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Status of infection prevention and control (IPC) as per the WHO standardised Infection Prevention and Control Assessment Framework (IPCAF) tool: existing evidence and its implication 根据世界卫生组织标准化感染预防和控制评估框架(IPCAF)工具进行感染预防和控制(IPC)的现状:现有证据及其影响
Q2 Medicine Pub Date : 2024-02-28 DOI: 10.1016/j.infpip.2024.100351
Akeza Awealom Asgedom

Healthcare settings have a high prevalence of infectious agents. This narrative review examines the existing evidence regarding infection prevention and control (IPC) using the WHO Infection Prevention and Control Assessment Framework (IPCAF) tool in healthcare facilities. A total of 13 full length papers from Africa, Asia and Europe were considered for this review. The findings showed that there are discrepancies in the IPCAF values from insufficient to advanced level. The current review shows an advanced IPCAF level in middle income and high income countries. Low income countries showed a lower IPCAF score. There is a need to enhance the IPC capacity building and to supply infection prevention resources to prevent healthcare associated infection (HAI) with a focus on low income countries.

医疗机构是传染病的高发区。这篇叙述性综述利用世界卫生组织感染预防与控制评估框架(IPCAF)工具,研究了医疗机构感染预防与控制(IPC)方面的现有证据。本综述共考虑了来自非洲、亚洲和欧洲的 13 篇长篇论文。研究结果表明,从不足级到高级级,IPCAF 的数值存在差异。本次审查显示,中等收入和高收入国家的 IPCAF 水平较高。低收入国家的 IPCAF 分数较低。有必要加强 IPC 能力建设并提供感染预防资源,以预防医疗相关感染 (HAI),重点关注低收入国家。
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引用次数: 0
Prescribing patterns of antimicrobials according to the WHO AWaRe classification at a tertiary referral hospital in the southern highlands of Tanzania 坦桑尼亚南部高地一家三级转诊医院根据世卫组织 AWaRe 分类开具抗菌药处方的模式
Q2 Medicine Pub Date : 2024-02-06 DOI: 10.1016/j.infpip.2024.100347
Anthony Nsojo , Lutengano George , Davance Mwasomola , Joseph Tawete , Christopher H. Mbotwa , Clement N. Mweya , Issakwisa Mwakyula

Background

Antimicrobial consumption continues to rise globally and contributes to the emergence and spread of antimicrobial resistance. This study aimed to evaluate antimicrobial prescribing patterns in a selected tertiary hospital in Tanzania.

Methods

This cross-sectional study was conducted for one year (September 2021–September 2022) at Mbeya Zonal Referral Hospital, a public hospital in the southern highlands zone of Tanzania. Data on clinical diagnosis, laboratory tests, prescribed antimicrobials, and prescribers' designations were collected through a custom eMedical system, aligning antimicrobials with the WHO's 2021 AWaRe classification. Descriptive analysis was performed to assess the pattern of antimicrobial prescriptions.

Results

Of 2,293 antimicrobial prescriptions, 62.41% were ACCESS, 37.42% were WATCH, and 0.17% fell in the RESERVE categories. Metronidazole, accounting for 23.8%, was the most commonly prescribed antimicrobial. More than 50% of the ACCESS and WATCH prescriptions were justified by laboratory diagnosis and were predominantly prescribed by clinicians. A very small proportion of prescriptions (<1%) were informed by culture and sensitivity (C/S) testing. The Paediatric department had the majority of WATCH prescriptions (72.2%).

Conclusion

The prescribing patterns at the study hospital generally align with WHO AWaRe guidelines, potentially mitigating antimicrobial resistance. Nevertheless, the scarcity of culture and sensitivity testing is a concern that warrants targeted improvement.

