Pub Date : 2024-10-10DOI: 10.1016/j.jhin.2024.09.019
T. Obenhuber , M. Pfister , C. Reiber , M. Dunic , C. Falk , W. Zingg , P.W. Schreiber
Background
Central line-associated bloodstream infections (CLABSIs) are associated with relevant morbidity and mortality. Longitudinal dynamics in CLABSI incidence and the spectrum of causative microorganisms are limited.
Aim
To describe trends in CLABSI incidence, use of central lines, and causative pathogens.
Methods
We analysed prospectively collected data on CLABSI at a Swiss tertiary care hospital between January 2016 and December 2023. We investigated longitudinal changes of incidence densities, catheter utilization and causative pathogens.
Findings
A total of 707 CLABSIs were observed, corresponding to an incidence density of 1.69 (95% confidence interval 1.56–1.81) CLABSIs per 1000 catheter-days. There was no significant trend of CLABSI incidence density per 1000 catheter-days (z = 0.86, P=0.391), but an increase of catheter utilization ratio (z = 8.88, P<0.001). Coagulase-negative staphylococci (N = 207, 23.4%) and Enterococcus spp. (N = 134, 15.2%; E. faecium N = 94, 10.6%; E. faecalis N = 37, 4.1%; other Enterococcus spp. N = 3, 0.34%) were the most frequent causative pathogens. Over the years, the proportion of Enterococcus spp. (z = 3.4, P<0.001), driven by an increase of E. faecium (z = 3.2, P=0.001), and yeast (z = 2.3, P=0.020) increased, whereas coagulase-negative staphylococci decreased (z = -6.1, P<0.001).
Conclusions
Prospective CLABSI surveillance indicated stable incidence densities per 1000 catheter-days, but there were significant shifts of causative microorganisms over time.
{"title":"Trends in surveillance indicators for central-catheter-associated bloodstream infections in a tertiary hospital in Switzerland","authors":"T. Obenhuber , M. Pfister , C. Reiber , M. Dunic , C. Falk , W. Zingg , P.W. Schreiber","doi":"10.1016/j.jhin.2024.09.019","DOIUrl":"10.1016/j.jhin.2024.09.019","url":null,"abstract":"<div><h3>Background</h3><div>Central line-associated bloodstream infections (CLABSIs) are associated with relevant morbidity and mortality. Longitudinal dynamics in CLABSI incidence and the spectrum of causative microorganisms are limited.</div></div><div><h3>Aim</h3><div>To describe trends in CLABSI incidence, use of central lines, and causative pathogens.</div></div><div><h3>Methods</h3><div>We analysed prospectively collected data on CLABSI at a Swiss tertiary care hospital between January 2016 and December 2023. We investigated longitudinal changes of incidence densities, catheter utilization and causative pathogens.</div></div><div><h3>Findings</h3><div>A total of 707 CLABSIs were observed, corresponding to an incidence density of 1.69 (95% confidence interval 1.56–1.81) CLABSIs per 1000 catheter-days. There was no significant trend of CLABSI incidence density per 1000 catheter-days (z = 0.86, <em>P</em>=0.391), but an increase of catheter utilization ratio (z = 8.88, <em>P</em><0.001). Coagulase-negative staphylococci (<em>N</em> = 207, 23.4%) and <em>Enterococcus</em> spp. (<em>N</em> = 134, 15.2%; <em>E. faecium N</em> = 94, 10.6%; <em>E. faecalis N</em> = 37, 4.1%; other <em>Enterococcus</em> spp. <em>N</em> = 3, 0.34%) were the most frequent causative pathogens. Over the years, the proportion of <em>Enterococcus</em> spp. (z = 3.4, <em>P</em><0.001), driven by an increase of <em>E. faecium</em> (z = 3.2, <em>P</em>=0.001), and yeast (z = 2.3, <em>P</em>=0.020) increased, whereas coagulase-negative staphylococci decreased (z = -6.1, <em>P</em><0.001).</div></div><div><h3>Conclusions</h3><div>Prospective CLABSI surveillance indicated stable incidence densities per 1000 catheter-days, but there were significant shifts of causative microorganisms over time.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"154 ","pages":"Pages 64-69"},"PeriodicalIF":3.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1016/j.jhin.2024.09.022
V. Gillitzer , A. Rath , A. Caplunik-Pratsch , S. Däumling , W. Schneider-Brachert , S. Gaube
Background
The spread of multi-drug-resistant organisms (MDROs) is a critical health issue. Isolation measures imposed to prevent transmission may result in adverse psychological effects among affected patients. This emphasizes the need for better communication and information to improve their hospital experience and mental well-being as well as to prevent inadequate treatment.
