Infection Prevention in Practice最新文献_第3页

Bacterial burden and drug-resistant bacteria in healthcare workers' mobile phones: a study in Puerto Rican outpatient clinics 卫生保健工作者移动电话中的细菌负担和耐药细菌：波多黎各门诊诊所的一项研究。

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2024-12-12 DOI: 10.1016/j.infpip.2024.100432

R. Scharbaai–Vázquez, A.N. García–Aponte, C. Huertas–Ayala, E.Y. Martínez–Monegro, G.M. Guadalupe–Ríos, J. Díaz–Portorreal, M.I. González–Torres, N.M. Fernández

Background

Mobile phones used by healthcare workers (HCWs) in hospitals are significant reservoirs of drug-resistant bacteria responsible for hospital-acquired infections (HAIs).

Aim

The objective of this study was to assess the level of contamination with such bacteria in outpatient clinics.

Methods

Swabs from 83 HCWs' mobile phones were processed using standard biochemical and enzymatic procedures to identify pathogenic bacteria. β-Lactamase tests, antimicrobial susceptibility tests, screening for extended-spectrum β-lactamase (ESBL), and carbapenemase production were performed according to CLSI guidelines. Molecular detection of multi-drug-resistant genes (mecA in Staphylococcus aureus and kpc/ndm carbapenemases in Klebsiella pneumoniae and Acinetobacter spp.) was performed using multiplex real-time polymerase chain reaction.

Findings

The overall prevalence of mobile phone contamination with one or more bacteria was 100%. A total of 51 Gram-positive and 44 Gram-negative isolates, including 20 coagulase-negative staphylococci (CoNS), 20 S. aureus (0 meticillin-resistant S. aureus), 11 Acinetobacter spp. and 10 K. pneumoniae were isolated. β-Lactamase production was detected in 45% of CoNS and 30% of S. aureus. Panton–Valentine Leukocidin (PVL) toxin gene in S. aureus was found in 20% (4/20) of the isolates. Twenty (20%) and 13% of the Acinetobacter spp. and K. pneumoniae isolates, respectively, were ESBL but not carbapenemase producers.

Conclusions

The presence of HAI-causing organisms on mobile phones used by HCWs in outpatient clinics necessitates the implementation of infection control measures to mitigate the risk of cross-contamination in critical healthcare settings.

背景：医院卫生保健工作者（HCWs）使用的移动电话是导致医院获得性感染（HAIs）的耐药细菌的重要宿主。目的：本研究的目的是评估这类细菌在门诊诊所的污染水平。方法：采用标准生化和酶法对83例医护人员手机拭子进行病原菌鉴定。根据CLSI指南进行β-内酰胺酶试验、抗菌药敏试验、广谱β-内酰胺酶（ESBL）筛选和碳青霉烯酶生产。多重耐药基因（金黄色葡萄球菌中的mecA、肺炎克雷伯菌和不动杆菌中的kpc/ndm碳青霉烯酶）采用多重实时聚合酶链反应进行分子检测。研究结果：手机被一种或多种细菌污染的总体发生率为100%。共分离到革兰氏阳性和革兰氏阴性葡萄球菌51株和44株，其中凝固酶阴性葡萄球菌20株、金黄色葡萄球菌20株（耐甲氧西林金黄色葡萄球菌0株）、不动杆菌11株和肺炎克雷伯菌10株。在45%的con和30%的金黄色葡萄球菌中检测到β-内酰胺酶的产生。20%（4/20）的金黄色葡萄球菌检出潘通-瓦伦丁白细胞介素（PVL）毒素基因。20株（20%）和13%的不动杆菌和肺炎克雷伯菌分离株为ESBL，但不产生碳青霉烯酶。结论：卫生保健工作者在门诊诊所使用的手机上存在导致hai的微生物，因此有必要实施感染控制措施，以减轻关键卫生保健机构交叉污染的风险。

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引用次数: 0

A multimedia tool for infection prevention and control practices in the intensive care unit: a participatory interventional before–after study 重症监护病房感染预防和控制实践的多媒体工具：参与性介入前后研究。

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2024-12-05 DOI: 10.1016/j.infpip.2024.100423

Sunil Kumar Bijarania , Rupinder Kaur , Manisha Biswal , Sangeeta Maheshwar , Rajarajan Ganesan , Goverdhan D. Puri , Sushant Konar , Shyam Thingnam

Background

Infection prevention and control (IPC) practices by critical care nurses are crucial in preventing ventilator-associated pneumonia (VAP) and central-line-associated bloodstream infection (CLABSI).

