Pub Date : 2024-09-12DOI: 10.1016/j.jhin.2024.08.012
T Sokolová, P Paterová, A Zavřelová, B Víšek, P Žák, J Radocha
Introduction: Febrile neutropenia (FN) is one of the most common complications of stem cell transplantation. The aim of this analysis was to evaluate the frequency of sepsis in patients with FN colonized with resistant Gram negative bacteria (Extended spectrum β-lactamase positive, multidrug resistant (MDR) P. aeruginosa) and the choice of primary antibiotic in colonized patients.
Patients and methods: This was a retrospective study analyzed data from patients who underwent hematopoietic stem cell transplantation from 01/2018 to 09/2022. Data were extracted from the hospital information system.
Results: Carbapenem as the primary antibiotic of choice was chosen in 10.9% of non-colonized +/-AmpC patients, 31.5% of ESBL+ patients, and 0% of MDR P. aeruginosa patients. Patients with FN and MDR P. aeruginosa colonization had a high prevalence of sepsis (namely 100%, p = 0.0197). The spectrum of sepsis appeared to be different, with Gram negative bacilli predominating in the ESBL+ group (p = 0.0123, OR 5.39 [95% CI 1.55-18.76]). Colonizer sepsis was present in 100% of sepsis with MDR P. aeruginosa colonization (p=0.002), all in allogeneic transplantation (p=0.0003), with a mortality rate of 33.3% (p=0.0384). The incidence of sepsis in patients with ESBL+ colonization was 25.9% (p=0.0197), with colonizer sepsis in 50% of sepsis cases (p=0.0002), most in allogeneic transplantation (p=0.0003).
Conclusion: The results show a significant risk of sepsis in FN with MDR P. aeruginosa colonization, this state is almost exclusively caused by the colonizer. At the same time, a higher risk of Gram negative sepsis has been demonstrated in patients colonized with ESBL+ bacteria.
{"title":"The role of colonization with resistant Gram negative bacteria in the treatment of febrile neutropenia after stem cell transplantation.","authors":"T Sokolová, P Paterová, A Zavřelová, B Víšek, P Žák, J Radocha","doi":"10.1016/j.jhin.2024.08.012","DOIUrl":"https://doi.org/10.1016/j.jhin.2024.08.012","url":null,"abstract":"<p><strong>Introduction: </strong>Febrile neutropenia (FN) is one of the most common complications of stem cell transplantation. The aim of this analysis was to evaluate the frequency of sepsis in patients with FN colonized with resistant Gram negative bacteria (Extended spectrum β-lactamase positive, multidrug resistant (MDR) P. aeruginosa) and the choice of primary antibiotic in colonized patients.</p><p><strong>Patients and methods: </strong>This was a retrospective study analyzed data from patients who underwent hematopoietic stem cell transplantation from 01/2018 to 09/2022. Data were extracted from the hospital information system.</p><p><strong>Results: </strong>Carbapenem as the primary antibiotic of choice was chosen in 10.9% of non-colonized +/-AmpC patients, 31.5% of ESBL+ patients, and 0% of MDR P. aeruginosa patients. Patients with FN and MDR P. aeruginosa colonization had a high prevalence of sepsis (namely 100%, p = 0.0197). The spectrum of sepsis appeared to be different, with Gram negative bacilli predominating in the ESBL+ group (p = 0.0123, OR 5.39 [95% CI 1.55-18.76]). Colonizer sepsis was present in 100% of sepsis with MDR P. aeruginosa colonization (p=0.002), all in allogeneic transplantation (p=0.0003), with a mortality rate of 33.3% (p=0.0384). The incidence of sepsis in patients with ESBL+ colonization was 25.9% (p=0.0197), with colonizer sepsis in 50% of sepsis cases (p=0.0002), most in allogeneic transplantation (p=0.0003).</p><p><strong>Conclusion: </strong>The results show a significant risk of sepsis in FN with MDR P. aeruginosa colonization, this state is almost exclusively caused by the colonizer. At the same time, a higher risk of Gram negative sepsis has been demonstrated in patients colonized with ESBL+ bacteria.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142301271","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 : 2024-08-30DOI: 10.1016/j.jhin.2024.08.010
Background
Pseudomonas aeruginosa is a growing concern in healthcare-associated infections and poses significant risk to those with serious underlying health conditions. The antimicrobial resistance traits of the pathogen and ability to form biofilms make effective mitigation and disinfection strategies difficult. Added to this challenge is the role that free-living amoebae such as Acanthamoeba play in the detection, disinfection and transmission of P. aeruginosa. P. aeruginosa can survive intracellularly within amoebae, which has the potential to limit detectability and permit transmission into high-risk areas.