Aim
The present study examined whether tailored counselling sessions during contact isolation could enhance patients' understanding of their situation concerning the significance of their MDRO status and enhance their well-being.
Methods
A pre-post-intervention study was conducted in a German tertiary-care hospital in which N = 64 patients who were isolated due to MDROs received tailored counselling. The counselling included information about MDROs, the reason for hospital isolation measures, and appropriate behaviour during and after hospitalization. Participants completed questionnaires before and after the counselling sessions to assess its impact on their informedness, patient (dis)satisfaction and well-being measures.
Findings
Prior to the counselling session, patient dissatisfaction was associated with anxiety and inadequate informedness about MDROs. After the counselling, patients reported a significantly improved comprehension of their MDROs-related situation and a notable decrease in dissatisfaction with their hospital situation, primarily attributed to the acquired information.
Conclusions
This is the first German study to show how improved information about MDROs impacts patient satisfaction in hospitals. The findings stress the crucial need for improving healthcare workers' interaction and communication with patients affected by MDROs.
{"title":"Counselling sessions for patients in contact isolation due to multi-drug-resistant organisms improve informedness and reduce dissatisfaction","authors":"V. Gillitzer , A. Rath , A. Caplunik-Pratsch , S. Däumling , W. Schneider-Brachert , S. Gaube","doi":"10.1016/j.jhin.2024.09.022","DOIUrl":"10.1016/j.jhin.2024.09.022","url":null,"abstract":"<div><h3>Background</h3><div>The spread of multi-drug-resistant organisms (MDROs) is a critical health issue. Isolation measures imposed to prevent transmission may result in adverse psychological effects among affected patients. This emphasizes the need for better communication and information to improve their hospital experience and mental well-being as well as to prevent inadequate treatment.</div></div><div><h3>Aim</h3><div>The present study examined whether tailored counselling sessions during contact isolation could enhance patients' understanding of their situation concerning the significance of their MDRO status and enhance their well-being.</div></div><div><h3>Methods</h3><div>A pre-post-intervention study was conducted in a German tertiary-care hospital in which <em>N</em> = 64 patients who were isolated due to MDROs received tailored counselling. The counselling included information about MDROs, the reason for hospital isolation measures, and appropriate behaviour during and after hospitalization. Participants completed questionnaires before and after the counselling sessions to assess its impact on their informedness, patient (dis)satisfaction and well-being measures.</div></div><div><h3>Findings</h3><div>Prior to the counselling session, patient dissatisfaction was associated with anxiety and inadequate informedness about MDROs. After the counselling, patients reported a significantly improved comprehension of their MDROs-related situation and a notable decrease in dissatisfaction with their hospital situation, primarily attributed to the acquired information.</div></div><div><h3>Conclusions</h3><div>This is the first German study to show how improved information about MDROs impacts patient satisfaction in hospitals. The findings stress the crucial need for improving healthcare workers' interaction and communication with patients affected by MDROs.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"154 ","pages":"Pages 53-59"},"PeriodicalIF":3.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481258","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-10DOI: 10.1016/j.jhin.2024.09.020
S. Oubbéa , B. Pilmis , D. Seytre , A. Lomont , T. Billard-Pomares , J-R. Zahar , L. Foucault-Fruchard
Background
Pulmonary tuberculosis (PTB) is an airborne disease, warranting the identification of suspected cases on admission, and their hospitalization in individual rooms with the implementation of airborne supplementary precautions (ASPs).
