Infection Prevention in Practice最新文献

Recent evidence suggests that Pseudomonas aeruginosa, a bacterium that has the ability to cause deadly infections in hospitalized patients, could originate in the patient's own flora. We employed the Oxford Nanopore platform to obtain whole genome sequences (WGS) from clinical and rectal screen P. aeruginosa strains belonging to 15 patients from two hospitals. Our study found evidence that clinical and rectal isolates were clonal, with some evidence suggesting that the infecting strain was present in the patient's intestine at the time of admission, ruling out hospital acquisition. The use of WGS analysis is crucial to detect alternative sources of P. aeruginosa to develop new preventive measures against these serious infections.

Background

High Consequence Infectious Diseases (HCIDs), have the potential to cause pandemics and require particular focus for preparedness due to their high mortality rates. The application of Personal Protective Equipment (PPE) for HCIDs is complex and carries significant risk of Health Care Worker (HCW) contamination if done incorrectly. Previous reviews have reported a lack of information on the nature of training provided and the ideal timing of repeat training to best retain skills. Simulation Based Mastery Learning (SBML) is a methodology for skill acquisition which encompasses deliberate practice and repeated assessment until the learner achieves a pre-set Mastery standard. SBML has been demonstrated to improve competence, skill retention and patient outcomes in other clinical procedures. SBML has not been previously studied or utilised in HCID PPE training.

Aim

We aimed to increase the likelihood of safe clinical practice by evidencing that Lothian modified SBML for PPE effectively prepares our priority learners.

Methods

A quasi-experimental within group post-test design was used. Learners undertook a modified SBML programme which included two-hour asynchronous and two-hour synchronous components.

Findings

11 learners (10 infectious diseases registrars and 1 infectious diseases consultant) were enrolled in the programme with 8 completing all stages, all of whom achieved the Mastery passing standard. The resources were highly rated by learners with the exemplar videos of skills highlighted as particularly useful. Self-assessed preparedness for each skill increased following pre-learning and synchronous sessions.

Conclusion

Modified SBML can be used as an effective methodology for the training and assessment of HCWs in the donning and doffing of HCID PPE.

Background

Chlorine-based disinfectants, such as bleach, are commonly used for cleaning in healthcare settings to prevent the transmission of nosocomial pathogens. To enhance the efficacy of disinfection, ultraviolet-C (UV-C) light systems have been proposed to supplement standard cleaning procedures. As bleach decomposes in UV light, we hypothesised that the use of UV-C light as an adjunct to manual cleaning with bleach, may decrease the efficacy of disinfection instead.

Methods

In the laboratory, stainless steel sheets and plastic keyboards were inoculated with Pseudomonas aeruginosa (∼10⁶ CFU/ml) and subjected to treatment with either UV-C light only, bleach only or a combination of UV-C light and bleach. The residual bioburden (CFU/ml) was quantified through conventional microbiological techniques. Results were compared to non-exposed control surfaces and against each treatment strategy.

Results

On tested surfaces, there were statistically significant reductions in P. aeruginosa when surfaces were treated with UV-C light only (>2.5 log₁₀ reduction), bleach only (>5.6 log₁₀ reduction) and a combination of UV-C light and bleach (>6.3 log₁₀ reduction) compared to positive control (P < 0.001, all treatment strategies). No significant differences were observed when surfaces were treated with the addition of UV-C light to bleach compared to treatment with bleach alone.

Conclusion

There was no difference in the efficacy of disinfection against P. aeruginosa with the combined treatment strategy of UV-C light and bleach compared to bleach alone under laboratory conditions. Further studies are warranted to elucidate the effectiveness of this technology on other healthcare-associated pathogens.

Aim

This study aimed to verify the efficacy of disinfection procedures to reduce Acinetobacter baumannii bla_OXA-23 bacterial load in needleless connectors that had been experimentally contaminated.

Methods

Two-way intermediate extender's hub and needle-free valve were contaminated with Acinetobacter baumannii bla_OXA-23. To disinfect them, the following procedures were carried out: sterile gauze with 70% ethanol, sterile gauze with Incidin®, and 70% isopropyl alcohol single-use cap, with eight times friction for 10 s, followed by 5 s drying time. The statistical tests Kruskal–Wallis and post-hoc Conover were performed using MedCalc®.

Results

A total of 82 experiments were conducted. All tested disinfection procedures were efficacious in reducing the A. baumannii bla_OXA-23 load. The 70% IPA single-use cap was found to be the best method for disinfecting the two-way intermediate extender's hub (87.28%), while all the methods were efficacious for the disinfection of the needle-free valve (more than 90%). During the inoculation period, A. baumannii bla_OXA-23 showed less adherence to the needle-free valve during the inoculation period, probably due to the device's design.

Conclusion

The three tested disinfection procedures using sterile gauze with 70% ethanol, sterile gauze with Incidin®, and 70% IPA single-use cap were found to be efficacious in reducing the bacterial load of A. baumanni bla_OXA-23 in needleless connectors. Proper disinfection of needleless connectors is a crucial nursing practice to prevent bloodstream infections, as it significantly reduces the bacterial load present in the device.

Antimicrobial resistance (AMR) is now regarded as one of the greatest global challenges of the 21^st century. The complexity, urgent timeframe, and lack of clear solution to AMR have contributed to its classification as a ‘super wicked problem’. Yet knowledge surveys of the general public have found that they still harbour numerous misconceptions linked to both the sources and impact of AMR. This confusion is compounded by AMR being a One Health issue, and therefore a factor in not just human health but in other industries, such as farming. This can further inhibit understanding and knowledge transfer around AMR for those without a prior knowledge base.

In order to address the escalating risk that AMR presents, however, it is essential to address this knowledge gap and engage with the public to support wide scale changes in behaviour and consumer choice. The WHO now requires national action plans tackling AMR to include patient and public involvement/engagement (PPI/E) to support changing the trajectory of AMR. Despite this, little detail is available as part of strategic plans on how PPI/E should be undertaken in order to aid implementation. This paper discusses a number of approaches to support the design and delivery of PPI/E in relation to AMR, including the different social behaviour models underlying successful PPI/E strategies, and key considerations linked to specific activity types. The framework produced includes features for steps from initial planning and design through to evaluation. The aim is to help improve the ability of scientists and healthcare professionals to produce high quality AMR PPI/E.