Aim

To implement an integrative approach to developing a set of IPC practices and disseminating information on the IPC practices through an educational multimedia tool to improve compliance with the practices.

Methods

This participatory interventional before–after study was conducted in a single tertiary care centre's cardiac surgical intensive care unit (ICU) from May 2022 to March 2023. Thirty-seven nursing IPC practices related to VAP and eight for CLABSI were finalized through a three-step process: systematized review, focused group discussions (five rounds), and Delphi rounds (three rounds). The IPC practices were disseminated through a multimedia tool, displayed continuously in the ICU. Nurses' compliance with the IPC practices observed directly was compared before and after implementing the multimedia tool.

Results

A total of 6043 observations for practices related to VAP and 1957 observations for those of CLABSI were performed. There was an increase in compliance post implementation for 11 IPC practices related to VAP and two IPC for those of CLABSI. There was an increase in compliance with practices relevant to chlorhexidine baths, oral care, cuff pressure maintenance, hypertonic saline nebulization, endotracheal suctioning, scrubbing the hub for central line access, and assessment of the central line for removal.

Conclusion

Through a participatory approach, we developed a set of IPC nursing practices for VAP and CLABSI. Implementing a multimedia tool, which encompasses the newly implemented IPC practices, improved compliance with many practices.

背景：重症监护护士的感染预防和控制（IPC）实践对于预防呼吸机相关性肺炎（VAP）和中央静脉相关血流感染（CLABSI）至关重要。目的：实施一种综合方法来开发一套IPC实践，并通过教育多媒体工具传播有关IPC实践的信息，以提高对实践的遵守。方法：这项参与式介入前后研究于2022年5月至2023年3月在单一三级保健中心的心脏外科重症监护病房（ICU）进行。37项与VAP相关的护理IPC实践和8项与CLABSI相关的护理IPC实践通过三步过程最终确定：系统化审查、重点小组讨论（5轮）和德尔菲（3轮）。IPC实践通过多媒体工具传播，在ICU中持续展示。比较使用多媒体工具前后直接观察到的护士对IPC操作的遵守情况。结果：VAP相关实践共6043次，CLABSI相关实践共1957次。实施后，与VAP相关的11项IPC实践和与CLABSI相关的2项IPC实践的合规性有所增加。对洗必泰浴、口腔护理、袖带压力维持、高渗盐水雾化、气管内吸引、擦洗中心静脉导管、评估中心静脉导管是否摘除的依从性有所增加。结论：通过参与式方法，我们开发了一套针对VAP和CLABSI的IPC护理实践。实现包含新实现的IPC实践的多媒体工具，提高了许多实践的遵从性。

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引用次数: 0

The correlation between subcutaneous fat thickness and the incidence of chemoport-related infection 皮下脂肪厚度与化疗口相关感染发生率的关系。

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2024-12-05 DOI: 10.1016/j.infpip.2024.100433

Thanaphon Khongyut, Tanapong Panpikoon, Chinnarat Buangam, Kaewpitcha Pichitpichatkul, Tharinton Treesit, Sasikorn Feinggumloon

Background

This study aimed to examine the correlation between subcutaneous fat thickness and chemoport-related infection and to determine the risk factors that lead to complications associated with chemoport.

Methods

This study retrospectively reviewed 363 patients with chemoport insertion between May 2018 and May 2022. The patients were classified into three groups, with 121 patients in each group, based on the tertiles of subcutaneous fat thickness measured in the computed tomography (CT) scan. The incidence of short-term and long-term complications, including dislocation, infection, and malfunction, were obtained and compared between the three groups. The risk factors of chemoport-related complications were analysed in multivariate analysis.

Results

The incidence of infection in the low, middle, and high subcutaneous fat thickness groups were 1.7%, 3.3%, and 0%, respectively (P = 0.131). No short-term complications occurred in this study group. After one year of follow-up, 11 patients (3.0%) had long-term complications; 6 patients (1.7%) developed chemoport infection, while five patients (1.4%) had chemoport dislocation. In multivariate analysis, the risk of dislocation was significantly higher when insertion was performed via the left internal jugular vein (OR = 9.87, P=0.033).

Conclusions

The thickness of subcutaneous fat does not significantly correlate with the incidence of chemoport infection, and placement of the port on the left side of the chest wall via the left internal jugular vein is the risk factor for chemoport dislocation.

