Journal of Hospital Infection最新文献

Background: Prions are protein-only infectious agents for which no prophylactic or curative treatment exists. Infectivity bioassays based on hamster-263K prions allowed to identify processes capable of inactivating prions on medical devices. However, a 2016 publication study revealed that detergent formulations effective against hamster strain had poor efficacy against human strains. Shortly after, three probable cases of accidental Creutzfeldt-Jakob disease underscored the risk for scientists, health workers, and patients exposed to contaminated materials. The governmental guidelines were modified and emphasizing the need for formulations effective against human prions and robust in vitro and in vivo evaluation protocols. Here, we aimed to compare infectivity bioassays with those of their PMCA counterparts to propose a robust method for evaluating prionicide treatments against human prions.

Methods: Stainless steel wires were contaminated with two humanized prion strains. The wires were then treated with different protocols based on a new formulation termed TFD Premium and WHO references. Residual prion seeding activity and infectivity on the wire and in wastewater were quantified using mb-PMCA and ad hoc bioassays. For vCJD, PMCA compared humanized prions and a human-derived prion isolate.

Findings: TFD Premium proved more efficient at decontaminating humanized prions than 1 N NaOH for 1 hour at room temperature. Tg650-sCJD-VV2 were more resistant to inactivation than vCJD prions. For vCJD, strain from both sources shown similar resistant profile against TFD Premium. Finally, there was perfect alignment between the highly sensitive PMCA cell-free assay and the bioassays.

Background: Reprocessing reusable medical devices and surgical instruments is vital for ensuring safe healthcare in hospitals. Medical Device Reprocessing Departments (MDRDs) handle the cleaning, disinfecting, and sterilizing of these instruments. While previous research has examined bioburden on surfaces and associated patient health risks, there is limited focus on occupational hazards for MDRD workers.

Aim: This study investigates the potential bioaerosol exposure and particle concentrations generated by ultrasonic sterilizing water baths within the MDRD at Mount Sinai Hospital, Toronto, Canada.

Methods: Bioaerosol sampling was conducted using Andersen-style samplers for bacterial and fungal cultures. Particle sampling was measured using optical particle samplers.

Results: Results showed that the majority of bioaerosols were composed of low-risk skin microflora and waterborne bacteria, predominantly Micrococcus luteus and Staphylococcal species. However, potentially harmful bacteria such as Citrobacter species and Acinetobacter species were detected. Fungal genera identified included Aspergillus, Cladosporium, and Penicillium.

Conclusions: Although the overall aerosol generation from ultrasonic cleaning appeared minimal, the study highlights the importance of appropriate PPE and suggests further research on ventilation and additional aerosol sources in MDRDs is needed.

This study aimed to assess trends in surgical site infection (SSI), reoperations for SSI, and reoperations for periprosthetic joint infection (PJI) following primary total hip arthroplasty (THA) in Norway from 2013 to 2022. Two national health registers were used to compare their abilities as surveillance tools for PJI after primary THA. There has been a corresponding decline in SSI and reoperation for PJI between 2013 and 2022. A 95% completeness of 30-days reoperation for PJI in the patient-consent based Norwegian Arthroplasty Register, compared to the mandatory Norwegian Surveillance System for Healthcare Associated Infections is considered excellent. The findings indicate a genuine reduction in SSI and PJI incidence after primary THA.

Objective: To report the epidemiologic, microbiologic and genetic investigation of a large outbreak of carbapenem-resistant Klebsiella pneumoniae associated with gastrointestinal endoscopy, including infection control interventions.

Methods: Internal and external audits of reprocessing procedure, systematic microbiological examination of reprocessed endoscopes, replacement of old endoscopes, investigation of channels of a dismantled endoscope, disinfectant efficacy testing on the outbreak strain´s biofilm, whole genome sequencing (WGS) analysis.

