Pub Date : 2024-08-29DOI: 10.1016/j.infpip.2024.100395
Syed A. Sattar , Bahram Zargar , Jason Tetro
Viruses pose a wide-ranging and significant risk to human health through acute and persistent infections that may confer risks for sequelae including musculoskeletal, immunological, and oncological disease. Infection prevention and control (IPAC) remains a highly effective, generic, global, and cost-effective means to mitigate virus spread. IPAC recommends proper disinfection of high-touch environmental surfaces (HITES) to reduce the risk of direct and indirect virus spread. The United States, Canada and many other countries mandate pre-market assessments of HITES disinfectants against viruses and other types of microbial pathogens. However, there are basic disparities in the regulation of disinfectants. Such incongruity in test protocols interferes with the determination of the true breadth of the microbicidal potential of a given product in the field where target pathogens are often unknown or may be encountered as mixtures. This review examines the various methodological disparities and recommends a more cohesive and harmonized approach. While there is particular emphasis on viruses here, an overall harmonization in microbicide testing of HITES disinfectants will greatly assist the numerous stakeholders involved in IPAC.
{"title":"Methods to assess environmental surface disinfectants against viruses: the quest and recommendations for a globally harmonized approach to microbicide testing","authors":"Syed A. Sattar , Bahram Zargar , Jason Tetro","doi":"10.1016/j.infpip.2024.100395","DOIUrl":"10.1016/j.infpip.2024.100395","url":null,"abstract":"<div><p>Viruses pose a wide-ranging and significant risk to human health through acute and persistent infections that may confer risks for sequelae including musculoskeletal, immunological, and oncological disease. Infection prevention and control (IPAC) remains a highly effective, generic, global, and cost-effective means to mitigate virus spread. IPAC recommends proper disinfection of high-touch environmental surfaces (HITES) to reduce the risk of direct and indirect virus spread. The United States, Canada and many other countries mandate pre-market assessments of HITES disinfectants against viruses and other types of microbial pathogens. However, there are basic disparities in the regulation of disinfectants. Such incongruity in test protocols interferes with the determination of the true breadth of the microbicidal potential of a given product in the field where target pathogens are often unknown or may be encountered as mixtures. This review examines the various methodological disparities and recommends a more cohesive and harmonized approach. While there is particular emphasis on viruses here, an overall harmonization in microbicide testing of HITES disinfectants will greatly assist the numerous stakeholders involved in IPAC.</p></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"6 4","pages":"Article 100395"},"PeriodicalIF":1.8,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590088924000593/pdfft?md5=7b013fc8e84836403eeab8c7c1b79514&pid=1-s2.0-S2590088924000593-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142274407","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}
Pub Date : 2024-08-29DOI: 10.1016/j.infpip.2024.100396
Sabina Herrera , Ignasi Roca , Ana Del Río , Javier Fernández , Cristina Pitart , Isabel Fortes , Blanca Torralbo , Gemina Santana , Romina Parejo-González , Andreu Veà-Baró , Josep Maria Campistol , Mireia Aguilar , Sergi Degea , Climent Casals-Pascual , Alex Soriano , José A. Martínez
Background
Ultraviolet- C (UV–C) light is effective for reducing environmental bioburden in hospitals, and the use of robots to deliver it may be advantageous.
Aim
To evaluate the feasibility and clinical efficacy of an autonomous programmable UV-C robot in surgical and intensive care unit (ICU) rooms of a tertiary hospital.
Method
During ten consecutive months, the device was used in six theatres where cardiac, colorectal and orthopaedic surgeries were performed, and in the rooms previously occupied by patients subjected to contact precautions of a 14-bed ICU. Surgical site infection (SSI) rates of procedures performed in the UV-cleaned theatres were compared with those of the previous year. Incidence in clinical samples of ICU-acquired multiple-drug resistant (MDR) microorganisms was compared with that of the same period of the previous year. An UV-C exposure study done by semi-quantitative dosimeters and a survey of the bioburden on surfaces were carried out.
Findings
SSI rates in the pre- and post-intervention periods were 8.67% (80/922) and 7.5% (61/813), respectively (p=0.37). Incidence of target microorganisms in clinical samples remained unchanged (38.4 vs. 39.4 per 10,000 patient-days, p=0.94). All the dosimeters exposed to ≤1 meter received ≥500 mJ/cm2. The bacterial load on surfaces decreased after the intervention, particularly in ICU rooms (from 4.57±7.4 CFU to 0.27±0.8 CFU, p<0.0001).
Conclusion
Deployment of an UV-C robot in surgical and ICU rooms is feasible, ensures adequate delivery of germicidal UV-C light and reduces the environmental bacterial burden. Rates of surgical site infections or acquisition of MDR in clinical samples of critically-ill patients remained unchanged.