Aim
To identify the frequency of non-isolated PTB and the factors associated with the delay in implementing ASPs in a high-prevalence hospital.
Methods
This retrospective observational study included patients with at least one Mycobacterium tuberculosis-positive specimen. Patient demographic and clinical data, as well as data related to the mode of admission, were collected. Univariate and multi-variate statistical analyses were performed.
Findings
During the study period, 256 patients were included. Among them, 134 (52.3%) had PTB (75% males, median age 39 years, 70% foreign-born). Among these patients, 46 (34%) were isolated beyond 24 h of admission. The average time to implement ASPs was 4.3 days, and seven patients (5.2%) were not isolated throughout their hospital stay. Multi-variate analysis indicated that three factors were associated with isolation. Previous consultation with a general practitioner was associated with greater likelihood of isolation, whereas admission through the emergency department was not. The presence of so-called ‘cardinal clinical signs’ and a suggestive chest x-ray were also associated with greater likelihood of isolation. Finally, European patients were isolated less frequently than foreign-born patients.
Conclusion
In this study, 34% of patients admitted with PTB were not isolated on admission. The likelihood of non-isolation was three times higher in cases admitted via the emergency department, and European patients were isolated less frequently than foreign-born patients. The presence of cardinal signs and prior consultation with a general practitioner were associated with greater likelihood of isolation.
肺结核（PT）是一种通过空气传播的疾病，因此有理由在可疑患者入院时对其进行识别，并在其住院期间在单人病房实施空气传播补充预防措施（ASP）。本研究的目的是在一家高发病率医院中确定非隔离型肺结核的发病率以及与延迟实施 ASP 相关的因素。这是一项回顾性观察研究，研究对象包括至少有一份结核分枝杆菌阳性标本的患者。研究收集了患者的人口统计学和临床数据，以及与入院方式相关的数据。进行了单变量和多变量统计分析。在研究期间，共纳入了 256 名患者。其中 134 人（52.3%）患有 PT。其中包括 100 名（75%）男性，中位年龄为 39 岁，70% 在国外出生。在这些患者中，有 46 人（34%）在入院 24 小时后仍被隔离。实施 ASP 的平均时间为 4.3 天，有 7 名患者（5.2%）在整个住院期间未被隔离。通过多变量分析，有三类因素与隔离有关。曾向全科医生就诊具有保护作用，而通过急诊科入院则不具有保护作用。存在所谓的主要临床症状和胸部 X 光片提示也是保护因素。最后，欧洲病人较少被隔离。在我们的研究中，34% 的 PT 患者在入院时未被隔离。经急诊科入院的患者未被隔离的风险是经急诊科入院的患者的三倍，而欧裔患者的隔离率较低。出现主要体征和事先咨询全科医生与较高的隔离频率有关。
{"title":"Risk factors for non-isolation of patients admitted for pulmonary tuberculosis in a high-incidence department: a single-centre retrospective study","authors":"S. Oubbéa , B. Pilmis , D. Seytre , A. Lomont , T. Billard-Pomares , J-R. Zahar , L. Foucault-Fruchard","doi":"10.1016/j.jhin.2024.09.020","DOIUrl":"10.1016/j.jhin.2024.09.020","url":null,"abstract":"<div><h3>Background</h3><div>Pulmonary tuberculosis (PTB) is an airborne disease, warranting the identification of suspected cases on admission, and their hospitalization in individual rooms with the implementation of airborne supplementary precautions (ASPs).</div></div><div><h3>Aim</h3><div>To identify the frequency of non-isolated PTB and the factors associated with the delay in implementing ASPs in a high-prevalence hospital.</div></div><div><h3>Methods</h3><div>This retrospective observational study included patients with at least one <em>Mycobacterium tuberculosis</em>-positive specimen. Patient demographic and clinical data, as well as data related to the mode of admission, were collected. Univariate and multi-variate statistical analyses were performed.