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Concurrent presence of Staphylococcal Cassette Chromosome mec types of Meticillin-Resistant Staphylococcus aureus in hospital environments and post-operative patients at a hospital in Kathmandu, Nepal 在尼泊尔加德满都一家医院的医院环境和术后患者中同时存在葡萄球菌盒染色体mec型耐甲氧西林金黄色葡萄球菌。
IF 1.8 Q3 INFECTIOUS DISEASES
Infection Prevention in Practice
Pub Date : 2024-12-28 DOI: 10.1016/j.infpip.2024.100436
Krishma Pandit , Supriya Sharma , Shreedhar Aryal , Asmita Lamichhane , Sushma Regmi , Prativa Paudel , Sirjana Koirala , Suprina Sharma , Sanjib Adhikari , Komal Raj Rijal , Pramod Poudel

Introduction

Meticillin resistant S. aureus (MRSA) is a major contributor to surgical site infections in post-operative patients. Hospital environments harbor MRSA, contributing to higher risk of nosocomial infections. Meticillin resistance is conferred by acquisition of mecA gene, typically carried on mobile genetic element called Staphylococcal Cassette Chromosome mec (SCCmec).

Objective

This study aimed to determine the prevalence of MRSA, detect mecA, characterize SCCmec types and compare their concurrent presence in clinical and environmental isolates.

Methods

A cross sectional study was conducted at Bhaktapur Hospital, Nepal among clinical specimens collected from postoperative patients. Air and environmental samples were collected by plate exposure and swabbing methods. Samples were processed for culture and antibiotic susceptibility testing by Kirby-Bauer Disc diffusion method, and identification of MRSA using cefoxitin disc. SCCmec typing was done by conventional PCR.

Results

The culture positivity among samples from post-operative patients was 13.9% (326/2350) with S.aureus (39.7%,29/73) being predominating Gram positive bacteria. MRSA accounted for 68 % (20/29) of clinical isolates and 66% (22/33) of environmental isolates, with mecA detected in 85% (17/20) and 72.8% (16/22) respectively. SCCmec Type II predominated followed by Type V and I, while other types were absent. Comparison of SCCmec elements between post-operative patients and hospital environmental samples revealed concurrent presence in both setting, with Type II being the most prevalent.

Conclusions

SCCmec Type I, II, V and mecA elements were concurrently present in both post-operative patients and hospital environments. Effective preventive measures are warranted to break the MRSA transmission between these settings.
导言：耐甲氧西林金黄色葡萄球菌（MRSA）是造成术后患者手术部位感染的主要因素。医院环境容易滋生 MRSA，导致院内感染的风险更高。梅迪西林耐药性是通过获得 mecA 基因而产生的，该基因通常携带在称为葡萄球菌盒式染色体 mec（SCCmec）的移动遗传元件上：本研究旨在确定 MRSA 的流行率、检测 mecA、描述 SCCmec 类型并比较它们在临床和环境分离物中的同时存在情况：在尼泊尔巴克塔普尔医院对术后患者的临床标本进行了横断面研究。采用平板暴露法和拭子法收集空气和环境样本。样本经处理后进行培养，采用柯比鲍尔盘扩散法进行抗生素药敏试验，并使用头孢西丁盘鉴定 MRSA。SCCmec 分型采用传统的 PCR 方法进行：术后患者样本培养阳性率为 13.9%（326/2350），其中金黄色葡萄球菌（39.7%，29/73）是主要的革兰氏阳性菌。MRSA 在临床分离菌中占 68%（20/29），在环境分离菌中占 66%（22/33），分别在 85%（17/20）和 72.8%（16/22）的环境分离菌中检测到 mecA。SCCmec 类型以 II 型为主，其次是 V 型和 I 型，其他类型不存在。对比术后患者和医院环境样本中的SCCmec元素发现，这两种环境中都同时存在SCCmec，其中以II型最为普遍：结论：SCCmec I型、II型、V型和mecA元素同时存在于术后患者和医院环境中。需要采取有效的预防措施来阻止 MRSA 在这些环境中的传播。
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引用次数: 0
Risk of nosocomial respiratory syncytial virus versus influenza among adult patients in acute care hospitals 急性护理医院成人患者院内呼吸道合胞病毒与流感的风险
IF 1.8 Q3 INFECTIOUS DISEASES
Infection Prevention in Practice
Pub Date : 2024-12-26 DOI: 10.1016/j.infpip.2024.100431
Raija Auvinen , Kaisa Huotari , Hanna Nohynek , Ritva K. Syrjänen , Kirsi Skogberg

Background

While nosocomial influenza is common, the risk of transmission in acute care remains unclear in the absence of systematic surveillance. Even less is known about the risk of nosocomial respiratory syncytial virus (RSV) among immunocompetent adults.

Aim

To compare the proportions and incidences of nosocomial cases caused by these two similar respiratory infections among hospitalized adults.

