Journal of Hospital Infection最新文献

Traditional infection prevention and control (IPC) education and training of healthcare workers (HCW) is expensive and rarely sustainable, gamification strategies support behaviour change by capitalizing on psychological drivers such as intrinsic and extrinsic motivation. However, little is known about which type of reward presentation best supports the engagement of HCW. This study aims to examine which reward strategy can facilitate engagement and acquisition of IPC knowledge. The study was performed in three gastroenterology wards, a palliative-care ward served as control. Endpoints on bed-occupancy, Alcohol-Based Hand Sanitizer (ABHS) consumption were collected during a two-month baseline period, number of right answers was gathered during the intervention phases and surveys on expectation and satisfaction were conducted pre and post intervention. The intervention of twice-weekly knowledge quizzes, employed loss aversion, standard reward, and in-game reward strategies. Multivariate analysis was used to analyze data on ABHS consumption and IPC knowledge. 105 HCW participated, leading to a 170% increase in the mean ABHS consumption between baseline and the last phase of the gamification. This represents a significant effect of the gamification phases (p < .05). However, no significant consumption difference was observed between the gamified wards (p > .05). Furthermore, Gamified strategies showed higher engagement than the control, though strategies of loss aversion and standard rewards did not display higher ABHS consumption or game engagement over gamification alone. The intervention effectively engaged medical and non-medical staff in IPC topics, positively influencing HCW workflow and increasing ABHS consumption. These findings highlight gamification as a promising approach for IPC education.

Background: Hepatitis A virus (HAV) is one of the leading causes of viral hepatitis with an estimated 159 million acute infections annually. The primary route of transmission is faecal-orally through contaminated drinking water and food. Limited data regarding its surface stability and sensitivity to surface disinfectants is available. Implementing effective disinfectants could have a significant impact on the prevention of HAV transmission. Therefore, the aim of this study was to evaluate HAV stability and sensitivity to surface disinfectants based on an established carrier assay.

Methods: We evaluated the stability of HAV on stainless steel discs over a period of 60 days and its sensitivity to different commercially available surface disinfectants. Steel-disc carriers were inoculated with HAV particles and incubated over a respective period. Furthermore, HAV resistance against several groups of disinfectant agents were tested with varying concentrations and exposure times according to the manufacturers' guidelines.

Results: We observed that HAV was recoverable from stainless steel discs for up to 40 days with an estimated half-life of 18.63 days. The evaluation of several surface disinfectants showed that, except for the aldehyde-based products, all other products insufficiently inactivated HAV.

Conclusion: Overall, HAV demonstrated a high resistance to a wide range of the tested surface disinfectants. Out of the nine surface disinfectants evaluated, only two aldehyde-based products demonstrated a reduction in viral titer below the limit of detection. These findings have strong implications for the recommendation of evidence-based hygiene guidelines to reduce HAV transmission.

Objectives: Hospital-acquired infections (HAIs) pose a significant risk to hospitalised patients. This study aimed to assess the relationship between medication use and the occurrence of HAIs.

Methods: This retrospective multicentre case -control study included 604 HAI cases reported across three hospitals in northwest China from January 2023 to July 2024. The control group consisted of 604 patients without HAIs from the same period and same hospitals. We performed multivariable log-binomial regression to assess the association between medication use and HAIs, adjusting for confounding variables. A trend chi-squared test was also used to evaluate if the risk of HAIs increased with longer medication durations.

Results: Univariate analysis revealed that the use of proton pump inhibitors (PPIs), antibiotics, glucocorticoids, and H2 receptor blockers significantly increased the risk of HAIs (P < 0.05. Multivariable log-binomial regression indicated that PPIs, glucocorticoids, and H2 receptor antagonists were associated with an elevated risk of HAIs, with relative risks (RRs) of 1.37 (95% CI: 1.19-1.57), 1.33 (95% CI: 1.10-1.62), and 1.84 (95% CI: 1.04-3.24), respectively. The duration of prolonged use of PPIs and glucocorticoids was significantly longer in the case group.

Conclusions: Glucocorticoids, PPIs, and H2 receptor antagonists increase HAI risk, with prolonged use exacerbating this risk. The use of a single antibiotic for up to 10 days is not associated with HAI acquisition.