背景：本研究旨在探讨皮下脂肪厚度与放化疗相关感染之间的关系，并确定导致放化疗相关并发症的危险因素。方法：本研究回顾性分析了2018年5月至2022年5月期间363例化疗孔插入患者。根据CT扫描测量的皮下脂肪厚度，将患者分为三组，每组121例。比较三组间脱位、感染、功能障碍等短期和长期并发症的发生率。采用多因素分析方法分析化疗相关并发症的危险因素。结果：皮下脂肪厚度低、中、高组感染发生率分别为1.7%、3.3%、0% （P = 0.131）。本研究组未发生短期并发症。随访1年后，11例（3.0%）出现长期并发症；6例（1.7%）发生化疗孔感染，5例（1.4%）发生化疗孔脱位。在多因素分析中，经左颈内静脉置入时脱位的风险明显更高（OR = 9.87， P=0.033）。结论：皮下脂肪厚度与放化疗孔感染发生率无显著相关性，放化疗孔经左颈内静脉置于胸壁左侧是放化疗孔脱位的危险因素。

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引用次数: 0

Coronavirus disease-2019 (COVID-19) outbreak in a long-term care hospital in Korea in early 2021 2021年初在国内长期护理医院爆发的冠状病毒病（COVID-19）。

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2024-11-30 DOI: 10.1016/j.infpip.2024.100427

Eun Jo Kim , JaHyun Kang , HyeonSuk Byeon

Background

This study describes the outbreak investigations and control measures for a coronavirus disease 2019 (COVID-19) outbreak at a long-term care hospital (LTCH) in Seoul.

Methods

The outbreak occurred from February 24, 2021 to March 2, 2021 at a 228-bed LTCH in Seoul. Monitoring of the outbreak continued until March 16, 2021. The LTCH investigated the outbreak in cooperation with the district public health centre. After approval from the institutional review board, the hospital's COVID-19 outbreak-related data were collected and analysed.

Results

The outbreak commenced when a new caregiver tested positive for COVID-19 in routine employee screening tests. During this outbreak, eight of 342 people including 175 patients and 64 caregivers were positive for the COVID-19 virus SARS-CoV-2. The mean age of the confirmed cases was 75.1 years (range 55–90). Of the eight, four (50%) were males; two (25%) were caregivers; six (75%) were asymptomatic; six (75%) had previously visited a rehabilitation centre, which was located on the basement level; and one visited different hospitals' outpatient clinics. Three of the 22 environmental specimens were test-positive at the corridor's handrail and the bed rails of confirmed patients. The outbreak ended with the immediate transfer of the confirmed cases to hospitals dedicated to infectious diseases and the transfer of close contacts of these cases to designated hospitals which were organised by the health authorities.

Conclusions

We found a potential link between the rehabilitation centre and the outbreak. To prevent future outbreaks at LTCHs, it is necessary to enhance each LTCH's infection control resources and competencies based on its specific requirements, with support from the government.

背景：本研究描述了首尔市一家长期护理医院（LTCH） 2019年冠状病毒病（COVID-19）暴发的疫情调查和控制措施。方法：疫情发生于2021年2月24日至2021年3月2日，地点为首尔一家拥有228张床位的LTCH。对疫情的监测持续到2021年3月16日。地方卫生科与地区公共卫生中心合作调查疫情。经过机构审查委员会的批准，收集并分析了该医院的新冠肺炎相关数据。结果：当一名新的护理人员在常规员工筛查测试中检测出COVID-19阳性时，疫情开始爆发。在这次疫情期间，342人中有8人（包括175名患者和64名护理人员）对COVID-19病毒SARS-CoV-2呈阳性反应。确诊病例的平均年龄为75.1岁（55-90岁）。在这8人中，4人（50%）是男性；2名（25%）是护理人员；6例（75%）无症状；其中6人（75%）曾去过位于地下室的康复中心；其中一个去了不同医院的门诊诊所。22个环境标本中，有3个在走廊扶手和确诊患者的床栏杆检测呈阳性。疫情结束后，立即将确诊病例转移到专门治疗传染病的医院，并将这些病例的密切接触者转移到卫生当局组织的指定医院。结论：我们发现康复中心与疫情之间存在潜在联系。为了防止LTCH今后爆发疫情，有必要在政府的支持下，根据每个LTCH的具体要求加强其感染控制资源和能力。

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引用次数: 0

Prevalence of difficult-to-treat resistance in ESKAPE pathogens in a third level hospital in Mexico 墨西哥某三级医院ESKAPE病原菌难治性耐药流行情况

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2024-11-29 DOI: 10.1016/j.infpip.2024.100426

Adrián Camacho-Ortiz, Samantha Flores-Treviño, Paola Bocanegra-Ibarias

Background

Antimicrobial resistance and difficult-to-treat resistance (DTR) in ESKAPE pathogens (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter species) is a threat to human health. The aim of this study was to determine the prevalence of antimicrobial resistance and DTR rates in ESKAPE pathogens over six years in a third-level hospital from Monterrey, Mexico.