背景在全球范围内,抗菌药物的消耗量持续上升,导致了抗菌药物耐药性的出现和蔓延。这项研究旨在评估坦桑尼亚一家选定的三级医院的抗菌药物处方模式。方法这项横断面研究在坦桑尼亚南部高原地区的一家公立医院姆贝亚分区转诊医院进行,为期一年(2021 年 9 月至 2022 年 9 月)。通过定制的电子医疗系统收集了临床诊断、实验室检测、处方抗菌药物和处方者指定的数据,并将抗菌药物与世界卫生组织 2021 年的 AWaRe 分类相一致。结果 在 2,293 个抗菌药物处方中,62.41% 属于 ACCESS,37.42% 属于 WATCH,0.17% 属于 RESERVE。甲硝唑是最常用的抗菌药物,占 23.8%。50% 以上的 ACCESS 和 WATCH 处方是根据实验室诊断开具的,并且主要由临床医生开具。只有很小一部分处方(1%)是根据培养和药敏试验(C/S)开出的。结论:研究医院的处方模式总体上符合世界卫生组织的 AWaRe 指南,有可能减轻抗菌药耐药性。然而,培养和药敏试验的缺乏是一个值得关注的问题,需要有针对性地加以改进。
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引用次数: 0
Impact of daily octenidine skin washing versus nonwashing on antiseptic tolerance of coagulase-negative staphylococci in two neonatal intensive care units with different skin cleansing practices 在两家采用不同皮肤清洁方法的新生儿重症监护病房中,每天清洗皮肤与不清洗皮肤对凝固酶阴性葡萄球菌抗菌耐受性的影响
Q2 Medicine Pub Date : 2024-02-03 DOI: 10.1016/j.infpip.2024.100344
Heather Felgate , Charlotte Quinn , Ben Richardson , Carol Hudson , Dheeraj Sethi , Sam Oddie , Paul Clarke , Mark A. Webber

Background

There is wide variation in practices regarding routine bathing/washing of babies in neonatal intensive care units (NICUs). Evidence is lacking as to the benefit of routine antiseptic washes for reducing infection. We aimed to compare the antiseptic tolerance of Coagulase Negative Staphylococci (CoNS) within two UK NICUs with very different approaches to skin washing.

Methods

We compared antiseptic susceptibility of CoNS isolated from skin swabs of neonates admitted to the Norfolk and Norwich University Hospital (NNUH) NICU in December 2017–March 2018 with those isolated in the Bradford Royal Infirmary (BRI) NICU in January–March 2020. The NNUH does not practise routine whole-body washing whereas BRI practises daily whole-body washing from post-menstrual age 27 weeks using Octenisan wash lotion (0.3% octenidine; 1 minute contact time before washing off with sterile water). A total of 78 CoNS isolates from BRI and 863 from the NNUH were tested for susceptibility against the antiseptics octenidine (OCT) and chlorhexidine (CHX).

Results

Isolates from the BRI with practice of routine washing did not show increased antiseptic tolerance to OCT or CHX. Isolates from the NNUH which does not practise routine whole-body washing and rarely uses octenidine, were comparatively less susceptible to both CHX and OCT antiseptics.

Conclusions

Daily whole-body skin washing with OCT does not appear to select for CoNS isolates that are antiseptic tolerant towards OCT and CHX. There remains considerable uncertainty about the impact of different antiseptic regimes on neonatal skin microbiota, the benefit of routine washing, and the development of antiseptic tolerance in the NICU.

背景新生儿重症监护室(NICU)中婴儿的常规沐浴/清洗方法存在很大差异。关于常规消毒清洗对减少感染的益处还缺乏证据。我们旨在比较英国两家皮肤清洗方法迥异的新生儿重症监护病房内凝固酶阴性葡萄球菌(CoNS)的抗菌耐受性。方法我们比较了 2017 年 12 月至 2018 年 3 月诺福克和诺威奇大学医院(NNUH)新生儿重症监护病房与 2020 年 1 月至 3 月布拉德福德皇家医院(BRI)新生儿重症监护病房从新生儿皮肤拭子中分离出的 CoNS 的抗菌敏感性。NNUH没有进行常规全身清洗,而BRI则从月经后27周开始使用Octenisan洗液(0.3%辛烯苷;接触时间为1分钟,然后用无菌水冲洗干净)进行每日全身清洗。对来自北京儿童研究所的 78 株 CoNS 分离物和来自北大人民医院的 863 株 CoNS 分离物进行了辛替尼定(OCT)和洗必泰(CHX)抗菌药敏感性测试。结论每天用 OCT 进行全身皮肤清洗似乎不会选育出对 OCT 和 CHX 具有抗菌耐受性的 CoNS 分离物。不同的防腐方案对新生儿皮肤微生物群的影响、常规清洗的益处以及新生儿重症监护室防腐耐受性的发展仍存在很大的不确定性。
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引用次数: 0
Evaluation of brushing efficiency in reducing oral microbiota in mechanically ventilated patients admitted to an intensive care unit 评估刷牙在减少重症监护室机械通气患者口腔微生物群方面的效率
Q2 Medicine Pub Date : 2024-02-03 DOI: 10.1016/j.infpip.2024.100346
Thainah Bruna Santos Zambrano , Ximena Sayonara Guillén Vivas , Caísa Batista Santos , Viviane de Fátima Mestre , Naga Raju Maddela , Lucia Elena Galarza Santana , Ricardo Sergio Couto de Almeida