背景紫外线-C(UV-C)光可有效减少医院的环境生物负荷,使用机器人提供紫外线-C光可能具有优势。 目的评估在一家三级医院的手术室和重症监护室(ICU)病房使用自主可编程紫外线-C机器人的可行性和临床疗效。方法在连续十个月内,在六间进行心脏、结肠直肠和骨科手术的手术室以及拥有 14 张床位的重症监护室中以前由接触性预防措施病人占用的房间中使用该设备。在紫外线清洁过的手术室中进行的手术的手术部位感染率(SSI)与前一年的感染率进行了比较。将重症监护室获得的多重耐药(MDR)微生物临床样本的发生率与上一年同期进行了比较。通过半定量剂量计进行了紫外线照射研究,并对表面的生物负载进行了调查。干预前后的感染率分别为 8.67%(80/922)和 7.5%(61/813)(P=0.37)。临床样本中目标微生物的发生率保持不变(38.4 vs. 39.4 per 10,000 patient-days,p=0.94)。所有照射量≤1 米的剂量计都接收了≥500 mJ/cm2。结论在手术室和重症监护室部署紫外线 C 波段机器人是可行的,它能确保提供足够的紫外线 C 波段杀菌光,并减少环境中的细菌负担。在重症患者的临床样本中,手术部位感染或获得 MDR 的比率保持不变。
{"title":"Performance of an Autonomous Sanitary Sterilisation Ultraviolet Machine (ASSUM) on terminal disinfection of surgical theaters and rooms of an intensive-intermediate care unit","authors":"Sabina Herrera , Ignasi Roca , Ana Del Río , Javier Fernández , Cristina Pitart , Isabel Fortes , Blanca Torralbo , Gemina Santana , Romina Parejo-González , Andreu Veà-Baró , Josep Maria Campistol , Mireia Aguilar , Sergi Degea , Climent Casals-Pascual , Alex Soriano , José A. Martínez","doi":"10.1016/j.infpip.2024.100396","DOIUrl":"10.1016/j.infpip.2024.100396","url":null,"abstract":"<div><h3>Background</h3><p>Ultraviolet- C (UV–C) light is effective for reducing environmental bioburden in hospitals, and the use of robots to deliver it may be advantageous.</p></div><div><h3>Aim</h3><p>To evaluate the feasibility and clinical efficacy of an autonomous programmable UV-C robot in surgical and intensive care unit (ICU) rooms of a tertiary hospital.</p></div><div><h3>Method</h3><p>During ten consecutive months, the device was used in six theatres where cardiac, colorectal and orthopaedic surgeries were performed, and in the rooms previously occupied by patients subjected to contact precautions of a 14-bed ICU. Surgical site infection (SSI) rates of procedures performed in the UV-cleaned theatres were compared with those of the previous year. Incidence in clinical samples of ICU-acquired multiple-drug resistant (MDR) microorganisms was compared with that of the same period of the previous year. An UV-C exposure study done by semi-quantitative dosimeters and a survey of the bioburden on surfaces were carried out.</p></div><div><h3>Findings</h3><p>SSI rates in the pre- and post-intervention periods were 8.67% (80/922) and 7.5% (61/813), respectively (p=0.37). Incidence of target microorganisms in clinical samples remained unchanged (38.4 vs. 39.4 per 10,000 patient-days, p=0.94). All the dosimeters exposed to ≤1 meter received ≥500 mJ/cm<sup>2</sup>. The bacterial load on surfaces decreased after the intervention, particularly in ICU rooms (from 4.57±7.4 CFU to 0.27±0.8 CFU, p<0.0001).</p></div><div><h3>Conclusion</h3><p>Deployment of an UV-C robot in surgical and ICU rooms is feasible, ensures adequate delivery of germicidal UV-C light and reduces the environmental bacterial burden. Rates of surgical site infections or acquisition of MDR in clinical samples of critically-ill patients remained unchanged.</p></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"6 4","pages":"Article 100396"},"PeriodicalIF":1.8,"publicationDate":"2024-08-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S259008892400060X/pdfft?md5=024a0d705dc6b17c7c6aa1506801f1f2&pid=1-s2.0-S259008892400060X-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142164862","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}
Infection prevention and control (IPC) is important for the reduction of healthcare-associated infections (HAI). The World Health Organization (WHO) developed the IPC Assessment Framework (IPCAF) tool to assess the level of IPC implementation and to identify areas for improvement in healthcare facilities.
