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Refining the hospitalization rate: A mixed methods approach to differentiate primary COVID-19 from incidental cases 完善住院率:采用混合方法区分原发性 COVID-19 和偶发病例
Q2 Medicine Pub Date : 2024-05-15 DOI: 10.1016/j.infpip.2024.100371
M. Misailovski , D. Koller , S. Blaschke , M. Berens , A.M. Köster , R. Strobl , R. Berner , P. Boor , M. Eisenmann , S. von Stillfried , D. Krefting , M. Krone , J. Liese , P. Meybohm , G. Ulrich- Merzenich , S. Zenker , S. Scheithauer , E. Grill

Purpose

Until now, the Hospitalization Rate (HR) served as an indicator (among others) for the COVID-19 associated healthcare burden. To ensure that the HR accomplishes its full potential, hospitalizations caused by COVID-19 (primary cases) and hospitalizations of patients with incidental positive SARS-CoV-2 test results (incidental cases) must be differentiated. The aim of this study was to synthesize the existing evidence on differentiation criteria between hospitalizations of primary cases and incidental cases.

Methods

An online survey of the members of the German Network University Medicine (NUM) was conducted. Additionally, senior clinicians with expertise in COVID-19 care were invited for qualitative, semi-structured interviews. Furthermore, a rapid literature review was undertaken on publications between 03/2020 and 12/2022.

Results

In the online survey (n=30, response rate 56%), pneumonia and acute upper respiratory tract infections were the most indicative diagnoses for a primary case. In contrast, malignant neoplasms and acute myocardial infarctions were most likely to be associated with incidental cases. According to the experts (n=6), the diagnosis, ward, and type of admission (emergency or elective), low oxygen saturation, need for supplemental oxygen, and initiation of COVID-19 therapy point to a primary case. The literature review found that respiratory syndromes and symptoms, oxygen support, and elevated levels of inflammatory markers were associated with primary cases.

Conclusion

There are parameters for the differentiation of primary from incidental cases to improve the objective of the HR. Ultimately, an updated HR has the potential to serve as a more accurate indicator of the COVID-19 associated healthcare burden.

目的迄今为止,住院率(HR)一直是衡量与 COVID-19 相关的医疗负担的指标之一。为确保住院率充分发挥其潜力,必须区分 COVID-19 引起的住院病例(原发病例)和 SARS-CoV-2 检测结果偶然呈阳性的住院病例(偶然病例)。本研究旨在综合现有证据,对原发病例和偶发病例的住院标准进行区分。此外,还邀请了在 COVID-19 护理方面具有专长的资深临床医生进行了半结构化定性访谈。此外,还对 2020 年 3 月至 2022 年 12 月期间发表的文献进行了快速查阅。结果在在线调查(n=30,回复率 56%)中,肺炎和急性上呼吸道感染是原发病例最有参考价值的诊断。相比之下,恶性肿瘤和急性心肌梗塞最有可能与偶发病例有关。根据专家(n=6)的意见,诊断、病房、入院类型(急诊或择期入院)、低血氧饱和度、需要补充氧气以及开始使用 COVID-19 治疗都表明是原发性病例。文献综述发现,呼吸综合征和症状、氧气支持和炎症标志物水平升高与原发性病例有关。最终,更新后的 HR 有可能成为 COVID-19 相关医疗负担的更准确指标。
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引用次数: 0
Evaluation of the detection of diarrhoea-associated RNA viruses in immunocompromised children in Iran 伊朗免疫力低下儿童腹泻相关 RNA 病毒检测评估
Q2 Medicine Pub Date : 2024-05-15 DOI: 10.1016/j.infpip.2024.100370
Shokouh Yasaie , Seyed Dawood Mousavi Nasab , Saeed Shams , Atousa Ferdousi , Hooman Kaghazian

Background

Gastroenteritis accounts for about 10% of the deaths among children, especially in immunocompromised children. Few studies on the prevalence of gastrointestinal infections caused by RNA viruses have been done in Iran. The aim of the study was to evaluate the detection of RNA viruses causing diarrhoea using a multiplex PCR.

Methods

Stool samples were collected from 130 paediatric patients with diarrhoea who had acute lymphocytic leukaemia, non-Hodgkin lymphoma, and retinoblastoma. After RNA extraction and synthesis of cDNA, multiplex PCR was done to evaluate the presence of rotavirus, norovirus, astrovirus, and enterovirus.