Methods/findings
We screened for the presence of Acanthamoeba spp. and P. aeruginosa within a functioning general hospital in Scotland using a culture and molecular approach, noting their presence at several sites over a four-month period, particularly within floor drains connecting patient rooms. In addition, microbiome analysis revealed that amoebae harbour a unique microbial community comprised primarily of Pseudomonas spp. that were not readily detected using microbiome sequencing techniques on environmental swabs. Having demonstrated that both organisms were consistently present in hospital settings, we investigated the relationship between acanthamoeba and P. aeruginosa in the laboratory, showing that (i) acanthamoeba growth rate is increased in the presence of pseudomonas biofilms and viable pseudomonas persist within the amoebae and (ii) hydrogen peroxide-based disinfectants are significantly less effective against an isolate of P. aeruginosa in the presence of acanthamoeba than when the bacteria are incubated alone.
Conclusions
These findings suggest that amoebae, and other protists, can influence the detection and persistence of P. aeruginosa in high-risk areas and should be considered when implementing mitigation strategies.
{"title":"Acanthamoebae as a protective reservoir for Pseudomonas aeruginosa in a clinical environment","authors":"","doi":"10.1016/j.jhin.2024.08.010","DOIUrl":"10.1016/j.jhin.2024.08.010","url":null,"abstract":"<div><h3>Background</h3><div><em>Pseudomonas aeruginosa</em> is a growing concern in healthcare-associated infections and poses significant risk to those with serious underlying health conditions. The antimicrobial resistance traits of the pathogen and ability to form biofilms make effective mitigation and disinfection strategies difficult. Added to this challenge is the role that free-living amoebae such as <em>Acanthamoeba</em> play in the detection, disinfection and transmission of <em>P. aeruginosa. P. aeruginosa</em> can survive intracellularly within amoebae, which has the potential to limit detectability and permit transmission into high-risk areas.</div></div><div><h3>Methods/findings</h3><div>We screened for the presence of <em>Acanthamoeba</em> spp. and <em>P. aeruginosa</em> within a functioning general hospital in Scotland using a culture and molecular approach, noting their presence at several sites over a four-month period, particularly within floor drains connecting patient rooms. In addition, microbiome analysis revealed that amoebae harbour a unique microbial community comprised primarily of <em>Pseudomonas</em> spp. that were not readily detected using microbiome sequencing techniques on environmental swabs. Having demonstrated that both organisms were consistently present in hospital settings, we investigated the relationship between acanthamoeba and <em>P. aeruginosa</em> in the laboratory<em>,</em> showing that (i) acanthamoeba growth rate is increased in the presence of pseudomonas biofilms and viable pseudomonas persist within the amoebae and (ii) hydrogen peroxide-based disinfectants are significantly less effective against an isolate of <em>P. aeruginosa</em> in the presence of acanthamoeba than when the bacteria are incubated alone.</div></div><div><h3>Conclusions</h3><div>These findings suggest that amoebae, and other protists, can influence the detection and persistence of <em>P. aeruginosa</em> in high-risk areas and should be considered when implementing mitigation strategies.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114889","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 : 2024-08-28DOI: 10.1016/j.jhin.2024.08.011
Miriam Schutte, Rosa van Mansfeld, Ralph de Vries, Mireille Dekker
Background: Despite evidence that application of infection prevention measures can reduce healthcare-associated infections, compliance with these measures is low, especially among physicians. Intervention effects often do not sustain. An overview of determinants for physicians' infection prevention behaviour and successful behaviour change strategies is lacking.
