Journal of Hospital Infection最新文献

英文中文

Variation in design of neonatal intensive care units: the need for consensus 新生儿重症监护室设计的差异：需要达成共识。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-08-01 DOI: 10.1016/j.jhin.2024.05.009

引用次数: 0

Comment on: Central-line-associated bloodstream infection (CLABSI) burden among Dutch neonatal intensive care units 评论：荷兰新生儿重症监护病房的中央管路相关血流感染（CLABSI）负担。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-08-01 DOI: 10.1016/j.jhin.2024.03.024

引用次数: 0

Burden of surgical management of prosthetic joint infections following hip and knee replacements in Alberta, Canada: an analysis and comparison of two major urban centres 加拿大艾伯塔省髋关节和膝关节置换术后人工关节感染手术治疗的经济负担：两个主要城市中心的分析与比较。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-08-01 DOI: 10.1016/j.jhin.2022.05.002

Background

Complex surgical site infections (SSIs) and revisions for these infectious complications following total knee and hip arthroplasties are associated with significant economic costs.

Aim

To evaluate the cost of one-stage and two-stage revision; debridement, antibiotics and implant retention (DAIR); and DAIR with liner exchange for complex hip or knee SSIs in Alberta, Canada.

Methods

The Alberta Health Services Infection Prevention and Control database was used to identify individuals aged ≥18 years from the two major urban centres in Alberta – Calgary and Edmonton – with complex hip or knee SSIs who underwent surgical intervention between 1^st April 2012 and 31^st March 2019. Micro-costing and gross costing methods were used to estimate 12- and 24-month costs following the initial hospital admission for arthroplasty. Subgroup, inverse Gaussian and gamma regression analyses were used to evaluate associations between cost and revision procedure, age, sex and comorbidities.

Findings

In total, 382 patients with complex SSIs were identified, with a mean age of 66.1 years. DAIR and DAIR with liner exchange resulted in the lowest 12- and 24-month costs at $53,197 [95% confidence interval (CI) $38,006–68,388] and $57,340 (95% CI $48,576–66,105), respectively; two-stage revision was the costliest procedure. Most of the costs incurred (>98%) were accrued within the first 12 months following the initial procedure.

Conclusions

Medical costs are highest in the 12 months following initial arthroplasty, and for two-stage revision procedures in hip and knee complex SSIs.

背景：目的：评估加拿大阿尔伯塔省复杂髋关节或膝关节SSI的一期和二期翻修、清创、抗生素和植入物保留（DAIR）以及带衬垫交换的DAIR的成本：我们利用阿尔伯塔省卫生服务感染预防与控制数据库，从阿尔伯塔省的两个主要城市中心--卡尔加里和埃德蒙顿区，找出了在2012年4月1日至2019年3月31日期间接受手术治疗的年龄大于18岁的复杂髋关节或膝关节SSI患者。采用微观成本计算和总成本计算方法估算了首次入院接受关节置换术后 12 个月和 24 个月的成本。采用分组、反高斯和伽玛回归分析评估翻修手术、年龄、性别和合并症对成本的影响：共有 382 例复杂 SSI 患者，平均年龄为 66.1 岁。DAIR和带衬垫交换的DAIR导致的12个月和24个月费用最低，分别为53,197美元（95% CI，38,006-68,388美元）和57,340美元（95% CI，48,576-66,105美元）；两阶段翻修是费用最高的手术。大部分产生的费用（>98%）都是在初次手术后的头 12 个月内产生的：结论：在髋关节和膝关节复合SSI患者中，初次关节置换术后12个月以及两阶段翻修术的医疗费用最高。

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引用次数: 0

Concordance between IDEXX Legiolert® (liquid culture assay) and plate culture (ISO 11731:2017) for the detection and quantification of Legionella pneumophila in water samples IDEXX Legiolert®（液体培养法）和平板培养法（ISO 11731:2017）在检测和定量水样中嗜肺军团菌方面的一致性。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-08-01 DOI: 10.1016/j.jhin.2023.10.019

Background

Legionella pneumophila is a water-borne bacterium that can cause Legionnaires' disease. Legiolert® (IDEXX, USA) is a low-labour liquid culture assay for the detection and enumeration of L. pneumophila (SG1-15) from water.

Aim

To analyse concordance between Legiolert and ISO 11731:2017 plate culture method (membrane filtration and culture on selective agars) using hospital water samples (N = 100).