Background

Patients admitted to the Intensive Care Unit (ICU) are at greater risk of developing nosocomial infections due to their investigations, treatment and changes in the immune system. One of the most prevalent nosocomial infections is respiratory tract infection, such as hospital acquired pneumonia and ventilator-associated pneumonia (VAP). The bacteria commonly found in the oral cavity in the hospital environment are Streptococcus viridians, Staphylococcus aureus, Pseudomonas aeruginosa, Enterococcus spp., and Klebsiella pneumoniae. There is a need to test and define appropriate standard protocols for oral hygiene in patients undergoing mechanical ventilation in ICUs through the intervention of a dental specialist, preventing the proliferation of microorganisms into the respiratory tract, thus reducing hospitalization time, the use of antibiotics, and increased morbidity/mortality. Objective: This study aimed to evaluate the effectiveness of dental brushing in the reduction of the pathogenic buccal microbiota associated with mechanical ventilation in patients admitted to the Evangelical Hospital from Londrina, Paraná, Brazil.

Methodology

The sample consisted of 90 patients (of both sexes), mean age of 65 years, under mechanical ventilation by orotracheal tube and tracheostomized patients, without suspected or confirmed diagnosis of pneumonia. Patients were randomized ∗∗∗

Results

Results showed that oral hygiene using a toothbrush by suction, with chlorhexidine gel 0.12% (Group B), was more effective than conventional hygiene using gauze soaked with chlorhexidine 0.12% (Group A) in reducing pathogenic buccal microbiota.

Conclusions

There was a reduction of the pathogenic buccal microbiota in mechanically ventilated patients receiving oral hygiene using a toothbrush by suction with chlorhexidine gel 0.12% (Group B)

背景由于检查、治疗和免疫系统的变化,重症监护病房(ICU)收治的患者发生院内感染的风险更大。最常见的院内感染之一是呼吸道感染,如医院获得性肺炎和呼吸机相关肺炎(VAP)。医院环境中口腔常见的细菌有病毒性链球菌、金黄色葡萄球菌、铜绿假单胞菌、肠球菌属和肺炎克雷伯菌。有必要通过牙科专家的干预,测试并确定重症监护病房机械通气患者口腔卫生的适当标准方案,防止微生物扩散到呼吸道,从而缩短住院时间、减少抗生素的使用并降低发病率/死亡率。研究目的本研究旨在评估刷牙在减少巴西巴拉那州隆德里纳福音医院住院患者机械通气相关的致病性口腔微生物群方面的效果。方法:样本包括 90 名患者(男女均有),平均年龄 65 岁,均使用气管插管进行机械通气,以及气管造口患者,均未怀疑或确诊肺炎。结果结果表明,使用牙刷抽吸并涂抹 0.12% 洗必泰凝胶进行口腔卫生(B 组),比使用浸有 0.12% 洗必泰凝胶的纱布进行传统卫生(A 组)更能有效减少肺炎的发生。结论机械通气患者使用含 0.12% 洗必泰凝胶的牙刷通过抽吸进行口腔卫生(B 组)后,病原性口腔微生物群有所减少。
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引用次数: 0
Diphtheria outbreak in Nigeria: what we know now 尼日利亚爆发白喉疫情:我们现在了解到的情况
Q2 Medicine Pub Date : 2024-02-03 DOI: 10.1016/j.infpip.2024.100345
Daniel Danladi Gaiya , Paul Chijioke Ozioko , Moses Edache Entonu , Chioma U. Umeasiegbu
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引用次数: 0
Epidemiological differences, clinical aspects, and short-term prognosis of patients with healthcare-associated and community-acquired infective endocarditis 医源性和社区获得性感染性心内膜炎患者的流行病学差异、临床表现和短期预后
Q2 Medicine Pub Date : 2024-02-02 DOI: 10.1016/j.infpip.2024.100343
Juliana Barros Becker , Valdir Ambrósio Moisés , María Dolores Guerra-Martín , Dulce Aparecida Barbosa

Background

The prevalence of healthcare-associated infective endocarditis in Brazil is poorly known.

