American journal of infection control最新文献

Background: The study aimed at developing and validating a bilingual competency self-assessment tool for infection prevention and control practitioners based on the core competencies proposed by the World Health Organization (WHO).

Methods: The study was conducted from December/2021 to June/2023. The bilingual tool (Brazilian Portuguese and English versions) was developed according to four stages: 1) conceptual framework establishment and item generation; 2) content validity; 3) response process validity; and 4) internal structure validity.

Results: The Brazilian Portuguese version of the tool was organized into five areas, 36 items, and a Cronbach's alpha coefficient between 0.89 and 0.97; the English version of the tool was organized into five areas, 37 items, and a Cronbach's alpha coefficient between 0.91 and 0.98.

Discussion: The bilingual tool gathers evidence of content validity and internal structure validity.

Conclusions: The current evidence suggests that these are the first self-assessment tools that have utilized the core competencies proposed by the WHO as a conceptual basis. Such tools can be applied in countries of all income classifications, which makes it possible to design educational initiatives and enhance core competencies.

Background: To address catheter associated urinary tract infections (CAUTI) in adult medical surgical (M/S) intensive care units ICUs, a strategy known as CAUTI out of nation (CAUTIoN) was implemented in MOH (Ministry of Health) facilities in KSA (Kingdom of Saudi Arabia).

Objectives: The aim of this study was to assess the effectiveness of the implementation of a national strategy, in healthcare facilities and evaluate the outcome of each strategy's components and to compare the pre and post intervention rates of CAUTI.

Methods: It was a retrospective, to assess changes in CAUTI rates after the implementation of strategy.

Results: CAUTI rates reduced by 3.6 percentage points (PP) between the second quarter of 2022 and the first quarter of 2024. The rate of CAUTI slightly increased to 0.9 per 1000 catheter-days in the first quarter after the intervention, then dropped to 0.34 per 1000 catheter-days in the fourth quarter of 2023, before increasing to 0.62 in the first quarter of 2024.

Conclusions: Strategy implementation of CAUTIoN is found to be effective for turning our organizational vision into action. We retrospectively studied the correlation of interventions and the CAUTI rates. Interventions like leadership, surveillance, data management, training, education and C2C (CAUTIoN to CAUTI) initiative were most effective in the implementation of the strategy.

In the United States, the system for special pathogen patient care incorporates a network of federally funded US biocontainment units that maintain operational readiness to care for patients afflicted by high-consequence infectious diseases (HCIDs). This network has expanded in number of facilities and in scope, serving as a regional resource for special pathogen preparedness. Lessons learned for maintaining these units are shared with the intent of informing new and existing biocontainment units.

Background: In response to a 1995 outbreak of sepsis caused by multidrug-resistant (MR) Gram-negative bacteria (GNB), a Brazilian level III neonatal unit established a series of control and prevention measures. This study evaluated the long-term effects of these measures on late-onset neonatal sepsis (LONS) caused by MR bacteria from 2000 to 2020 and examined their impact on in-hospital mortality.

Methods: Newborns with LONS and positive cultures for Staphylococcus aureus, GNB, and Enterococcus sp were selected, adhering to Center for Desease Control and Prevention and local criteria. Joinpoint regression analysis was used to assess annual trends.

Results: Over the 21-year period, the overall LONS rate was 4.6%, showing a significant decline from 2000 to 2016 (P < .0001, slope -0.36). However, from 2016 to 2020, there was a non-significant increase in sepsis rates (slope +0.92, P = .08). MR sepsis were in 15.8% of sepsis cases and displayed a non-significant upward trend (slope +0.50, P = .08) with no major shifts. In-hospital mortality rates for MR and non-MR LONS showed no significant differences (P = .413).

Discussion: The study indicates a low prevalence of MR sepsis due to effective antimicrobial use and educational interventions.

Conclusions: MR sepsis prevalence remained low and stable, not increasing in-hospital mortality.

