American journal of infection control最新文献

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.

Background: We examined how state regulations for long-term care facilities address environmental sanitation.

Methods: State regulations for nursing homes and assisted living facilities across all 50 US states and the District of Columbia were sourced from government Web sites. We searched using key terms about environmental sanitation and then quantified our findings to answer 4 questions.

Results: More states required infection preventionists in nursing homes (29 states) than in assisted living facilities (14 states). References for environmental service workers appeared more frequently in nursing home regulations (22 states) than in assisted living regulations (6 states). Infection control training was required more often in nursing homes (32 states) than in assisted living facilities (27 states). Gloves were the most common personal protective equipment cited, addressed in 14 state nursing home regulations and 13 state-level assisted living regulations. Only 7 state nursing home regulations and 2 assisted living regulations addressed carpet, with only 6 addressing high-touch items.

Conclusions: State regulations inadequately address environmental service workers, staff training, carpets, and high-touch items. These regulatory gaps could pose significant risks to long-term care residents if infection control policies and procedures rely solely on regulatory requirements.

Background: Surgical site infections can cause significant morbidity requiring lengthy antimicrobial treatment. Infections have been linked to surgical instruments with retained tissue and foreign debris, as the presence of blood or soil interferes with sterilization effectiveness. This study aimed to determine the prevalence of visible soil or debris inside instruments and evaluate the impact of recleaning efforts.

Methods: Borescopes were used to inspect lumens of instruments used for orthopedic, neurologic, or ear-nose-throat procedures. Whenever visible soil or debris was observed, the instrument was recleaned up to 3 times and reinspected to assess the impact of additional cleaning.

Results: Researchers performed 117 inspections (40 unique instruments, 77 reinspections). All instruments had complex lumens that impede access by brushes. Debris and discoloration or residues were observed inside 100% of instruments, with rusty patches in 95%. Some soil was removed by recleaning, but visible soil remained in most lumens and fragments of lint or brush bristles were visible upon repeat inspection.

Conclusions: Cleaning in accordance with the manufacturer's instructions was not effective for lumened surgical instruments. Solutions will require collaboration between infection prevention, sterile processing, and manufacturers to evaluate risk and develop strategies for improving processing outcomes.

Background: Coagulase-negative Staphylococci (CoNS) are frequently cited as the most common cause of bacteremia in patients receiving extracorporeal membrane oxygenation (ECMO), yet there is significant variability in reporting rates between centers.

Methods: All patients who received ECMO with CoNS isolated from blood cultures between January 2022 and March 2024 were included in this retrospective cohort study. Previously reported bacteremia definitions were applied to determine the variability in rates by definition.

Results: In 68 patients who received ECMO during the study period, 424 blood culture sets were obtained, of which 20 (4%) yielded CoNS in 13 (19%) patients. Only 5 (38%) patients had repeat isolation. Clinical variables, such as fever and leukocytosis, did not predict repeat positivity. Rates of CoNS varied from 0 to 15 infections per 1,000 ECMO days depending on the definition utilized.

Conclusions: CoNS were frequently isolated in blood cultures from patients receiving ECMO. Despite the concern for biofilm formation, most CoNS were only isolated in a single culture. With the limited utility of clinical markers and frequent false positives, clinicians should order repeat blood cultures on those with CoNS isolated from blood cultures. We propose a standardized definition for CoNS bacteremia, which entails isolations of CoNS from 2 subsequent blood cultures.

Background: Aerosol generation in dental practice is a significant concern in infection control. This study aimed to investigate the strategies for controlling and preventing aerosol-generated microbes during dental procedures.

Methods: A comprehensive literature search was performed using Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines through electronic databases (PubMed, ScienceDirect, Cochrane Library, Google Scholar, and Scopus) for studies reporting interventions, including mouthwash and suction devices, that were effective against pathogens generated during dental procedures. Predefined criteria identified eligible studies. Pooled efficacy was estimated using RevMan 5.4's random-effects model.Quality assessments were performed using RoB-2.0 and the Robvis web application.

Results: This systematic review and meta-analysis included 19 papers. Cetylpyridinium chloride, chlorhexidine, chlorine dioxide, hydrogen peroxide, botanical medicines, and suction devices are the most used dental therapies to minimise microbial contamination. Overall, these treatments showed success with a pooled effectiveness of -46.64 (95% CI: -60.89 to -32.38, I2=100%, p<0.00001).

Conclusions: This study emphasises the need for a multifaceted approach that uses antiseptic mouthwash and suction devices to reduce cross-contamination and infection transmission during aerosol-generated dental procedures, safeguarding patients and dental workforce.

A staff-initiated outbreak of COVID-19 among residents in a long-term care facility was notable for differences in attack rates between units and the association with dry hydrogen peroxide (DHP) deployment for continuous microbial reduction. DHP had previously been shown to significantly reduce environmental bioburden in the facility, but the association with infection had not been monitored. This outbreak highlights the potential for DHP to reduce infection transmission without requiring additional staff intervention.

We developed a tool to evaluate antibiotic stewardship in outpatient hemodialysis infection prevention and control assessments, based on the Centers for Disease Control and Prevention's Core Elements of Outpatient antibiotic stewardship. Of facilities assessed (n=12), the average score was 79% (range 44%-100%) for implementation of the Core Elements. Tracking and reporting had the highest engagement (94.1%) and education had the lowest (58.3%). By leveraging hemodialysis-specific tools, infection preventionists can assess antibiotic use and provide actionable feedback.

Background: Health care-associated infections pose a significant risk for the patients in intensive care due to the use of medical instrumentation required for care.

Methods: We conducted a cross-sectional, nationwide survey on awareness of recommended infection prevention practices involving central venous catheters and invasive ventilators in intensive care units.

Results: A total of 810 (50% of those surveyed) nurses and physicians participated in the survey. We found that 8% of the respondents had good knowledge of infection prevention in central venous care, while 24% had good knowledge of ventilator-associated pneumonia prevention practices.

Discussion: The overall level of knowledge measured with this nationwide survey was suboptimal. The level varied between units, and depending on individual questions for particular professions. The displayed knowledge may have partially been based on tradition rather than on up-to-date evidence-based guidelines.

Conclusions: Educational training in evidence-based infection prevention is needed for practical implementation to be improved.