Methods

Antimicrobial susceptibility testing was determined by either disk diffusion or broth microdilution in strains from 2018 to 2023. Isolates were screened for carbapenemase genes. Multidrug resistance (MDR), extensively drug resistance (XDR), carbapenem resistance (CR), extended-spectrum cephalosporin-resistance (ESCR), fluoroquinolone resistance (FQR), and DTR were determined.

Results

From 3,239 strains, 48.5% were from respiratory infections, resistance was 87.5% to meticillin in Staphylococcus spp. and 39.8% in S. aureus, and 13.9% to vancomycin in Enterococcus spp. MDR, FQR and ESCR rates were between 54−90% in A. baumannii, 20–60% in Enterobacterales and 17−25% in P. aeruginosa. CR was 85.7% in A. baumannii, 33.3% in P. aeruginosa and <5% in Enterobacterales. Most frequent CR genes were OXA-24/40-like in A. baumannii and NDM and OXA-48 in carbapenem-resistant Enterobacterales. DTR rates were 59.7% in A. baumannii (49.2% in 2018 vs 62.9% in 2023), 8.9% in P. aeruginosa and <3% in Enterobacterales. XDR in A. baumannii was 14.4%.

Conclusions

Antimicrobial resistance rates were high in Gram-negative pathogens. CR and DTR rates were higher in A. baumannii than P. aeruginosa and Enterobacterales. DTR surveillance in healthcare providers should be continuous updating local and regional DTR trends among Gram-negative bacteria.

背景：ESKAPE病原菌（粪肠球菌、金黄色葡萄球菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌和肠杆菌）的耐药和难治性耐药（DTR）对人类健康构成威胁。本研究的目的是确定墨西哥蒙特雷一家三级医院6年来ESKAPE病原菌的抗微生物药物耐药性流行情况和DTR率。方法：采用纸片扩散法或微量肉汤稀释法对2018 ~ 2023年菌株进行药敏试验。对分离物进行碳青霉烯酶基因筛选。检测多药耐药（MDR）、广泛耐药（XDR）、碳青霉烯类耐药（CR）、广谱头孢菌素耐药（ESCR）、氟喹诺酮类耐药（FQR）和DTR。结果：3239株细菌中，呼吸道感染占48.5%，葡萄球菌和金黄色葡萄球菌对甲氧西林的耐药率分别为87.5%和39.8%，肠球菌和肠球菌对万古霉素的耐药率分别为13.9%，鲍曼不动杆菌、肠杆菌和铜绿假单胞菌的耐药率分别为54 ~ 90%、20 ~ 60%和17 ~ 25%。鲍曼不动杆菌的CR为85.7%，铜绿假单胞菌和鲍曼不动杆菌的CR为33.3%，耐碳青霉烯肠杆菌的CR为NDM和OXA-48。鲍曼不动杆菌的DTR率为59.7%(2018年为49.2%，2023年为62.9%)，铜绿假单胞菌为8.9%，鲍曼不动杆菌为14.4%。结论：革兰氏阴性病原菌耐药率较高。鲍曼不动杆菌的CR和DTR率高于铜绿假单胞菌和肠杆菌。卫生保健提供者的DTR监测应不断更新当地和区域革兰氏阴性菌的DTR趋势。

