Journal of Hospital Infection最新文献

Applying alcohol-based handrubs (ABHRs) can be a key factor in controlling the spread of infection, yet only if the proper amount of an effective handrub formulation is used. Healthcare workers often prefer to apply small ABHR amounts, since it dries faster. In response to this market preference, dispenser manufacturers tend to design their dispensers to dose small amounts. This study aims to investigate whether manufacturers' preset volume is suitable to achieve complete coverage. Medical students were asked to perform hand hygiene using foam format handrubs from three different wall-mounted, automatic dispensers. Drying time and hand coverage were objectively measured at each hand hygiene event. Participants were also asked to qualitatively assess the amount of ABHR received. 60 medical students tried all three dispensers, applying either one or two doses from each. Hand coverage strongly correlated with the applied ABHR volume. When less than 1 ml of handrub was applied, more than 10% of the hand surface was missed. Drying time appeared to be a limiting factor: when 2.6 ml of handrub was applied, the average drying time was 47.5 seconds. The participants' perception of the amount of ABHR received was inconsistent. As the dispensed ABHR volume determined the coverage achieved, it should be among the key indicators of quality when selecting a dispenser for installation. Participants frequently misjudged whether the received handrub amount was appropriate, suggesting that we cannot rely on people's intuition. Higher volumes cover the hands better, but require longer drying times, which can impede compliance.

Background: Clinical practice guidelines are essential in hospitals to guide the use of surgical antibiotic prophylaxis for women delivering via caesarean section. Although CPGs exist, the quality of these documents is infrequently examined.

Objective: The purpose of this systematic review is to examine the quality of CPGs directing the use of antibiotic prophylaxis in c-sections and review the evidence informing current recommendations.

Search strategy: We systematically searched Medline, EMBASE, and LILACS for publications which included recommendations for surgical antibiotic prophylaxis in caesarean deliveries published between 2015 and 2025. Google Scholar, databases of organisations and reference lists of included studies were also searched.

Selection criteria: Two reviewers independently screened the titles and abstracts of the retrieved publications. Two reviewers independently screened articles identified for full-text review.

Data collection and analysis: Data were independently collected by two reviewers using a standardised data collection tool. Discrepancies were resolved via discussion.

Main results: Eleven guidelines from several geographical regions were included in the review. Pre-incision cefazolin was explicitly recommended by 45% of guidelines. When appraised using the AGREE II Tool, the methodological quality of guidelines varied substantially for 4 of the examined domains. Stakeholder involvement had a median score of 54% (range 7-96), rigour of development 43% (4-97), applicability 14 % (0-88) and editorial independence 58% (0-100). Information relevant to guideline development was not accessible for some CPGs.

Conclusion: CPG development should be a rigorous process, with all information about development made easily accessible for the users and recipients of the practice recommendations.

Registration: https://osf.io/vqgpm.

Background: In order to explore the application of failure mode and effect analysis (FMEA) and logistic regression for managing nosocomial infections in the neonatal intensive care unit (NICU) cases.

Aim: Premature infants in NICUs face high infection risks from immature immunity and invasive procedures. However, traditional reactive management sometimes fails; research integrating FMEA (qualitative) and logistic regression (quantitative) is scarce. This study combined them to prioritize risks, validate, and guide control.

Methods: We categorized 100 infected neonates from NICU and 200 non-infected neonates into infection and control groups. Univariate and logistic regression analyses identified key risk factors for NICU infections. FMEA was applied to address these factors, and intervention effect was evaluated.

Results: Independent risk factors for NICU nosocomial infections included birth weight <1500g, gestational age <37 weeks, hospitalization time >14 days, mechanical ventilation, and invasive procedures like central venous catheterization, as well as endotracheal intubation (p<0.05). Following FMEA, the 2022 NICU infection rate (3.55%) was significantly lower than the 2021 rate (5.02%, p<0.05). Other outcomes included a reduction in the mean length of stay from 14.2 to 10.8 days (p<0.001), no change in mortality (0.58% vs 0.24%, p=0.174), as well as a decline in Multidrug-resistant organisms (MDROs) infection rate from 1.9% to 0.9% (p=0.014), and antibiotic therapy duration from 7.5 to 6.2 days (p<0.001), respectively.

Findings: Based on statistical regression, FMEA management is an efficient and feasible tool for controlling nosocomial infection risks in the NICU, thereby enabling targeted intervention selection and potential scientific decision-making for infection managers.

Background: Carbapenemase-producing organisms (CPOs) are an increasing public health threat. In October 2020, English laboratories were mandated to report acquired CPO detections in Gram-negative organisms from human clinical samples and screens to the existing national laboratory reporting system.

Aim: To describe acquired CPO epidemiology and evaluate the laboratory coverage, data quality, timeliness, simplicity, and acceptability of the mandatory surveillance system.

Methods: Using a mixed-methods approach, we extracted laboratory-confirmed CPO reports from 1/10/2020 - 31/12/2023 to assess laboratory coverage (proportion of laboratories reporting at least one CPO to SGSS in 2023) and data quality (completeness of variables). We conducted semi-structured interviews with stakeholders to assess simplicity, acceptability, and perceived timeliness via thematic analysis.

Findings: Reports of acquired CPO episodes in England doubled, from 2,670 (2021) to 5,759 (2023), with regional variation in rates (London 21.3/100,000 population vs. South-West 1.8/100,000). In 2023, laboratory coverage was 72% (83/115), from 38-100% by region. Data quality was high. Participants (n=12) described laboratory reporting delays due to technical issues, limited staff capacity, or human error, but were satisfied with the timeliness of surveillance outputs for monitoring longer-term trends. Mandatory reporting was acceptable, and some participants experienced streamlined, automated reporting, whereas others noted complicated or manual workarounds using pre-existing systems.

Conclusions: Reported CPO incidence is increasing, and CPO surveillance is perceived as efficient, valuable, and acceptable. However, despite being mandatory, laboratory reporting is still not comprehensive. We recommend investing in improvements to the existing surveillance system, ensuring that all laboratories have capacity to report and optimise processes.