Results

There were 9 (6.9%), 7 (5.4%), 3 (2.3%), and 6 (4.6%) cases of rotavirus, norovirus, astrovirus, and enterovirus detected, respectively. One case of co-infection with astrovirus and norovirus was observed.

Conclusions

This is the first report from Iran which identified the presence of common RNA viruses causing diarrhoea in immunocompromised children. Increased awareness of these viruses will enable healthcare professionals to improve strategies and policies to control spread and infection caused by these viruses.

背景肠胃炎约占儿童死亡人数的 10%,尤其是免疫力低下的儿童。伊朗很少对 RNA 病毒引起的胃肠道感染流行情况进行研究。研究的目的是评估使用多重 PCR 检测导致腹泻的 RNA 病毒的情况。方法从 130 名患有急性淋巴细胞白血病、非霍奇金淋巴瘤和视网膜母细胞瘤的腹泻儿科患者中收集工具样本。结果分别有 9 例(6.9%)、7 例(5.4%)、3 例(2.3%)和 6 例(4.6%)检测到轮状病毒、诺如病毒、星状病毒和肠道病毒。结论这是伊朗首次报告发现常见的 RNA 病毒会导致免疫力低下儿童腹泻。提高对这些病毒的认识将有助于医疗保健专业人员改进策略和政策,控制这些病毒的传播和感染。
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引用次数: 0
Adherence to Personal Protective Equipment practices during the COVID-19 pandemic: A pilot study 在 COVID-19 大流行期间坚持使用个人防护设备:试点研究
Q2 Medicine Pub Date : 2024-05-09 DOI: 10.1016/j.infpip.2024.100369
Taryn B. Amos , Cameron Griffin , Joshua K. Schaffzin , Andrea Ankrum , Felicia Scaggs Huang

A direct observational pilot project of healthcare personnel (HCP) was conducted to validate a tool that measures personal protective equipment (PPE) adherence at a large pediatric institution. Overall unit PPE adherence for all moments ranged from 50–61%. Masking was the most adhered to PPE moment (100%); hand hygiene prior to donning PPE had the lowest adherence (13%). Using data from this standardized tool, researchers can evolve PPE standards to maximize their adherence, effectiveness, and ease of utilization.

一项针对医护人员(HCP)的直接观察试点项目在一家大型儿科机构开展,目的是验证一种测量个人防护设备(PPE)依从性的工具。在所有时刻,单位个人防护设备的总体遵守率为 50%-61%。戴口罩是坚持使用个人防护设备最多的时刻(100%);穿戴个人防护设备前的手部卫生坚持率最低(13%)。利用这一标准化工具提供的数据,研究人员可以改进个人防护设备标准,最大限度地提高其依从性、有效性和易用性。
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引用次数: 0
Use of low-dose, high-frequency in situ simulation for preventing healthcare-associated infections – the STOP-HCAI pilot project 使用低剂量、高频率原位模拟预防医护人员相关感染--STOP-HCAI 试点项目
Q2 Medicine Pub Date : 2024-05-08 DOI: 10.1016/j.infpip.2024.100368
Akaninyene Otu , Zoe Wellbelove , Anda Samson , Andrew Blackmore
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引用次数: 0
Hand hygiene perceptions, preferences, and practices among hospital staff in the Dominican Republic in the context of COVID-19: a qualitative study 多米尼加共和国医院工作人员在 COVID-19 背景下的手卫生观念、偏好和做法:一项定性研究
Q2 Medicine Pub Date : 2024-05-01 DOI: 10.1016/j.infpip.2024.100367
Christina E. Craig , Charles D. Schnorr , Cecilia J. Then Paulino , Eulogia Cristina Payano , Paloma Martínez Guzmán , Carrie Ripkey , Michael de St Aubin , Devan Dumas , Kathryn W. Roberts , William Duke , Ronald Skewes-Ramm , Matthew J. Lozier , Eric J. Nilles

Background

Proper hand hygiene (HH), which includes sanitizing with alcohol-based hand rub (ABHR) (or handwashing with soap and water if ABHR is unavailable), is key for preventing healthcare-associated infections (HCAI), including COVID-19. Understanding drivers of HH is key to improving adherence.

Aim

This study aims to explore drivers and barriers to HH practice at two hospitals in the Dominican Republic in the context of the COVID-19 pandemic to inform development of HH behaviour change interventions.