Aim: To identify what determinants influence physicians' infection prevention behaviour, what strategies to improve compliance have been explored, and whether theories, models and frameworks from implementation science have been used in these studies.
Methods: Scoping review methodology. We performed a literature search in PubMed, Embase, APA PsycInfo and Web of Science up to June 2, 2023, in collaboration with a medical information specialist. All study types focusing on infection prevention behaviour of physicians in high-income countries were included. Data on determinants and strategies was extracted; determinants were categorized into the Theoretical Domains Framework (TDF).
Findings: We included 56 articles. The TDF domains "environmental context and resources", "social influences", "beliefs about consequences", "memory, attention and decision-making", "knowledge" and "skills" were found most relevant. The prevailing determinant covers a theme outside the TDF: socio-demographic factors. Sustainable interventions are multimodal approaches that at least include feedback, education and a champion. Theories, models and frameworks have rarely been used to guide implementation strategy development.
Conclusion: This review presents an overview of determinants of physicians' infection prevention behaviour. Intervention studies rarely specify the determinants that they aim to address and lack theoretical underpinning. Future initiatives should combine knowledge about determinants with implementation science to develop theory-based interventions tailored to determinants.
{"title":"DETERMINANTS OF COMPLIANCE WITH INFECTION PREVENTION MEASURES BY PHYSICIANS: A SCOPING REVIEW.","authors":"Miriam Schutte, Rosa van Mansfeld, Ralph de Vries, Mireille Dekker","doi":"10.1016/j.jhin.2024.08.011","DOIUrl":"https://doi.org/10.1016/j.jhin.2024.08.011","url":null,"abstract":"<p><strong>Background: </strong>Despite evidence that application of infection prevention measures can reduce healthcare-associated infections, compliance with these measures is low, especially among physicians. Intervention effects often do not sustain. An overview of determinants for physicians' infection prevention behaviour and successful behaviour change strategies is lacking.</p><p><strong>Aim: </strong>To identify what determinants influence physicians' infection prevention behaviour, what strategies to improve compliance have been explored, and whether theories, models and frameworks from implementation science have been used in these studies.</p><p><strong>Methods: </strong>Scoping review methodology. We performed a literature search in PubMed, Embase, APA PsycInfo and Web of Science up to June 2, 2023, in collaboration with a medical information specialist. All study types focusing on infection prevention behaviour of physicians in high-income countries were included. Data on determinants and strategies was extracted; determinants were categorized into the Theoretical Domains Framework (TDF).</p><p><strong>Findings: </strong>We included 56 articles. The TDF domains \"environmental context and resources\", \"social influences\", \"beliefs about consequences\", \"memory, attention and decision-making\", \"knowledge\" and \"skills\" were found most relevant. The prevailing determinant covers a theme outside the TDF: socio-demographic factors. Sustainable interventions are multimodal approaches that at least include feedback, education and a champion. Theories, models and frameworks have rarely been used to guide implementation strategy development.</p><p><strong>Conclusion: </strong>This review presents an overview of determinants of physicians' infection prevention behaviour. Intervention studies rarely specify the determinants that they aim to address and lack theoretical underpinning. Future initiatives should combine knowledge about determinants with implementation science to develop theory-based interventions tailored to determinants.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114890","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 : 2024-08-28DOI: 10.1016/j.jhin.2024.08.008
{"title":"Simulation as a tool for promoting infection control measures during a carbapenemase-producing Enterobacterales outbreak: lessons learned","authors":"","doi":"10.1016/j.jhin.2024.08.008","DOIUrl":"10.1016/j.jhin.2024.08.008","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114892","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 : 2024-08-28DOI: 10.1016/j.jhin.2024.08.007
Background
Healthcare-associated infections (HAIs) are a global concern in healthcare facilities, and hand hygiene (HH) using alcohol-based hand rubs (ABHR) is fundamentally crucial for their prevention. While previous studies report improvements in HH compliance amid the COVID-19 pandemic, the real situation in Japanese medical settings remains unclear.
