Journal of Hospital Infection最新文献

Surgical headwear is designed to maintain sterility and prevent microbial contamination. However, the environmental impact of the healthcare industry carries an obligation to develop sustainable alternatives. We aim to explore the environmental impact and safety of reusable surgical headwear. A systematic review and meta-analysis were performed using MEDLINE, Embase, Scopus, Google Scholar, PubMed, and the Cochrane Library until December 10, 2023. Studies were reviewed for suitability and risk of bias using the ROBINS-I tool, with the results aggregated using Review Manager Version 5.4 for odds ratios (ORs) and 95% confidence intervals (CIs), and the I2 was used to assess heterogeneity. This systematic review included nine studies, and the meta-analysis included six studies involving 45,708 procedural cases. There was no significant difference in surgical site infection (SSI) rates between the reusable and disposable groups (OR: 0.79; 95% CI: 0.59–1.07; P=0.13). Policy implementation did not affect SSI rates (OR: 1.21; 95% CI: 0.85–1.73; P=0.30). Reusable surgical head covers demonstrated a significantly lower carbon footprint (P<0.001), ozone depletion (P<0.005), fossil fuel depletion (P<0.005), terrestrial acidification (P<0.005), and fine particulate matter formation (P<0.005) than disposable alternatives. Reusable surgical headwear matches disposable options for SSI incidence and offers environmental advantages. These findings support a shift towards reusable alternatives in healthcare, aligning patient safety with ecological responsibility. By adopting reusable alternatives, healthcare systems can actively contribute to planetary health, thereby highlighting the significant role of sustainable practices in modern medical settings.

Background

Aim

Methods

Findings

Conclusion

Background

Despite the important role that cleaning plays in reducing the risk of healthcare-associated infections, no research has been undertaken to quantify the time required for effective cleaning and disinfection of different pieces of shared medical equipment commonly used in hospitals. This short report presents the results from a study that aimed to quantify the time required to clean common pieces of shared medical equipment effectively.

Methods

An observational time and motion study was conducted in a nursing simulation laboratory to determine the time required for effective cleaning and disinfection of 12 pieces of shared medical equipment commonly used in hospital. After training, the participants cleaned and disinfected equipment, with the time taken to clean recorded. Cleaning was deemed to be effective if ≥80% of ultraviolet fluorescent dots were removed during the cleaning process.

Main results

The time to clean equipment effectively ranged from 50 s [blood glucose testing kit; 95% confidence interval (CI) 0:40–1:00 (min:s)] to 3 min 53 s [medication trolley; 95% CI 3:36–4:11 (min:s)]. The intravenous stand was cleaned most effectively, with 100% of dots removed (N = 100 dots). In contrast, the bladder scanner was the most difficult to clean, with 12 attempts required to meet the 80% threshold for effective cleaning.

Conclusion

This study will inform staffing and training requirements to plan the cleaning and disinfection of shared medical equipment effectively. The findings can also be used for business cases, and in future cost-effectiveness evaluations of cleaning interventions that include shared medical equipment.

Background

Water and wastewater in healthcare settings are recognized to represent a risk to patients. However, waterless care has not been widely implemented in UK healthcare settings.

Aim

To identify barriers to implementation of waterless care.

Methods

A questionnaire study of infection prevention and control (IPC) practitioners, non-IPC clinicians, and estates managers and engineers was undertaken.

Findings

Alternatives to water present challenges in perceived acceptability to patients, particularly cleansing wipes for bathing and dry shampoo. There are concerns about cleansing wipes in terms of storage, disposal, sustainability and contamination during manufacture. Estates and engineering concerns include relative water tank size for water turnover and clinical disruption due to works.

Conclusion

Further work is required on acceptability of reduced water scenarios and patient views but the results of this questionnaire provide a grounding for sentiment from healthcare workers on waterless care.