Methods

A retrospective study was conducted at two tertiary care hospitals in Southern Finland. Data on all hospitalized adult patients with a positive RSV or influenza test during 2016–22 were used to detect all nosocomial and community-acquired RSV and influenza cases. The proportion of nosocomial cases of all hospitalized cases was calculated. The incidences of nosocomial cases per 1000 bed-days were calculated by season and ward type for the five seasons before the COVID-19 pandemic.

Results

Nosocomial RSV and influenza occurred in 2.8% and 8.1% of all hospitalized adult patients with a laboratory-confirmed infection. Over five seasons, 2016–20, the total incidences of nosocomial RSV and influenza cases per 1000 bed-days were 0.027 (95% confidence interval: 0.013, 0.050) and 0.32 (0.27, 0.39). Nosocomial RSV infections were especially poorly recorded with a virus-specific ICD-10 diagnosis code listed for only 16.7% of RSV and 59.8% of nosocomial influenza patients.

Conclusion

Despite preventive measures, the incidence of nosocomial influenza was more than tenfold, and the proportion of nosocomial cases was almost threefold compared with RSV among hospitalized adults in acute care. Prevention and surveillance of both nosocomial influenza and RSV should be improved also among immunocompetent adult patients.
背景：虽然医院源性流感很常见，但在缺乏系统监测的情况下，急性护理中传播的风险仍不清楚。在免疫功能正常的成年人中，医院感染呼吸道合胞病毒（RSV）的风险就更少了。目的：比较两种相似呼吸道感染在住院成人中的比例和发病率。方法：在芬兰南部的两所三级医院进行回顾性研究。使用2016-22年期间所有RSV或流感检测阳性的住院成年患者的数据来检测所有医院和社区获得性RSV和流感病例。计算院内病例占所有住院病例的比例。按季节和病区类型计算疫情前5个季节的每1000个床位日住院病例数。结果：医院感染的呼吸道合胞病毒和流感发生率分别为2.8%和8.1%。2016- 2020年5个季节，医院内RSV和流感病例的总发病率分别为0.027（95%可信区间分别为0.013、0.050）和0.32（95%可信区间分别为0.27、0.39）。医院内RSV感染的记录尤其少，仅16.7%的RSV和59.8%的医院内流感患者有病毒特异性的ICD-10诊断代码。结论：尽管采取了预防措施，但医院源性流感的发生率仍在10倍以上，在急诊科住院成人中，医院源性流感病例的比例几乎是呼吸道合胞病毒的3倍。在免疫功能正常的成人患者中，应加强对医院流行性感冒和呼吸道合胞病毒的预防和监测。
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引用次数: 0
Genomic evaluation of phenotypic antibiotic susceptibility patterns as a surrogate for MRSA relatedness and putative transmission during outbreak investigations 在疫情调查期间，表型抗生素敏感性模式的基因组评估作为MRSA相关性和推定传播的替代品。
IF 1.8 Q3 INFECTIOUS DISEASES
Infection Prevention in Practice
Pub Date : 2024-12-26 DOI: 10.1016/j.infpip.2024.100435
Francesc Coll , Michelle S. Toleman , Ewan M. Harrison , Beth Blane , Dorota Jamrozy , Nicholas M. Brown , Julian Parkhill , Sharon J. Peacock
Antibiograms have been used during outbreak investigations for decades as a surrogate for genetic relatedness of Methicillin-resistant Staphylococcus aureus (MRSA). In this study, we evaluate the accuracy of antibiograms in detecting transmission, using genomic epidemiology as the reference standard. We analysed epidemiological and genomic data from 1,465 patients and 1,465 MRSA isolates collected at a single clinical microbiology laboratory in the United Kingdom over a one-year period. A total of 132 unique antibiograms (AB) were identified based on VITEK 2 susceptibility testing, with two profiles (AB1 and AB2) accounting for 698 isolates (48%). We identified MRSA-positive patients with a known hospital or community contact and evaluated the prediction of MRSA transmission based on identical antibiograms. The sensitivity and specificity of identical antibiograms to infer genetically related MRSA isolates (≤25 SNPs) within hospital contacts (presumed transmission events) was 66.4% and 85.5% respectively and 73.8% and 85.7% within community contacts. Reanalysis, where any single drug mismatch in susceptibility results was allowed, increased sensitivity but reduced specificity: 95.2% and 58.8%, respectively, for hospital contacts; and 91.7% and 62.6% for community contacts. Overall, the sensitivity and specificity of identical antibiograms for inferring genetically related MRSA isolates (≤25 SNPs), regardless of epidemiological links, were 49.1% and 87.5%, respectively. We conclude that using an antibiogram with one mismatch can detect most transmission events; however, its poor specificity may lead to an increased workload through the evaluation of numerous pseudo-outbreaks. This study further supports the integration of genomic epidemiology into routine practice for the detection and control of MRSA transmission.
几十年来，抗生素谱在疫情调查中被用作耐甲氧西林金黄色葡萄球菌（MRSA）遗传相关性的替代方法。本研究以基因组流行病学为参考标准，评价抗生素谱检测传播的准确性。我们分析了在英国一个临床微生物实验室收集的1465名患者和1465株MRSA分离株的流行病学和基因组数据，为期一年。VITEK 2药敏试验共鉴定出132个独特抗生素谱（AB），其中AB1和AB2两个谱占698株（48%）。我们确定了与已知医院或社区接触的MRSA阳性患者，并根据相同的抗生素图评估了MRSA传播的预测。在医院接触者（假定的传播事件）中，相同抗生素谱推断遗传相关MRSA分离株（≤25个snp）的敏感性和特异性分别为66.4%和85.5%，在社区接触者中分别为73.8%和85.7%。在允许药敏结果中存在任何单一药物不匹配的情况下，再分析增加了敏感性，但降低了特异性：对医院接触者分别为95.2%和58.8%；社区接触者分别为91.7%和62.6%。总体而言，在不考虑流行病学联系的情况下，相同抗生素谱推断遗传相关MRSA分离株（≤25个snp）的敏感性和特异性分别为49.1%和87.5%。我们的结论是，使用一个不匹配的抗生素谱可以检测到大多数传播事件；然而，由于其特异性较差，可能会通过对许多伪疫情的评估导致工作量增加。本研究进一步支持将基因组流行病学纳入MRSA传播检测和控制的常规实践。
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引用次数: 0
Hospital toilets and drainage systems as a reservoir for a long-term polyclonal outbreak of clinical infections with multidrug-resistant Klebsiella oxytoca species complex 医院厕所和排水系统是耐多药氧化克雷伯菌物种复合体临床感染长期多克隆爆发的蓄水池。
IF 1.8 Q3 INFECTIOUS DISEASES
Infection Prevention in Practice
Pub Date : 2024-12-21 DOI: 10.1016/j.infpip.2024.100430
Astri Lervik Larsen , Torunn Pedersen , Arnfinn Sundsfjord , Theodor A. Ross , Anja Dyresen Guleng , Jon Birger Haug , Anna K. Pöntinen , Ørjan Samuelsen