Methods
This observational study sought data from the Japanese national surveillance, focusing on ABHR use in hospitals before and after the COVID-19 pandemic. Data were retrieved from facilities certified to receive the Additional Healthcare Reimbursements for Infection Prevention and Control I. The study spanned five years (2019–2023), segmented quarterly, and employed Joinpoint regression analysis to assess the annual percentage change (APC).
Results
Overall, ABHR use per patient per day significantly increased both in critical care units and general wards amid the pandemic. However, the APC in the critical care units demonstrated a downward trend from Q4 of 2021 to Q1 of 2023, and ABHR use in general wards remained below the amount of WHO recommendations.
Conclusion
This trend analysis highlighted recent patterns of ABHR use in Japanese hospitals by comparing pre- and post-COVID-19 periods. Although increases in ABHR use were observed over time, sustained efforts to promote HH compliance are necessary, particularly in general wards.
{"title":"Trends in the hand hygiene practices using alcohol-based hand rubs in Japanese hospitals before and after the novel coronavirus pandemic: an observational study using national surveillance data","authors":"","doi":"10.1016/j.jhin.2024.08.007","DOIUrl":"10.1016/j.jhin.2024.08.007","url":null,"abstract":"<div><h3>Background</h3><p>Healthcare-associated infections (HAIs) are a global concern in healthcare facilities, and hand hygiene (HH) using alcohol-based hand rubs (ABHR) is fundamentally crucial for their prevention. While previous studies report improvements in HH compliance amid the COVID-19 pandemic, the real situation in Japanese medical settings remains unclear.</p></div><div><h3>Methods</h3><p>This observational study sought data from the Japanese national surveillance, focusing on ABHR use in hospitals before and after the COVID-19 pandemic. Data were retrieved from facilities certified to receive the Additional Healthcare Reimbursements for Infection Prevention and Control I. The study spanned five years (2019–2023), segmented quarterly, and employed Joinpoint regression analysis to assess the annual percentage change (APC).</p></div><div><h3>Results</h3><p>Overall, ABHR use per patient per day significantly increased both in critical care units and general wards amid the pandemic. However, the APC in the critical care units demonstrated a downward trend from Q4 of 2021 to Q1 of 2023, and ABHR use in general wards remained below the amount of WHO recommendations.</p></div><div><h3>Conclusion</h3><p>This trend analysis highlighted recent patterns of ABHR use in Japanese hospitals by comparing pre- and post-COVID-19 periods. Although increases in ABHR use were observed over time, sustained efforts to promote HH compliance are necessary, particularly in general wards.</p></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114893","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 : 2024-08-27DOI: 10.1016/j.jhin.2024.08.009
Stefano Oggiano, Aiden J Plant
{"title":"Is Clostridioides difficile diarrhoea associated with greater social deprivation in England?","authors":"Stefano Oggiano, Aiden J Plant","doi":"10.1016/j.jhin.2024.08.009","DOIUrl":"https://doi.org/10.1016/j.jhin.2024.08.009","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142114891","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 : 2024-08-26DOI: 10.1016/j.jhin.2024.07.017