</div></div><div><h3>Findings</h3><div>During the study period, 256 patients were included. Among them, 134 (52.3%) had PTB (75% males, median age 39 years, 70% foreign-born). Among these patients, 46 (34%) were isolated beyond 24 h of admission. The average time to implement ASPs was 4.3 days, and seven patients (5.2%) were not isolated throughout their hospital stay. Multi-variate analysis indicated that three factors were associated with isolation. Previous consultation with a general practitioner was associated with greater likelihood of isolation, whereas admission through the emergency department was not. The presence of so-called ‘cardinal clinical signs’ and a suggestive chest x-ray were also associated with greater likelihood of isolation. Finally, European patients were isolated less frequently than foreign-born patients.</div></div><div><h3>Conclusion</h3><div>In this study, 34% of patients admitted with PTB were not isolated on admission. The likelihood of non-isolation was three times higher in cases admitted via the emergency department, and European patients were isolated less frequently than foreign-born patients. The presence of cardinal signs and prior consultation with a general practitioner were associated with greater likelihood of isolation.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 130-134"},"PeriodicalIF":3.9,"publicationDate":"2024-10-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142481265","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-09DOI: 10.1016/j.jhin.2024.09.018
K. van der Ploeg , M.C. Vos , N.S. Erler , A.J.C. Bulkmans , B.C.G.C. Mason-Slingerland , J.A. Severin , M.J. Bruno
Background
Despite adherence to reprocessing protocols, duodenoscopes frequently remain contaminated, highlighting significant knowledge gaps in reprocessing efficiency.
Aim
To identify risk factors in duodenoscope reprocessing procedures affecting contamination rates.
Methods
Cultures from Pentax ED34-i10T2 duodenoscopes collected between February 2022 and December 2023 were included. Contamination was determined by the presence of micro-organisms of gut or oral origin (MGO). Data on duodenoscope use, reprocessing lead times and personnel were retrieved from electronic medical records. Risk factors were derived from reprocessing guidelines and literature. These included a delay >30 min in initiating manual cleaning, manual cleaning duration of ≤5 min, drying time <90 min, personnel reprocessing frequency, and storage exceeding seven days. A logistic mixed-effects model evaluated these factors' impact on duodenoscope contamination.
Findings
Out of 307 duodenoscope cultures, 58 (18.9%) were contaminated with MGO. Throughout the study period, the duodenoscopes underwent 1296 reprocessing cycles. Manual cleaning times of ≤5 min significantly increased contamination odds (adjusted odds ratio (aOR): 1.61; 95% confidence interval (CI): 1.10–2.34; P = 0.01). Increased usage of a duodenoscope was associated with reduced odds of contamination (aOR: 0.80; 95% CI: 0.64–0.995; P = 0.045). Other studied risks showed no clear association with contamination rates.
Conclusion
Manual cleaning times of ≤5 min increased the odds of contamination with MGO. Delays in reprocessing initiation and incomplete drying, traditionally considered as risk factors, were not associated with an increased risk of contamination in this study. Future research should explore whether enhanced surveillance of reprocessing times can mitigate duodenoscope contamination.