Aspergillus spp. are most commonly associated with disease in the severely immunocompromised host and those with chronic chest disease. The scope of patients at risk is expanding, including intensive care (inclusive of severe viral pneumonia), trauma, burns and major surgery. As exposure or colonisation is a prerequisite to Aspergillus-related disease, this has prompted a global review of preventative measures recommended in healthcare establishments. This global review includes 75 documents from 24 countries, categorised into clinical, infection prevention and control, and building-related guidance for prevention of invasive aspergillosis (IA). We overview the IA incubation period and different acceptable levels of airborne Aspergilli in protected environments (PE), including critical care and operating rooms. Few documents cover all aspects of prevention, prophylaxis, avoidance, preventative measures and monitoring (environmental and clinical). A multi-disciplinary approach is required to identify and minimise the multiple risks and ensure adequate preventative measures. Most building-related guidance addresses construction and internal hospital alterations, but we also review the importance of good management of the healthcare environment (including ventilation systems) and uncertainties of environmental monitoring. We highlight the differences in standards recommended for protective patient environments including the critical care environment. The large capital investment required for protective environments is often limited to patient groups most at risk. Single document comprehensive guidance is lacking, and many countries provide no guidance. Reduction in healthcare-associated acquisition of invasive aspergillosis during vulnerable in-patient episodes requires heightened awareness of patients at risk, careful risk assessment and attentive maintenance of the general hospital environment.

Background: Antimicrobial resistant (AMR) pathogens in drinking water plumbing systems represent a significant yet underestimated public health threat.

Methods: This is the first study to use qPCR and culture-based methods to investigate the prevalence of key AMR threats, methicillin resistant Staphylococcus aureus (MRSA) and carbapenem resistant Pseudomonas aeruginosa and Acinetobacter baumannii, in Australian hospital and residential drinking water and biofilm samples.

Results: Seventy three percent of residential water and biofilm samples were qPCR positive for at least one target pathogen compared with 38% of hospital samples, and 45% of residential plumbing fixtures harboured at least two target pathogens. Thirty seven percent of water and biofilm samples were qPCR positive for P. aeruginosa, 22.3% for A. baumannii and 21.7% for S. aureus. Using culture, 10% of samples were positive for P. aeruginosa, 8% for A. baumannii and 7% for S. aureus. Of these, 29% of P. aeruginosa and 28% of A. baumannii culture isolates were carbapenem resistant, and 54% of S. aureus isolates were identified as MRSA. Drain biofilms were the most common reservoir for AMR A. baumannii, S. aureus and P. aeruginosa. Carbapenem resistance genes including bla_NDM-1, bla_OXA-48, bla_KPC-2 and bla_VIM were found in biofilm samples otherwise negative for P. aeruginosa, indicating plumbing biofilms may act as eDNA reservoirs.

Conclusion: These findings underscore the critical role of plumbing biofilms as hotspots for diverse AMR pathogens, amplifying risks for vulnerable populations, particularly in home healthcare settings. This study highlights an urgent need for enhanced surveillance and targeted interventions to mitigate AMR risks in drinking water plumbing systems.

Objective: To describe the evolving epidemiology and risk associations of vancomycin-resistant Enterococcus (VRE) between 2018 and 2023 in a tertiary hospital in Singapore.

Methods: Inpatients in Singapore General Hospital (SGH) between January 2018 and December 2023 were included. VRE surveillance criteria changed in August 2020 and November 2022. Incidence of any VRE (VRE (all)), VRE from surveillance (VRE (surveillance)), clinical VRE isolates (VRE (clinical)), healthcare-associated VRE infections (HA-VRE (infections)) and bacteremia (VRE (bacteremia)) were reviewed. Three case-control studies were conducted. Environmental screening was performed.