Methods

We conducted in-depth interviews with 20 hospital staff during September 2021. We used the COM-B (capability, opportunity, motivation, behaviour) model to explore HH experiences and preferences. Interviews were recorded, transcribed, coded, and analysed using a thematic approach.

Results

A total of 11 parent codes and 27 sub-codes were identified, and 1145 coded segments were analysed. Use of handwashing with soap and water and/or sanitizing with ABHR was reported by all participants; handwashing was generally preferred. Participants expressed knowledge of proper HH methods (capability), but inconsistent supplies and lack of time presented HH challenges (opportunity). Interviewees described practicing HH to protect themselves and their families from COVID-19 and other infections (reflective motivation) or out of habit (automatic motivation).

Discussion

By understanding and addressing underlying factors affecting HH, hospitals can decrease the risk of HCAIs. Our findings suggest that interventions implemented to improve HH in these hospitals should target motivation and opportunity. These findings informed a multimodal intervention to increase ABHR access and implement message-tested communications campaigns; end-point assessments will provide insights into the intervention's impact.

背景正确的手部卫生(HH),包括用酒精擦手液(ABHR)消毒(如果没有酒精擦手液,则用肥皂和水洗手),是预防包括 COVID-19 在内的医疗相关感染(HCAI)的关键。本研究旨在探讨在 COVID-19 大流行的背景下多米尼加共和国两家医院开展洗手实践的驱动因素和障碍,为制定改变洗手行为的干预措施提供信息。我们使用 COM-B(能力、机会、动机、行为)模型来探讨 HH 经验和偏好。我们对访谈进行了记录、转录、编码,并采用主题方法对访谈进行了分析。所有参与者都报告了用肥皂和水洗手和/或用 ABHR 消毒的情况;他们普遍倾向于洗手。受访者表示了解正确的洗手方法(能力),但供应不稳定和缺乏时间给洗手带来了挑战(机会)。受访者表示,进行 HH 是为了保护自己和家人免受 COVID-19 和其他感染(反思动机)或出于习惯(自动动机)。我们的研究结果表明,在这些医院实施的改善 HH 的干预措施应针对动机和机会。这些发现为采取多模式干预措施提供了依据,以增加 ABHR 的使用机会,并实施经过信息检验的宣传活动;终点评估将为了解干预措施的效果提供依据。
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引用次数: 0
Carbapenemase producing Enterobacterales at a large teaching hospital in Ohio: comparison to state surveillance and retrospective analysis of patient characteristics 俄亥俄州一家大型教学医院中产生碳青霉烯酶的肠杆菌:与州立监测机构的比较以及对患者特征的回顾性分析
Q2 Medicine Pub Date : 2024-04-27 DOI: 10.1016/j.infpip.2024.100366
Amanda Carroll , Rebekah Carman , Tammy Bannerman , Preeti Pancholi

Background

The presence of carbapenemase-producing carbapenem-resistant Enterobacterales (CP-CRE) around the world is increasing, particularly in healthcare settings. Surveillance testing for plasmid-mediated carbapenemase genes is necessary to tracking CP-CRE infections.

Aim

In the state of Ohio, surveillance of carbapenem-resistant Enterobacterales (CRE) began in 2018, and to the authors' knowledge data on these cases has not been published to date. This study analyzed data on CRE from a large teaching hospital in Ohio, and by the Ohio Department of Health Laboratory (ODHL).

Methods

Carbapenemase production was detected using mCIM, and plasmid-mediated carbapenemase genes were detected using rtPCR. Data was collected on 344 standard-of-care isolates from a large teaching hospital in Ohio, including data collected from chart review. Deidentified surveillance data on 4,391 CRE isolates was provided by the ODHL. Statistical analysis was performed using binary logistic regression.

Findings

While KPC was the most common carbapenemase gene (n=1590), NDM (n=98), VIM (n=10), IMP (n=39) and OXA-48 (n=35) were also detected in the isolates studied. Klebsiella pneumoniae and Enterobacter cloacae were the most common CRE, and carbapenemase genes were most commonly detected in K. pneumoniae. Inpatient hospital stays and long-term care were associated with CP-CRE and were more common in women.

