American journal of infection control最新文献

Background: To pursue an irreducible minimum overall surgical site infection (SSI) rate, a 32-bed surgical hospital employed an outside consultant and performed sterile processing and surgery internal audits: no obvious improvements were identified. A ten-year review determined 70% of SSI's were spine procedure patients. After a nasal decolonization product literature review an intervention was implemented. The purpose of this study was to assess if the intervention impacted spine SSI rates.

Methods: A 36-month implementation science study was conducted. The 18-month intervention was immediate preoperative application of a manufactured pre-saturated 10% povidone iodine nasal decolonization product in spine surgery patients, with monthly product application documentation surveillance feedback to the preoperative staff. Chi-square test was used to determine the difference in types of spine SSI surgery rates pre and post intervention.

Results: Overall spine SSI decreased 35.7% (p=0.04) with 58.7% reduction in superficial incisional SSI (p=0.02). The 16.1% decline in deep incisional SSI was not significant (p=0.29).

Conclusion: Within this hospital, conducting 7,576 surgical spine procedures over 36-months, with the immediate preoperative application of a pre-saturated ten percent povidone-iodine nasal decolonization product, the only intervention in SSI prevention protocol, produced a statistically significant decrease in spine patient SSI rate percent.

Background: During COVID-19 pandemic, the general public used any face-worn products they could get to overcome the shortage of N95 respirators and surgical masks. These products, often not meeting any standards, raised concerns about their effectiveness in reducing the spread of respiratory viruses.

Methods: This study quantified total outward leakage (TOL) of units from nine face-worn product categories used by members of the general public. A benchtop system was devised to test two units from each category on two different-sized headforms with silicone elastomer skin. Each unit was donned five times per headform.

Results: Both face-worn product category and headform size significantly affected TOL (P-Value <0.05). The TOL of tested face-worn products varied from 10% to 58% depending on both model and headform size. Face-worn products donned on the medium headform had a higher mean TOL compared to those donned on the larger headform.

Conclusions: Overall, single-layer cloth masks are the least effective measure for source control due to their highest TOL among the tested face-worn products. Three-layer disposable face masks may be a favorable option for source control among the public. A standard should be developed for face-worn product design and manufacturing to accommodate different facial sizes.

Background: In this paper we describe an outbreak of Ralstonia mannitolilytica infection declared in our facility between January 2021 and January 2022.

Methods: In order to identify the source of the outbreak, we applied widespread epidemiological investigation and infection control measures, including device isolation, environmental sampling, and PFGE typing.

Results: Thirty-six cases of R. mannitolilytica infection were identified, mostly adults (78%) and males (75%). Initially, neurological procedures were a common risk factor among cases, leading to sampling of related environmental settings. Cases with other medical procedures started to be reported. The PFGE results showed most R. mannitolilytica isolates were indistinguishable which expanded our investigation to all hospital areas. The infection source was discovered later as a single lot number of sodium chloride solution that had been used in practice. The contaminated solution was recalled from all hospital units and the findings were reported to the Saudi FDA to communicate with the manufacturer and other healthcare organizations involved. No new cases of R. mannitolilytica were identified thereafter.

Conclusion: Our findings indicate that identifying the source of an outbreak could be challenging. An extended incubation period might be considered to improve and accelerate the identification of R. mannitolilytica. In order to minimize similar incidents, it is essential to regularly monitor the compliance of manufacturers and suppliers with regulations related to the safety of solutions administered in medical practice.

The Infection Control Advocate and Resident Education (ICARE) educational modules integrate and promote infection prevention and control (IPC) measures and residents' rights in nursing homes, targeting long-term care ombudsmen, residents, families, and other resident advocates. Survey respondents (N=102) reported increased knowledge in understanding IPC and preserving resident rights. Integrating these topics and identifying barriers to promoting IPC is necessary for implementing quality IPC in nursing homes.

Background: Hospital-acquired infections (HAIs) increase morbidity, mortality, and healthcare costs. Effective hand hygiene (HH) is crucial for prevention, but achieving high compliance remains challenge. This study explores using machine learning to integrate an electronic HH auditing system with electronic health records to predict HAIs.

Methods: A retrospective cohort study was conducted at a Brazilian hospital during 2017-2020. HH compliance was recorded electronically, and patient data were collected from electronic health records. The primary outcomes were HAIs per CDC/NHSN surveillance definitions. Machine learning algorithms, balanced with Random Over Sampling Examples (ROSE), were utilized for predictive modeling, including generalized linear models (GLM); generalized additive models for location, scale, and shape (GAMLSS); random forest; support vector machine; and extreme gradient boosting (XGboost).

Results: 125 of 6,253 patients (2%) developed HAIs and 920,489 HH opportunities (49.3% compliance) were analyzed. A direct correlation between HH compliance and HAIs was observed. The GLM algorithm with ROSE demonstrated superior performance, with 84.2% sensitivity, 82.9% specificity, and a 93% AUC.

Conclusions: Integrating electronic HH auditing systems with electronic health records and using machine learning models can enhance infection control surveillance and predict patient outcomes. Further research is needed to validate these findings and integrate them into clinical practice.

Background: Enhanced Barrier Precautions (EBP) recommends using gowns and gloves for certain nursing home residents during specific high-contact care activities associated with multidrug-resistant organism (MDRO) transmission. Though EBP is included in CDC guidance as an MDRO control strategy, optimal implementation approaches remain unclear.

Methods: We implemented a quality improvement initiative using the 4E process model (Engagement, Education, Execution, and Evaluation) to optimize EBP implementation in four Maryland nursing homes. Semi-structured interviews with healthcare personnel (HCP) occurred to understand EBP acceptability.

Results: Glove use during high-contact care increased from 85% in the baseline to 97% during the intervention (p<0.01). Gown use increased from 27% to 78% (p<0.01). Accuracy of identifying residents eligible for EBP improved from 63% to 99% (p<0.01). Of 780 residents observed, one-third met EBP indications - MDRO colonization (21%), indwelling medical device (14%), and/or chronic wound (10%). The most noted facilitator to EBP implementation included HCP perception that EBP reduces MDRO transmission to other residents and staff. The most noted barrier was uncomfortable gowns.

Conclusions: Implementation was complex and required comprehensive assessments of barriers and facilitators within each facility. HCP interviews identified common barriers and facilitators of EBP that can inform future EBP implementation projects.