Background

Nosocomial outbreaks with multidrug-resistant bacteria with a probable reservoir in hospital toilets and drainage systems have been increasingly reported.

Aim

To investigate an increase in bacteraemia with extended-spectrum β-lactamase (ESBL)-producing Klebsiella oxytoca at our hospital in 2021; the epidemiology of the outbreak suggested an environmental source.

Methods

Available clinical K. oxytoca isolates from patient with infection or rectal carriage from 2019 to 2022 were collected. Clinical information was gathered from included patients and sampled sinks, shower drains, and toilet water. Short- and long-read whole-genome sequencing (WGS) was performed on patient and environmental isolates to assess phylogenetic relationships, antibiotic resistance genes/mutations, and plasmid profiles.

Results

WGS revealed four clusters and a polyclonal population consisting of ESBL-producing K. oxytoca and Klebsiella michiganensis. All clusters contained both clinical and environmental isolates. The environmental sampling revealed widespread contamination of the outbreak strains in the outbreak ward, and plasmid analyses indicated possible transfer of plasmids between species and clones. Most environmental findings in the outbreak ward were from toilet water, and enhanced cleaning of bathrooms and toilets was introduced. The following year, a decrease in outbreak strains in systemic infections was observed.

Conclusion

This investigation uncovered a polyclonal outbreak of multidrug-resistant K. oxytoca and K. michiganensis and unveiled a persistent reservoir of outbreak clones in the drainage system and toilet water, facilitating exchange of resistance genes. The risk of toilet water as a source of clinical infections warrants further investigation.
背景：医院内多药耐药菌暴发的报道越来越多，多药耐药菌可能存在于医院厕所和排水系统中。目的：了解我院2021年产β-内酰胺酶（ESBL）克雷伯菌菌血症的增加情况；疫情的流行病学分析表明这是环境因素造成的。方法：收集2019 - 2022年感染或直肠直肠携带患者临床分离的产氧克雷伯菌。从纳入的患者和取样的水槽、淋浴排水管和厕所用水中收集临床信息。对患者和环境分离株进行短读和长读全基因组测序（WGS），以评估系统发育关系、抗生素耐药基因/突变和质粒谱。结果：WGS检测到产esbl的oxytoca和Klebsiella michiganensis的4个聚类和多克隆群体。所有群集均含有临床和环境分离株。环境采样显示暴发病区暴发菌株受到广泛污染，质粒分析表明质粒可能在物种和克隆之间转移。疫情病房的大多数环境发现来自厕所水，并加强了浴室和厕所的清洁。次年，观察到全身感染的爆发菌株有所减少。结论：本次调查发现了多药耐药的oxytoca和k.m akanensis的多克隆爆发，并在排水系统和厕所水中发现了一个持续的爆发克隆库，促进了耐药基因的交换。厕所水作为临床感染源的风险值得进一步调查。
{"title":"Hospital toilets and drainage systems as a reservoir for a long-term polyclonal outbreak of clinical infections with multidrug-resistant Klebsiella oxytoca species complex","authors":"Astri Lervik Larsen ,&nbsp;Torunn Pedersen ,&nbsp;Arnfinn Sundsfjord ,&nbsp;Theodor A. Ross ,&nbsp;Anja Dyresen Guleng ,&nbsp;Jon Birger Haug ,&nbsp;Anna K. Pöntinen ,&nbsp;Ørjan Samuelsen","doi":"10.1016/j.infpip.2024.100430","DOIUrl":"10.1016/j.infpip.2024.100430","url":null,"abstract":"<div><h3>Background</h3><div>Nosocomial outbreaks with multidrug-resistant bacteria with a probable reservoir in hospital toilets and drainage systems have been increasingly reported.</div></div><div><h3>Aim</h3><div>To investigate an increase in bacteraemia with extended-spectrum β-lactamase (ESBL)-producing <em>Klebsiella oxytoca</em> at our hospital in 2021; the epidemiology of the outbreak suggested an environmental source.</div></div><div><h3>Methods</h3><div>Available clinical <em>K. oxytoca</em> isolates from patient with infection or rectal carriage from 2019 to 2022 were collected. Clinical information was gathered from included patients and sampled sinks, shower drains, and toilet water. Short- and long-read whole-genome sequencing (WGS) was performed on patient and environmental isolates to assess phylogenetic relationships, antibiotic resistance genes/mutations, and plasmid profiles.</div></div><div><h3>Results</h3><div>WGS revealed four clusters and a polyclonal population consisting of ESBL-producing <em>K. oxytoca</em> and <em>Klebsiella michiganensis</em>. All clusters contained both clinical and environmental isolates. The environmental sampling revealed widespread contamination of the outbreak strains in the outbreak ward, and plasmid analyses indicated possible transfer of plasmids between species and clones. Most environmental findings in the outbreak ward were from toilet water, and enhanced cleaning of bathrooms and toilets was introduced. The following year, a decrease in outbreak strains in systemic infections was observed.</div></div><div><h3>Conclusion</h3><div>This investigation uncovered a polyclonal outbreak of multidrug-resistant <em>K. oxytoca</em> and <em>K. michiganensis</em> and unveiled a persistent reservoir of outbreak clones in the drainage system and toilet water, facilitating exchange of resistance genes. The risk of toilet water as a source of clinical infections warrants further investigation.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 1","pages":"Article 100430"},"PeriodicalIF":1.8,"publicationDate":"2024-12-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11760810/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143048050","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
Bacterial burden and drug-resistant bacteria in healthcare workers' mobile phones: a study in Puerto Rican outpatient clinics 卫生保健工作者移动电话中的细菌负担和耐药细菌：波多黎各门诊诊所的一项研究。
IF 1.8 Q3 INFECTIOUS DISEASES
Infection Prevention in Practice
Pub Date : 2024-12-12 DOI: 10.1016/j.infpip.2024.100432
R. Scharbaai–Vázquez, A.N. García–Aponte, C. Huertas–Ayala, E.Y. Martínez–Monegro, G.M. Guadalupe–Ríos, J. Díaz–Portorreal, M.I. González–Torres, N.M. Fernández