Surgical headwear is designed to maintain sterility and prevent microbial contamination. However, the environmental impact of the healthcare industry carries an obligation to develop sustainable alternatives. We aim to explore the environmental impact and safety of reusable surgical headwear. A systematic review and meta-analysis were performed using MEDLINE, Embase, Scopus, Google Scholar, PubMed, and the Cochrane Library until December 10, 2023. Studies were reviewed for suitability and risk of bias using the ROBINS-I tool, with the results aggregated using Review Manager Version 5.4 for odds ratios (ORs) and 95% confidence intervals (CIs), and the I2 was used to assess heterogeneity. This systematic review included nine studies, and the meta-analysis included six studies involving 45,708 procedural cases. There was no significant difference in surgical site infection (SSI) rates between the reusable and disposable groups (OR: 0.79; 95% CI: 0.59–1.07; P=0.13). Policy implementation did not affect SSI rates (OR: 1.21; 95% CI: 0.85–1.73; P=0.30). Reusable surgical head covers demonstrated a significantly lower carbon footprint (P<0.001), ozone depletion (P<0.005), fossil fuel depletion (P<0.005), terrestrial acidification (P<0.005), and fine particulate matter formation (P<0.005) than disposable alternatives. Reusable surgical headwear matches disposable options for SSI incidence and offers environmental advantages. These findings support a shift towards reusable alternatives in healthcare, aligning patient safety with ecological responsibility. By adopting reusable alternatives, healthcare systems can actively contribute to planetary health, thereby highlighting the significant role of sustainable practices in modern medical settings.
{"title":"Reusable surgical headwear has a reduced carbon footprint and matches disposables regarding surgical site infection: a systematic review and meta-analysis","authors":"","doi":"10.1016/j.jhin.2024.07.017","DOIUrl":"10.1016/j.jhin.2024.07.017","url":null,"abstract":"<div><p>Surgical headwear is designed to maintain sterility and prevent microbial contamination. However, the environmental impact of the healthcare industry carries an obligation to develop sustainable alternatives. We aim to explore the environmental impact and safety of reusable surgical headwear. A systematic review and meta-analysis were performed using MEDLINE, Embase, Scopus, Google Scholar, PubMed, and the Cochrane Library until December 10, 2023. Studies were reviewed for suitability and risk of bias using the ROBINS-I tool, with the results aggregated using Review Manager Version 5.4 for odds ratios (ORs) and 95% confidence intervals (CIs), and the I2 was used to assess heterogeneity. This systematic review included nine studies, and the meta-analysis included six studies involving 45,708 procedural cases. There was no significant difference in surgical site infection (SSI) rates between the reusable and disposable groups (OR: 0.79; 95% CI: 0.59–1.07; <em>P</em>=0.13). Policy implementation did not affect SSI rates (OR: 1.21; 95% CI: 0.85–1.73; <em>P</em>=0.30). Reusable surgical head covers demonstrated a significantly lower carbon footprint (<em>P</em><0.001), ozone depletion (<em>P</em><0.005), fossil fuel depletion (<em>P</em><0.005), terrestrial acidification (<em>P</em><0.005), and fine particulate matter formation (<em>P</em><0.005) than disposable alternatives. Reusable surgical headwear matches disposable options for SSI incidence and offers environmental advantages. These findings support a shift towards reusable alternatives in healthcare, aligning patient safety with ecological responsibility. By adopting reusable alternatives, healthcare systems can actively contribute to planetary health, thereby highlighting the significant role of sustainable practices in modern medical settings.</p></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0195670124002871/pdfft?md5=eb473a578b210005452a2fc47e4f0b6e&pid=1-s2.0-S0195670124002871-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142094226","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 : 2024-08-22DOI: 10.1016/j.jhin.2024.08.005
Raeseok Lee, Se Yoon Park, Ji Young Park, Bongyoung Kim, Yong Chan Kim, Hyuk Ga, Myung Jin Lee, Hyo Won Park, I Ji Yun, Seok-Jae Heo, Song Mi Moon, Hong Bin Kim
Background: Evaluation of hospital-specific antimicrobial use is necessary for successful national antimicrobial stewardship. This study aimed to identify antimicrobial use in long-term care hospitals (LCHs) in Korea.
