American journal of infection control最新文献

Background: During Coronavirus disease 2019 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 9 face-worn product categories used by members of the general public. A benchtop system was devised to test 2 units from each category on 2 different-sized headforms with silicone elastomer skin. Each unit was donned 5 times per headform.

Results: Both face-worn product category and headform size significantly affected TOL (P value < .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: Intensive care unit (ICU) nurses require advanced expertise and skills in critical care and need infection control nursing competency (ICNC). Given the lack of research on it, this study aimed to develop a model of ICU nurses' ICNC.

Methods: A Delphi panel consisting of experts in intensive care nursing and infection control was organized to provide discerning and professional perspective on ICNC. Approved by the Institutional Review Board, a 3-round Delphi survey was conducted via email from July to December 2023. The content validity ratio and the coefficient of variation were calculated for panel responses.

Results: Among 17, 15 nurses (88.2%) participated and completed the surveys. About 80% were female, and the panel had an average working experience of 14.2years specifically in the ICUs or infection control departments at hospitals. After the initial round, a preliminary model was developed, consisting of 10 main components and 59 subelements. After eliminating 5 elements with content validity ratio values below 0.49 in the second survey, the final model, consisting of 10 main components and 54 subelements, was confirmed in the third survey.

Conclusions: ICU nurses' ICNC can be understood based on this study's results, and further research can be designed to improve this competency.

This study sought to determine the incidence and characteristics of midline-associated bloodstream infections (MABSI) at an urban health system during the COVID-19 pandemic. A MABSI rate similar to the central line-associated bloodstream infection rate was found. A large number of MABSI were caused by Staphylococcus spp and Enterococcus spp, as has previously been reported for central line-associated bloodstream infection. Patients with MABSI had high in-hospital mortality rates.

High-level disinfection and sterilization are complex processes, requiring initial and ongoing training of frontline staff.¹ A key component of appropriate disinfection and sterilization is point-of-use precleaning performed by front-line staff. Our facility implemented an annual hospital-wide education and competency program for staff that perform precleaning of reusable medical devices.

Background: The COVID-19 pandemic resulted in constant changes to Infection Prevention and Control (IPAC) recommendations, impacting clinician capacity to stay up to date. The COVID-19 IPAC Response and Escalation Framework (IPAC Framework), rarely reported or evaluated was developed to provide scalable IPAC guidance during the pandemic to health care in New South Wales (NSW), Australia.

Methods: Using a thematic analysis approach, a qualitative study using an online, cross-sectional survey comprising 27 questions was sent to 248 key stakeholders. Participants were health workers with broad clinical and system representation with responsibilities for risk assessment, communicating, implementing, or monitoring the IPAC Framework.

Results: The IPAC Framework provided a useful IPAC tool for the management of COVID-19 as perceived by 93% of respondents. The overwhelming majority (91%) reported the Framework provided enough information on IPAC strategies needed for COVID-19 that were aligned with transmission risk. Resources supporting the IPAC Framework were reported by most respondents (84%) as being widely accepted as the authoritative guidance.

Conclusions: An IPAC Framework is perceived as invaluable by clinicians and administrators to manage IPAC requirements in health care during a pandemic. The IPAC Framework can be applied more generally to support ongoing IPAC requirements.

Background: To analyze the epidemiological characteristics of the SARS-CoV-2 infection and reinfection associated with the emergence of Omicron variant in Healthcare workers (HCWs).

Methods: We enrolled 760 HCWs who received 2-4 vaccination doses of COVID-19 and followed by BA.5/BF.7 and/or XBB.1.5 breakthrough infections between December 2022 and July 2023. Serum sample from each individual were collected approximately 1,3 and 6 months after last exposure. IgM, IgG and Total antibodies against SARS-CoV-2 were measured by chemiluminescent immunoassay. Meanwhile, we created an Enterprise WeChat link for HCWs to self-report SARS-CoV-2 infections, symptoms and post COVID-19 conditions.