Aim

To analyze the epidemiological, clinical and microbiological characteristics, and the prognosis of healthcare-associated infective endocarditis (HAIE) compared with community-acquired infective endocarditis (CIE) and identify the associated factors with hospital mortality.

Method

A historical cohort study was carried out, with a data collection period from January 2009 to December 2019 at the Federal University of São Paulo. Data were collected from medical records of patients with infective endocarditis (IE) hospitalized during the study period. Patients were classified into three groups: CIE, non-nosocomial HAIE (NN-HAIE) and nosocomial HAIE (NHAIE).

Results

A total of 204 patients with IE were included; of these, 127 (62.3%) were cases of HAIE, of which 83 (40.7%) were NN-HAIE and 44 (21.6%) were NHAIE. Staphylococcus spp. Were the main causative agents, especially in HAIE groups (P<0.001). Streptococcus spp. were more prevalent in the CIE group (P<0.001). In-hospital mortality was 44.6%, with no differences between groups. Independent risk factors for in-hospital mortality were age ≥ 60 years (odds ratio (OR): 6.742), septic shock (OR 5.264), stroke (OR 3.576), heart failure (OR 7.296), and Intensive Care Unit admission (OR 7.768).

Conclusion

HAIE accounted for most cases in this cohort, with a higher prevalence of non-nosocomial infections. Staphylococcus spp. were the main causative agents. Hospital mortality was high, 44.6%, with no difference between groups.

背景巴西医源性感染性心内膜炎的发病率鲜为人知。目的分析与社区获得性感染性心内膜炎(CIE)相比,医源性感染性心内膜炎(HAIE)的流行病学、临床和微生物学特征及预后,并确定与住院死亡率相关的因素。方法在圣保罗联邦大学开展了一项历史队列研究,数据收集期为2009年1月至2019年12月。数据来自研究期间住院的感染性心内膜炎(IE)患者的医疗记录。患者被分为三组:结果共纳入204例IE患者,其中127例(62.3%)为HAIE,83例(40.7%)为NN-HAIE,44例(21.6%)为NHAIE。葡萄球菌是主要致病菌,尤其是在 HAIE 组中(P<0.001)。链球菌在CIE组中更为常见(P<0.001)。院内死亡率为44.6%,组间无差异。院内死亡率的独立风险因素为年龄≥60岁(比值比(OR):6.742)、脓毒性休克(OR 5.264)、中风(OR 3.576)、心力衰竭(OR 7.296)和入住重症监护室(OR 7.768)。葡萄球菌是主要致病菌。住院死亡率高达44.6%,组间无差异。
{"title":"Epidemiological differences, clinical aspects, and short-term prognosis of patients with healthcare-associated and community-acquired infective endocarditis","authors":"Juliana Barros Becker ,&nbsp;Valdir Ambrósio Moisés ,&nbsp;María Dolores Guerra-Martín ,&nbsp;Dulce Aparecida Barbosa","doi":"10.1016/j.infpip.2024.100343","DOIUrl":"https://doi.org/10.1016/j.infpip.2024.100343","url":null,"abstract":"<div><h3>Background</h3><p>The prevalence of healthcare-associated infective endocarditis in Brazil is poorly known.</p></div><div><h3>Aim</h3><p>To analyze the epidemiological, clinical and microbiological characteristics, and the prognosis of healthcare-associated infective endocarditis (HAIE) compared with community-acquired infective endocarditis (CIE) and identify the associated factors with hospital mortality.</p></div><div><h3>Method</h3><p>A historical cohort study was carried out, with a data collection period from January 2009 to December 2019 at the <em>Federal University of São Paulo</em>. Data were collected from medical records of patients with infective endocarditis (IE) hospitalized during the study period. Patients were classified into three groups: CIE, non-nosocomial HAIE (NN-HAIE) and nosocomial HAIE (NHAIE).</p></div><div><h3>Results</h3><p>A total of 204 patients with IE were included; of these, 127 (62.3%) were cases of HAIE, of which 83 (40.7%) were NN-HAIE and 44 (21.6%) were NHAIE. <em>Staphylococcus spp.</em> Were the main causative agents, especially in HAIE groups (<em>P</em>&lt;0.001). <em>Streptococcus spp.</em> were more prevalent in the CIE group (<em>P</em>&lt;0.001). In-hospital mortality was 44.6%, with no differences between groups. Independent risk factors for in-hospital mortality were age ≥ 60 years (<em>odds ratio</em> (OR): 6.742), septic shock (OR 5.264), stroke (OR 3.576), heart failure (OR 7.296), and Intensive Care Unit admission (OR 7.768).</p></div><div><h3>Conclusion</h3><p>HAIE accounted for most cases in this cohort, with a higher prevalence of non-nosocomial infections. <em>Staphylococcus spp.</em> were the main causative agents. Hospital mortality was high, 44.6%, with no difference between groups.</p></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S2590088924000076/pdfft?md5=afd81b9a81d795ef689f4910ed61c5d9&pid=1-s2.0-S2590088924000076-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139718423","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
Barriers and facilitators to infection prevention practices in home healthcare: a scoping review and proposed implementation framework 家庭保健中预防感染做法的障碍和促进因素:范围审查和拟议实施框架
Q2 Medicine Pub Date : 2024-01-30 DOI: 10.1016/j.infpip.2024.100342
Lisa Brockhaus, Nikita Sass, Niklaus D. Labhardt