Conclusion

Surveillance data shows that CP-CRE are present in Ohio, most commonly in Klebsiella pneumoniae. A better understanding of the prevalence of CRE, plasmid-mediated carbapenemase genes present, and the populations affected are important when tracking the spread of disease. Further study and surveillance of carbapenem-resistant organisms can provide a better understanding of their prevalence in the state.

背景全世界产碳青霉烯酶的耐碳青霉烯类肠杆菌(CP-CRE)越来越多,尤其是在医疗机构。在俄亥俄州,对耐碳青霉烯类肠杆菌(CRE)的监测始于 2018 年,据作者所知,有关这些病例的数据迄今尚未公布。本研究分析了俄亥俄州一家大型教学医院和俄亥俄州卫生部实验室(ODHL)的 CRE 数据。方法 使用 mCIM 检测碳青霉烯酶的产生,使用 rtPCR 检测质粒介导的碳青霉烯酶基因。从俄亥俄州的一家大型教学医院收集了 344 例标准护理分离菌株的数据,包括从病历审查中收集的数据。ODHL 提供了 4,391 例 CRE 分离物的去标识监控数据。研究结果虽然 KPC 是最常见的碳青霉烯酶基因(n=1590),但在研究的分离菌株中还检测到了 NDM(n=98)、VIM(n=10)、IMP(n=39)和 OXA-48 (n=35)。肺炎克雷伯菌和泄殖腔肠杆菌是最常见的 CRE,肺炎克雷伯菌中最常检测到碳青霉烯酶基因。住院治疗和长期护理与 CP-CRE 有关,而且在女性中更为常见。更好地了解 CRE 的流行情况、质粒介导的碳青霉烯酶基因以及受影响的人群对于追踪疾病的传播非常重要。对碳青霉烯类耐药菌的进一步研究和监控可以更好地了解它们在该州的流行情况。
{"title":"Carbapenemase producing Enterobacterales at a large teaching hospital in Ohio: comparison to state surveillance and retrospective analysis of patient characteristics","authors":"Amanda Carroll ,&nbsp;Rebekah Carman ,&nbsp;Tammy Bannerman ,&nbsp;Preeti Pancholi","doi":"10.1016/j.infpip.2024.100366","DOIUrl":"https://doi.org/10.1016/j.infpip.2024.100366","url":null,"abstract":"<div><h3>Background</h3><p>The presence of carbapenemase-producing carbapenem-resistant <em>Enterobacterales</em> (CP-CRE) around the world is increasing, particularly in healthcare settings. Surveillance testing for plasmid-mediated carbapenemase genes is necessary to tracking CP-CRE infections.</p></div><div><h3>Aim</h3><p>In the state of Ohio, surveillance of carbapenem-resistant <em>Enterobacterales</em> (CRE) began in 2018, and to the authors' knowledge data on these cases has not been published to date. This study analyzed data on CRE from a large teaching hospital in Ohio, and by the Ohio Department of Health Laboratory (ODHL).</p></div><div><h3>Methods</h3><p>Carbapenemase production was detected using mCIM, and plasmid-mediated carbapenemase genes were detected using rtPCR. Data was collected on 344 standard-of-care isolates from a large teaching hospital in Ohio, including data collected from chart review. Deidentified surveillance data on 4,391 CRE isolates was provided by the ODHL. Statistical analysis was performed using binary logistic regression.</p></div><div><h3>Findings</h3><p>While KPC was the most common carbapenemase gene (n=1590), NDM (n=98), VIM (n=10), IMP (n=39) and OXA-48 (n=35) were also detected in the isolates studied. <em>Klebsiella pneumoniae</em> and <em>Enterobacter cloacae</em> were the most common CRE, and carbapenemase genes were most commonly detected in <em>K. pneumoniae</em>. Inpatient hospital stays and long-term care were associated with CP-CRE and were more common in women.</p></div><div><h3>Conclusion</h3><p>Surveillance data shows that CP-CRE are present in Ohio, most commonly in <em>Klebsiella pneumoniae</em>. A better understanding of the prevalence of CRE, plasmid-mediated carbapenemase genes present, and the populations affected are important when tracking the spread of disease. Further study and surveillance of carbapenem-resistant organisms can provide a better understanding of their prevalence in the state.</p></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-04-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590088924000301/pdfft?md5=d0c24b68a06f947884147711cd29447a&pid=1-s2.0-S2590088924000301-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140905821","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
Impact of postoperative skin disinfection with chlorhexidine on bacterial colonisation following shoulder arthroplasty surgery: a controlled randomised study 用洗必泰进行术后皮肤消毒对肩关节置换手术后细菌定植的影响:随机对照研究
Q2 Medicine Pub Date : 2024-04-26 DOI: 10.1016/j.infpip.2024.100365
Ida Markström , Karin Falk-Brynhildsen , Margareta Bachrack-Lindström , Gunilla Hollman Frisman , Sara Mernelius , Kristofer Bjerså