{"title":"Prevalence of difficult-to-treat resistance in ESKAPE pathogens in a third level hospital in Mexico","authors":"Adrián Camacho-Ortiz, Samantha Flores-Treviño, Paola Bocanegra-Ibarias","doi":"10.1016/j.infpip.2024.100426","DOIUrl":"10.1016/j.infpip.2024.100426","url":null,"abstract":"<div><h3>Background</h3><div>Antimicrobial resistance and difficult-to-treat resistance (DTR) in ESKAPE pathogens (<em>Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa,</em> and <em>Enterobacter</em> species) is a threat to human health. The aim of this study was to determine the prevalence of antimicrobial resistance and DTR rates in ESKAPE pathogens over six years in a third-level hospital from Monterrey, Mexico.</div></div><div><h3>Methods</h3><div>Antimicrobial susceptibility testing was determined by either disk diffusion or broth microdilution in strains from 2018 to 2023. Isolates were screened for carbapenemase genes. Multidrug resistance (MDR), extensively drug resistance (XDR), carbapenem resistance (CR), extended-spectrum cephalosporin-resistance (ESCR), fluoroquinolone resistance (FQR), and DTR were determined.</div></div><div><h3>Results</h3><div>From 3,239 strains, 48.5% were from respiratory infections, resistance was 87.5% to meticillin in <em>Staphylococcus</em> spp. and 39.8% in <em>S. aureus,</em> and 13.9% to vancomycin in <em>Enterococcus</em> spp. MDR, FQR and ESCR rates were between 54−90% in <em>A. baumannii</em>, 20–60% in Enterobacterales and 17−25% in <em>P. aeruginosa</em>. CR was 85.7% in <em>A. baumannii,</em> 33.3% in <em>P. aeruginosa</em> and <5% in Enterobacterales. Most frequent CR genes were OXA-24/40-like in <em>A. baumannii</em> and NDM and OXA-48 in carbapenem-resistant Enterobacterales. DTR rates were 59.7% in <em>A. baumannii</em> (49.2% in 2018 vs 62.9% in 2023), 8.9% in <em>P. aeruginosa</em> and <3% in Enterobacterales. XDR in <em>A. baumannii</em> was 14.4%.</div></div><div><h3>Conclusions</h3><div>Antimicrobial resistance rates were high in Gram-negative pathogens. CR and DTR rates were higher in <em>A. baumannii</em> than <em>P. aeruginosa</em> and Enterobacterales. DTR surveillance in healthcare providers should be continuous updating local and regional DTR trends among Gram-negative bacteria.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 1","pages":"Article 100426"},"PeriodicalIF":1.8,"publicationDate":"2024-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699456/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932825","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

Implementation of the Hand hygiene self-assessment framework in a primary healthcare Centre in Saudi Arabia: A follow-up study

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2024-11-29 DOI: 10.1016/j.infpip.2024.100428

Olaa M. Alharbi , Mohammed A. Imam , Ahmad M. Alharbi

Although HH (HH) practices can prevent healthcare related infections, low compliance is a major concern. We evaluated HH using a WHO observational tool and HH self-assessment framework (HHSAF) in 30 individuals in a mix of healthcare professions, before and after the implementation of the framework. In 182 opportunities to demonstrate HH practices, pre-implementation scores were assessed across five different domains including system change, training, and evaluation and feedback. Post-implementation scores obtained after 12 months showed HH compliance of 53%, with highest improvements seen across evaluation and feedback domain. The compliance rates after exposure to body fluids was 100%.

引用次数: 0

An outbreak of carbapenemase producing Enterobacterales – importance of thorough decontamination of beds

IF 1.8 Q3 INFECTIOUS DISEASES

Infection Prevention in Practice

Pub Date : 2024-11-28 DOI: 10.1016/j.infpip.2024.100422

Richard Puleston , Kirsty Morgan , Iresha Asanthi , Helen Bucior , Kerry Rawlin , Jeorge Orendi , Jonathan Snape , Steven Bourne , Ann-Marie Riley , Lorraine Whitehead , Tom O'Leary , Emyr Phillips , Catherine Alves , Matthew Knock

引用次数: 0

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 爱尔兰一家外科高度依赖病房发生的4年MRSA ST72-MRSA-IV spa型t1597暴发与多次医护人员再定殖有关

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.

背景：接受心脏手术的患者被认为是金黄色葡萄球菌感染的高危人群，包括MRSA。当两名患者在心胸高依赖病房同时出现MRSA感染时，确定了MRSA的爆发，之前不常见的MRSA检测和既定的筛查计划。方法召集疫情控制小组，开展手部卫生和环境卫生的进修培训，对医疗器械无菌准入的做法进行审查，并考虑在该单位使用抗生素。MRSA分离株送交爱尔兰国家MRSA参考实验室，spa分型将所有分离株鉴定为t1597，全基因组测序将其鉴定为ST72-MRSA-IV多位点序列型。这种菌株仅在爱尔兰的这个单位恢复，在欧洲很少报告，促使工作人员进行MRSA筛查，发现两名工作人员携带爆发菌株。尽管成功地去殖民化，但仍发生了再殖民化和进一步传播给患者的情况。结论在发生该病例的临床单位，预防MRSA传播的常规控制措施已到位。最近的联合卫生保健感染学会和感染预防学会指南不建议常规工作人员进行MRSA筛查，但确实支持在不寻常菌株爆发时考虑进行筛查。总共有9名病人和2名工作人员受到这次疫情的影响。有4人感染，3人死亡。为了保护某些国家临床方案，有必要持续关闭疫情，只有在被殖民的工作人员不再在该单位工作时才能实现。

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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。

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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}

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