Journal of Hospital Infection最新文献

Background: Clostridioides difficile infection (CDI) is a major cause of healthcare-associated diarrhoea with significant morbidity and mortality worldwide. In Germany, CDI incidence has declined in recent years. However, prospective multicentre data on all-cause in-hospital mortality among CDI patients and on risk factors for death remain scarce.

Methods: We conducted a prospective multicentre surveillance study in six German university hospitals between 2016 and 2020 to assess all-cause in-hospital mortality among CDI patients. Additionally, multivariable logistic regression was used to identify risk factors for death.

Results: A total of 3,592 CDI cases were recorded, of whom 46.7% were female. Overall all-cause in-hospital mortality was 11.7%, whereas CDI-attributable mortality was 0.4% (n = 16). Independent risk factors for death in CDI patients included increasing age (3% per year, aOR 1.03, 95% CI 1.02-1.04), longer hospital stay (1% per day, aOR 1.01, 95% CI 1.00-1.01), admission to internal medicine (aOR 1.60, 95% CI 1.32-1.94) or haematology-oncology (aOR 2.38, 95% CI 1.75-3.24) as proxies for patient complexity, and elevated creatinine levels within +/- 2 days of sampling (6% per mg/dl, aOR 1.06, 95% CI 0.99-1.13). In contrast, diagnosis on a general ward (versus ICU or intermediate care, irrespective of speciality) was associated with a lower risk of death (aOR 0.34, 95% CI 0.28-0.42).

Conclusions: Our study provides a comprehensive assessment of all-cause in-hospital mortality among CDI patients in Germany. By identifying robust and easily accessible risk factors for death, our findings support improved risk stratification and may inform targeted management strategies for high-risk patient populations.

Objective: The objective of this study was to evaluate the impact of dental antibiotic guidelines recommending amoxicillin (AMPC) over third-generation cephalosporins (3GCs) for prophylactic use on surgical site infections (SSIs), prescription patterns, and cost-effectiveness across facility types, considering the presence of infection control departments and ward pharmacists.

Method: Using a health insurance claims database of individuals aged ≤ 75 years, we performed an interrupted time-series analysis of dental visits with tooth extractions from April 2012 to March 2024. A segmented regression model was applied to assess the impact of antibiotic guidelines (December 2014, 2014 guidelines; April 2016, 2016 guidelines) on 3GCs days of therapy (DOT) and SSI rates. Antibiotic costs and in-hospital vs out-of-hospital prescription patterns in dental clinics were also evaluated.

Results: Overall, the number of 3GCs DOT decreased, although the impact of the guidelines differed between facilities. After the implementation of the 2014 guidelines, 3GCs use decreased in hospitals, but not in dental clinics. After the implementation of the 2016 guidelines, it was further reduced in hospitals with infection control departments and ward pharmacists, and a decline in 3GCs use in dental clinics was initiated. No changes were observed in hospitals with infection control departments alone. The shift from 3GCs to AMPC was more evident in out-of-hospital prescriptions than in in-hospital prescriptions. SSI rates remained unchanged; however, antibiotic costs decreased significantly over time.

Conclusion: Guideline-based antimicrobial stewardship can reduce 3GC use and healthcare costs without compromising patient safety. Our findings highlight the importance of a multi-disciplinary collaboration to enhance the impact of guidelines.

Introduction: Hands are a key vector for pathogen transmission in healthcare, making effective hand antisepsis crucial for infection prevention. According to the European standard EN 1500, the reference method for evaluating hand antiseptics, a minimum rub-in time of 30 s is required. However, observations show healthcare workers typically spend less time on hand antisepsis.

Method: To assess the feasibility of a reduced rub-in time under standardized conditions, the German Association for Applied Hygiene conducted a multi-centre ring trial in 14 laboratories using a modified EN 1500 protocol (15 s, 3 mL of 60% v/v propan-2-ol). In a randomized crossover design, volunteers' hands were contaminated with Escherichia coli K12 and treated either with the reference (2 × 3 mL/2 × 30 s) or the test protocol (1 x 3 mL/15 s). Microbial reduction was measured and non-inferiority statistically analysed.

Results: The 15-second protocol yielded significantly lower log₁₀ reductions than the reference in 13 out of 14 laboratories but demonstrated consistent reproducibility and satisfactory interlaboratory performance. Challenges in completing the full rub-in technique within 15 s were reported, indicating the need for targeted training.