Infection prevention and control (IPC) research has focused on the hospital setting, neglecting the rapidly expanding home healthcare (HHC) sector. Current infection prevention recommendations do not reflect the challenges specific to the HHC setting.

This scoping review considered any original studies reporting on barriers or facilitators to infection prevention practices in the context of HHC. Study characteristics were mapped, and a descriptive content analysis was performed. Based on the findings we propose a framework of eight HHC setting characteristics relevant to infection prevention implementation.

33 studies fulfilled the eligibility criteria. A majority of studies addressed sharps injury or blood and body fluid exposure prevention (N=15) and the majority were conducted in the United States (N=23). Study methodologies employed were surveys (N=18), qualitative (N=11), direct observation (N=7), and one interventional study. The HHC setting characteristics relevant to infection prevention implementation were: the care process in the patient's immediate environment; the need to bring equipment and materials into the home; the provision and financing of equipment and materials; the use of patient space and facilities; the unique position of and the expectations towards HHC providers; working alone with little support; the intermittent nature of care; the attitudes of HHC providers formed by their work circumstances.

Interventional studies generating higher-quality evidence for implementation are lacking. Furthermore, implementation of aseptic technique and the decontamination and reprocessing of equipment are poorly studied in the HHC setting and deserve more research interest. The proposed framework may guide future research and implementation work.

感染预防与控制(IPC)研究主要集中在医院环境中,而忽视了快速发展的家庭医疗保健(HHC)领域。目前的感染预防建议并没有反映出家庭医疗保健环境所面临的特殊挑战。本范围界定综述考虑了所有报告家庭医疗保健环境中感染预防实践的障碍或促进因素的原创性研究。我们绘制了研究特征图,并进行了描述性内容分析。根据研究结果,我们提出了与实施感染预防相关的八种健康护理环境特征框架。大多数研究涉及利器伤害或血液和体液暴露预防(15 项),大多数研究在美国进行(23 项)。采用的研究方法包括调查(18 项)、定性(11 项)、直接观察(7 项)和一项干预研究。与实施感染预防相关的家庭健康中心环境特点包括:在患者的直接环境中进行护理过程;需要将设备和材料带入家中;设备和材料的提供和资助;患者空间和设施的使用;家庭健康中心提供者的独特地位和对其的期望;独自工作且几乎没有支持;护理的间歇性;家庭健康中心提供者因其工作环境而形成的态度。此外,对无菌技术的实施以及设备的净化和再处理在健康护理环境中的研究较少,值得更多研究关注。所提出的框架可为今后的研究和实施工作提供指导。
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引用次数: 0
Predictors of in-hospital mortality in elderly unvaccinated patients during SARS-CoV-2 Alpha variants epidemic SARS-CoV-2 Alpha 变体流行期间未接种疫苗的老年患者院内死亡率的预测因素
Q2 Medicine Pub Date : 2024-01-28 DOI: 10.1016/j.infpip.2024.100341
Zenya Saito , Shota Uchiyama , Saiko Nishioka , Kentaro Tamura , Nobumasa Tamura , Kazuyoshi Kuwano

Background

COVID-19, caused by SARS-CoV-2, has caused a global pandemic. This study aimed to identify predictors of in-hospital mortality in unvaccinated elderly patients with COVID-19 by comparing various predictive factors between the survivors and non-survivors.