Methods

Incubation was at 39 °C and 36 °C, respectively, for seven days, followed by most-probable enumeration for Legiolert and subculturing and serogrouping of suspected Legionella colonies, with plate culture.

Findings

L. pneumophila (SG1-15) was isolated from 25 out of 100 samples when using Legiolert or plate culture. Fourteen additional Legiolert samples tested positive for L. pneumophila; analysis of the same samples by plate culture was negative (12 out of 14) or yielded only Legionella rubrilucens (two out of 14; confirmed via matrix-assisted ionization/desorption time-of-flight mass spectrometry). L. pneumophila was not captured from Quanti-Tray/Legiolert pouch wells of these positive samples after subculture of puncture aliquots on buffered charcoal yeast-extract agar. Both methods in concordance did not detect L. pneumophila in 61 out of 100 samples.

Conclusion

Legiolert and plate culture are both satisfactory methods to detect L. pneumophila from water samples, and both to detect isolated L. pneumophila in 25% of the sample population. Legiolert provides a faster time to result, and is less resource-demanding and labour-intensive; however, there may be a low risk of cross-reactivity with other organisms. Both methods are suitable for the analysis of water in healthcare settings, where the monitoring of L. pneumophila is imperative in preventing cases of Legionnaires' disease.

背景：嗜肺军团菌是一种可引起军团病的水传播细菌。在医疗环境中监测这种生物对于保护弱势群体至关重要。Legiolert®（美国IDEXX）是一种低产程液体培养法，用于从水中检测和计数嗜肺乳杆菌（SG1-15），只需最少的操作员培训，并在7天内提供确认结果。目的：使用Legiolert®和ISO 11731:2017平板培养法（膜过滤和选择性琼脂培养）对医院水样（n=100）进行处理，以分析程序之间的一致性。方法：分别在39°C和36°C下培养7天，然后对Legiolert®进行最可能的计数，并用平板培养法对疑似军团菌菌落进行亚培养和血清分组。结果：当使用Legiollert®或平板培养时，从25/100个样本中分离出嗜肺乳杆菌（SG1-15）。另外14份Legiolert®样本的嗜肺乳杆菌检测呈阳性；通过平板培养对相同样品的分析为阴性（12/14）或仅产生红色军团菌（2/14；通过MALDI ToF MS确认）。在BCYE琼脂上继代培养穿刺等分试样后，未从这些阳性样品的Quanti Tray/Legiolert®袋孔中捕获嗜肺乳杆菌。两种方法一致，在61/100份样本中未检测到嗜肺乳杆菌。结论：Legiolert®和平板培养都是从水样中检测嗜肺乳杆菌的令人满意的方法，并且都在25%的样本群体中分离出嗜肺乳球菌。Legiolert®提供了更快的结果时间、更少的资源需求和劳动密集型。尽管如此，与其他生物体发生交叉反应的风险可能很低。这两种方法都适用于医疗环境中的水分析，在医疗环境中，对嗜肺乳杆菌的监测对于预防军团病病例至关重要。

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引用次数: 0

Insight into microbiological control potential of pathogens in a veterinary hospital. 洞察兽医院病原体的微生物控制潜力。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-08-01 Epub Date: 2024-05-16 DOI: 10.1016/j.jhin.2024.05.002

C F Dumont, A L M Ferreira, R L M Santos, B de Jesus E Silva, L R M Costa, D J Z Delfiol, D A Rossi, R T Melo

引用次数: 0

Insight into microbiological control potential of pathogens in a veterinary hospital 洞察兽医院病原体的微生物控制潜力

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-08-01 DOI: 10.1016/j.jhin.2024.05.002

引用次数: 0

Clostridioides difficile infection following COVID-19: A nationwide analysis using routine surveillance data in Wales. COVID-19 之后的艰难梭菌感染：利用威尔士常规监测数据进行的全国性分析。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-07-31 DOI: 10.1016/j.jhin.2024.07.011

Ember Hilvers, Joshua Matizanadzo, Victoria McClure, Philip Butterick, Mari Morgan

Background: CDI incidence has increased in Wales from summer 2020 and has remained elevated. There is evidence of poorer outcomes from concurrent CDI and COVID-19 infections, but it is not clear if infection with COVID-19 directly impacts likelihood of CDI infection.

Aim: We investigated the relationship between CDI and COVID-19 and the impact of secondary infections.