Results: Over the six-year study period there were 5,173 patients with VRE, of whom 3,141 (60.7%) had HA-VRE, 5157 (99.7%) had E.faecium and 4,336 (84%) carried vanA.121 (2.2%) patients had VRE bacteraemia with mortality 50.4%. There were significant changes in incidence of VRE (all), VRE (surveillance) and VRE (clinical) but HA-VRE (infections) and VRE (bacteremia) remained stable. VRE acquisition was associated with presence of concurrent MRSA (OR 9.4, 95% CI 1.3-66.8, p-value < 0.02), CPE (OR 7.2, 95% CI 2.0-26.0, p-value <0.001), ICU admission (OR 6.1, 95% CI 2.8-13.2, p<0.001), hemodialysis (OR 4.6, 95% CI 1.8-12.0, p<0.001), surgery (OR 3.7, 95% CI 1.6-8.3, p<0.001), vancomycin use (OR 28.2, 95% CI 5.4-146.5, p<0.001) and metronidazole use (OR 4.4, 95% CI 1.0-19.0, p-value 0.04) in the preceding three-months. VRE infection had similar risk associations. 12.5% of environmental samples were VRE positive.

Conclusion: VRE endemic state in SGH is associated with significant patient and environmental VRE burden. VRE acquisition and infection have been associated with co-carriage of MRSA or CPE, vancomycin and metronidazole use, ICU admission and prior surgery. Targeted infection prevention and antimicrobial-stewardship programs may reduce VRE (infections).

Background: Surgical site infections (SSIs) after intracranial neurosurgical procedures derive from both endogenous and exogenous factors and are associated with increased morbidity, mortality and additional socio-economic costs. The addition of mobile laminar airflow (MLAF) units to the operating room ventilation decreases bacteria-carrying particles, but its influence on SSI incidence, and along with concurrence with other factors, is unclear. This is a continuation study of a previous study using MLAF units.

Aim: To explore factors associated with surgical site infections after intracranial procedures during a period when MLAF units were used.

Methods: This retrospective register study had an explorative design. The electronic medical records of patients undergoing intracranial neurosurgical procedures were retrospectively reviewed for signs or symptoms of SSIs using a 45-item protocol. Demographic, patient and procedure specific variables were collected as well as exogenous factors and SSI variables regarding depth, type of bacteria, time to infection and treatment. Data was analysed using univariate and multivariate logistic regression.

Findings: An SSI occurred in 55 of 800 included patients (6.9%). In univariate and multivariate analysis, only remote infections during the hospital stay were associated with the risk of an SSI (OR: 2.02; 95% CI: 1.07-3.82; P = 0.031). The most common infection depth was superficial SSIs. Median time to infection was 18 days and the most offending microorganism was Staphylococcus aureus.

Conclusions: In clinical context, considerations are recommended for neurosurgical patients with ongoing remote infections during their hospital stay. Further perioperative studies are needed in the field of surgical infection prevention.

Background and study aims: The risk of duodenoscope-associated colonisations (DAC) and infections (DAI) after endoscopic retrograde cholangiopancreatography (ERCP) with a contaminated duodenoscope remains unknown. Determining the incidence of these events is crucial for developing prevention strategies. This study aimed to assess the incidence of DACs and DAIs.

Methods: This prospective observational study included adult patients who underwent ERCP from January 2022 to December 2023. Duodenoscopes were sampled prior to each procedure. Contamination was defined as the presence of microorganisms of gut or oral origin (MGO). Post-ERCP, upon availability of culture results, patients exposed to contaminated duodenoscopes were asked to provide a stool sample and were followed for six months. Microorganisms isolated from patient samples and clinical cultures were compared with those found in the duodenoscopes. Whole-genome sequencing (WGS) was used to confirm DAC or DAI.

Findings: Among 341 ERCP patients, 73 (21.4%) procedures involved MGO-contaminated duodenoscopes. No duodenoscope-associated outbreaks occurred during the study. Stool samples were returned by 45 of the 73 patients (61.6%). Additionally, 80 MGOs from clinical cultures and 37 residual samples were stored. WGS was performed on eight duodenoscope-patient microorganism pairs from six patients. No DAC or DAI cases were detected.

Conclusion: In a non-outbreak setting, supported by monthly routine microbiological surveillance and a quarantine protocol for duodenoscopes, the risk of DAC and DAI appears low. These findings suggest limited value in intensive patient surveillance for DACs/DAIs. Further research is warranted to confirm these results and address knowledge gaps regarding risk factors for DACs and DAIs.