Methods: We conducted a multicentre retrospective study to evaluate the prescription patterns and appropriateness of antimicrobials in 20 LCHs in Korea. The medical record data of hospitalised patients who were newly prescribed antimicrobials at each hospital were collected manually between 10 July and 31 October 2023 to evaluate the appropriateness of antimicrobial use.
Results: The prevalence of antimicrobial prescriptions was 8.9% (365/4,086) and 10.3% (402/3,892) on July 12, 2023 and October 18, 2023, respectively. A total of 885 antimicrobials were prescribed to 740 patients. Among the antimicrobials, third- or fourth-generation cephalosporins (31.9%) represented the most prescribed antimicrobial class. A large majority of antimicrobials (855/885, 96.6%) were prescribed for the treatment of infectious diseases; however, only 37.7% (322/855) of antimicrobials were appropriately prescribed for infections. The route of administration, dosage, and prescribed antimicrobial were appropriate in 99.6% (852/855), 56.1% (480/855), and 62.0% (530/855) of cases, respectively. In total, 35.2% (252/715) of patients were appropriately prescribed antimicrobials. The diagnosis of infectious diseases was appropriate for 52.9% (472/892) of the cases. Of the 5, 15, and 10 antimicrobials used for surgical site infection prophylaxis, medical prophylaxis, and other purposes, respectively, none were appropriately used.
Conclusion: The proportion of antimicrobials used appropriately is low in Korean LCHs. These data highlight the importance of establishing antimicrobial stewardship in LCHs.
{"title":"Evaluating Antimicrobial Utilisation in 20 Korean Long-Term Care Hospitals: A Call to Action for Antimicrobial Stewardship.","authors":"Raeseok Lee, Se Yoon Park, Ji Young Park, Bongyoung Kim, Yong Chan Kim, Hyuk Ga, Myung Jin Lee, Hyo Won Park, I Ji Yun, Seok-Jae Heo, Song Mi Moon, Hong Bin Kim","doi":"10.1016/j.jhin.2024.08.005","DOIUrl":"https://doi.org/10.1016/j.jhin.2024.08.005","url":null,"abstract":"<p><strong>Background: </strong>Evaluation of hospital-specific antimicrobial use is necessary for successful national antimicrobial stewardship. This study aimed to identify antimicrobial use in long-term care hospitals (LCHs) in Korea.</p><p><strong>Methods: </strong>We conducted a multicentre retrospective study to evaluate the prescription patterns and appropriateness of antimicrobials in 20 LCHs in Korea. The medical record data of hospitalised patients who were newly prescribed antimicrobials at each hospital were collected manually between 10 July and 31 October 2023 to evaluate the appropriateness of antimicrobial use.</p><p><strong>Results: </strong>The prevalence of antimicrobial prescriptions was 8.9% (365/4,086) and 10.3% (402/3,892) on July 12, 2023 and October 18, 2023, respectively. A total of 885 antimicrobials were prescribed to 740 patients. Among the antimicrobials, third- or fourth-generation cephalosporins (31.9%) represented the most prescribed antimicrobial class. A large majority of antimicrobials (855/885, 96.6%) were prescribed for the treatment of infectious diseases; however, only 37.7% (322/855) of antimicrobials were appropriately prescribed for infections. The route of administration, dosage, and prescribed antimicrobial were appropriate in 99.6% (852/855), 56.1% (480/855), and 62.0% (530/855) of cases, respectively. In total, 35.2% (252/715) of patients were appropriately prescribed antimicrobials. The diagnosis of infectious diseases was appropriate for 52.9% (472/892) of the cases. Of the 5, 15, and 10 antimicrobials used for surgical site infection prophylaxis, medical prophylaxis, and other purposes, respectively, none were appropriately used.</p><p><strong>Conclusion: </strong>The proportion of antimicrobials used appropriately is low in Korean LCHs. These data highlight the importance of establishing antimicrobial stewardship in LCHs.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057380","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 : 2024-08-22DOI: 10.1016/j.jhin.2024.08.006
Bärbel Kieninger, Rebecca Fechter, Wolfgang Bäumler, David Raab, Anca Rath, Aila Caplunik-Pratsch, Stephan Schmid, Thomas Müller, Wulf Schneider-Brachert, Anja Eichner
Background: Surfaces in close proximity to patients within hospitals may cause healthcare-associated infections. These surfaces are repositories for pathogens facilitating their transmission among staff and patients. Regular cleaning and disinfection of these surfaces provides only a temporary elimination of pathogens with inevitable recontamination. Antimicrobial coatings (AMC) of such surfaces may additionally reduce the risk of pathogen transmissions. The study aimed to find out whether photodynamic coatings can be effective even at very low light intensities.