Results: Our study revealed that the reinfection rate among HCWs reached 26.1%. The main symptoms were fever (91.2% vs 60.1%), cough (78.8% vs 58.0%), and sore throat (75.4% vs 59.6%) during infection and reinfection in Omicron BA.5/BF.7 and XBB.1.5 wave, and the interval for reinfection ranged from 91 to 210 days (median 152). Fatigue (23.6%), memory loss (18.8%) and coughing (18.6%) were the most prevalent long COVID symptoms, with a higher prevalence among female HCWs.

Conclusions: HCWs reinfection with SARS-CoV-2 causes milder symptoms, but high reinfection rate and short intervals. Strengthen infection prevention and control is crucial to mitigating infection risk and improving health services.

Background: The high frequency of antibiotic use in US nursing homes is a public health concern. Facility-level prescribing patterns may provide a measure for antibiotic stewardship targeting.

Methods: An analysis of 2018-2019 data from linked files from the Centers for Medicaid and Medicare was conducted. Multilevel generalized linear models were used to calculate odds ratios for antibiotic receipt for calendar year 2019 using the 2018 facility prescribing rate.

Results: In 2019, 186,274 (19%) residents were prescribed an antibiotic. The most frequently prescribed class of antibiotics was cephalosporins (26%), and the average duration of antibiotic use was 9 days. Residents who were dually eligible for Medicare and Medicaid had 37% increased odds of antibiotic receipt (all adjusted odds ratio (aOR): 1.37, 95% confidence interval [CI]: 1.35, 1.39). The 2018 facility prescribing rate was associated with 14% increased odds of antibiotic receipt in 2019 in NHs in the medium (11.9%-20.2%) prescribing category (all aOR: 1.14, 95% CI: 1.11, 1.17) and 36% increased odds of antibiotic receipt in NHs in the high (> 20.3%) prescribing category (all aOR: 1.36, 95% CI: 1.32, 1.40) when compared with the lowest (0%-11.8%) prescribing category.

Conclusions: Antibiotic stewardship strategies should target nursing homes with high antibiotic prescribing rates and high populations of dually eligible patients to improve care in this population.

Infections in long-term care facilities pose a critical challenge, with 1 to 3 million serious infections annually and up to 380,000 associated deaths. The vulnerability of aging populations and inadequate infection prevention and control programs underscore the need for intervention. This initiative provided tailored continuing education through 8 virtual learning collaboratives serving 541 infection preventionists. The project also developed 9 infection prevention and control toolkits and a manual to further support long-term care facilities' infection prevention efforts.

Measures to reduce airborne pathogen transmission in health care settings, such as increased air exchange, air decontamination, and reductions in peak occupancy, can be expensive and disruptive, particularly when employed in an untargeted manner. We report the empirical identification of high transmission risk zones in a tertiary hospital, using carbon dioxide-based assessments of air exchange. This rapid, cost-effective, and unobtrusive approach led to the targeted remediation of a high transmission risk zone.

Background: The COVID-19 pandemic highlighted that hand hygiene (HH) is key in preventing health care-associated infections. Patients and families are understudied targets for infection prevention and control practices. Previous campaigns to change HH behavior have been effective, but often face systemic challenges with implementation.

Methods: The "Hand Hygiene Heroes" educational campaign was developed to improve patient and family HH at 2 tertiary care pediatric and obstetrics hospitals. Its multiple phases included visual materials, tailored activities for 9 hospital units, and long-term evaluation during a 2-year period. HH rates among patients/families and health care workers were measured at baseline and throughout the campaign via direct observation.

Results: Overall, HH significantly increased for both patients/families (OR 1.82, P .041) and health care workers (OR 2.15, P < .001) after campaign initiation. However, individual units had varying degrees of sustainment on follow-up evaluations.

Discussion: Duration of intervention, activity simplicity, active participation, and resource availability may affect success of campaign initiatives. Positive prognostic factors included mixed leadership support from administration and frontline workers, predetermined sustainability plans, and tailored activities by target audience.

Conclusions: Implementation of hospital educational campaigns can be resource-intensive but can positively impact patient and family HH.