Background

Surgical site infections are a significant threat to patient safety. Shoulder arthroplasty carries an increased risk due to foreign implants. Skin preparation in general is a key preoperative preventive intervention, and the use of chlorhexidine can have a prolonged effect on bacterial colonisation. There is a lack of evidence regarding whether postoperative disinfection has an impact on bacterial colonisation during the first 48 hours after surgery. Our hypothesis was that applying postoperative antiseptic with 5 mg/ml chlorhexidine in 70% ethanol would lead to reduced bacterial colonisation with Staphylococcus aureus, coagulase-negative staphylococcus and Cutibacterium acnes around the surgical wound within the initial 48 hours after elective shoulder surgery, compared with the use of sodium chloride.

Methods

A single-blinded, controlled study was conducted at a county hospital in Sweden. Swabs from the skin were collected four times: at baseline, preoperatively, after the intervention and after 48 hours.

Results

Our hypothesis was not confirmed. Although not statistically significant, the chlorhexidine group had a higher prevalence of bacterial colonisation of clinically relevant bacteria.

Conclusions

Our study could not confirm that postoperative disinfection with chlorhexidine reduces bacterial colonisation compared with sodium chloride. The results highlight the complexity of SSIs and the importance of evidence-based preventive skin preparation to ensure patient safety. Further research is needed, considering the study's limitations, to explore and evaluate the effectiveness of different skin cleansing solutions and preventive strategies in diverse surgical contexts.

背景手术部位感染是对患者安全的重大威胁。肩关节置换术因外来植入物而增加了风险。一般来说,皮肤准备是术前预防性干预的关键,使用洗必泰可对细菌定植产生长期影响。关于术后消毒是否会对术后 48 小时内的细菌定植产生影响,目前还缺乏相关证据。我们的假设是,与使用氯化钠相比,术后使用 5 毫克/毫升氯己定溶于 70% 乙醇中的消毒剂会减少金黄色葡萄球菌、凝固酶阴性葡萄球菌和痤疮杆菌在择期肩部手术后最初 48 小时内在手术伤口周围的细菌定植。结果我们的假设没有得到证实。尽管没有统计学意义,但洗必泰组的临床相关细菌定植率较高。结论我们的研究无法证实,与氯化钠相比,术后使用洗必泰消毒可减少细菌定植。研究结果凸显了 SSI 的复杂性以及循证预防性备皮对确保患者安全的重要性。考虑到研究的局限性,还需要进一步研究,探索和评估不同皮肤清洁解决方案和预防策略在不同手术环境中的有效性。
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引用次数: 0
Hand hygiene compliance and improvement interventions in the Eastern Mediterranean Region: a systematic review and meta-analysis 东地中海地区手部卫生达标情况和改善干预措施:系统回顾与元分析
Q2 Medicine Pub Date : 2024-03-27 DOI: 10.1016/j.infpip.2024.100363
Rbab M. Bajunaid , Abduallah Saeed , Muataz Bostaji , Nada J. Farsi

Hand hygiene compliance among healthcare workers is crucial for preventing infections in healthcare settings. This systematic review and meta-analysis aimed to assess the compliance of healthcare workers in the Eastern Mediterranean region with hand hygiene guidelines and synthesize evidence on the success rate of strategies to improve hand hygiene. Five electronic databases (PubMed, CINAHL, Cochrane, Web of Science, and Scopus) were searched up to August 2020. Articles were included if they were conducted in the Eastern Mediterranean Region. A manual search was conducted for reference lists of included papers, and relevant additional references were reviewed. Two reviewers independently screened articles for inclusion, performed data extraction, and assessed quality. A meta-analysis was conducted to synthesize findings and determine the prevalence of hand hygiene compliance interventions. The search yielded 6678 articles. After removing duplicates and applying inclusion/exclusion criteria, 42 articles were included, of which 24 were meta-analyzed. The meta-analysis showed a compliance prevalence of 32% with significant heterogeneity (I2= 99.7% p <0.001). Interventions using the World Health Organization (WHO) guidelines were over two times more likely to improve compliance rates (OR= 2.26, [95% CI:(2.09 - 2.44)], I2= 95%, p<0.001) compared to no intervention. Other interventions were close to two times more likely to improve compliance rates (OR= 1.84, [95% CI:(1.66 - 2.04)], I2= 98% p= 0.001). Approximately two-thirds of healthcare providers in the Eastern Mediterranean region were non-compliant with standard hand hygiene practices, highlighting the need for increased efforts, awareness, observation, and control policies.