Background

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

Aim

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

Methods

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

Findings

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

Conclusions

The presence of HAI-causing organisms on mobile phones used by HCWs in outpatient clinics necessitates the implementation of infection control measures to mitigate the risk of cross-contamination in critical healthcare settings.
背景：医院卫生保健工作者（HCWs）使用的移动电话是导致医院获得性感染（HAIs）的耐药细菌的重要宿主。目的：本研究的目的是评估这类细菌在门诊诊所的污染水平。方法：采用标准生化和酶法对83例医护人员手机拭子进行病原菌鉴定。根据CLSI指南进行β-内酰胺酶试验、抗菌药敏试验、广谱β-内酰胺酶（ESBL）筛选和碳青霉烯酶生产。多重耐药基因（金黄色葡萄球菌中的mecA、肺炎克雷伯菌和不动杆菌中的kpc/ndm碳青霉烯酶）采用多重实时聚合酶链反应进行分子检测。研究结果：手机被一种或多种细菌污染的总体发生率为100%。共分离到革兰氏阳性和革兰氏阴性葡萄球菌51株和44株，其中凝固酶阴性葡萄球菌20株、金黄色葡萄球菌20株（耐甲氧西林金黄色葡萄球菌0株）、不动杆菌11株和肺炎克雷伯菌10株。在45%的con和30%的金黄色葡萄球菌中检测到β-内酰胺酶的产生。20%（4/20）的金黄色葡萄球菌检出潘通-瓦伦丁白细胞介素（PVL）毒素基因。20株（20%）和13%的不动杆菌和肺炎克雷伯菌分离株为ESBL，但不产生碳青霉烯酶。结论：卫生保健工作者在门诊诊所使用的手机上存在导致hai的微生物，因此有必要实施感染控制措施，以减轻关键卫生保健机构交叉污染的风险。
{"title":"Bacterial burden and drug-resistant bacteria in healthcare workers' mobile phones: a study in Puerto Rican outpatient clinics","authors":"R. Scharbaai–Vázquez,&nbsp;A.N. García–Aponte,&nbsp;C. Huertas–Ayala,&nbsp;E.Y. Martínez–Monegro,&nbsp;G.M. Guadalupe–Ríos,&nbsp;J. Díaz–Portorreal,&nbsp;M.I. González–Torres,&nbsp;N.M. Fernández","doi":"10.1016/j.infpip.2024.100432","DOIUrl":"10.1016/j.infpip.2024.100432","url":null,"abstract":"<div><h3>Background</h3><div>Mobile phones used by healthcare workers (HCWs) in hospitals are significant reservoirs of drug-resistant bacteria responsible for hospital-acquired infections (HAIs).</div></div><div><h3>Aim</h3><div>The objective of this study was to assess the level of contamination with such bacteria in outpatient clinics.</div></div><div><h3>Methods</h3><div>Swabs from 83 HCWs' mobile phones were processed using standard biochemical and enzymatic procedures to identify pathogenic bacteria. β-Lactamase tests, antimicrobial susceptibility tests, screening for extended-spectrum β-lactamase (ESBL), and carbapenemase production were performed according to CLSI guidelines. Molecular detection of multi-drug-resistant genes (<em>mecA</em> in <em>Staphylococcus aureus</em> and <em>kpc</em>/<em>ndm</em> carbapenemases in <em>Klebsiella pneumoniae</em> and <em>Acinetobacter</em> spp.) was performed using multiplex real-time polymerase chain reaction.</div></div><div><h3>Findings</h3><div>The overall prevalence of mobile phone contamination with one or more bacteria was 100%. A total of 51 Gram-positive and 44 Gram-negative isolates, including 20 coagulase-negative staphylococci (CoNS), 20 <em>S. aureus</em> (0 meticillin-resistant <em>S. aureus</em>), 11 <em>Acinetobacter</em> spp. and 10 <em>K. pneumoniae</em> were isolated. β-Lactamase production was detected in 45% of CoNS and 30% of <em>S. aureus</em>. Panton–Valentine Leukocidin (PVL) toxin gene in <em>S. aureus</em> was found in 20% (4/20) of the isolates. Twenty (20%) and 13% of the <em>Acinetobacter</em> spp. and <em>K. pneumoniae</em> isolates, respectively, were ESBL but not carbapenemase producers.</div></div><div><h3>Conclusions</h3><div>The presence of HAI-causing organisms on mobile phones used by HCWs in outpatient clinics necessitates the implementation of infection control measures to mitigate the risk of cross-contamination in critical healthcare settings.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 1","pages":"Article 100432"},"PeriodicalIF":1.8,"publicationDate":"2024-12-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11732673/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143012992","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
A multimedia tool for infection prevention and control practices in the intensive care unit: a participatory interventional before–after study 重症监护病房感染预防和控制实践的多媒体工具：参与性介入前后研究。
IF 1.8 Q3 INFECTIOUS DISEASES
Infection Prevention in Practice
Pub Date : 2024-12-05 DOI: 10.1016/j.infpip.2024.100423
Sunil Kumar Bijarania , Rupinder Kaur , Manisha Biswal , Sangeeta Maheshwar , Rajarajan Ganesan , Goverdhan D. Puri , Sushant Konar , Shyam Thingnam

