Journal of Hospital Infection最新文献

Background: Surgical site infection (SSI) remains a challenge in healthcare, contributing to prolonged hospital stays, increased healthcare costs, and adverse patient outcomes, including mortality. Effective preoperative skin disinfection interventions, such as povidone-iodine (PVI) and chlorhexidine (CHG), are widely used but their efficacy remains debated. To address this gap, this meta-analysis aims to evaluate the efficacy of PVI and CHG.

Method: We searched PubMed, Embase, and Cochrane databases up to June 2024 to identify studies comparing PVI versus CHG for preoperative skin antisepsis. We calculated odds ratios (ORs) for binary outcomes, with 95% confidence intervals (CIs). A random-effects model was used with statistical significance set at p < 0.05. Data were analysed using R software (version 4.4.0), and heterogeneity was assessed using I² statistics.

Findings: Sixteen randomised controlled trials (RCTs) were included, involving a total of 13,721 patients, among whom 6,836 (49.8%) received PVI. Compared to CHG, PVI was associated with a non-significant reduction in deep SSI (OR 1.00; 95% CI 0.66 - 1.50; p = 0.994), but an increased risk of overall SSI (OR 1.25; 95% CI 1.06 - 1.48; p = 0.007) and superficial SSI (OR 1.67; 95% CI 1.25 - 2.24; p < 0.001).

Conclusion: PVI as preoperative skin antisepsis demonstrated a non-significant reduction in deep SSI compared to CHG but was associated with an increased risk of overall and superficial SSI. Despite these findings, PVI remains an effective option, especially in resource-limited settings. Further research is needed to optimise its use and improve infection prevention strategies in clinical practice.

Background: Health workers were at higher risk for SARS-CoV-2 infection during the COVID-19 pandemic due to occupational risk factors. As part of the WHO Unity Studies initiative, we aimed to characterise these risk factors.

Methods: This global, multicentre, nested, case-control study was conducted in 121 healthcare facilities in 21 countries. Cases were health workers who tested positive for SARS-CoV-2 infection with a documented occupational exposure to COVID-19 patients in the 14 days pre-enrolment. Controls were enrolled from the same facility with a similar exposure but negative serology. Case and control status was confirmed with serological testing at baseline and after 3-4 weeks. Demographic and infection risk factor data were collected using structured questionnaires.

Findings: Between June 2020 and December 2021, data were obtained for 1213 cases and 1844 controls. SARS-CoV-2 infection risk was associated with non-adherence to personal protective equipment (PPE) guidelines (aOR 1·67 [95% CI 1·32-2·12]) and not consistently performing hand hygiene after patient contact (aOR 2·52 [1·72-3·68]). Direct close contact with COVID-19 patients was also associated with an increased risk, particularly during prolonged contact (>15 min.). Items associated with a lower risk were respirators during aerosol-generating procedures and gloves, gowns or coveralls during contact with contaminated materials/surfaces. No difference was observed among health workers using respirators versus surgical masks for routine care.

Conclusion: Appropriate implementation of infection prevention and control measures and PPE use remain a priority to protect health workers from SARS-CoV-2 infection.

Background: Healthcare-associated infections (HAIs) are an important issue that needs to be continuously addressed in healthcare institutions, and healthcare professionals (HCPs) are expected to strengthen educational programmes on infection prevention. Although the incidence of HAIs in Japan has been decreasing, the actual state of knowledge on infection prevention among HCPs remains unclear.

Aim: To clarify the actual infection prevention knowledge of HCPs in Japan.

Methods: The study participants were 1158 HCPs working in healthcare institutions with frequent contact with patients (283 doctors, 591 nurses, 115 physical therapists, 97 radiologists, and 72 medical technologists). HCPs described the infection prevention behaviours they consciously adhered to via an online self-administered questionnaire. Data were analysed by text mining. Categories were extracted from the responses to reveal HCPs' infection prevention knowledge.

Findings: More than half of the participants (64.9%) were aged > 40 years, and 48.1% had over 20 years of clinical experience. The majority of the participants were nurses (51.0%), 43.9% had a bachelor's degree, and 56.6% were female. Seven categories regarding infection prevention knowledge were extracted: "performing hand hygiene and gargling," "wearing personal protective equipment," "strengthening one's immunity," "protecting oneself and patients from infection," "distinguishing clean and unclean zones," "actions to prevent transmission to others in daily life activities," and "maintaining distance from others."

