American journal of infection control最新文献

External urinary device (EUD) use and modification of the electronic medical record system with defaulting EUD for selected indications significantly decreased the utilization of indwelling urinary catheters while there was no observed significant reduction in catheter-associated urinary tract infections. The introduction of EUD alone may not decrease catheter-associated urinary tract infections and a comprehensive approach involving various strategies from different perspectives will be necessary, particularly diagnostic stewardship.

Background: Verona integron-encoded metallo-β-lactamase-producing Pseudomonas aeruginosa (VIM-PA) outbreaks are frequently linked to contaminated sink-drains in the intensive care unit (ICU). This study aims to investigate a VIM-PA outbreak occurring at 4 ICUs in a Belgian university center.

Methods: Between 01/01/2019 and 30/07/2023, data were retrospectively retrieved. Whole-genome sequencing of VIM-PA was carried out for available isolates and the core genome multilocus sequencing typing (cgMLST) was used to confirm clonality. New case incidence was estimated by analyzing the weekly data of at-risk and VIM-PA-colonized patients, fitting a regression model.

Results: Fifty-one patients were colonized, among them, 32 (63%) were infected by VIM-PA, which contributed to 7 deaths. The outbreak investigation showed that 19 (47%) of the examined sink-drains grew at least once a VIM-PA. Two major clusters were observed by cgMLST: ST111 (59 clones with 40 clinical isolates), and ST17 (8 clones with 6 clinical isolates). The estimated incidence rate of new cases was significantly higher in one unit.

Conclusions: A 5-year prolonged outbreak at the UZ Brussel ICUs was caused by only 2 VIM-PA clones, both linked to sink-drains, with minimal mutations occurring throughout the years. Statistical modeling found different incidence rates between units. Tailored interventions were hence prioritized.

Background: Given the risk of infection through face-touching behaviors, investigators have called for more research into the development of interventions to reduce the frequency of face-touching. The current study aims to test the effectiveness of messages on reducing face-touching behaviors.

Methods: Nine different messages that highlighted the risk of face-touching were developed. Study 1, an online survey-experiment with a national sample of US adults (N = 998), examined message-, risk perceptions, and face-touching-related behavioral intentions. The most promising messages identified in study 1 were then tested in study 2, a follow-up behavioral observation study with a class of undergraduate students. Students' face-touching behaviors were observed during a 4-week period when intervention versus control messages were displayed in the classroom.

Results: Four messages performed better in study 1, 2 of which were selected to test the actual message effectiveness in study 2. Study 2 results showed that on average, students touched their faces less frequently when a "Don't touch your face" message was present, although such decrease was not statistically significant.

Conclusions: Having reminder messages of "Don't touch your face" in public spaces hold the potential to be a low-cost, effective strategy to reduce face-touching behaviors.

Background: Frailty is often more predictive of disease and mortality compared with chronological age. This study determined the impact of frailty on Clostridioides difficile infection (CDI) risk and outcomes in a national veteran population.

Methods: This was a retrospective cohort study of CDI and control veteran inpatients and outpatients from fiscal year 2003 to 2018. Baseline frailty was presented as the Veterans Affairs (VA) Frailty Index. Propensity score--matched analyses were conducted to compare CDI risk, CDI health outcomes, and 1-year new-onset frailty-associated conditions.

Results: A total of 11,451 CDI and 11,451 matched control patients were included. Baseline frailty conditions were more common among CDI patients, especially involuntary weight loss (6.0% vs 3.4%, P < .001) and anemia (24.6% vs 18.7%, P < .001). VA Frailty Index was significantly higher for CDI patients (0.13 vs 0.11, P = .019). Frail CDI patients were more likely to experience 30-day mortality (11.3% vs 1.1%, P < .001) and 60-day CDI recurrence (20.4% vs 16.3%, P < .001) compared with non-/prefrail CDI patients. At 1year, CDI patients were significantly more likely to be categorized as frail (19.6% vs 17.0%, P < .001).

Conclusions: This study demonstrated the potential association between frailty and CDI risk and health outcomes, as well as new-onset frailty diagnoses in patients who develop CDI.

Background: New elastomeric half-mask respirator (EHMR) models without exhalation valves (EVs) or with exhalation valve filters (EVFs) are facilitating expanded use in health settings to reduce workers' exposure to airborne hazards while acting as source control to prevent pathogen spread. The physical comfort of new models has not been assessed in comparison to previously used EHMRs with EVs.

Methods: Researchers assessed 1,962 health care and emergency medical service personnels' self-reported adverse experiences from 2 cohorts while wearing EHMR models with EVs (cohort 1, n = 1,080) and without EVs or with EVFs (cohort 2, n = 882). Fisher exact test identified differences between the cohorts accounting for organizational factors when possible.

