Journal of Hospital Infection最新文献

Background: Two main approaches are employed to monitor healthcare-associated infections (HAIs): longitudinal surveillance, which allows the measurement of incidence rates, and point prevalence surveys (PPSs). PPSs are less time-consuming; however, they are affected by length-biased sampling, which can be corrected through inverse probability weighting. We assessed the accuracy of this method by analysing data from two Italian national surveillance systems.

Methods: Ventilator-associated pneumonia (VAP) and central-line-associated bloodstream infection (CLABSI) incidence measured through a prospective surveillance system (GiViTI) was compared with incidence estimates obtained through conversion of crude and inverse probability weighted prevalence of the same HAIs in intensive care units (ICUs) measured through a PPS. Weighted prevalence rates were obtained after weighting all patients inversely proportional to their time-at-risk. Prevalence rates were converted into incidence per 100 admissions using an adapted version of the Rhame and Sudderth formula.

Findings: Overall, 30,988 patients monitored through GiViTI, and 1435 patients monitored through the PPS were included. A significant difference was found between incidence rates estimated based on crude VAP and CLABSI prevalence and measured through GiViTI (relative risk 2.5 and 3.36; 95% confidence interval 1.42-4.39 and 1.33-8.53, P=0.006 and 0.05, respectively). Conversely, no significant difference was found between incidence rates estimated based on weighted VAP and CLABSI prevalence and measured through GiViTI (P=0.927 and 0.503, respectively).

Conclusions: When prospective surveillance is not feasible, our simple method could be useful to obtain more accurate incidence rates from PPS data.

Background: Surgical site infection preventions bundles have been used to reduce infection rate in most types of surgery. In colorectal surgery they have been used with success as well, with tailored care bundles designed for that purpose.

Aim: To identify and review the individual interventions that constitute each infection prevention care bundle in colorectal surgery, and the surgical site infection rate reduction related to their implementation.

Methods: A scoping review was conducted in PUBMED, CINAHL; Web of Science Core Collection and Scopus databases, during December 2022.

Results: This review analysed 48 of 164 identified studies on surgical site infection (SSI) prevention in colorectal surgery from 2011 to 2022. It revealed an average of 11 interventions per study, primarily in preoperative (mechanical bowel preparation, oral antibiotic bowel decontamination, hair removal, CHG showers, normoglycemia), intraoperative (antibiotic prophylaxis, normothermia, CHG skin preparation, antibiotic prophylaxis re-dosing, gown/glove change), and postoperative phases (normothermia, normoglycemia, dressing removal, oxygen optimization, incision cleansing). Despite these interventions, SSI rates remain high, indicating a need for further research to optimize intervention bundles and improve compliance across surgical stages.

Conclusions: The implementation of Surgical Site Infection prevention bundles, tailored to Colorectal surgery, have shown a reduction in surgical site infection rates and costs. Grouping intervention according to the perioperative phase, may contribute to increased compliance rates.

Background: Vancomycin-resistant Enterococcus faecium (VRE_fm) is an opportunistic pathogen, which can cause outbreaks in hospitals. In the Netherlands, several national guidelines and guidance documents on different aspects of VRE_fm management are available. Most available guidelines are written towards the hospital setting and only few on long-term care facilities (LTCFs). Moreover, not all aspects of VRE_fm management are covered, recommendations differ and the level of compliance to these guidelines is unknown. The aim of this study was to get insight into the routine VRE_fm policies in Dutch healthcare facilities with regard to screening, diagnostics and infection control measures.

Methods: Online questionnaires were sent to representatives of Dutch hospitals and LTCFs. The questionnaire included questions regarding the definition of VRE, screening, diagnostics, patient isolation, cleaning procedures, VRE_fm clearance and VRE_fm outbreaks.

Findings: The questionnaire was completed by 61 hospitals with a response rate of 84.1% and 57 LTCFs, mostly nursing homes. Most hospitals reported VRE_fm outbreaks in the previous decade, whereas only one LTCF reported an outbreak. Of the hospitals, 87% perform VRE_fm screening versus 50% of the LTCFs. VRE_fm-positive patients are isolated in 98% of hospitals and 83% of LTCFs. Protocols regarding how to unlabel VRE_fm-positive patients are in place in 84% of the hospitals and in 51% of LTCFs. The details of these measures differ substantially between healthcare facilities.

Conclusion: This study has shown that most hospitals and some LTCFs in the Netherlands have standard procedures for VRE_fm management to some level, although the comprehensiveness and details of the measures differ per hospital. More uniform policies would improve comparability of VRE_fm data on a regional/national level.

Objective: We aimed to evaluate whether subcutaneous tunneling in peripherally inserted central catheters (PICC) placement could reduce the occurrence of central-line associated blood stream infection (CLABSI).

Methods: We conducted an open-label, multicentre, randomized, controlled trial in five tertiary hospitals. Adult hospitalized patients requiring a PICC were randomized in a one-to-one ratio to conventional (cPICC) or tunneled PICC (tPICC) arms using a centralized web-based computer-generated stratified randomization. CLABSI rates between groups were compared in a modified intention-to-treat population. Safety including the incidence of exit-site infection or hemorrhage-associated catheter removal were also compared. This trial was registered with Clinical Research Information Service of Republic of Korea (KCT0005521).

Results: From November 2020 to March 2023, 1,324 participants were enrolled and randomly assigned to tPICC (n=662) and cPICC (n=662). This study was terminated early due to the cohort CLABSI rate being lower than estimated, therefore, the original sample size of 1,694 would render the study underpowered to detect a difference in CLABSI rates. In the tPICC, CLABSI occurred in 13 of 651 participants over 11,071 catheter-days (1.2/1,000 catheter-days), compared with 20 among 650 patients with cPICC over 11,141 catheter-days (1.8/1,000 catheter-days, rate ratio 0.65, 95% CI 0.30-1.38, p=0.30). The incidence of exit-site infection (29 tPICC, 36 cPICC, p=0.5) and hemorrhage-associated catheter removal (11 tPICC, 11 cPICC, p=0.99) was not different between both groups.

Conclusion: Due to insufficient sample size, this study could not demonstrate a statistically significant CLABSI risk reduction in the tPICC group compared to the cPICC group. Both groups had similar rates of exit site infection and bleeding.

Although administrative data are not originally intended for surveillance purposes, they are frequently used for monitoring public health and patient safety. This article provides a narrative overview of the barriers and facilitators for the use of administrative data for surveillance, with a focus on healthcare-associated infection (HAI) in Canada. In this case, only articles on administrative data in general or related to HAI were included. Validation study and meta-analyses on administrative data accuracy were excluded. Medline, Embase and Google Scholar were searched as well as references list of all included articles, for a total of 90 articles included. Our analysis identified 78 barriers at the individual, organizational and systemic levels and outlined 75 facilitators and solutions to improve administrative data utilization and quality. This narrative overview will help to understand barriers, facilitators and offer practical recommendations for optimizing the use of administrative data.