Journal of Hospital Infection最新文献

Background: This study aimed to summarize the characteristics of laboratory-acquired infections (LAIs) and review exposure incidents in clinical laboratories. Additionally, a meta-analysis was conducted to estimate post-exposure incidence rates and evaluate the efficacy of post-exposure prophylaxis (PEP) following Brucella exposures.

Methods: A systematic search across databases including PubMed, Embase, Web of Science, CNKI, Wanfang, CMB, and the ABSA LAI database was conducted to extract relevant literature published during January 1, 1990, to August 31, 2023. Case reports and laboratory exposure risk events in clinical laboratories were included. Negative-binomial regression was used to estimate the relative increase in reported numbers per year of LAIs. A meta-analysis was performed to estimate the incidence rate (IR) of LAIs among exposed laboratory personnel after Brucella exposure risk events.

Findings: A total of 164 LAIs were reported in hospital laboratories. Negative-binomial regression analysis indicated no significant decline in annual LAIs reports (relative risk and 95% CI: 0.9834 [0.9667,1.0001], P value: 0.052). Most LAIs (68.3%) occurred during routine work, with only 9.8% linked to laboratory unintended exposure. The leading pathogens were Brucella (55.5%), Neisseria meningitidis (7.3%), and Shigella sonnei (5.5%). The proportion of LAIs caused by Brucella in developing countries was higher than that in developed countries (72.4% vs. 48.7%). The meta-analysis revealed that the incidence rate for Brucella-related LAIs among laboratory personnel was calculated to be 60 per 100,000 laboratory personnel. Laboratory personnel exposed to high-risk Brucella incidents faced a notably elevated infection risk, estimated at 80 per 100,000 laboratory personnel. Among higher-risk Brucella exposures, laboratory personnel who did not receive PEP experienced a 6.33 times higher risk of infection compared to those who did. The attributable fraction associated with the absence of PEP was 84.2%.

Conclusions: Clinical laboratory personnel remain at infection risk, with no reduction in reported LAI cases, mainly resulting from Brucella acquisitions. PEP proved effective against high-risk Brucella exposures.

The cleaning of reusable medical devices involves inherent challenges that can impact on the effectiveness of the cleaning process; consequently, the subsequent safety of patients. Fluid dynamics play a critical role in determining the flow and distribution of cleaning agents where the design of the device can either facilitate or hinder this important process. Complex geometries, narrow channels, or irregular surfaces can impede effective flushing of contaminants leading to incomplete cleaning that creates a greater likelihood for patient contamination risks. Device features (n =23) were exposed to the most challenging cleaning conditions to find the point of failure in both fluid dynamics and soil retention. Experimental results obtained from the aforementioned along with associated compound risks were used to assign a risk value. Using the "hardest to clean" device feature approach as the base risk value, the total quantitative risk score was calculated for different reusable medical devices from numerical values obtained from addressing 14 questions focusing on variability in geometry, material use, types of cleaning, and intended patient use. Patient risk values for devices with different features were calculated from using Kremer's cleaning categories based on position within value ranges. Occurrences less than 18 correspond to minimal risk devices while a total risk score between the values of 18-39 are moderate and equal to or above 40 scores corresponds to the maximal category. Application of this quantitative assessment approach will facilitate appropriate mitigation of risk for cleaning reusable medical devices by informing use of targeted effective interventions. Future use of this Kremer cleaning classification will complement and augment disinfection and sterilization modalities.

Pulmonary tuberculosis (PT) is an airborne disease, justifying the identification of suspect patients on admission, and their hospitalization in individual rooms with the implementation of Airborne Supplementary Precautions (ASP). The aim of this study was to identify, in a high-prevalence hospital, the frequency of non-isolated PT and the factors associated with the delay in implementing ASP. This was a retrospective observational study, including 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 multivariate statistical analyses were performed. During the study period, 256 patients were included. Among them 134 (52.3%) had PT. These included 100 (75%) men, median age 39, 70% foreign-born. Among these patients, 46 (34%) were isolated beyond the 24th hour of admission. The average time to implement ASP was 4.3 days, and 7 patients (5.2%) were not isolated throughout their stay. Three classes of factors were associated by multivariate analysis with isolation. Previous consultation with a general practitioner was protective whereas admission through emergency department was not. Presence of so-called cardinal clinical signs and a suggestive chest X-ray were protective factors. Finally, European patients were less frequently isolated. In our study, 34% of patients admitted with PT were not isolated on admission. The risk of non-isolation was 3 times higher in cases of admission via the emergency department, and European patients were less well isolated. The presence of cardinal signs and prior consultation with a general practitioner were associated with a higher frequency of isolation.