Methods
A cross -sectional survey was conducted using the WHO IPCAF tool from May to June 2023. The aim was to provide a baseline assessment of the IPC programme and activities within health care facilities in Malawi. Forty healthcare facilities were invited to participate. IPC teams were requested to complete the IPCAF and return the scores. The IPCAF tool scores were assessed as recommended in the WHO IPCAF tool.
Results
The response rate was 82.5%. The median IPCAF score was 445 out of 800 corresponding to an intermediate IPC implementation level. The results revealed that 66.7% facilities were at intermediate level, 26.4% at basic level, and 6.9% at advanced level. Most facilities (76%) had an IPC program in place with clear objectives and an IPC focal person. Few had a dedicated budget for IPC. The IPCAF domain “monitoring/audit of IPC practices and feedback” had the lowest median score of 15/100, and in 90% of facilities, no monitoring, audit, and feedback was done. HAI surveillance median score was 40/100, workload, staffing and bed occupancy median score was 45/100.
Conclusions
Whilst there has been some degree of implementation of WHO IPC guidelines in Malawi's healthcare system, there is significant room for improvement. The IPCAF tool revealed that monitoring/audit and feedback, HAI surveillance and workload, staffing and bed occupancy need to be strengthened. The IPCAF scoring system may need reconsidering given the centrality of these domains to IPC.
{"title":"An assessment of infection prevention and control implementation in Malawian hospitals using the WHO Infection Prevention and Control Assessment Framework (IPCAF) tool","authors":"Dorica Ng'ambi , Thomasena O'Byrne , Emmie Jingini , Hope Chadwala , Owen Musopole , Wala Kamchedzera , Tara Tancred , Nicholas Feasey","doi":"10.1016/j.infpip.2024.100388","DOIUrl":"10.1016/j.infpip.2024.100388","url":null,"abstract":"<div><h3>Background</h3><p>Infection prevention and control (IPC) is important for the reduction of healthcare-associated infections (HAI). The World Health Organization (WHO) developed the IPC Assessment Framework (IPCAF) tool to assess the level of IPC implementation and to identify areas for improvement in healthcare facilities.</p></div><div><h3>Methods</h3><p>A cross -sectional survey was conducted using the WHO IPCAF tool from May to June 2023. The aim was to provide a baseline assessment of the IPC programme and activities within health care facilities in Malawi. Forty healthcare facilities were invited to participate. IPC teams were requested to complete the IPCAF and return the scores. The IPCAF tool scores were assessed as recommended in the WHO IPCAF tool.</p></div><div><h3>Results</h3><p>The response rate was 82.5%. The median IPCAF score was 445 out of 800 corresponding to an intermediate IPC implementation level. The results revealed that 66.7% facilities were at intermediate level, 26.4% at basic level, and 6.9% at advanced level. Most facilities (76%) had an IPC program in place with clear objectives and an IPC focal person. Few had a dedicated budget for IPC. The IPCAF domain “monitoring/audit of IPC practices and feedback” had the lowest median score of 15/100, and in 90% of facilities, no monitoring, audit, and feedback was done. HAI surveillance median score was 40/100, workload, staffing and bed occupancy median score was 45/100.</p></div><div><h3>Conclusions</h3><p>Whilst there has been some degree of implementation of WHO IPC guidelines in Malawi's healthcare system, there is significant room for improvement. The IPCAF tool revealed that monitoring/audit and feedback, HAI surveillance and workload, staffing and bed occupancy need to be strengthened. The IPCAF scoring system may need reconsidering given the centrality of these domains to IPC.</p></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"6 4","pages":"Article 100388"},"PeriodicalIF":1.8,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590088924000520/pdfft?md5=8b28b2547fe669741f33b412897af756&pid=1-s2.0-S2590088924000520-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096081","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}
This study investigates the impact of invasive procedures on healthcare-associated infections (HAI) at Policlinico Universitario Tor Vergata in Rome, Italy, aiming to understand their role in device-associated HAI and to inform prevention strategies.
Methods
A retrospective cohort analysis was conducted, examining mandatory discharge records and microbiology data from 2018 across all departments. The study focused on adult patients, analysing the correlation between invasive procedures and HAI through univariate and multivariate logistic regression.
Results
Of the 12,066 patients reviewed, 1,214 (10.1%) experienced HAI. Univariate analysis indicated an association between invasive procedures and HAI (OR = 1.81, P < 0.001), which was not observed in multivariable analysis. Specific procedures significantly raised HAI risks: temporary tracheostomy (AOR = 22.69, P <0.001), central venous pressure monitoring (AOR = 6.74, P <0.001) prolonged invasive mechanical ventilation (AOR = 4.44, P <0.001), and venous catheterisation (AOR = 1.58, P <0.05). Aggregated high-risk procedures had an increased likelihood of HAI in multivariable analysis (OR = 2.51, P < 0.001). High-risk departments were also notably associated with HAI (OR = 6.13, P < 0.001).