{"title":"Impact of duodenoscope reprocessing factors on duodenoscope contamination: a retrospective observational study","authors":"K. van der Ploeg , M.C. Vos , N.S. Erler , A.J.C. Bulkmans , B.C.G.C. Mason-Slingerland , J.A. Severin , M.J. Bruno","doi":"10.1016/j.jhin.2024.09.018","DOIUrl":"10.1016/j.jhin.2024.09.018","url":null,"abstract":"<div><h3>Background</h3><div>Despite adherence to reprocessing protocols, duodenoscopes frequently remain contaminated, highlighting significant knowledge gaps in reprocessing efficiency.</div></div><div><h3>Aim</h3><div>To identify risk factors in duodenoscope reprocessing procedures affecting contamination rates.</div></div><div><h3>Methods</h3><div>Cultures from Pentax ED34-i10T2 duodenoscopes collected between February 2022 and December 2023 were included. Contamination was determined by the presence of micro-organisms of gut or oral origin (MGO). Data on duodenoscope use, reprocessing lead times and personnel were retrieved from electronic medical records. Risk factors were derived from reprocessing guidelines and literature. These included a delay >30 min in initiating manual cleaning, manual cleaning duration of ≤5 min, drying time <90 min, personnel reprocessing frequency, and storage exceeding seven days. A logistic mixed-effects model evaluated these factors' impact on duodenoscope contamination.</div></div><div><h3>Findings</h3><div>Out of 307 duodenoscope cultures, 58 (18.9%) were contaminated with MGO. Throughout the study period, the duodenoscopes underwent 1296 reprocessing cycles. Manual cleaning times of ≤5 min significantly increased contamination odds (adjusted odds ratio (aOR): 1.61; 95% confidence interval (CI): 1.10–2.34; <em>P</em> = 0.01). Increased usage of a duodenoscope was associated with reduced odds of contamination (aOR: 0.80; 95% CI: 0.64–0.995; <em>P</em> = 0.045). Other studied risks showed no clear association with contamination rates.</div></div><div><h3>Conclusion</h3><div>Manual cleaning times of ≤5 min increased the odds of contamination with MGO. Delays in reprocessing initiation and incomplete drying, traditionally considered as risk factors, were not associated with an increased risk of contamination in this study. Future research should explore whether enhanced surveillance of reprocessing times can mitigate duodenoscope contamination.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"154 ","pages":"Pages 88-94"},"PeriodicalIF":3.9,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142402024","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.jhin.2024.09.016
L-H. Wu , J-L. Wang , Y-H. Liu , C-C. Su , Y-H.K. Yang , S-J. Lin , C-L. Cheng
Background
Previous studies on Clostridioides difficile infection (CDI) in proton pump inhibitor (PPI) users generally enrolled a heterogeneous population and did not include a control group of histamine H2 receptor antagonists (H2RAs) users or adjust for confounding variables, such as previous antibiotics. It is uncertain whether hospitalized patients using PPIs for stress ulcer prophylaxis (SUP) are at a higher risk of CDI compared with those using H2RAs. This study aimed to compare the association between CDI and the usage of antisecretory drugs (ASDs): PPIs and H2RAs, for SUP among hospitalized patients, and the impact of the duration of their use on CDI.
Methods
In this nationwide population-based cohort study using the Taiwan National Health Insurance Database, hospitalized patients using ASDs for SUP were identified between 2017 and 2018. A total of 63,266 and 69,269 individuals were included in the PPI and H2RA groups, respectively. The primary endpoint was a 90-day monitoring of CDI occurrence.
Findings
The incidences of CDI were 1.6/10,000 and 0.5/10,000 person-days in the PPIs and H2RAs groups, respectively. After adjusting for confounding factors, the risk of infection in the PPIs group remained significantly higher than in the H2RAs group (hazard ratio (HR), 2.49; 95% confidence interval (CI), 1.63–3.81). In the subgroup analysis, during hospitalization, the risk of CDI for patients using high-risk antibiotics or admitted to the intensive care unit (ICU), as well as patients with immunodeficiency, using PPIs for SUP, was higher than using H2RAs. Furthermore, the risk of CDI was higher in patients using ASDs for durations >14 days than in those using them for <7 days (adjusted HR, 3.66; 95% CI, 2.34–5.75).
Conclusions
The risk of occurrence CDI for hospitalized patients using PPIs for SUP was higher than using H2RAs. It is recommended not to exceed 14 days of any gastric ASDs for SUP during hospitalization, especially for patients who have used high-risk antibiotics, have been admitted to the ICU, or have immunodeficiency.