Conclusion: These results suggest that most HCPs working in healthcare settings in Japan prioritize and adhere to standard precautionary measures, and that the low incidence of HAIs may be influenced by perceptions of the knowledge of "handwashing and gargling" among HCPs.

Purpose: Nosocomial infections pose a serious threat. In neonatal intensive care units (NICUs) in particular, there are repeated outbreaks caused by microorganisms without the sources or dynamics being conclusively determined. This study aims to use amorphous silica nanoparticles with encapsulated DNA (SPED) to simulate outbreak events and to visualize dissemination patterns in a NICU to gain a better understanding of these dynamics.

Methods: Three types of SPED were strategically placed on the ward to mimic three different dissemination dynamics among real-life conditions and employee activities. SPED DNA, resistant to disinfectants, was sampled at 22 predefined points across the ward for four days and qPCR analysis was conducted.

Results: Starting from staff areas, a rapid ward-wide SPED dissemination including numerous patient rooms was demonstrated. In contrast, a primary deployment in a patient room only led to the spread in the staff area, with no distribution in the patient area.

Conclusion: This study pioneers SPED utilization in simulating outbreak dynamics. By unmasking staff areas as potential key trigger spots for ward-wide dissemination the revealed patterns could contribute to a more comprehensive view of outbreak events leading to rethinking of hygiene measures and training to reduce the rate of nosocomial infections in hospitals.

Background: The relationship between anti-tuberculosis (TB) agents and Clostridioides difficile infection (CDI) remains unclear. This study aimed to investigate the epidemiological characteristics and risk factors for CDI in patients with TB.

Methods: This nationwide, population-based cohort study was conducted in the Republic of Korea (ROK) between January 2018 and December 2022. Data were extracted from the National Health Insurance Service (NHIS) National Health Information Database. The risk factors for CDI in patients with TB were identified through multivariate logistic regression analysis using a 1:4 greedy matching method based on age and sex.

Results: During the study period, CDI developed in 2,901 of the 131,950 patients with TB who were prescribed anti-TB agents. The incidence of CDI in patients with TB has increased annually in the ROK from 12.31/1000 in 2018 to 33.51/1000 in 2022. Oral metronidazole (81.94%) was the most common first-line treatment for CDI. The in-hospital mortality rate of patients with concomitant CDI and tuberculosis was 9.9% compared with 6.9% in those with TB alone (P<0.0001). Multivariate logistic regression analysis found intensive care unit admission, Charlson Comorbidity Index ≥3, antibiotics exposure, standard regimen, multidrug resistant TB, and extrapulmonary TB as significant risk factors for development of CDI in patients with TB.

Conclusion: CDI is uncommon in patients with TB, but it results in a significantly increased mortality rate. Patients being treated for TB should be carefully monitored for the development of CDI. Further clinical research is warranted to identify effective interventions for preventing and controlling CDI during TB treatment.

Background: Ventilator-associated pneumonia (VAP) is the main healthcare-associated infection in the intensive care units with Staphylococcus aureus as the first pathogen in early VAP.

Objectives: Primary objective was to compare, using whole genome sequencing (WGS), consecutive S. aureus isolates from lower respiratory samples of mechanically ventilated patients for identification of potential cross-transmissions. Secondary objective was to determine a potential link between S. aureus WGS data and patients with S. aureus early VAP.

Study design: and Methods: All MV patients with a documentation of respiratory S. aureus isolates were included over a two-years period. WGS allowed typing, comparative genomic and phylogenic analyses, as well as analyses of antibiotic resistance genes and virulence genes. Virulence genes were compared between patients who developed respiratory infectious event and those who did not.

Results: A total of 172 S. aureus isolates from 167 patients were sequenced. WGS revealed that the S. aureus population was polyclonal with only two potential healthcare cross-transmissions, each involving two isolates (2.3%). A very low resistance rate was observed with a strong genotypic/phenotypic association, and with a virulence profile highly dependent on the sequence type. No significant correlation was observed between VAP and virulence profile.

Conclusion: This study on consecutive respiratory S. aureus isolates of MV patients revealed a very low level of cross-transmission. No association was observed between S. aureus WGS data and VAP occurrence.