Conclusions
This study suggests that specific invasive procedures, such as temporary tracheostomy, significantly increase HAI risks. The results highlighting the need for targeted infection prevention and control procedures and supports the need for innovative methods such as record-linkage in policymaking to address HAI. These findings inform clinical practice and healthcare policy to improve patient safety and care quality.
导言本研究调查了意大利罗马 Tor Vergata Policlinico Universitario 大学的侵入性程序对医疗相关感染(HAI)的影响,旨在了解侵入性程序在器械相关 HAI 中的作用,并为预防策略提供参考。方法进行了回顾性队列分析,检查了所有科室 2018 年的强制出院记录和微生物学数据。研究以成年患者为重点,通过单变量和多变量逻辑回归分析了侵入性程序与 HAI 之间的相关性。单变量分析表明,侵入性手术与 HAI 存在关联(OR = 1.81,P <0.001),但在多变量分析中未发现这种关联。特定手术会明显增加 HAI 风险:临时气管切开术(AOR = 22.69,P <0.001)、中心静脉压力监测(AOR = 6.74,P <0.001)、延长有创机械通气(AOR = 4.44,P <0.001)和静脉导管插入术(AOR = 1.58,P <0.05)。在多变量分析中,综合高风险手术发生 HAI 的可能性更高(OR = 2.51,P <0.001)。高风险科室也与 HAI 明显相关(OR = 6.13,P <0.001)。结论这项研究表明,特定的侵入性手术(如临时气管切开术)会显著增加 HAI 风险。研究结果强调了有针对性的感染预防和控制程序的必要性,并支持在制定应对 HAI 的政策时采用记录关联等创新方法的必要性。这些发现为临床实践和医疗保健政策提供了参考,以提高患者安全和护理质量。
{"title":"Device associated healthcare associated infection (DA-HAI): a detailed analysis of risk factors and outcomes in a university hospital in Rome, Italy","authors":"Luca Guarente , Claudia Mosconi , Mariagrazia Cicala , Carolina De Santo , Fausto Ciccacci , Mariachiara Carestia , Leonardo Emberti Gialloreti , Leonardo Palombi , Giuseppe Quintavalle , Daniele Di Giovanni , Ersilia Buonomo , Stefania Moramarco , Fabio Riccardi , Stefano Orlando","doi":"10.1016/j.infpip.2024.100391","DOIUrl":"10.1016/j.infpip.2024.100391","url":null,"abstract":"<div><h3>Introduction</h3><p>This study investigates the impact of invasive procedures on healthcare-associated infections (HAI) at Policlinico Universitario Tor Vergata in Rome, Italy, aiming to understand their role in device-associated HAI and to inform prevention strategies.</p></div><div><h3>Methods</h3><p>A retrospective cohort analysis was conducted, examining mandatory discharge records and microbiology data from 2018 across all departments. The study focused on adult patients, analysing the correlation between invasive procedures and HAI through univariate and multivariate logistic regression.</p></div><div><h3>Results</h3><p>Of the 12,066 patients reviewed, 1,214 (10.1%) experienced HAI. Univariate analysis indicated an association between invasive procedures and HAI (OR = 1.81, <em>P</em> < 0.001), which was not observed in multivariable analysis. Specific procedures significantly raised HAI risks: temporary tracheostomy (AOR = 22.69, <em>P</em> <0.001), central venous pressure monitoring (AOR = 6.74, <em>P</em> <0.001) prolonged invasive mechanical ventilation (AOR = 4.44, <em>P</em> <0.001), and venous catheterisation (AOR = 1.58, <em>P</em> <0.05). Aggregated high-risk procedures had an increased likelihood of HAI in multivariable analysis (OR = 2.51, <em>P</em> < 0.001). High-risk departments were also notably associated with HAI (OR = 6.13, <em>P</em> < 0.001).</p></div><div><h3>Conclusions</h3><p>This study suggests that specific invasive procedures, such as temporary tracheostomy, significantly increase HAI risks. The results highlighting the need for targeted infection prevention and control procedures and supports the need for innovative methods such as record-linkage in policymaking to address HAI. These findings inform clinical practice and healthcare policy to improve patient safety and care quality.</p></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"6 4","pages":"Article 100391"},"PeriodicalIF":1.8,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590088924000556/pdfft?md5=43d7c06fec6ad516bbc45fda70374095&pid=1-s2.0-S2590088924000556-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142238686","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}
Pub Date : 2024-08-18DOI: 10.1016/j.infpip.2024.100390
Szava Bansaghi , Jörn Klein
Background
Using far-Ultraviolet-C (UVC) radiation with an emission maximum of 222 nm, has the potential to kill bacteria while not being harmful to humans and can be used continuously in public areas. Elevators pose a high risk of infection transmission, as they are small, crowded spaces with poor ventilation. In such a setting continuous decontamination would be very useful. This study aimed to measure the effectiveness of a far-UVC lamp installed in a frequently used elevator by comparing the bacterial load found in that elevator with the bacterial load in a control elevator.
