Journal of Hospital Infection最新文献

Objectives: The overuse of antibiotics is a primary driver of resistance development, particularly in low-resource settings such as Madagascar where broad-spectrum antibiotic use is excessive. The objective was to identify factors that could influence changes to the initial antibiotic regimen upon receipt of the microbiological results in Malagasy hospitals.

Methods: This study was part of the TSARA antibiotic resistance surveillance system implemented in eight hospitals in Madagascar belonging to the RESAMAD (Réseau des Laboratoires à Madagascar) network. The outcome was the change in the spectrum or the discontinuation of the empiric antibiotic regimen upon receiving the laboratory results.

Results: Across the eight participating hospitals, 793 patients were included and the majority of the antibiotic regimens were broad-spectrum (78.8%) which were prescribed in 208 (99.1%) of 210 blood samples. Third-generation cephalosporins were most common (441, 32.1%), with ceftriaxone being the most frequently used antibiotic (421, 30.6%). Upon the receipt of the laboratory results, 21 (2.6%) patients had their empiric antibiotic therapy changed and 530 (66.8%) stopped. A total of 269 (33.9%) patients had positive cultures, with 105 (13.3%) infected by multi-drug-resistant bacteria - primarily third-generation cephalosporin-resistant Enterobacterales. The use of ≥3 empiric antibiotics mainly ceftriaxone, gentamicin, and metronidazole, increased the likelihood of discontinuation (adjusted odds ratio (aOR) = 2.85, P<0.001). Conversely, the availability of antibiotics susceptibility test results decreased the odds of antibiotic discontinuation (aOR = 0.37, P=0.004).

Conclusion: This study based in the TSARA surveillance system in Madagascar highlights the influence of clinical factors and microbiological data on antibiotic therapy adjustments. Broad-spectrum antibiotics were widely used as empiric treatment. Availability of the microbiological results decreased the odds of antibiotic discontinuation.

Background: Endoscopic procedures carry a risk of infection, often due to inadequate cleaning of internal channels. Manual cleaning is essential but prone to human error. Automated systems are emerging to standardize this step, yet no specific performance standard exists for these 'pre-cleaning' devices, making their evaluation challenging.

Aim: To propose a standardized evaluation approach for automated endoscope cleaning devices based on existing ISO benchmarks, and to assess the cleaning efficacy of the AquaTYPHOON device, a chemical-free and brushless system on the market.

Methods: The AquaTYPHOON was tested using protocols from ISO 15883-4:2018 and ISO 15883-5:2021. Cleaning efficacy was evaluated on: (i) surrogate devices with Pseudomonas aeruginosa biofilm; (ii) complex surrogate devices soiled with blood; and (iii) endoscopes contaminated with Austrian test soil. Residual protein and total organic carbon (TOC) levels were measured post-cleaning and compared with action levels (6.4 μg/cm² for protein, 12 μg/cm² for TOC).

Findings: Across all test conditions, the AquaTYPHOON achieved protein and TOC levels below the action levels, except for one surrogate position. The device showed significant reduction of soil levels, meeting the efficacy requirements for endoscope cleaning before disinfection.

Conclusion: This study supports the feasibility of using ISO-based methods to evaluate automated pre-cleaning devices, and confirms the effectiveness of the AquaTYPHOON. Establishing clear performance criteria for such systems is essential to improve patient safety, reduce human error, and standardize endoscope reprocessing practices in clinical settings.

Background: A six-step technique is recommended for applying alcohol-based hand rubs (ABHRs) in health care. However, evidence supporting the effectiveness of individual steps is limited and healthcare workers' (HCWs)' compliance is low, potentially due to low acceptability or feasibility or inadequate training. This study evaluated the effectiveness of the six-step hand rubbing technique for healthcare staff with consideration of microbiological efficacy, acceptability and feasibility.

Methods: A mixed-method design was used. Data were collected in two stages between 2017 and 2020. Stage 1 used a Latin square design with a modified EN 1500 procedure to compare the six-step technique with six variations omitting one step each, for bacterial load reduction and hand surface coverage (N = 35). Stage 2 was a cross-sectional online survey of the acceptability and feasibility of using the six-step hand rubbing technique in clinical practice (N = 78).

Results: Omitting step 4 (backs of fingers) resulted in significantly lower bacterial load reduction than with the full six-step technique (P = 0.001). Omitting step 1 (palms) or step 2 (dorsa) resulted in significantly lower hand coverage than with all other technique variations (P ≤ 0.001). Stage 2 participants perceived the six-step technique as acceptable and feasible, with step 1 as the most acceptable and feasible step.

Conclusion: Step 4 contributed most to bacterial load reduction, and steps 1 and 2 were key for hand coverage. HCWs should continue using the six-step technique, with efforts to improve compliance with individual steps. Future research should investigate the effects of altering step sequence and the contribution of individual steps during handwashing with soap and water.