American journal of infection control最新文献

Background: Multidrug-resistant organisms pose a significant challenge in intensive care units (ICUs). Despite contact precautions (CP) being recommended as an infection prevention measure, little is known about the burden of CP on health care workers (HCWs).

Methods: An online survey was conducted between May 2021 and August 2022 at baseline (BP) and intervention period (IP) of a multicenter trial discontinuing CP for patients colonized with third-generation cephalosporin resistant gram-negative bacteria in which 38 ICUs participated.

Results: 147 HCWs from 33 ICUs (BP), 154 HCWs from 38 ICUs (IP) responded to the survey. At BP, most burdensome were: donning personal protective equipment (PPE) in case of emergency (84.0%), need of additional time (73.5%), elevated time management requirements to complete all daily tasks (68.7%), transport to diagnostic areas (65.2%). A significant reduction during IP was shown for: transport to diagnostic areas (p = .010), elevated time management requirements to complete all daily tasks (p = .004), need of additional time (p = .020), donning and doffing PPE (p = .014), increased hand and surface disinfection (p = .035) and anxiety (p = .031).

Conclusions: Removing CP may be associated with considerable relief in burden for HCWs. However, removing CP must be guided by defined evidence since infection prevention control must be ensured.

Nontuberculous mycobacteria (NTM) are ubiquitous and can be inhaled from household water sources, posing a potential risk of pulmonary NTM disease. Exposure to 222-nm far ultraviolet-C shows comparable inactivation efficiency to 254-nm ultraviolet-C, while employing specialized optical filters to significantly enhance safety for human skin and eyes. Exposure of NTM to 222-nm far ultraviolet-C radiation demonstrated an irradiance-dependent inactivating effect, highlighting its potential as a safe and effective for water disinfection.

Efficient, rapid means of air decontamination are needed against widespread respiratory pathogens such as SARS-CoV-2, the virus that causes COVID-19. This study demonstrated the efficacy of advanced photohydrolysis technology in significantly reducing infectious, aerosolized SARS-CoV-2, achieving over 99% viral inactivation. Proof-of-concept assessments for respiratory syncytial virus and monkeypox virus showed similar results, suggesting broad applicability. These findings highlight the potential of the novel technology to enhance air purification and infection control strategies against multiple airborne viral pathogens.

Background: We investigated 5 touch-free automatic foam alcohol-based handrub (ABHR) hand hygiene dispensers common in US hospitals. Output dosing was evaluated for consistency to comply with the Leapfrog 2022 guidance requirement of ≥1.0mL per ABHR dispense.

Methods: Fifteen dispensers and 32 distinct refills were tested, with >10,000 dispenses analyzed for 5 different dispensing systems. Automated testing used computer programming and mechatronics to activate the dispensers and capture output weights at predetermined delay patterns. Low, medium, and high usage patterns per day were set with dispense delay patterns. In another laboratory, dispensers were activated manually for measurements; 50 doses were collected and weighed within an hour for each refill.

Results: Three of the dispenser systems had mean output >1.0 mL, and 2 were <1.0 mL. Two dispensers have significantly greater variability, which is driven by the foam pump design.

Conclusions: It was discovered that usage/testing patterns impact dosing performance. The dispenser design and engineering cause significant differences in volume dispensed and consistency across dispenses. Using sufficient ABHR to cover hands completely and keeping hands wet long enough to significantly reduce pathogens is an important requirement. Facilities should assess ABHR dispenser outputs and consider consistent dosing as an essential performance criterion for effective hand hygiene policies and practices.

Background: The Centres for Antimicrobial Optimization Network Brazil aims to implement an antimicrobial stewardship program in Brazilian municipality. This study explores barriers and enablers to its implementation, through understanding the context and beliefs regarding antimicrobial use in this environment.

Methods: The study occurred in 12 primary health care units, where a mixed-method study was conducted. A total of 208 out of 450 health care workers completed a Theoretical Domain Framework-based survey, and 16 patients and 12 health workers were interviewed. Survey results were compared by professional category; interviews were analyzed using Critical Discourse Analysis.

Results: Professionals with higher education scored higher across most domains. In the "Optimism" domain, these professionals scored ≥6.0, while others scored ≤5.0. Similar patterns were observed in the domains "Knowledge" (≥6.0 vs ≤5.5), "Social/professional role and identity" (≥6.36 vs ≤5.79), and "Intentions" (≥6.0 vs ≤5.0). Qualitative data highlighted breaks in the continuity of care and gaps in patient knowledge about antimicrobial use. Key barriers included disparities in training, physician-centered decision-making, and patient knowledge gaps. Enablers included health care workers' willingness to learn and home caregivers' understanding of patient conditions.

Conclusions: The implementation of the antimicrobial stewardship program depends on addressing training disparities and leveraging health care workers' willingness to learn.

Background: Nine Comprehensive Cancer Centers sought to understand COVID-19 infection management experiences to improve future immunocompromised host guidelines.

Methods: Volunteers from Comprehensive Cancer Center Infection Prevention and Control (C3IC) completed 2 surveys on COVID-19 practices from March 2020 to December 2023. Three reviewers independently validated qualitative analysis of findings. Virtual meetings were leveraged to discuss findings and identify themes.

Results: 100% (9/9) of respondents changed COVID-19-associated isolation discontinuation guidance at least once. All (9/9) included patient immune status as criterion. All (9/9) required clearance testing at some point in the pandemic, 6 of 9 (66%) continued to require clearance testing at the time of the survey. Only 1 of 9 (11%) allowed antigen testing to meet criteria. Seven isolation titles were noted across 9 institutions, despite near agreement on measures employed.

Discussion: Variability existed in COVID-19 management among study participants, despite serving similar populations, which may stem from limited data supporting understanding of viral transmissibility in immunocompromised hosts.

Conclusions: Guideline development for immunocompromised hosts, potential drivers for viral evolution, can lack clarity for consistent management of the population. Engaging subject matters in specialty populations with future guideline development will improve infection prevention in health care settings.