Methods
Microbial load was measured by different methods; ATP bioluminescence, surface samples were collected by contact slides, contact plates, and swabbing. Air samples were also collected.
Results
No significant differences were found in the microbial content between the control elevator and the UV-lamp elevator, regardless of whether the UV-lamp was always on, or was used with a motion sensor to turn off when someone entered the elevator.
Conclusions
The results suggest that the far-UVC requires a longer time to kill the bacteria, while the people traffic were continuously re-contaminating the elevators.
{"title":"Evaluation of the antimicrobial effect of a far-uv radiation lamp in a real-life environment","authors":"Szava Bansaghi , Jörn Klein","doi":"10.1016/j.infpip.2024.100390","DOIUrl":"10.1016/j.infpip.2024.100390","url":null,"abstract":"<div><h3>Background</h3><p>Using far-Ultraviolet-C (UVC) radiation with an emission maximum of 222 nm, has the potential to kill bacteria while not being harmful to humans and can be used continuously in public areas. Elevators pose a high risk of infection transmission, as they are small, crowded spaces with poor ventilation. In such a setting continuous decontamination would be very useful. This study aimed to measure the effectiveness of a far-UVC lamp installed in a frequently used elevator by comparing the bacterial load found in that elevator with the bacterial load in a control elevator.</p></div><div><h3>Methods</h3><p>Microbial load was measured by different methods; ATP bioluminescence, surface samples were collected by contact slides, contact plates, and swabbing. Air samples were also collected.</p></div><div><h3>Results</h3><p>No significant differences were found in the microbial content between the control elevator and the UV-lamp elevator, regardless of whether the UV-lamp was always on, or was used with a motion sensor to turn off when someone entered the elevator.</p></div><div><h3>Conclusions</h3><p>The results suggest that the far-UVC requires a longer time to kill the bacteria, while the people traffic were continuously re-contaminating the elevators.</p></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"6 4","pages":"Article 100390"},"PeriodicalIF":1.8,"publicationDate":"2024-08-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590088924000544/pdfft?md5=29655e69d51ea531cc3d3b154d3c0331&pid=1-s2.0-S2590088924000544-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142096080","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}
Pub Date : 2024-08-17DOI: 10.1016/j.infpip.2024.100389
Sara Thuresson , Malin Alsved , Åsa Leijonhufvud , Andreas Herbst , Patrik Medstrand , Jakob Löndahl , Carl-Johan Fraenkel
Background
Healthcare workers in obstetric clinics may be exposed to airborne SARS-CoV-2 when treating patients with COVID-19.
Method
In this study, performed during the midst of the pandemic, air samples were collected in delivery rooms during childbirth and analysed for SARS-CoV-2 RNA content.
Result
Six of 28 samples collected inside delivery rooms were positive for SARS-CoV-2, but none in anterooms or corridors. Five of the six positive samples were from the same occasion.
Discussion
This indicates that some patients could be major sources of exhaled virus, although the individual variation is large, and it is thus difficult to predict the risk of infection.
{"title":"Airborne SARS-CoV-2 RNA detected during deliveries with unmasked patients","authors":"Sara Thuresson , Malin Alsved , Åsa Leijonhufvud , Andreas Herbst , Patrik Medstrand , Jakob Löndahl , Carl-Johan Fraenkel","doi":"10.1016/j.infpip.2024.100389","DOIUrl":"10.1016/j.infpip.2024.100389","url":null,"abstract":"<div><h3>Background</h3><p>Healthcare workers in obstetric clinics may be exposed to airborne SARS-CoV-2 when treating patients with COVID-19.</p></div><div><h3>Method</h3><p>In this study, performed during the midst of the pandemic, air samples were collected in delivery rooms during childbirth and analysed for SARS-CoV-2 RNA content.</p></div><div><h3>Result</h3><p>Six of 28 samples collected inside delivery rooms were positive for SARS-CoV-2, but none in anterooms or corridors. Five of the six positive samples were from the same occasion.</p></div><div><h3>Discussion</h3><p>This indicates that some patients could be major sources of exhaled virus, although the individual variation is large, and it is thus difficult to predict the risk of infection.</p></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"6 4","pages":"Article 100389"},"PeriodicalIF":1.8,"publicationDate":"2024-08-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590088924000532/pdfft?md5=ed47fc1c05c49b6fa552d8211d8b0c9d&pid=1-s2.0-S2590088924000532-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142135976","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}
Pub Date : 2024-07-26DOI: 10.1016/j.infpip.2024.100386
Michèle Birrer , Katrien Draps , Fabienne Hobi , Marianne Laguardia , Eveline Hofmann , Martin Luginbühl , Martin Perrig , Drahomir Aujesky , Jonas Marschall , Rami Sommerstein
Single room isolation for respiratory viral infections (RVI), like influenza, puts hospitals under pressure. During the influenza season 2019/20, we implemented Droplet precautions on-site (DroPS) for RVI in two acute care hospitals and prospectively assessed the rate of hospital-acquired RVI (HARVI). 318 patients were admitted with RVI, 85 had Influenza or RSV, 75 stayed in multi-bed rooms with DroPS. From 764 patients at risk, hospitalised ≥ three days in a multi-bed room, 11 (1.4%) developed a clinical HARVI, and three tested positive (3/764, 0.4%; 2x RSV, 1x influenza). DroPS may represent an alternative strategy to deal with respiratory viral infections.