医护人员遵守手部卫生规范对于预防医疗机构中的感染至关重要。本系统综述和荟萃分析旨在评估东地中海地区医护人员遵守手部卫生指南的情况,并综合有关改善手部卫生策略成功率的证据。截至 2020 年 8 月,共检索了五个电子数据库(PubMed、CINAHL、Cochrane、Web of Science 和 Scopus)。在东地中海地区进行研究的文章均被收录。对纳入论文的参考文献目录进行了人工检索,并查阅了相关的其他参考文献。两名审稿人独立筛选纳入文章、进行数据提取和质量评估。我们进行了一项荟萃分析,以综合研究结果并确定手卫生依从性干预措施的普及率。搜索共获得 6678 篇文章。在去除重复文章并应用纳入/排除标准后,共纳入 42 篇文章,并对其中 24 篇文章进行了荟萃分析。荟萃分析表明,合规率为 32%,异质性显著(I2= 99.7% p <0.001)。与不采取干预措施相比,采用世界卫生组织(WHO)指南进行干预可提高依从率(OR= 2.26,[95% CI:(2.09 - 2.44)],I2= 95%,p<0.001)两倍多。其他干预措施提高依从率的可能性接近两倍(OR= 1.84,[95% CI:(1.66 - 2.04)],I2= 98%,p= 0.001)。东地中海地区约有三分之二的医疗服务提供者不遵守标准手卫生规范,这凸显了加强努力、提高认识、观察和控制政策的必要性。
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引用次数: 0
Workflows and locations matter – insights from electronic hand hygiene monitoring into the use of hand rub dispensers across diverse hospital wards 工作流程和地点很重要--电子手部卫生监控对不同医院病房使用擦手纸分配器的启示
Q2 Medicine Pub Date : 2024-03-27 DOI: 10.1016/j.infpip.2024.100364
Christoph Senges , Christiane Herzer , Erlandas Norkus , Marco Krewing , Clara Mattner , Leonard Rose , Tobias Gebhardt , Frauke Mattner , Heide Niesalla

Background

While healthcare-associated infections (HAIs) affect approximately 3.2–6.5% of hospitalised patients in the US and Europe, improving hand hygiene (HH) could reduce HAI rates. Investigating HH is time-consuming and not always objective, and comprehensive, unbiased data is needed to develop effective strategies. Using electronic tools can provide new and detailed insights on the determinants of HH.

Aim

To evaluate location-dependent usage of wall-mounted dispensers (WMDs) and point-of-care dispensers (POCs) using an electronic HH recording system.

Methods

In this retrospective study, hand rub volumes were anonymously recorded for 931,446 disinfections from 17 wards in nine German hospitals using the electronic monitoring system NosoEx®. Number of disinfections and rub volumes of WMDs/POCs by ward and room type were analysed.

Findings

Generally, WMDs were most prevalent. With >3 dispensers per bed and >20 disinfections per patient day, availability and use were highest in intensive care (ICU) and intermediate care (IMC), but here rub volumes from WMDs were lowest (∼2.0 mL). Although most dispensers are located in patient rooms (∼42%), they are more frequently used in hallways. In surgical ICUs, dispensers are often used in patient rooms, where contact with open wounds is common. About 3.6 mL of hand rub is used per disinfection in treatment rooms, the highest volume of all room types.

Conclusion

Dispenser use was dependent on location, room type, ward specialisation and workflow. Optimising the location of hand rub dispensers (HRDs)s is not the only solution to improve HH, but can help reduce inconvenience, achieve more ergonomic workflows and better meet user needs.