Results: In the early phase of outbreak, the outbreak strain was detected in 19 patients, 16 (84%) of whom had undergone GI endoscopy. The strain was also isolated from a reprocessed endoscope. WGS confirmed clonal relatedness of isolates and suggested transmission between patients via contaminated endoscopes. The reprocessing was audited, old endoscopes were replaced by new ones, and systematic microbiological examination of new endoscopes was introduced. In the follow-up, the outbreak strain was isolated from a new endoscope after reprocessing. Repeat audit revealed residual moisture in endoscope channels after reprocessing. Inspection of a dismantled endoscope revealed debris and scratches in channels. Disinfectant efficacy testing revealed tolerance of the outbreak strain´s biofilm to peracetic acid. Together, the outbreak strain was isolated from 32 patients and two reprocessed endoscopes. WGS suggested patient-to-patient as route of transmission in the outbreak's later phase.

Conclusions: A multi-stage strategy was required to contain this outbreak. Microscopic analysis showed evidence of biofilm formation in endoscope channels and the outbreak strain´s biofilm showed tolerance to the disinfectant used for reprocessing. Our data underscores the need for continued vigilance in infection control practices and reprocessing protocols for endoscopes.

Background: Patients with infection by multidrug-resistant organisms (MDROs) are often complicated, are difficult to cure, require advanced antimicrobial drugs for treatment, and are susceptible to bacterial colonization. This places a heavy economic burden on patients, which can even lead to death, and also increases the economic burden on healthcare services.

Aim: We aimed to systematically assess the risk factors for infection by MDROs in patients in the intensive care unit (ICU).

Methods: PubMed, Embase, MEDLINE, and the Cochrane Library were queried from database inception to September 21, 2023, for literature on risk factors for MDRO infection in patients in the ICU. Two researchers independently performed the screening, data extraction, and quality assessment of the retrieved articles. Data were statistically analysed using Stata 16.0.

Results: This meta-analysis included 29 articles involving 18,063 patients, of whom 2,955 had contracted MDRO infections. The results of the meta-analysis revealed that diabetes mellitus, cardiovascular disease, history of hospitalization within the previous year, abnormal liver function, history of MDRO infection, injury severity score, length of ICU stay, nasogastric tube, parenteral nutrition, colonization pressure, multiple traumas, mechanical ventilation, tracheostomy, central venous catheter, previous antibiotic treatment, immunosuppressive agents, piperacillin-tazobactam, multi-antibiotic treatment, glycopeptide antibiotics, carbapenems, imipenem, and nitroimidazoles were risk factors for MDRO infection in patients in the ICU.

Conclusions: The ICU is a high-risk area for MDRO infection. Healthcare professionals should adopt prevention and control measures based on these risk factors to reduce the occurrence of MDRO infections.

Background: Hospital-associated infections (HAIs) are a significant burden on healthcare systems, necessitating effective prevention strategies. Ultraviolet light (UVL) disinfection has emerged as a potential method for reducing HAIs by decontaminating healthcare environments.

Aim: This systematic review evaluates the effectiveness of UVL in reducing HAIs across various hospital settings.

Methods: A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with searches performed in PubMed, Web of Science, and Scopus through July 2023. Peer-reviewed observational and experimental studies assessing UVL's impact on HAIs were included. Data extraction focused on study characteristics, UVL type, and infection outcomes. Studies focusing on environmental contamination or lacking sufficient data were excluded.

Findings: Twenty-five studies met the inclusion criteria. UVL types included ultraviolet-C (UV-C), pulsed xenon UV (PX-UV), and unspecified UVL. For PX-UV, several studies reported reductions in infection rates, with some showing up to a 70% decrease in Clostridium difficile infection rates, especially in high-risk areas like intensive care units, though results vary across settings, with some studies not observing significant improvements. UV-C disinfection has also been found to reduce HAIs, with its effectiveness varying based on the healthcare setting and targeted pathogens, and it is most effective when used in conjunction with other infection control strategies.

Conclusion: UVL disinfection technologies have demonstrated potential in reducing HAIs, particularly when integrated into a comprehensive infection prevention strategy. Their effectiveness, however, varies by application, pathogen type, and healthcare setting. Further research is needed to optimize UVL implementation and assess its cost-effectiveness in diverse clinical environments.