{"title":"Hospital-acquired respiratory viral infections while applying droplet precautions on-site (DroPS) - prospective observation during the 2019/20 influenza season, Bern, Switzerland","authors":"Michèle Birrer , Katrien Draps , Fabienne Hobi , Marianne Laguardia , Eveline Hofmann , Martin Luginbühl , Martin Perrig , Drahomir Aujesky , Jonas Marschall , Rami Sommerstein","doi":"10.1016/j.infpip.2024.100386","DOIUrl":"10.1016/j.infpip.2024.100386","url":null,"abstract":"<div><p>Single room isolation for respiratory viral infections (RVI), like influenza, puts hospitals under pressure. During the influenza season 2019/20, we implemented <em>Droplet precautions on-site</em> (DroPS) for RVI in two acute care hospitals and prospectively assessed the rate of hospital-acquired RVI (HARVI). 318 patients were admitted with RVI, 85 had Influenza or RSV, 75 stayed in multi-bed rooms with DroPS. From 764 patients <em>at risk</em>, hospitalised ≥ three days in a multi-bed room<em>,</em> 11 (1.4%) developed a clinical HARVI, and three tested positive (3/764, 0.4%; 2x RSV, 1x influenza). DroPS may represent an alternative strategy to deal with respiratory viral infections.</p></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"6 3","pages":"Article 100386"},"PeriodicalIF":1.8,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590088924000507/pdfft?md5=080f9af36a9f99f276333294824106dd&pid=1-s2.0-S2590088924000507-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847203","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}
Pub Date : 2024-07-26DOI: 10.1016/j.infpip.2024.100387
O.A. Saba, Y. Benylles, M.H. Howe, T. Inkster, E.L. Hooker
Patients undergoing cataract surgery are at risk of post-cataract surgery endophthalmitis (PCSE), a sight-threatening complication. Cataract surgery is a relatively straightforward and quick procedure often performed under local anaesthetic. It is therefore simple to scale up to reduce the currently long waiting times, but it is important to maintain patient safety when considering high throughput surgery. This literature review aimed to identify appropriate infection prevention and control (IPC) measures to support increased throughput of cataract surgery in Scotland. Database searches were conducted using Medline and Embase from 2010 to 2023. Further hand-searching was also performed. The organisms associated with PCSE and IPC factors relevant to PCSE were analyzed. A range of microorganisms was associated with PCSE, where outbreak reports were most associated with Gram-negative bacteria and fungi, whereas retrospective chart reviews were most associated with Gram-positive bacteria. IPC risk factors identified were related to the built environment and issues with sterilization. Specifically, the sources of outbreaks included failures in the ventilation system, as well as contaminated ophthalmic solutions, surgical instruments, and medications. The factors identified in this review should be considered when implementing high throughput cataract surgery to ensure that patient safety is maintained.