Methods

We retrospectively selected 132 unvaccinated patients aged over 65 years with COVID-19 at a hospital in Kanagawa, Japan, during SARS-CoV-2 Alpha variants epidemic. We compared the clinical characteristics, laboratory and radiological findings, treatment, and complications of the survivors and non-survivors. In logistic regression analysis, variables that were significant in the univariate analysis were subjected to multivariate analysis using the variable increase method.

Results

There were 119 and 13 patients in the survivor and non-survivor groups, respectively. Multivariate regression revealed increasing odds with the presence of ARDS and DIC (odd ratio (OR) = 16.35, 34.36; P=0.002, 0.001, respectively) and prolonged hospital stay (OR = 1.17; P=0.004).

Conclusions

We found the complications of ARDS and DIC and hospital length of stay to be independent predictors of in-hospital mortality in elderly unvaccinated patients with COVID-19. Establishing treatments and prevention methods for ARDS and DIC could result in lower mortality rates.

背景由SARS-CoV-2引起的COVID-19已导致全球大流行。本研究旨在通过比较存活者和非存活者的各种预测因素,确定未接种疫苗的 COVID-19 老年患者院内死亡率的预测因素。方法 在 SARS-CoV-2 Alpha 变种流行期间,我们在日本神奈川的一家医院回顾性地选择了 132 名 65 岁以上未接种疫苗的 COVID-19 患者。我们比较了幸存者和非幸存者的临床特征、实验室和放射学检查结果、治疗和并发症。在逻辑回归分析中,使用变量增加法对单变量分析中显著的变量进行了多变量分析。多变量回归显示,出现 ARDS 和 DIC(奇数比 (OR) = 16.35、34.36;P=0.002、0.001)以及住院时间延长(OR = 1.17;P=0.004)的几率增加。建立 ARDS 和 DIC 的治疗和预防方法可降低死亡率。
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引用次数: 0
Faecal microbiota transplantation for multidrug-resistant organism decolonization in spinal cord injury patients: a case series 粪便微生物群移植用于脊髓损伤患者耐多药生物体的去殖民化:一个病例系列
Q2 Medicine Pub Date : 2024-01-27 DOI: 10.1016/j.infpip.2024.100340
Jiri Kriz , Veronika Hysperska , Eliska Bebrova , Marketa Roznetinska

Introduction

The increase of multidrug-resistant (MDR) bacteria in healthcare settings is a worldwide concern. Isolation precautions must be implemented to control the significant risk of transmitting these pathogens among patients. Antibiotic decolonization is not recommended because of the threat of increasing antibiotic resistance. However, restoring gut microflora through faecal microbiota transplantation (FMT) is a hopeful solution.

Patients and method

In 2019–2022, FMT was indicated in seven patients of the Spinal Cord Unit at University Hospital Motol who were colonized with MDR bacterial strains. Five patients tested positive for carriage of carbapenemase-producing Enterobacteriaceae, and two were carriers of vancomycin-resistant enterococci. Isolation measures were implemented in all patients. Donor faeces were obtained from healthy, young, screened volunteers. According to local protocol, 200–300 ml of suspension was applied through a nasoduodenal tube.

Results

The mean age of the patients was 43 years. The mean length of previous hospital stay was 93.2 days. All patients were treated with broad-spectrum antibiotics for infectious complications before detecting colonisation with MDR bacteria. MDR organism decolonization was achieved in five patients, and consequently, isolation measures could be removed. Colonization persisted in two patients, one of whom remained colonized even after a third FMT. No adverse events were reported after FMT.

Conclusion

FMT is a safe and effective strategy to eradicate MDR bacteria, even in spinal cord injured patients. FMT can allow relaxation of isolation facilitates, the participation of patients in a complete rehabilitation program, their social integration, and transfer to follow-up rehabilitation centres.