Background: The hospital environment is a significant source of healthcare-associated infections, necessitating effective cleaning practices to mitigate risks. Various tools, including fluorescent markers, adenosine triphosphate assays, microbiological methods, and direct observation, are used for monitoring, but their comparative effectiveness remains unclear.

Methods: This scoping review followed Joanna Briggs Institute guidelines and PRISMA-ScR standards. Literature from 2000-2024 was sourced from PubMed, Web of Science, and Google Scholar, focusing on tools for monitoring hospital cleaning services. Twenty studies were included and analyzed using a standardized data extraction framework.

Results: Fluorescent markers and adenosine triphosphate assays were practical for routine monitoring and training but had limitations in detecting microbial contamination. Microbiological methods provided accurate contamination data but were resource intensive. Direct observation identified gaps in staff compliance but was subject to observer bias. Studies reported variability in standards, cleaning durations, and resource allocation, with limited data on full-time equivalents. Digital technologies, such as Artificial Intelligence and Internet of Things, offer potential for real-time monitoring and optimization.

Conclusions: A combination of visual inspection, ATP assays, and microbiological methods is recommended for effective monitoring. Collaborative efforts are needed to establish global standards, incorporating emerging technologies to address resource disparities and improve environmental hygiene practices, ultimately enhancing patient safety.

Background: Hospital sinks are known to harbour bacteria with the potential to infect patients.

Aim: To examine bacterial growth in the sinks of a newly constructed Neonatal Intensive Care Unit (NICU) during the transition from an established NICU within the same facility.

Methods: This was a prospective study of pathogenic bacterial growth in NICU handwashing sinks before and after the new NICU was occupied. Samples from various sink traps were cultured longitudinally and comparison was made between an established NICU and the new NICU.

Findings: Potentially pathogenic bacteria rapidly colonised sinks in the new NICU within a month of occupation of the unit. During the study period, between 29 June 2021 and 2 September 2022, 62 samples were collected from 11 sinks, of which 43 (69.4%) tested positive. The mean semi-quantitative bacterial growth score was notably higher in the milk preparation room sink than in the patient care area sinks within the new NICU (40.67 vs. 1.768; p = 0.025). The bacterial profiles in the new milk preparation room sink mirrored that of the established NICU with a predominance of Klebsiella pneumoniae and Enterobacter cloacae complex. In handwashing sinks of both established and new NICUs, the dominant colonizing pathogens were Burkholderia cepacia complex, followed by Serratia marcescens and Elizabethkingia species. Cessation of sink use significantly reduced the bioburden of bacteria in the NICU handwashing sink drains.

Conclusion: Handwashing sinks were rapidly colonised with pathogenic bacteria in a newly constructed NICU. More diversified and prolific growth of pathogenic bacteria was noted in the milk preparation room sinks.

Background and objectives: Despite recommendations to limit the use of vancomycin for known resistant infections, it remains one of the most commonly prescribed antibiotics in neonatal intensive care units (NICUs). One of the most effective approaches to reducing unnecessary antibiotic exposure is through the implementation of antibiotic stewardship programs (ASPs). The objective of this study was to evaluate the effectiveness of ASPs in reducing the use of vancomycin in neonates hospitalized in our NICU.

Methods: This study was a quasi-experimental single-centre study for a quality improvement (QI) initiative. Interventions were implemented to limit the use of vancomycin, including education of the neonatal intensive care team, standardization of vancomycin therapy, and prospective audit and feedback. The pre-intervention period was compared with the post-intervention period.

Results: The initiation of vancomycin decreased from 166 times in the pre-intervention period to 71 times after stewardship implementations, representing a 57.2% reduction. Total vancomycin DOT per 1000 PD gradually declined from 113 to 45 (60.2%) (p<0.001) during the study period. There was an increase in the Gram (+) growth in the culture of patients who were started on vancomycin (p= 0.04). The number of patients receiving two or more courses of vancomycin treatment decreased by 85.7% (p= 0.03).

Conclusion: This study has demonstrated that implementing effective multidisciplinary strategies can significantly reduce vancomycin exposure in the NICU. The application of ASP practices and management in the NICU is essential and achievable, without any increase in the duration of hospitalization or mortality rates.