{"title":"Hospitalized patients on proton pump inhibitors for stress ulcer prophylaxis have a higher risk of Clostridioides difficile infection compared with those on histamine-2 receptor antagonists","authors":"L-H. Wu , J-L. Wang , Y-H. Liu , C-C. Su , Y-H.K. Yang , S-J. Lin , C-L. Cheng","doi":"10.1016/j.jhin.2024.09.016","DOIUrl":"10.1016/j.jhin.2024.09.016","url":null,"abstract":"<div><h3>Background</h3><div>Previous studies on <em>Clostridioides difficile</em> infection (CDI) in proton pump inhibitor (PPI) users generally enrolled a heterogeneous population and did not include a control group of histamine H2 receptor antagonists (H2RAs) users or adjust for confounding variables, such as previous antibiotics. It is uncertain whether hospitalized patients using PPIs for stress ulcer prophylaxis (SUP) are at a higher risk of CDI compared with those using H2RAs. This study aimed to compare the association between CDI and the usage of antisecretory drugs (ASDs): PPIs and H2RAs, for SUP among hospitalized patients, and the impact of the duration of their use on CDI.</div></div><div><h3>Methods</h3><div>In this nationwide population-based cohort study using the Taiwan National Health Insurance Database, hospitalized patients using ASDs for SUP were identified between 2017 and 2018. A total of 63,266 and 69,269 individuals were included in the PPI and H2RA groups, respectively. The primary endpoint was a 90-day monitoring of CDI occurrence.</div></div><div><h3>Findings</h3><div>The incidences of CDI were 1.6/10,000 and 0.5/10,000 person-days in the PPIs and H2RAs groups, respectively. After adjusting for confounding factors, the risk of infection in the PPIs group remained significantly higher than in the H2RAs group (hazard ratio (HR), 2.49; 95% confidence interval (CI), 1.63–3.81). In the subgroup analysis, during hospitalization, the risk of CDI for patients using high-risk antibiotics or admitted to the intensive care unit (ICU), as well as patients with immunodeficiency, using PPIs for SUP, was higher than using H2RAs. Furthermore, the risk of CDI was higher in patients using ASDs for durations >14 days than in those using them for <7 days (adjusted HR, 3.66; 95% CI, 2.34–5.75).</div></div><div><h3>Conclusions</h3><div>The risk of occurrence CDI for hospitalized patients using PPIs for SUP was higher than using H2RAs. It is recommended not to exceed 14 days of any gastric ASDs for SUP during hospitalization, especially for patients who have used high-risk antibiotics, have been admitted to the ICU, or have immunodeficiency.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"154 ","pages":"Pages 9-17"},"PeriodicalIF":3.9,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382480","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.jhin.2024.09.014
S. Hanif, I. Khanum, S. Shariq, A. Fareed, A. Hafeez, M. Fatima, M. Azhar, N. Nasir
{"title":"A nosocomial outbreak of Crimean–Congo haemorrhagic fever in a tertiary-care centre in Pakistan","authors":"S. Hanif, I. Khanum, S. Shariq, A. Fareed, A. Hafeez, M. Fatima, M. Azhar, N. Nasir","doi":"10.1016/j.jhin.2024.09.014","DOIUrl":"10.1016/j.jhin.2024.09.014","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"154 ","pages":"Pages 140-141"},"PeriodicalIF":3.9,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142382400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-10-05DOI: 10.1016/j.jhin.2024.09.017
R.C. Brock , R.J.B. Goudie , C. Peters , R. Thaxter , T. Gouliouris , C.J.R. Illingworth , A. Conway Morris , C.B. Beggs , M. Butler , V.L. Keevil
Background
Nosocomial infections are costly, and airborne transmission is increasingly recognized as important for spread. Air cleaning units (ACUs) may reduce transmission, but little research has focused on their effectiveness on open wards.
Aim
To assess whether ACUs reduce nosocomial severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), or other, infections on older adult inpatient wards.
Methods
This was a quasi-experimental before-and-after study on two intervention–control ward pairs in a UK teaching hospital. Infections were identified using routinely collected electronic health record data during 1 year of ACU implementation and the preceding year (‘core study period’). Extended analyses included 6 months of additional data from one ward pair following ACU removal. Hazard ratios (HRs) were estimated through Cox regression controlling for age, sex, ward and background infection risk. The time that the ACUs were switched on was also recorded for Intervention Ward 2.
Findings
ACUs were initially feasible, but compliance reduced towards the end of the study (average operation in first vs second half of ACU time on Intervention Ward 2: 77% vs 53%). In total, 8171 admissions for >48 h (6112 patients, median age 85 years) were included. Overall, the incidence of ward-acquired SARS-CoV-2 was 3.8%. ACU implementation was associated with a non-significant trend of lower hazard for SARS-CoV-2 infection [HR core study period 0.90, 95% confidence interval (CI) 0.53–1.52; HR extended study period 0.78, 95% CI 0.53–1.14]. Only 1.5% of admissions resulted in other notable ward-acquired infections.