{"title":"Infection prevention and control factors associated with post-cataract surgery endophthalmitis - a review of the literature from 2010 – 2023","authors":"O.A. Saba, Y. Benylles, M.H. Howe, T. Inkster, E.L. Hooker","doi":"10.1016/j.infpip.2024.100387","DOIUrl":"10.1016/j.infpip.2024.100387","url":null,"abstract":"<div><p>Patients undergoing cataract surgery are at risk of post-cataract surgery endophthalmitis (PCSE), a sight-threatening complication. Cataract surgery is a relatively straightforward and quick procedure often performed under local anaesthetic. It is therefore simple to scale up to reduce the currently long waiting times, but it is important to maintain patient safety when considering high throughput surgery. This literature review aimed to identify appropriate infection prevention and control (IPC) measures to support increased throughput of cataract surgery in Scotland. Database searches were conducted using Medline and Embase from 2010 to 2023. Further hand-searching was also performed. The organisms associated with PCSE and IPC factors relevant to PCSE were analyzed. A range of microorganisms was associated with PCSE, where outbreak reports were most associated with Gram-negative bacteria and fungi, whereas retrospective chart reviews were most associated with Gram-positive bacteria. IPC risk factors identified were related to the built environment and issues with sterilization. Specifically, the sources of outbreaks included failures in the ventilation system, as well as contaminated ophthalmic solutions, surgical instruments, and medications. The factors identified in this review should be considered when implementing high throughput cataract surgery to ensure that patient safety is maintained.</p></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"6 3","pages":"Article 100387"},"PeriodicalIF":1.8,"publicationDate":"2024-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590088924000519/pdfft?md5=1777309c5f718f20deed0f7b67065b99&pid=1-s2.0-S2590088924000519-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141847374","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}
Pub Date : 2024-07-24DOI: 10.1016/j.infpip.2024.100381
Sue Bowler , Jo Brown
Background
Diagnostic stewardship is ‘coordinated guidance and interventions to improve appropriate use of microbiological diagnostics to guide therapeutic decisions’ and a fundamental part of antimicrobial stewardship and the nursing role. The role of the nurse in diagnostic stewardship is relatively unknown and an underused resource. Lack of involvement and training in diagnostic stewardship can lead to inaction or incorrect actions, either of which may be detrimental to patient management, outcomes and care.
Aim
To determine the role of the hospital adult nurse in diagnostic stewardship to inform local engagement strategies.
Methods
The methodology was informed by Whiffin's (2020) systematic search approach. Electronic databases were searched from 2016 to 2022. The studies included were primary research papers involving adult nurses working in a hospital setting, with findings relevant to a diagnostic stewardship role. Thematic analysis was chosen to understand and compare the results, findings and recommendations of the studies.
Findings
Seven studies were included in the review. The identified themes were: (i) nursing role – to recognize infection, aid diagnosis and review results; (ii) nurse challenges – lack of knowledge and confidence to implement diagnostic stewardship; and (iii) Nurse education, empowerment and use of clinical tools.
Conclusion
Research studies do not consistently recognize the full scope of the diagnostic stewardship nursing role, signifying that nurses remain an underused resource in promoting diagnostic stewardship. Research-based clarification of the role of the nurse in diagnostic stewardship, outlined in this review, is therefore vital. Further UK-based, nurse-led research is needed to capture the impact of nurse-driven diagnostic stewardship interventions.
{"title":"Diagnostic stewardship: establishing the role of the hospital nurse to inform local engagement strategies","authors":"Sue Bowler , Jo Brown","doi":"10.1016/j.infpip.2024.100381","DOIUrl":"10.1016/j.infpip.2024.100381","url":null,"abstract":"<div><h3>Background</h3><p>Diagnostic stewardship is ‘coordinated guidance and interventions to improve appropriate use of microbiological diagnostics to guide therapeutic decisions’ and a fundamental part of antimicrobial stewardship and the nursing role. The role of the nurse in diagnostic stewardship is relatively unknown and an underused resource. Lack of involvement and training in diagnostic stewardship can lead to inaction or incorrect actions, either of which may be detrimental to patient management, outcomes and care.</p></div><div><h3>Aim</h3><p>To determine the role of the hospital adult nurse in diagnostic stewardship to inform local engagement strategies.</p></div><div><h3>Methods</h3><p>The methodology was informed by Whiffin's (2020) systematic search approach. Electronic databases were searched from 2016 to 2022. The studies included were primary research papers involving adult nurses working in a hospital setting, with findings relevant to a diagnostic stewardship role. Thematic analysis was chosen to understand and compare the results, findings and recommendations of the studies.</p></div><div><h3>Findings</h3><p>Seven studies were included in the review. The identified themes were: (i) nursing role – to recognize infection, aid diagnosis and review results; (ii) nurse challenges – lack of knowledge and confidence to implement diagnostic stewardship; and (iii) Nurse education, empowerment and use of clinical tools.</p></div><div><h3>Conclusion</h3><p>Research studies do not consistently recognize the full scope of the diagnostic stewardship nursing role, signifying that nurses remain an underused resource in promoting diagnostic stewardship. Research-based clarification of the role of the nurse in diagnostic stewardship, outlined in this review, is therefore vital. Further UK-based, nurse-led research is needed to capture the impact of nurse-driven diagnostic stewardship interventions.</p></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"6 3","pages":"Article 100381"},"PeriodicalIF":1.8,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590088924000453/pdfft?md5=09a3e76733890c6cc6531202bde91314&pid=1-s2.0-S2590088924000453-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141843785","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}
Pub Date : 2024-07-18DOI: 10.1016/j.infpip.2024.100385
Tuba Yavuz , Kate Clezy , Kristina Skender , Jacob Goldberg , Frédérique Vallières
Introduction
Both high- and low-income countries reported increased antibiotic consumption among COVID-19 patients during the first months of the pandemic. To date, however, no studies have examined changes in antibiotic consumption during the COVID-19 pandemic within humanitarian emergency contexts.
