Journal of Hospital Infection最新文献

Background

Water and wastewater in healthcare settings are recognized to represent a risk to patients. However, waterless care has not been widely implemented in UK healthcare settings.

Aim

To identify barriers to implementation of waterless care.

Methods

A questionnaire study of infection prevention and control (IPC) practitioners, non-IPC clinicians, and estates managers and engineers was undertaken.

Findings

Alternatives to water present challenges in perceived acceptability to patients, particularly cleansing wipes for bathing and dry shampoo. There are concerns about cleansing wipes in terms of storage, disposal, sustainability and contamination during manufacture. Estates and engineering concerns include relative water tank size for water turnover and clinical disruption due to works.

Conclusion

Further work is required on acceptability of reduced water scenarios and patient views but the results of this questionnaire provide a grounding for sentiment from healthcare workers on waterless care.

Background

When processing surgical instruments after use, the safe, residue-free removal of blood and blood-containing soiling is one of the most important tasks. There are recommendations from various working groups regarding the ideal timeframe for cleaning used instruments in order to ensure safe disinfection and sterilization and avoid adverse effects. These are generally based primarily on practical experience and there is little systematic work on this topic.

Aim

In the present study, cleaning experiments with test specimens previously contaminated with sheep's blood were performed, and in this way the effects of the drying time of whole blood on the results of the subsequent cleaning were examined.

Methods

Reflecting practice, both visual and spectroscopic methods were used to quantify residual protein. The experimental results were evaluated both as a function of the drying time and the residual moisture of the blood.

Findings

Drying blood was particularly difficult to remove within the first 1–2 h. In this phase, in which the blood is coagulated but not yet completely dried, considerably more protein residues remained on the test specimens after cleaning than after longer standing times.

Conclusion

There is a timeframe for the removal of blood residues in which optimum cleaning results can be expected. As a consequence, there are also standing times that are disadvantageous for reprocessing. Based on the experimental data, it was deduced that this optimum time is either directly after contamination or in the range of >3 h and <24 h after soiling.

Background

Aim

Methods

Findings

Conclusion

Background

Accurate effect estimates are needed to inform input parameters of health economic models. Central-line-associated bloodstream infections (CLABSIs) and catheter-related bloodstream infections (CRBSIs) are different definitions used for central-line bloodstream infections and may represent dissimilar patients, but previous meta-analyses did not differentiate between CLABSIs/CRBSIs.

Aim

To determine outcome effect estimates in CLABSI and CRBSI patients, compared to uninfected patients.

Methods

PubMed, Embase, and CINAHL were searched from January 2000 to March 2024 for full-text studies reporting all-cause mortality and/or hospital length of stay (LOS) in adult inpatients with and without CLABSI/CRBSI. Two investigators independently reviewed all potentially relevant studies and performed data extraction. Odds ratio for mortality and mean difference in LOS were pooled using random-effects models. Risk of study bias was assessed using ROBINS-E.

Findings

Thirty-six studies were included. Sixteen CLABSI and 12 CRBSI studies reported mortality. The mortality odds ratios of CLABSIs and CRBSIs, compared to uninfected patients, were 3.19 (95% CI: 2.44, 4.16; I² = 49%) and 2.47 (95% CI: 1.51, 4.02; I² = 82%), respectively. Twelve CLABSI and eight CRBSI studies reported hospital LOS; only three CLABSI studies and two CRBSI studies accounted for the time-dependent nature of CLABSIs/CRBSIs. The mean differences in LOS for CLABSIs and CRBSIs compared to uninfected patients were 16.14 days (95% CI: 9.27, 23.01; I² = 91%) and 16.26 days (95% CI: 10.19, 22.33; I² = 66%), respectively.

Conclusion

CLABSIs and CRBSIs increase mortality risk and hospital LOS. Few published studies accounted for the time-dependent nature of CLABSIs/CRBSIs, which can result in overestimation of excess hospital LOS.

Background

The need to monitor manual cleaning of high-risk endoscopes is recommended or more so required by the current endoscope reprocessing guidelines. The objective of this study was to establish the optimal extraction volume for colonoscopes and bronchoscopes and demonstrate the extraction efficacy for the ChannelCheck™ rapid test.

Methods

The test soil utilized as a positive control was ATS2015 containing 20% defibrinated bovine blood. The extraction from the instrument channel of a colonoscope and bronchoscope was evaluated to establish the optimal extraction volume and the extraction efficacy for protein, carbohydrate and haemoglobin.

Results

Of the extraction volumes tested, 10 mL was optimal for both colonoscopes and bronchoscopes. The extraction efficacy was 91% for carbohydrate, 83.7% for haemoglobin and 82.4% for protein.

Conclusions

The limit of detection for these analytes by the ChannelCheck rapid test meet or exceed the established levels that correlate with adequate manual cleaning of flexible endoscopes.

Background

Irradiation with violet-blue light (VBL), in the spectrum of 405–450 nm, has been reported to be effective against pathogenic bacteria.

Aim

To investigate whether VBL irradiation could reduce the level of surface contamination at seven shared patient bathrooms in two wards at a hospital in Sweden.

Methods

Repeated sampling of five separate surfaces (door handle, tap water handle, floor, toilet seat, and toilet armrest) was performed in the bathrooms where 405 nm light-emitting diode spotlights had been installed. A prospective study with a cross-over design was carried out, which included two study periods, first with the spotlights either switched on or off and a second study period with the opposite spotlight status.

Findings

In total, 665 surface samples were collected during the study (133 samples per surface). Bacterial growth was found in 84% of all samples. The most common findings were coagulase-negative staphylococci and Bacillus spp. The median number of colony-forming units (cfu)/cm² was 15 (interquartile range: 5–40) for all surfaces. In our main outcome, mean cfu/cm² of all surfaces in a bathroom, no difference was observed with or without VBL. Clean surfaces (<5 cfu/cm²) were more commonly observed in bathrooms with VBL, also when controlling for confounding factors. No difference was observed in the number of heavily contaminated surfaces.

Conclusion

This study did not safely demonstrate an additive effect on bacterial surface levels when adding VBL to routine cleaning in shared patient bathrooms.