Conclusion
ACUs may reduce SARS-CoV-2 infection to a clinically meaningfully degree. Larger studies could reduce uncertainty, perhaps using a crossover design, and factors influencing acceptability to staff and patients should be explored further.
背景：非医院感染的成本很高，而空气传播越来越被认为是传播的重要因素。空气净化装置（ACU）可以减少传播，但很少有研究关注其在开放式病房中的效果。目的：评估空气净化装置是否可以减少老年人住院病房中的非典型肺炎-CoV-2 或其他感染：方法：对英国一家教学医院的两对干预-对照病房进行前后对比的准实验研究。在实施 ACU 的一年和前一年（"核心研究期"），通过常规收集的电子健康记录数据确定感染情况。扩展分析包括取消 ACU 后一对病房 6 个月的额外数据。通过控制年龄、性别、病房和背景感染风险的 Cox 回归估算出危险比 (HR)。干预病房2.的研究结果也记录了ACU的开启时间：研究结果：ACU 最初是可行的，但在研究结束时，依从性有所下降（干预病房 2 ACU 上半年与下半年的平均手术率分别为 77% 与 53%）。研究纳入了 8171 名住院时间超过 48 小时的患者（6112 名患者，中位年龄为 85 岁）。总体而言，病房获得性 SARS-CoV-2 的发病率为 3.8%。实施 ACU 后，SARS-CoV-2 感染的风险呈下降趋势，但并不显著（核心研究期间的 HR 为 0.90，95% CI 为 0.53，1.52；扩展研究期间的 HR 为 0.78，95% CI 为 0.53，1.14）。只有1.5%的入院患者发生了其他明显的病房感染：ACU可在一定程度上减少SARS-CoV-2感染。更大规模的研究可以减少不确定性，也许可以采用交叉设计，同时应进一步探讨影响员工和患者接受程度的因素。
{"title":"Efficacy of air cleaning units for preventing SARS-CoV-2 and other hospital-acquired infections on medicine for older people wards: a quasi-experimental controlled before-and-after study","authors":"R.C. Brock , R.J.B. Goudie , C. Peters , R. Thaxter , T. Gouliouris , C.J.R. Illingworth , A. Conway Morris , C.B. Beggs , M. Butler , V.L. Keevil","doi":"10.1016/j.jhin.2024.09.017","DOIUrl":"10.1016/j.jhin.2024.09.017","url":null,"abstract":"<div><h3>Background</h3><div>Nosocomial infections are costly, and airborne transmission is increasingly recognized as important for spread. Air cleaning units (ACUs) may reduce transmission, but little research has focused on their effectiveness on open wards.</div></div><div><h3>Aim</h3><div>To assess whether ACUs reduce nosocomial severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), or other, infections on older adult inpatient wards.</div></div><div><h3>Methods</h3><div>This was a quasi-experimental before-and-after study on two intervention–control ward pairs in a UK teaching hospital. Infections were identified using routinely collected electronic health record data during 1 year of ACU implementation and the preceding year (‘core study period’). Extended analyses included 6 months of additional data from one ward pair following ACU removal. Hazard ratios (HRs) were estimated through Cox regression controlling for age, sex, ward and background infection risk. The time that the ACUs were switched on was also recorded for Intervention Ward 2.</div></div><div><h3>Findings</h3><div>ACUs were initially feasible, but compliance reduced towards the end of the study (average operation in first vs second half of ACU time on Intervention Ward 2: 77% vs 53%). In total, 8171 admissions for >48 h (6112 patients, median age 85 years) were included. Overall, the incidence of ward-acquired SARS-CoV-2 was 3.8%. ACU implementation was associated with a non-significant trend of lower hazard for SARS-CoV-2 infection [HR core study period 0.90, 95% confidence interval (CI) 0.53–1.52; HR extended study period 0.78, 95% CI 0.53–1.14]. Only 1.5% of admissions resulted in other notable ward-acquired infections.</div></div><div><h3>Conclusion</h3><div>ACUs may reduce SARS-CoV-2 infection to a clinically meaningfully degree. Larger studies could reduce uncertainty, perhaps using a crossover design, and factors influencing acceptability to staff and patients should be explored further.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"155 ","pages":"Pages 1-8"},"PeriodicalIF":3.9,"publicationDate":"2024-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142395400","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-09-30DOI: 10.1016/j.jhin.2024.07.020
A. Igel , M. Moudjou , P. Destrez , P. Clayette , V. Béringue
