion

A higher rate of contamination was identified at 3 hours after the entrance to the COVID-19 patient care area. Virus-containing aerosols were trapped in the HEPA filter of air supply equipment, representing a potential protective factor against infection to HCWs.

背景个人防护装备（PPE）有助于保护医护人员免受感染并防止交叉污染。在临时医院管理新冠肺炎患者期间，对PPE污染动态的了解有限。目的描述严重急性呼吸系统综合征冠状病毒2型在个人防护装备中的污染率，并评估不同时间点的污染变化。方法对HCW进行长达4小时的随访，每小时从新冠肺炎临时医院的PPE表面采集拭子样本。使用定量逆转录聚合酶链式反应（RT-qPCR）检测拭子中的严重急性呼吸系统综合征冠状病毒2型RNA。结果，在来自医务人员穿戴的全身PPE 9个不同部位的1620份拭子样本中，50.9%的样本检测到严重急性呼吸系统冠状病毒2型。被严重急性呼吸系统综合征冠状病毒2型核糖核酸污染的部位比例从10.6%到95.6%不等。病毒核糖核酸最常见于外脚蹬（95.6%），最不常见于面罩（10.6%）。ORF1ab和N基因的阳性样本Ct中值分别为34.20（IQR，32.61-35.22）和34.05（IQR），32.20-35.39。PPE拭子样本的严重急性呼吸系统综合征冠状病毒2型核糖核酸污染率最高的是在使用3小时后。在临时医院满负荷运转期间，来自供气装置的高效空气过滤器外表面的阳性率为82.1%。结论进入新冠肺炎患者护理区后3小时发现较高的污染率。含有病毒的气溶胶被困在空气供应设备的高效空气过滤器中，这是一个潜在的保护因素，可以防止感染HCW。

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