引言 在医疗机构中,耐多药(MDR)细菌的增加是一个全球关注的问题。必须实施隔离预防措施,以控制这些病原体在患者之间传播的巨大风险。由于抗生素耐药性不断增加的威胁,不建议使用抗生素去污。然而,通过粪便微生物群移植(FMT)恢复肠道微生物菌群是一个充满希望的解决方案。患者和方法2019-2022年,莫托尔大学医院脊髓科的七名患者定植了耐药菌株。五名患者检测出产碳青霉烯酶肠杆菌科细菌携带阳性,两名患者为耐万古霉素肠球菌携带者。所有患者均采取了隔离措施。捐献者粪便取自经过筛选的健康年轻志愿者。根据当地规定,通过鼻十二指肠管使用 200-300 毫升混悬液。平均住院时间为 93.2 天。在检测到 MDR 细菌定植前,所有患者均接受过广谱抗生素治疗,以治疗感染性并发症。五名患者体内的 MDR 菌被清除,因此可以取消隔离措施。两名患者的定植仍然存在,其中一名患者在接受了第三次 FMT 治疗后仍有定植。结论即使在脊髓损伤患者中,FMT 也是一种安全有效的根除 MDR 细菌的策略。FMT 可使患者放松隔离,参与完整的康复计划,融入社会,并转至后续康复中心。
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引用次数: 0
Methods for SARS-CoV-2 hospital disinfection, in vitro observations SARS-CoV-2 医院消毒方法,体外观察
Q2 Medicine Pub Date : 2024-01-12 DOI: 10.1016/j.infpip.2024.100339
Dora E. Corzo-Leon , Hadeel Mohammed Abbood , Rosa A. Colamarino , Markus F.C. Steiner , Carol Munro , Ian M. Gould , Karolin Hijazi

Introduction

Escalation of chemical disinfection during the COVID-19 pandemic has raised occupational hazard concerns. Alternative and potentially safer methods such as ultraviolet-C (UVC) irradiation and ozone have been proposed, notwithstanding the lack of standardized criteria for their use in the healthcare environment.

Aim

Compare the virucidal activity of 70% ethanol, sodium dichloroisocyanurate (NaDCC), chlorhexidine, ozonated water, UVC-222 nm, UVC-254 nm against three SARS-CoV-2 variants of concern cultured in vitro.

Methods

Inactivation of three SARS-CoV-2 variants (alpha, beta, gamma) by the following chemical methods was tested: ethanol 70%, NaDCC (100 ppm, 500 ppm, 1000 ppm), chlorhexidine (2%, 1% and 0.5%), ozonated water 7 ppm. For irradiation, a je2Care 222nm UVC Lamp was compared to a Sylvania G15 UV254 nm lamp.

Results

Viral inactivation by >3 log was achieved with ethanol, NaDCC and chlorhexidine. The minor virucidal effect of ozonated water was <1 log. Virus treatment with UVC-254 nm reduced viral activity by 1–5 logs with higher inactivation after exposure for 3 minutes compared to 6 seconds. For all three variants, under equivalent conditions, exposure to UVC-222 nm did not achieve time-dependent inactivation as was observed with treatment with UVC-254 nm.

Conclusion

The virucidal activity on replication-competent SARS-CoV-2 by conventional chemical methods, including chlorhexidine at concentrations as low as 0.5%, was not matched by UVC irradiation, and to an even lesser extent by ozonated water treatment.

导言在 COVID-19 大流行期间,化学消毒的减少引起了人们对职业危害的担忧。目的比较 70% 乙醇、二氯异氰尿酸钠 (NaDCC)、洗必泰、臭氧水、UVC-222 纳米和 UVC-254 纳米对体外培养的三种 SARS-CoV-2 变异株的杀病毒活性。方法测试了以下化学方法对三种 SARS-CoV-2 变体(α、β、γ)的灭活作用:70% 乙醇、NaDCC(100 ppm、500 ppm、1000 ppm)、洗必泰(2%、1% 和 0.5%)、臭氧水 7 ppm。在照射方面,将 je2Care 222nm 紫外线灯与 Sylvania G15 UV254nm 灯进行了比较。臭氧水的杀毒效果为 1 log。用波长为 254 纳米的紫外线处理病毒可使病毒活性降低 1-5 个对数,与 6 秒钟相比,暴露 3 分钟后的灭活率更高。对于所有三种变体,在同等条件下,紫外线-222 纳米照射不能达到与紫外线-254 纳米处理相同的随时间变化的灭活效果。结论:传统化学方法(包括浓度低至 0.5%的洗必泰)对复制能力强的 SARS-CoV-2 的杀病毒活性无法与紫外线照射相媲美,臭氧水处理的效果甚至更差。
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Infection Prevention in Practice
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