Conclusion: These findings support the methodological feasibility of a shortened protocol and are consistent with evolving clinical guidelines advocating reduced rub-in times, as well as with real-world practice, where healthcare workers typically spend less than 30 s on hand antisepsis. Nonetheless, any revision of EN 1500 should proceed cautiously to ensure antimicrobial efficacy, emphasizing complete hand coverage and strict adherence to technique.

Background: Family caregivers (FCGs) are integral to hospital patients' care but are often overlooked in hospital infection prevention and control (IPC) strategies, particularly in low- and middle-income countries. In Bangladesh, FCGs provide direct and indirect patient care; however, their incorporation in hospital IPC efforts is rare.

Aims: This pilot study aimed to develop and assessed an IPC intervention in improving hygiene compliance of FCGs in Bangladeshi hospitals.

Methods: A pre-intervention and postintervention study was conducted from July to September 2024 in six tertiary hospitals across Bangladesh. Participants included FCGs of hospitalized patients, and data were collected using a semi-structured observation questionnaire. A total of 8665 hand hygiene (HH) opportunities out of 9824 caregiving activities were documented from 783 h of observation. The prevalence differences (PDs) with a 95% confidence interval were calculated to assess the changes following the intervention.

Findings: The intervention led to a nearly threefold improvement in HH compliance among FCGs, increasing from 6.7% (204/3060) at baseline to 18.2% (1021/5605) following the intervention (PD: 11.5%, 95% confidence interval [CI]: 9.2-13.9). Hygiene compliance among FCGs improved for appropriate waste disposal (24.2%-51.8%) and patient file management (29.9%-53.2%). Self-purchase of alcohol-based hand rub bottles by FCGs elevated from 4.5% to 33.8%, and the visitor-to-patient ratio decreased from 3.23 to 1.41 following the IPC intervention.

Conclusion: The IPC intervention substantially improved FCGs' compliance with hygiene practices, highlighting its scalability in hospitalized patient care. These findings underscore the continued importance of incorporating FCGs into hospital IPC strategies and implementing targeted interventions to reduce infection risk and improve patient safety.

Background: Aseptic technique is integral to infection prevention but not clearly defined in international guidelines. Recommendations for practice lack concordance.

Aim: Establish whether there is consensus for the aims of aseptic technique and how it should be undertaken by nurses outside operating theatres.

Methods: Online modified Delphi survey in two rounds with follow-up study day.

Results: According to participants, aseptic technique is necessary to prevent transmission of potential pathogens; undertaken primarily to protect the patient undergoing the procedure; should be preceded by risk assessment; and only sterile items should enter the sterile field or contact the vulnerable site. To undertake risk assessment, information about the patient and venue are considered necessary. There is no consensus concerning whether the aim is to protect other patients and health workers; whether aseptic technique is possible in all settings; and appropriateness of personal protective equipment. Findings from the follow-up study day suggest that participants can undertake risk assessment when supplied with basic information related to patients and environment. The outcome of risk assessment is influenced by the venue where the procedure is undertaken, previous experience and perceptions about how invasive the procedure is; distinction is made between procedures considered highly invasive and those perceived to carry less risk.

Conclusion: Nurses agree on some, but not all key issues related to aseptic technique. Decision to undertake it appears to depend on venue, experience and perceptions of how invasive the procedure is. More focus is needed on education, delivery and audit of aseptic procedures to improve consistency of understanding and practice.

Background: The permeability of surgical scrubs affects the bacterial load in the operating room (OR) air. Bacterial load can be measured by counting fluorescent bioparticles per unit of air. This study aimed to compare fluorescent bioparticle sized ≥3 μm per 50 dm³ of OR air (FBP) in air during primary arthroplasty surgeries using two different staff clothing systems.

Methods: The average FBP for 37 consecutive arthroplasty surgeries using reusable scrubs was compared with 37 surgery type-matched arthroplasties using single-use scrubs. An analysis of covariance (ANCOVA) was conducted to analyse the effects of surgery duration on log10-transformed FBP while controlling for the number of staff members present and surgery duration.

Findings: Mean FBP levels were 101 (95% confidence interval [CI]: 96-107) for the reusable scrubs and 18 (95% CI:16-20) for the single-use scrubs. In the ANCOVA, clothing type was strongly associated with log10-transformed FBP, accounting for 86% of the partial variance (η² = 0.86). In contrast, neither the number of staff nor surgery duration had a significant effect on FBP.

Conclusion: Clothing system permeability to bioparticles is one key factor in achieving air with low levels of bioparticles in OR air. Measuring FBP in real time during arthroplasty surgery is a new possibility for studying the effect of distinct OR-related factors on air bacterial load.