背景在美国和欧洲,约有 3.2%-6.5% 的住院病人受到医疗相关感染 (HAI) 的影响,而改善手部卫生 (HH) 可以降低 HAI 发生率。调查手部卫生不仅耗时,而且并不总是客观的,因此需要全面、无偏见的数据来制定有效的策略。方法在这项回顾性研究中,使用电子监控系统 NosoEx® 匿名记录了 9 家德国医院 17 个病房 931446 次消毒的擦手次数。研究结果总体而言,大规模毁灭性武器最为普遍。重症监护室(ICU)和中级监护室(IMC)每张病床有 3 台消毒机,每天为 20 名患者进行消毒,其可用性和使用率最高,但 WMD 的擦拭量最低(2.0 mL)。虽然大多数配药机位于病房内(42%),但在走廊上的使用频率更高。在外科重症监护室中,分配器通常用于与开放性伤口接触频繁的病房。治疗室每次消毒使用的擦手纸约为 3.6 毫升,是所有病房类型中使用量最大的。优化擦手纸分配器 (HRDs) 的位置并不是改善 HH 的唯一解决方案,但有助于减少不便、实现更符合人体工程学的工作流程并更好地满足用户需求。
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引用次数: 0
Reducing catheter-associated urinary tract infection in high dependency unit: an eighteen-month quality improvement intervention study period 减少高依赖病房导尿管相关尿路感染:为期 18 个月的质量改进干预研究期
Q2 Medicine Pub Date : 2024-03-24 DOI: 10.1016/j.infpip.2024.100362
Waleed Abdulmotalib Mazi , Mylene Bondad , Maryam Althumali , Turki Alzahrani

Background

The urinary catheter usually leads to a catheter-associated urinary tract infection (CAUTI) contributing to further morbidity and mortality. There is very limited data on the CAUTI incidence rate in high-dependency units (HDUs) in the Kingdom of Saudi Arabia. The institutional CAUTI incidence rate in HDU was six times higher compared to the United States National Healthcare Safety Network (US–NHSN) in 2021.

Objective

To reduce 50% CAUTI incidence rate by the end of 2022.

Method

A prospective study was conducted in tertiary HDU from January 2022 to June 2023. A gap analysis was assessed between the hospital practices and the Society Healthcare Epidemiology of America/Infectious Diseases Society of America (SHEA/IDSA) basic recommendations. The Kotter and Rathgebers' changing behavior model was applied at the beginning of the project. Formal education and prevention of CAUTI were applied using the National Strategy Model. Surveillance and statistical data analysis were carried out using US-NHSN guidelines.

Results

The overall CAUTI incidence rate declined from 7.07- to 3.57/1000 urinary catheter days despite of significant increase in the utilization ratio from 0.79 to 0.94 (P value 0.0001). The compliance rate of the bundle CAUTI prevention was improved and sustained above 90%. A CAUTI incidence rate reduction was observed following the combination of the changing behavior and SHEA/IDSA of CAUTI prevention models over 18 months.

Conclusion

We assumed the combination of the changing behavior and the prevention models for a long period is useful in reducing the CAUTI incidence rate and possibly applied to reduce other healthcare-associated infections.

背景导尿管通常会导致导尿管相关性尿路感染(CAUTI),进一步增加发病率和死亡率。沙特阿拉伯王国高危病房(HDU)的 CAUTI 发病率数据非常有限。与美国国家医疗安全网(US-NHSN)相比,2021 年高危病房的 CAUTI 发病率是后者的六倍。目标到 2022 年底将 CAUTI 发病率降低 50%。方法从 2022 年 1 月至 2023 年 6 月在三级高危病房开展前瞻性研究。对医院实践与美国卫生保健流行病学学会/美国传染病学会(SHEA/IDSA)基本建议之间的差距进行了评估分析。在项目开始时,采用了科特(Kotter)和拉斯格伯斯(Rathgebers)的行为改变模型。采用国家战略模式对 CAUTI 进行正规教育和预防。结果尽管导尿管使用率从 0.79 显著上升至 0.94(P 值为 0.0001),但 CAUTI 的总发病率却从 7.07/1000 降至 3.57/1000(P 值为 0.0001)。捆绑式 CAUTI 预防的依从率有所提高,并保持在 90% 以上。结论:我们认为,将行为改变与 CAUTI 预防模型的 SHEA/IDSA 结合使用 18 个月后,CAUTI 发病率有所下降。
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Infection Prevention in Practice
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