Method
Data was collected by Médecins Sans Frontières (MSF) for the years 2018–2021 across the following humanitarian settings: Afghanistan (Lashkar Gah), Bangladesh (Kutupalong), the Democratic Republic of Congo (Mweso and Baraka), and South Sudan (Bentiu). Inpatient and outpatient antibiotic consumption was calculated as Daily Defined Dose (DDD) per 1000 inhabitants per day, as per the World Health Organisation's (WHO) Collaborating Centre for Drug Statistics Methodology. Interrupted time series (ITS) analysis, using an autoregressive integrated moving average (ARIMA) model was used to analyse retrospective monthly antibiotic consumption. The impact of COVID-19 pandemic was evaluated as total antibiotic consumption and according to WHO Access, Watch, Reserve (AWaRe) group classifications within each humanitarian setting.
Results
The COVID-19 pandemic had no statistically significant impact on total antibiotic consumption in South Sudan (Bentiu) and Bangladesh (Kutupalong). Similarly, the pandemic had no impact on total antibiotic consumption in DR Congo (Baraka), despite an initial 0.27% (estimate=.274, p-value=0.006) increase in March 2020 driven by Access group antibiotics. Meanwhile, total antibiotic consumption in DR Congo (Mweso) and Afghanistan (Lashkar Gah) declined by 0.74% (estimate = −.744, p = 0.003) and 0.26% (estimate = −.26, p < 0.001), respectively with the COVID-19 pandemic.
Conclusion
Further studies are required to investigate what may have contributed to these results.
{"title":"How did the COVID-19 pandemic affect antibiotic consumption within humanitarian emergencies? Results from five humanitarian contexts","authors":"Tuba Yavuz , Kate Clezy , Kristina Skender , Jacob Goldberg , Frédérique Vallières","doi":"10.1016/j.infpip.2024.100385","DOIUrl":"10.1016/j.infpip.2024.100385","url":null,"abstract":"<div><h3>Introduction</h3><p>Both high- and low-income countries reported increased antibiotic consumption among COVID-19 patients during the first months of the pandemic. To date, however, no studies have examined changes in antibiotic consumption during the COVID-19 pandemic within humanitarian emergency contexts.</p></div><div><h3>Method</h3><p>Data was collected by Médecins Sans Frontières (MSF) for the years 2018–2021 across the following humanitarian settings: Afghanistan (Lashkar Gah), Bangladesh (Kutupalong), the Democratic Republic of Congo (Mweso and Baraka), and South Sudan (Bentiu). Inpatient and outpatient antibiotic consumption was calculated as Daily Defined Dose (DDD) per 1000 inhabitants per day, as per the World Health Organisation's (WHO) Collaborating Centre for Drug Statistics Methodology. Interrupted time series (ITS) analysis, using an autoregressive integrated moving average (ARIMA) model was used to analyse retrospective monthly antibiotic consumption. The impact of COVID-19 pandemic was evaluated as total antibiotic consumption and according to WHO Access, Watch, Reserve (AWaRe) group classifications within each humanitarian setting.</p></div><div><h3>Results</h3><p>The COVID-19 pandemic had no statistically significant impact on total antibiotic consumption in South Sudan (Bentiu) and Bangladesh (Kutupalong). Similarly, the pandemic had no impact on total antibiotic consumption in DR Congo (Baraka), despite an initial 0.27% (estimate=.274, p-value=0.006) increase in March 2020 driven by Access group antibiotics. Meanwhile, total antibiotic consumption in DR Congo (Mweso) and Afghanistan (Lashkar Gah) declined by 0.74% (estimate = −.744, p = 0.003) and 0.26% (estimate = −.26, p < 0.001), respectively with the COVID-19 pandemic.</p></div><div><h3>Conclusion</h3><p>Further studies are required to investigate what may have contributed to these results.</p></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"6 3","pages":"Article 100385"},"PeriodicalIF":1.8,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590088924000490/pdfft?md5=5ad2a6afb432bb553d59c9b69d07fad7&pid=1-s2.0-S2590088924000490-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141840867","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}