Aim: To evaluate the efficacy of a standard and a novel photodynamic AMC in a field study conducted in two ICUs at our university hospital.
Methods: The microbial burden was determined on three coatings: standard photodynamic AMC (A), a novel photodynamic AMC (B), and an inactive AMC as control (C). The control coating C was identical to standard coating A, but it contained no photosensitizer. During a 3-month period, 699 samples were collected from identical surfaces using eSwab and were analyzed (cfu/cm2).
Findings: Mean values of all surfaces covered with control coating (C) showed a microbial burden of 5.5 ± 14.8 cfu/cm2. Photodynamic AMC showed significantly lower mean value of 1.6 ± 4.6 CFU/cm2 (coating A; p<0.001) and 2.7 ± 9.6 (coating B; p<0.001). When considering a benchmark of 2.5 cfu/cm2, the relative risk for higher microbial counts was reduced by 52 % (coating A) or 40 % (coating B), respectively.
Conclusions: Both photodynamic AMCs offer a substantial, permanent risk reduction of microbial counts on near patient surfaces in ICUs with low light intensities.
{"title":"Photodynamic coatings kill bacteria on near-patient surfaces in intensive care units with low light intensities.","authors":"Bärbel Kieninger, Rebecca Fechter, Wolfgang Bäumler, David Raab, Anca Rath, Aila Caplunik-Pratsch, Stephan Schmid, Thomas Müller, Wulf Schneider-Brachert, Anja Eichner","doi":"10.1016/j.jhin.2024.08.006","DOIUrl":"https://doi.org/10.1016/j.jhin.2024.08.006","url":null,"abstract":"<p><strong>Background: </strong>Surfaces in close proximity to patients within hospitals may cause healthcare-associated infections. These surfaces are repositories for pathogens facilitating their transmission among staff and patients. Regular cleaning and disinfection of these surfaces provides only a temporary elimination of pathogens with inevitable recontamination. Antimicrobial coatings (AMC) of such surfaces may additionally reduce the risk of pathogen transmissions. The study aimed to find out whether photodynamic coatings can be effective even at very low light intensities.</p><p><strong>Aim: </strong>To evaluate the efficacy of a standard and a novel photodynamic AMC in a field study conducted in two ICUs at our university hospital.</p><p><strong>Methods: </strong>The microbial burden was determined on three coatings: standard photodynamic AMC (A), a novel photodynamic AMC (B), and an inactive AMC as control (C). The control coating C was identical to standard coating A, but it contained no photosensitizer. During a 3-month period, 699 samples were collected from identical surfaces using eSwab and were analyzed (cfu/cm<sup>2</sup>).</p><p><strong>Findings: </strong>Mean values of all surfaces covered with control coating (C) showed a microbial burden of 5.5 ± 14.8 cfu/cm<sup>2</sup>. Photodynamic AMC showed significantly lower mean value of 1.6 ± 4.6 CFU/cm<sup>2</sup> (coating A; p<0.001) and 2.7 ± 9.6 (coating B; p<0.001). When considering a benchmark of 2.5 cfu/cm<sup>2</sup>, the relative risk for higher microbial counts was reduced by 52 % (coating A) or 40 % (coating B), respectively.</p><p><strong>Conclusions: </strong>Both photodynamic AMCs offer a substantial, permanent risk reduction of microbial counts on near patient surfaces in ICUs with low light intensities.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142057381","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 : 2024-08-21DOI: 10.1016/j.jhin.2024.08.001
Background
Despite the important role that cleaning plays in reducing the risk of healthcare-associated infections, no research has been undertaken to quantify the time required for effective cleaning and disinfection of different pieces of shared medical equipment commonly used in hospitals. This short report presents the results from a study that aimed to quantify the time required to clean common pieces of shared medical equipment effectively.