Background

When processing surgical instruments after use, the safe, residue-free removal of blood and blood-containing soiling is one of the most important tasks. There are recommendations from various working groups regarding the ideal timeframe for cleaning used instruments in order to ensure safe disinfection and sterilization and avoid adverse effects. These are generally based primarily on practical experience and there is little systematic work on this topic.

Aim

In the present study, cleaning experiments with test specimens previously contaminated with sheep's blood were performed, and in this way the effects of the drying time of whole blood on the results of the subsequent cleaning were examined.

Methods

Reflecting practice, both visual and spectroscopic methods were used to quantify residual protein. The experimental results were evaluated both as a function of the drying time and the residual moisture of the blood.

Findings

Drying blood was particularly difficult to remove within the first 1–2 h. In this phase, in which the blood is coagulated but not yet completely dried, considerably more protein residues remained on the test specimens after cleaning than after longer standing times.

Conclusion

There is a timeframe for the removal of blood residues in which optimum cleaning results can be expected. As a consequence, there are also standing times that are disadvantageous for reprocessing. Based on the experimental data, it was deduced that this optimum time is either directly after contamination or in the range of >3 h and <24 h after soiling.

Background

Aim

Methods

Findings

Conclusion

Background

Accurate effect estimates are needed to inform input parameters of health economic models. Central-line-associated bloodstream infections (CLABSIs) and catheter-related bloodstream infections (CRBSIs) are different definitions used for central-line bloodstream infections and may represent dissimilar patients, but previous meta-analyses did not differentiate between CLABSIs/CRBSIs.

Aim

To determine outcome effect estimates in CLABSI and CRBSI patients, compared to uninfected patients.

Methods

PubMed, Embase, and CINAHL were searched from January 2000 to March 2024 for full-text studies reporting all-cause mortality and/or hospital length of stay (LOS) in adult inpatients with and without CLABSI/CRBSI. Two investigators independently reviewed all potentially relevant studies and performed data extraction. Odds ratio for mortality and mean difference in LOS were pooled using random-effects models. Risk of study bias was assessed using ROBINS-E.

Findings

Thirty-six studies were included. Sixteen CLABSI and 12 CRBSI studies reported mortality. The mortality odds ratios of CLABSIs and CRBSIs, compared to uninfected patients, were 3.19 (95% CI: 2.44, 4.16; I² = 49%) and 2.47 (95% CI: 1.51, 4.02; I² = 82%), respectively. Twelve CLABSI and eight CRBSI studies reported hospital LOS; only three CLABSI studies and two CRBSI studies accounted for the time-dependent nature of CLABSIs/CRBSIs. The mean differences in LOS for CLABSIs and CRBSIs compared to uninfected patients were 16.14 days (95% CI: 9.27, 23.01; I² = 91%) and 16.26 days (95% CI: 10.19, 22.33; I² = 66%), respectively.

Conclusion

CLABSIs and CRBSIs increase mortality risk and hospital LOS. Few published studies accounted for the time-dependent nature of CLABSIs/CRBSIs, which can result in overestimation of excess hospital LOS.

Background

The need to monitor manual cleaning of high-risk endoscopes is recommended or more so required by the current endoscope reprocessing guidelines. The objective of this study was to establish the optimal extraction volume for colonoscopes and bronchoscopes and demonstrate the extraction efficacy for the ChannelCheck™ rapid test.

Methods

The test soil utilized as a positive control was ATS2015 containing 20% defibrinated bovine blood. The extraction from the instrument channel of a colonoscope and bronchoscope was evaluated to establish the optimal extraction volume and the extraction efficacy for protein, carbohydrate and haemoglobin.

Results

Of the extraction volumes tested, 10 mL was optimal for both colonoscopes and bronchoscopes. The extraction efficacy was 91% for carbohydrate, 83.7% for haemoglobin and 82.4% for protein.

Conclusions

The limit of detection for these analytes by the ChannelCheck rapid test meet or exceed the established levels that correlate with adequate manual cleaning of flexible endoscopes.