Background

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

Aim

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

Methods

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

Results

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

Conclusion

Through a participatory approach, we developed a set of IPC nursing practices for VAP and CLABSI. Implementing a multimedia tool, which encompasses the newly implemented IPC practices, improved compliance with many practices.
背景：重症监护护士的感染预防和控制（IPC）实践对于预防呼吸机相关性肺炎（VAP）和中央静脉相关血流感染（CLABSI）至关重要。目的：实施一种综合方法来开发一套IPC实践，并通过教育多媒体工具传播有关IPC实践的信息，以提高对实践的遵守。方法：这项参与式介入前后研究于2022年5月至2023年3月在单一三级保健中心的心脏外科重症监护病房（ICU）进行。37项与VAP相关的护理IPC实践和8项与CLABSI相关的护理IPC实践通过三步过程最终确定：系统化审查、重点小组讨论（5轮）和德尔菲（3轮）。IPC实践通过多媒体工具传播，在ICU中持续展示。比较使用多媒体工具前后直接观察到的护士对IPC操作的遵守情况。结果：VAP相关实践共6043次，CLABSI相关实践共1957次。实施后，与VAP相关的11项IPC实践和与CLABSI相关的2项IPC实践的合规性有所增加。对洗必泰浴、口腔护理、袖带压力维持、高渗盐水雾化、气管内吸引、擦洗中心静脉导管、评估中心静脉导管是否摘除的依从性有所增加。结论：通过参与式方法，我们开发了一套针对VAP和CLABSI的IPC护理实践。实现包含新实现的IPC实践的多媒体工具，提高了许多实践的遵从性。
{"title":"A multimedia tool for infection prevention and control practices in the intensive care unit: a participatory interventional before–after study","authors":"Sunil Kumar Bijarania ,&nbsp;Rupinder Kaur ,&nbsp;Manisha Biswal ,&nbsp;Sangeeta Maheshwar ,&nbsp;Rajarajan Ganesan ,&nbsp;Goverdhan D. Puri ,&nbsp;Sushant Konar ,&nbsp;Shyam Thingnam","doi":"10.1016/j.infpip.2024.100423","DOIUrl":"10.1016/j.infpip.2024.100423","url":null,"abstract":"<div><h3>Background</h3><div>Infection prevention and control (IPC) practices by critical care nurses are crucial in preventing ventilator-associated pneumonia (VAP) and central-line-associated bloodstream infection (CLABSI).</div></div><div><h3>Aim</h3><div>To implement an integrative approach to developing a set of IPC practices and disseminating information on the IPC practices through an educational multimedia tool to improve compliance with the practices.</div></div><div><h3>Methods</h3><div>This participatory interventional before–after study was conducted in a single tertiary care centre's cardiac surgical intensive care unit (ICU) from May 2022 to March 2023. Thirty-seven nursing IPC practices related to VAP and eight for CLABSI were finalized through a three-step process: systematized review, focused group discussions (five rounds), and Delphi rounds (three rounds). The IPC practices were disseminated through a multimedia tool, displayed continuously in the ICU. Nurses' compliance with the IPC practices observed directly was compared before and after implementing the multimedia tool.</div></div><div><h3>Results</h3><div>A total of 6043 observations for practices related to VAP and 1957 observations for those of CLABSI were performed. There was an increase in compliance post implementation for 11 IPC practices related to VAP and two IPC for those of CLABSI. There was an increase in compliance with practices relevant to chlorhexidine baths, oral care, cuff pressure maintenance, hypertonic saline nebulization, endotracheal suctioning, scrubbing the hub for central line access, and assessment of the central line for removal.</div></div><div><h3>Conclusion</h3><div>Through a participatory approach, we developed a set of IPC nursing practices for VAP and CLABSI. Implementing a multimedia tool, which encompasses the newly implemented IPC practices, improved compliance with many practices.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 1","pages":"Article 100423"},"PeriodicalIF":1.8,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11728882/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142980200","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
The correlation between subcutaneous fat thickness and the incidence of chemoport-related infection 皮下脂肪厚度与化疗口相关感染发生率的关系。