Validation of prion inactivation processes for medical devices relies on in-vivo experimental protocols. However, bioassays are costly, long (1–2 years) and ethically disputable. Additionally, results obtained with one prion strain – for example, 263K (hamster-adapted strain originating from sheep scrapie) – cannot be easily extrapolated to relevant human prion strains, further questioning the utility of bioassays. Over the past two decades, cell-free prion amplification assays have emerged as potential alternatives to bioassays. Rather than measuring prion infectivity, they quantify prion seeding activity (i.e. the capacity to convert the normal prion protein into the disease-associated isoform). The results obtained from an optimized cell-free assay termed ‘miniaturized-bead protein misfolding cyclic amplification’ (mb-PMCA) with four processes using three different prion strains – 263K and two human prions derived from variant and sporadic Creutzfeldt–Jakob disease – were compared with published bioassays using the same three strains and processes, when available. Tests performed on reference processes (steam, sodium hydroxide, sodium hypochlorite) and low temperature H2O2 sterilization (STERRAD NXTM Advanced cycle) showed perfect alignment between mb-PMCA and available bioassays. STERRAD NXTM Advanced cycle was efficacious against all three prion strains. These data confirm that PMCA, particularly mb-PMCA, is a relevant alternative to animal bioassays for the assessment of prion inactivation processes, and highlight the interest of some low temperature H2O2 sterilization cycles.
{"title":"PMCA to demonstrate the efficacy of prion inactivation methods on reusable medical devices: a relevant alternative to animal bioassays","authors":"A. Igel , M. Moudjou , P. Destrez , P. Clayette , V. Béringue","doi":"10.1016/j.jhin.2024.07.020","DOIUrl":"10.1016/j.jhin.2024.07.020","url":null,"abstract":"<div><div>Validation of prion inactivation processes for medical devices relies on in-vivo experimental protocols. However, bioassays are costly, long (1–2 years) and ethically disputable. Additionally, results obtained with one prion strain – for example, 263K (hamster-adapted strain originating from sheep scrapie) – cannot be easily extrapolated to relevant human prion strains, further questioning the utility of bioassays. Over the past two decades, cell-free prion amplification assays have emerged as potential alternatives to bioassays. Rather than measuring prion infectivity, they quantify prion seeding activity (i.e. the capacity to convert the normal prion protein into the disease-associated isoform). The results obtained from an optimized cell-free assay termed ‘miniaturized-bead protein misfolding cyclic amplification’ (mb-PMCA) with four processes using three different prion strains – 263K and two human prions derived from variant and sporadic Creutzfeldt–Jakob disease – were compared with published bioassays using the same three strains and processes, when available. Tests performed on reference processes (steam, sodium hydroxide, sodium hypochlorite) and low temperature H<sub>2</sub>O<sub>2</sub> sterilization (STERRAD NX<sup>TM</sup> Advanced cycle) showed perfect alignment between mb-PMCA and available bioassays. STERRAD NX<sup>TM</sup> Advanced cycle was efficacious against all three prion strains. These data confirm that PMCA, particularly mb-PMCA, is a relevant alternative to animal bioassays for the assessment of prion inactivation processes, and highlight the interest of some low temperature H<sub>2</sub>O<sub>2</sub> sterilization cycles.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"154 ","pages":"Pages 60-63"},"PeriodicalIF":3.9,"publicationDate":"2024-09-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142367491","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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