Methods: We conducted two analytical studies using routine surveillance data: i) population level ecological case control study comparing CDI cases in the Welsh population by SARS-COV-2 exposure in the previous 90 days, ii) cohort study of COVID-19 cases by secondary infection presence, investigating CDI development within 90 days.

Findings: Case control: 12% (196/1645) of CDI cases had prior COVID-19 and were twice as likely to have had COVID-19 compared to general population controls, when controlling for other infection history (OR 2.1, CI 1.8-2.5, p<0.0001). CDI cases were 8 times more likely to have had other infections, independent of COVID-19 history (OR 8.0, CI 7.0-9.0, p<0.001).

Cohort study: 2% (2,255/137,620)) of the COVID-19 cohort developed >1 secondary infection, and <1% (185/137620) developed CDI within 90 days. CDI risk was four times higher in those with secondary infections, after age and sex adjustment (RR 4.6, CI 3.1 - 6.1, p<0.001). CDI risk increased with age and did not differ by sex.

Conclusions: Findings suggest a relationship between COVID-19 and CDI. However, incidence of CDI following COVID-19 was a rare outcome generally, suggesting other factors are likely contributing to the increased rates of CDI observed since 2020.

背景：威尔士的 CDI 发病率从 2020 年夏季开始上升，并持续升高。有证据表明，同时感染 CDI 和 COVID-19 会导致较差的结果，但目前尚不清楚感染 COVID-19 是否会直接影响感染 CDI 的可能性：我们利用常规监测数据进行了两项分析研究：i) 人口级生态病例对照研究，比较威尔士人口中的 CDI 病例与过去 90 天内 SARS-COV-2 暴露的关系；ii) COVID-19 病例的队列研究，根据是否存在继发感染调查 CDI 在 90 天内的发展情况：病例对照：12%（196/1645）的 CDI 病例曾感染 COVID-19，与普通人群对照相比，感染 COVID-19 的几率是普通人群对照的两倍（OR 2.1，CI 1.8-2.5，p队列研究：COVID-19 队列中有 2%（2255/137620）的病例发生了 1 次以上的继发感染）：研究结果表明，COVID-19 与 CDI 之间存在关系。然而，COVID-19 后的 CDI 发病率一般很少见，这表明自 2020 年以来观察到的 CDI 发病率增加可能是其他因素造成的。

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引用次数: 0

Quality control efforts of medical institutions: the impacts of a value-based payment system on medical staff and healthcare-associated infections 医疗机构的质量控制工作：基于价值的支付系统对医务人员和医疗相关感染的影响。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-07-31 DOI: 10.1016/j.jhin.2024.06.021

Background

In South Korea, various quality assessments have been introduced to improve the quality of care; as such, the overall level of quality of medical institutions has improved. However, gaps still exist between institutions.

Aim

To evaluate the impact of quality management efforts of medical institutions on securing medical staff and healthcare-associated infections in intensive care units (ICUs).

Methods

This study used data from the second and third ICU quality assessments conducted by the Health Insurance Review and Assessment Service, which included 265 hospitals and 39,096 inpatients. The continuous quality improvement efforts of medical institutions were measured according to changes in their grade based on quality assessment results. In addition, healthcare-associated infection rates were measured, including rates for ventilator-associated pneumonia and catheter-associated infections. The incidence rate ratio (IRR) was calculated using generalized estimating equation Poisson regression models that included hospital and patient characteristics.

Results

Healthcare-associated infections occurred in approximately 2% of patients using ventilators or catheters. Ventilator-associated pneumonia increased significantly in institutions with a decline in grade [IRR 2.038, 95% confidence interval (CI) 1.426–2.915]. In institutions with an improvement in grade, infections associated with central venous catheters (IRR 0.484, 95% CI 0.330–0.711) and urinary catheters (IRR 0.587, 95% CI 0.398–0.866) decreased.

Conclusions

Although quality assessment has been introduced in ICUs in South Korea, some gaps remain between medical institutions. Differences in securing medical resources through the quality management efforts of medical institutions were observed, and the infection rate was low in hospitals with high-quality management and high in hospitals with low-quality management.