IF 1.8 Q3 INFECTIOUS DISEASES
Infection Prevention in Practice
Pub Date : 2024-12-05 DOI: 10.1016/j.infpip.2024.100433
Thanaphon Khongyut, Tanapong Panpikoon, Chinnarat Buangam, Kaewpitcha Pichitpichatkul, Tharinton Treesit, Sasikorn Feinggumloon

Background

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

Methods

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

Results

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

Conclusions

The thickness of subcutaneous fat does not significantly correlate with the incidence of chemoport infection, and placement of the port on the left side of the chest wall via the left internal jugular vein is the risk factor for chemoport dislocation.
背景：本研究旨在探讨皮下脂肪厚度与放化疗相关感染之间的关系，并确定导致放化疗相关并发症的危险因素。方法：本研究回顾性分析了2018年5月至2022年5月期间363例化疗孔插入患者。根据CT扫描测量的皮下脂肪厚度，将患者分为三组，每组121例。比较三组间脱位、感染、功能障碍等短期和长期并发症的发生率。采用多因素分析方法分析化疗相关并发症的危险因素。结果：皮下脂肪厚度低、中、高组感染发生率分别为1.7%、3.3%、0% （P = 0.131）。本研究组未发生短期并发症。随访1年后，11例（3.0%）出现长期并发症；6例（1.7%）发生化疗孔感染，5例（1.4%）发生化疗孔脱位。在多因素分析中，经左颈内静脉置入时脱位的风险明显更高（OR = 9.87， P=0.033）。结论：皮下脂肪厚度与放化疗孔感染发生率无显著相关性，放化疗孔经左颈内静脉置于胸壁左侧是放化疗孔脱位的危险因素。
{"title":"The correlation between subcutaneous fat thickness and the incidence of chemoport-related infection","authors":"Thanaphon Khongyut,&nbsp;Tanapong Panpikoon,&nbsp;Chinnarat Buangam,&nbsp;Kaewpitcha Pichitpichatkul,&nbsp;Tharinton Treesit,&nbsp;Sasikorn Feinggumloon","doi":"10.1016/j.infpip.2024.100433","DOIUrl":"10.1016/j.infpip.2024.100433","url":null,"abstract":"<div><h3>Background</h3><div>This study aimed to examine the correlation between subcutaneous fat thickness and chemoport-related infection and to determine the risk factors that lead to complications associated with chemoport.</div></div><div><h3>Methods</h3><div>This study retrospectively reviewed 363 patients with chemoport insertion between May 2018 and May 2022. The patients were classified into three groups, with 121 patients in each group, based on the tertiles of subcutaneous fat thickness measured in the computed tomography (CT) scan. The incidence of short-term and long-term complications, including dislocation, infection, and malfunction, were obtained and compared between the three groups. The risk factors of chemoport-related complications were analysed in multivariate analysis.</div></div><div><h3>Results</h3><div>The incidence of infection in the low, middle, and high subcutaneous fat thickness groups were 1.7%, 3.3%, and 0%, respectively (<em>P</em> = 0.131). No short-term complications occurred in this study group. After one year of follow-up, 11 patients (3.0%) had long-term complications; 6 patients (1.7%) developed chemoport infection, while five patients (1.4%) had chemoport dislocation. In multivariate analysis, the risk of dislocation was significantly higher when insertion was performed via the left internal jugular vein (OR = 9.87, <em>P</em>=0.033).</div></div><div><h3>Conclusions</h3><div>The thickness of subcutaneous fat does not significantly correlate with the incidence of chemoport infection, and placement of the port on the left side of the chest wall via the left internal jugular vein is the risk factor for chemoport dislocation.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 1","pages":"Article 100433"},"PeriodicalIF":1.8,"publicationDate":"2024-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699447/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932855","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
Coronavirus disease-2019 (COVID-19) outbreak in a long-term care hospital in Korea in early 2021 2021年初在国内长期护理医院爆发的冠状病毒病（COVID-19）。
IF 1.8 Q3 INFECTIOUS DISEASES
Infection Prevention in Practice
Pub Date : 2024-11-30 DOI: 10.1016/j.infpip.2024.100427
Eun Jo Kim , JaHyun Kang , HyeonSuk Byeon