Results: Cohort 1 respondents experienced communication challenges and discomfort when wearing the EHMR > 1 hour statistically significantly more often than cohort 2. Cohort 2 respondents reported statistically significantly more instances of difficulty breathing, moisture buildup, being uncomfortable to wear < 1 hour, and being uncomfortably warm.

Conclusions: Discomfort is prevalent among end users and more often among those wearing EHMRs without an EV/with an EVF. As EHMR research and development advances, prevalence in use may increase for emergency and routine situations. Organizations may not only need guidance about respirator selection but also model-specific selection.

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) causes life-threating hospital-acquired. Due to a limited number of Intensive-Care-Unit (ICU) beds, these patients are often treated in high-dependency (HD) non-ICUs within internal-medicine wards (IMW) in Israel. We aimed to assess the effectiveness of a multilayered infection-control intervention on CRAB infection rate in IMWs, especially in its HD non-ICUs with ongoing CRAB transmission.

Methods: A quasi-experimental, before-and-after, interrupted time-series study with control outcomes. We conducted a multilayered intervention over 3.5years, which included 4 phases: (1) Pre intervention; (2) Intervention introduction: introduced enhanced environment cleaning; (3) Intervention phase 1: introduced active surveillance; (4) Intervention phase 2: introduced CRAB-positive patient cohorting, in addition to previous ongoing measures taken.

Results: CRAB was isolated from 204 patients aged 69.8y/o ± 15.86y, 59.8% male, 34.3% had CRAB-positive clinical samples. Mean hospital length-of-stay was 30.5days, with a 30-day postdischarge mortality rate of 55.9%. Mean CRAB clinical cases decreased from 0.89 in preintervention to 0.11 at the end of phase 2, with a change in slope and level after the intervention of P = .02 (CI: -0.204 to -0.040) and P = .004 (CI: -0.013 to -0.003), respectively.

Conclusions: This intervention, including enhanced environment cleaning, active surveillance, and patient cohorting, successfully reduced CRAB acquisition in IMWs and their HD non-ICUs.

The typical duration of positive nucleic acid tests for methicillin-resistant Staphylococcus aureus (MRSA) in the nares of patients receiving systemic anti-MRSA antimicrobials is unknown. In this study, hospitalized adult patients with an initial positive MRSA nares nucleic acid test prescribed systemic anti-MRSA antimicrobials had follow-up testing done 48 to 96 hours later. A positive follow-up test was detected in 100/113 (88.5%), indicating that MRSA nares DNA tests still have utility for screening after patients have initiated anti-MRSA therapy.

Background: Educating health care staff on infection prevention and control (IPC) is an essential role of infection preventionists (IPs), but the COVID-19 pandemic diverted resources away from IPC education.

Methods: Association for Professionals in Infection Control and Epidemiology members were invited to complete an online survey from spring 2023 to assess current and preferred approaches and tools for training health care personnel on IPC. Vendors, retirees, APIC staff, or those not working in health care or public health were excluded.

Results: In all, 2,432 IPs participated. IPs were more likely to report engaging in impromptu health care worker training (ie, just-in-time teaching and team huddles) versus planned educational activities (ie, learning modules, formal presentations, train-the-trainer, or simulation; Kruskal-Wallis = 288, P < .001). IPs' top preferred teaching methodologies included simulation or interactive activity, and their lowest preferred approach was independent learning modules. IPC training apps were frequently requested technology.

Discussion: IPs ranked simulation as their top preferred teaching method; however, simulation was one of the least frequently used approaches. IP education should include strategies for delivering effective impromptu training and how to develop and implement interactive simulation-based education.

Conclusions: The expressed needs and preferences of IPs should be considered when developing IPC-related teaching and training tools.

Background: Contaminated environmental surfaces in the health care setting put patients at risk of acquiring health care-associated infections. Highlight (Kinnos) is a novel color-additive technology for disinfectant wipes that helps users visualize surfaces that have been cleaned by producing a transient color on wiped surfaces that fades off after effective cleaning.

Methods: To quantify the impact of real-time visual feedback on room cleanliness and efficiency, a pre-post quasi-experimental study was conducted by comparing Replicate Organism Detection and Counting (RODAC) plate counts and room turnaround times with and without the use of the color additive.

Results: Compared with the control group of disinfectant alone, disinfection with the color additive resulted in a 69.2% improvement in room cleanliness accompanied by a 5.9% faster room turnover time.

Discussion: As far as we know, this study is the first to publish on the impact of a novel color additive on the environment of care as measured by microbial culturing and room turnaround times, finding advantages in both metrics relative to the status quo.

Conclusions: The use of real-time visual feedback can improve the thoroughness of disinfection cleaning while maintaining operational efficiency.