背景：韩国引入了各种质量评估来提高医疗质量，因此医疗机构的整体质量水平有所提高。目的：本研究评估了医疗机构的质量管理工作对重症监护病房（ICU）医务人员安全和医疗相关感染的影响：本研究使用了医疗保险审查和评估服务机构进行的第二和第三次 ICU 质量评估的数据，评估对象包括 265 家医院和 39,096 名住院患者。根据质量评估结果的等级变化来衡量医疗机构的持续质量改进工作。我们还测量了医疗相关感染率，包括呼吸机相关肺炎和导管相关感染率。使用包含医院和患者特征的广义估计方程泊松回归模型计算发病率比（IRR）：使用呼吸机或导管的患者中约有 2% 发生了医疗相关感染。在等级下降的机构中，呼吸机相关肺炎的发生率明显增加（IRR：2.038，95% CI：1.426-2.915）。在等级提升的机构中，与中心静脉导管（IRR：0.484；95% CI：0.330-0.711）和导尿管（IRR：0.587，95% CI：0.398-0.866）相关的感染有所减少：尽管韩国已在重症监护室引入质量评估，但各医疗机构之间仍存在一些差距。结论：虽然韩国已在重症监护室引入了质量评估，但各医疗机构之间仍存在一些差距。在通过医疗机构的质量管理工作确保医疗资源方面存在差异，管理质量高的医院感染率低，管理质量低的医院感染率高。

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引用次数: 0

Active follow-up of patients identified with multidrug-resistant Gram-negative bacteria to discontinue contact precautions and isolation measures 积极跟进被确认患有耐多药革兰氏阴性菌的患者，停止接触预防措施和隔离措施。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-07-31 DOI: 10.1016/j.jhin.2024.07.008

Background

It is essential to refrain from unnecessary isolation measures indicated for patients identified with multidrug-resistant Gram-negative bacteria (MDR-GNB).

Aim

To evaluate whether a pro-active follow-up strategy to discontinue isolation measures of patients identified with MDR-GNB (without carbapenemase production) resulted in reduced isolation days during hospitalization, compared to passive follow-up.

Methods

A comparison was made between active and passive follow-up strategies over a two-year period after first MDR-GNB identification. Patients could be declared negative after two consecutive negative screening cultures. Active follow-up patients received a questionnaire for screening cultures within six months of MDR-GNB identification. Of the 2208 patients included, 1424 patients (64.5%) underwent passive follow-up and 784 patients (35.5%) underwent active follow-up.

Findings

A significantly higher proportion of active follow-up patients who had sufficient (at least two) screening cultures were declared MDR-GNB negative compared to those with passive follow-up; 66.9% vs 20.6% (P < 0.001) for adult patients and 76.0% vs 17.1% (P < 0.001) for paediatric patients. A comparison between active follow-up patients with sufficient versus those with active follow-up but insufficient cultures revealed a reduction of isolation days for paediatric patients (median 10.6 vs 1.6 days; P = 0.031). Though this difference was not statistically significant for adults (median 5.3 vs 4.2 isolation days), there was a valuable decrease in the number of isolation days for both adult and paediatric patients under active follow-up with sufficient (≥2) cultures, indicating clinical relevance.

Conclusion

We recommend an active follow-up strategy for patients identified with an MDR-GNB, to prevent further unneeded infection prevention measures.

因此，本研究旨在评估主动随访策略与被动随访相比，是否能减少住院期间的隔离天数，主动随访策略能终止对已确定为耐多药革兰氏阴性菌（MDR-GNB）患者（不产生碳青霉烯酶）的隔离措施。在首次发现 MDR-GNB 后的两年内，对主动和被动随访策略进行了比较。患者在筛查培养结果连续两次阴性后可被宣布为阴性。主动随访患者在 MDR-GNB 鉴定后 6 个月内收到筛查培养问卷。在纳入的 2208 名患者中，1424 名患者（64.5%）接受了被动随访，784 名患者（35.5%）接受了主动随访。与被动随访的患者相比，主动随访的患者中，有足够（至少两次）筛查培养的患者被宣布为 MDR-GNB 阴性的比例明显更高；66.9% 对 20.6%（P

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引用次数: 0

Will we need water in the hospitals of the future? The role of water vs. waterless systems - Case for Vs Case against. 未来的医院还需要水吗？水与无水系统的作用 - 支持与反对。

IF 3.9 3区医学 Q1 INFECTIOUS DISEASES

Journal of Hospital Infection

Pub Date : 2024-07-31 DOI: 10.1016/j.jhin.2024.07.010

Mark I Garvey, Elisabeth Holden

引用次数: 0

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