Background

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

Methods

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

Results

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

Conclusions

We found a potential link between the rehabilitation centre and the outbreak. To prevent future outbreaks at LTCHs, it is necessary to enhance each LTCH's infection control resources and competencies based on its specific requirements, with support from the government.
背景：本研究描述了首尔市一家长期护理医院（LTCH） 2019年冠状病毒病（COVID-19）暴发的疫情调查和控制措施。方法：疫情发生于2021年2月24日至2021年3月2日，地点为首尔一家拥有228张床位的LTCH。对疫情的监测持续到2021年3月16日。地方卫生科与地区公共卫生中心合作调查疫情。经过机构审查委员会的批准，收集并分析了该医院的新冠肺炎相关数据。结果：当一名新的护理人员在常规员工筛查测试中检测出COVID-19阳性时，疫情开始爆发。在这次疫情期间，342人中有8人（包括175名患者和64名护理人员）对COVID-19病毒SARS-CoV-2呈阳性反应。确诊病例的平均年龄为75.1岁（55-90岁）。在这8人中，4人（50%）是男性；2名（25%）是护理人员；6例（75%）无症状；其中6人（75%）曾去过位于地下室的康复中心；其中一个去了不同医院的门诊诊所。22个环境标本中，有3个在走廊扶手和确诊患者的床栏杆检测呈阳性。疫情结束后，立即将确诊病例转移到专门治疗传染病的医院，并将这些病例的密切接触者转移到卫生当局组织的指定医院。结论：我们发现康复中心与疫情之间存在潜在联系。为了防止LTCH今后爆发疫情，有必要在政府的支持下，根据每个LTCH的具体要求加强其感染控制资源和能力。
{"title":"Coronavirus disease-2019 (COVID-19) outbreak in a long-term care hospital in Korea in early 2021","authors":"Eun Jo Kim ,&nbsp;JaHyun Kang ,&nbsp;HyeonSuk Byeon","doi":"10.1016/j.infpip.2024.100427","DOIUrl":"10.1016/j.infpip.2024.100427","url":null,"abstract":"<div><h3>Background</h3><div>This study describes the outbreak investigations and control measures for a coronavirus disease 2019 (COVID-19) outbreak at a long-term care hospital (LTCH) in Seoul.</div></div><div><h3>Methods</h3><div>The outbreak occurred from February 24, 2021 to March 2, 2021 at a 228-bed LTCH in Seoul. Monitoring of the outbreak continued until March 16, 2021. The LTCH investigated the outbreak in cooperation with the district public health centre. After approval from the institutional review board, the hospital's COVID-19 outbreak-related data were collected and analysed.</div></div><div><h3>Results</h3><div>The outbreak commenced when a new caregiver tested positive for COVID-19 in routine employee screening tests. During this outbreak, eight of 342 people including 175 patients and 64 caregivers were positive for the COVID-19 virus SARS-CoV-2. The mean age of the confirmed cases was 75.1 years (range 55–90). Of the eight, four (50%) were males; two (25%) were caregivers; six (75%) were asymptomatic; six (75%) had previously visited a rehabilitation centre, which was located on the basement level; and one visited different hospitals' outpatient clinics. Three of the 22 environmental specimens were test-positive at the corridor's handrail and the bed rails of confirmed patients. The outbreak ended with the immediate transfer of the confirmed cases to hospitals dedicated to infectious diseases and the transfer of close contacts of these cases to designated hospitals which were organised by the health authorities.</div></div><div><h3>Conclusions</h3><div>We found a potential link between the rehabilitation centre and the outbreak. To prevent future outbreaks at LTCHs, it is necessary to enhance each LTCH's infection control resources and competencies based on its specific requirements, with support from the government.</div></div>","PeriodicalId":33492,"journal":{"name":"Infection Prevention in Practice","volume":"7 1","pages":"Article 100427"},"PeriodicalIF":1.8,"publicationDate":"2024-11-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11699601/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142932822","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
Prevalence of difficult-to-treat resistance in ESKAPE pathogens in a third level hospital in Mexico 墨西哥某三级医院ESKAPE病原菌难治性耐药流行情况
IF 1.8 Q3 INFECTIOUS DISEASES
Infection Prevention in Practice
Pub Date : 2024-11-29 DOI: 10.1016/j.infpip.2024.100426
Adrián Camacho-Ortiz, Samantha Flores-Treviño, Paola Bocanegra-Ibarias