Methods
An observational time and motion study was conducted in a nursing simulation laboratory to determine the time required for effective cleaning and disinfection of 12 pieces of shared medical equipment commonly used in hospital. After training, the participants cleaned and disinfected equipment, with the time taken to clean recorded. Cleaning was deemed to be effective if ≥80% of ultraviolet fluorescent dots were removed during the cleaning process.
Main results
The time to clean equipment effectively ranged from 50 s [blood glucose testing kit; 95% confidence interval (CI) 0:40–1:00 (min:s)] to 3 min 53 s [medication trolley; 95% CI 3:36–4:11 (min:s)]. The intravenous stand was cleaned most effectively, with 100% of dots removed (N = 100 dots). In contrast, the bladder scanner was the most difficult to clean, with 12 attempts required to meet the 80% threshold for effective cleaning.
Conclusion
This study will inform staffing and training requirements to plan the cleaning and disinfection of shared medical equipment effectively. The findings can also be used for business cases, and in future cost-effectiveness evaluations of cleaning interventions that include shared medical equipment.
{"title":"Cleaning time and motion: an observational study on the time required to clean shared medical equipment in hospitals effectively","authors":"","doi":"10.1016/j.jhin.2024.08.001","DOIUrl":"10.1016/j.jhin.2024.08.001","url":null,"abstract":"<div><h3>Background</h3><p>Despite the important role that cleaning plays in reducing the risk of healthcare-associated infections, no research has been undertaken to quantify the time required for effective cleaning and disinfection of different pieces of shared medical equipment commonly used in hospitals. This short report presents the results from a study that aimed to quantify the time required to clean common pieces of shared medical equipment effectively.</p></div><div><h3>Methods</h3><p>An observational time and motion study was conducted in a nursing simulation laboratory to determine the time required for effective cleaning and disinfection of 12 pieces of shared medical equipment commonly used in hospital. After training, the participants cleaned and disinfected equipment, with the time taken to clean recorded. Cleaning was deemed to be effective if ≥80% of ultraviolet fluorescent dots were removed during the cleaning process.</p></div><div><h3>Main results</h3><p>The time to clean equipment effectively ranged from 50 s [blood glucose testing kit; 95% confidence interval (CI) 0:40–1:00 (min:s)] to 3 min 53 s [medication trolley; 95% CI 3:36–4:11 (min:s)]. The intravenous stand was cleaned most effectively, with 100% of dots removed (<em>N</em> = 100 dots). In contrast, the bladder scanner was the most difficult to clean, with 12 attempts required to meet the 80% threshold for effective cleaning.</p></div><div><h3>Conclusion</h3><p>This study will inform staffing and training requirements to plan the cleaning and disinfection of shared medical equipment effectively. The findings can also be used for business cases, and in future cost-effectiveness evaluations of cleaning interventions that include shared medical equipment.</p></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-08-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0195670124002688/pdfft?md5=4c1d60b5346c9e59c03c0104a8295c6a&pid=1-s2.0-S0195670124002688-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142001375","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}
扫码关注我们
求助内容：
应助结果提醒方式：
京公网安备 11010802042870号