Background

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

Methods

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

Results

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

Conclusions

Antimicrobial resistance rates were high in Gram-negative pathogens. CR and DTR rates were higher in A. baumannii than P. aeruginosa and Enterobacterales. DTR surveillance in healthcare providers should be continuous updating local and regional DTR trends among Gram-negative bacteria.
背景：ESKAPE病原菌（粪肠球菌、金黄色葡萄球菌、肺炎克雷伯菌、鲍曼不动杆菌、铜绿假单胞菌和肠杆菌）的耐药和难治性耐药（DTR）对人类健康构成威胁。本研究的目的是确定墨西哥蒙特雷一家三级医院6年来ESKAPE病原菌的抗微生物药物耐药性流行情况和DTR率。方法：采用纸片扩散法或微量肉汤稀释法对2018 ~ 2023年菌株进行药敏试验。对分离物进行碳青霉烯酶基因筛选。检测多药耐药（MDR）、广泛耐药（XDR）、碳青霉烯类耐药（CR）、广谱头孢菌素耐药（ESCR）、氟喹诺酮类耐药（FQR）和DTR。结果：3239株细菌中，呼吸道感染占48.5%，葡萄球菌和金黄色葡萄球菌对甲氧西林的耐药率分别为87.5%和39.8%，肠球菌和肠球菌对万古霉素的耐药率分别为13.9%，鲍曼不动杆菌、肠杆菌和铜绿假单胞菌的耐药率分别为54 ~ 90%、20 ~ 60%和17 ~ 25%。鲍曼不动杆菌的CR为85.7%，铜绿假单胞菌和鲍曼不动杆菌的CR为33.3%，耐碳青霉烯肠杆菌的CR为NDM和OXA-48。鲍曼不动杆菌的DTR率为59.7%(2018年为49.2%，2023年为62.9%)，铜绿假单胞菌为8.9%，鲍曼不动杆菌为14.4%。结论：革兰氏阴性病原菌耐药率较高。鲍曼不动杆菌的CR和DTR率高于铜绿假单胞菌和肠杆菌。卫生保健提供者的DTR监测应不断更新当地和区域革兰氏阴性菌的DTR趋势。
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引用次数: 0
Implementation of the Hand hygiene self-assessment framework in a primary healthcare Centre in Saudi Arabia: A follow-up study 在沙特阿拉伯初级卫生保健中心实施手卫生自我评估框架：一项后续研究。
IF 1.8 Q3 INFECTIOUS DISEASES
Infection Prevention in Practice
Pub Date : 2024-11-29 DOI: 10.1016/j.infpip.2024.100428
Olaa M. Alharbi , Mohammed A. Imam , Ahmad M. Alharbi
Although HH (HH) practices can prevent healthcare related infections, low compliance is a major concern. We evaluated HH using a WHO observational tool and HH self-assessment framework (HHSAF) in 30 individuals in a mix of healthcare professions, before and after the implementation of the framework. In 182 opportunities to demonstrate HH practices, pre-implementation scores were assessed across five different domains including system change, training, and evaluation and feedback. Post-implementation scores obtained after 12 months showed HH compliance of 53%, with highest improvements seen across evaluation and feedback domain. The compliance rates after exposure to body fluids was 100%.
尽管HH （HH）实践可以预防与医疗保健相关的感染，但低遵从性是主要问题。在实施框架之前和之后，我们使用世卫组织观察工具和HH自我评估框架（HHSAF）对30名医疗保健专业人员的HH进行了评估。在182个展示HH实践的机会中，评估了五个不同领域的实施前得分，包括系统变更、培训、评估和反馈。12个月后获得的实施后得分显示，HH的依从性为53%，在评估和反馈领域看到了最高的改善。体液接触后的依从率为100%。
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引用次数: 0
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