Background: Despite local and national recommendations, health care provider adherence to personal protective equipment (PPE) varied during the COVID-19 pandemic. Previous studies have identified factors influencing initial PPE adherence but did not address factors influencing behaviors leading to correction after initial nonadherence.

Methods: We conducted a retrospective video review of 18 pediatric resuscitations involving aerosol-generating procedures from March 2020 to December 2022 to identify factors associated with nonadherence correction. We quantified adherent and nonadherent providers, instances of PPE nonadherence, and time to correction. We also analyzed correction behaviors, including provider actions and correction locations.

Results: Among 434 providers, 362 (83%) were nonadherent with at least 1 PPE. Only 186 of 1,832 instances of nonadherence were corrected, primarily upon room entry and during patient care. Correction time varied by PPE type and nonadherence level (incomplete vs absent). Most corrections were self-initiated, with few reminders from other providers.

Discussion: Potential barriers to correction include a lack of social pressure and external reminders. Solutions include optimizing PPE availability, providing real-time feedback, and educating on double gloving.

Conclusions: Most providers were nonadherent to PPE requirements during high-risk infection transmission events. The low correction rate suggests challenges in promoting collective responsibility and maintaining protective behaviors during medical emergencies.

Background: Analyze the incidence, risk factors, and fatality rates of bloodstream infections by Gram-negative bacteria (GNB-BSIs) in a Neonatal Intensive Care Unit.

Methods: This study employs a retrospective cohort design utilizing records of neonates admitted to the Neonatal Intensive Care Unit between January 2015 and June 2022.

Results: Among 1,495 neonates, 5.2% developed GNB-BSIs. The average incidence of infection per 1,000 patient-days was 2.9. Primary risk factors for infection that included preceeding carbapenem use were significant risk factors (odds ratio=514.4; P < .01) and fourth-generation cephalosporins (odds ratio=66; P < .01). Among the 85 GNB, 75.3% were fermenters, and 24.7% were non-fermenters. Of the isolates, 14.1% produced extended-spectrum beta-lactamase, and 2.3% carbapenem-resistant. Infection correlated with prolonged hospital stays (10-39days) and increased mortality (10%-29.9%).

Conclusions: The high incidence of GNB-BSIs was exacerbated by the preceeding use of broad-spectrum antimicrobials, increasing the presence of multidrug-resistant isolates and fatality rates. These findings emphasize the importance of active surveillance.

Background: Age, race, ethnicity, and sex are important determinants of coronavirus disease of 2019 (COVID-19) outcomes. Older adults (65 years and older) are at the highest risk of COVID-19 morbidity and mortality. Analyzing their vaccine uptake by subclassifying demographics is rare and can assist vaccination policies. This study investigates COVID-19 dose 1 and 2 vaccine uptakes among them by race, ethnicity, and sex.

Methods: Immunization registry data were used to calculate temporal changes in older adults' COVID-19 vaccine uptake by race, ethnicity, race-sex, and ethnicity-sex in Kentucky's most populous county, Jefferson County, during the first 6 quarters of the COVID-19 vaccination program.

Results: By May 2022, the county's Asian residents had the highest dose 1 and 2 vaccination rates (97.0% and 80.4%), then White residents (90.0% and 80.2%). Black residents had one of the lowest COVID-19 vaccination rates (87.3% and 77.3%). The rate among Hispanic residents (82.0% and 66.4%) was considerably lower than non-Hispanic residents (90.2% and 80.1%). The rates were consistently lower in males.

Conclusions: Racial, ethnic, and sex-based COVID-19 vaccine inequalities were largely maintained during the study period. Vaccine rollout practices and promotional programs should aim to boost the uptake of the COVID-19 vaccination among racial minority and male older adults.

Carbapenem-resistant Acinetobacter baumannii is an opportunistic pathogen which has caused numerous health care-associated outbreaks particularly in intensive care and burn units. We describe an outbreak in a burn unit where 3 patients were identified as being colonized or infected with carbapenem-resistant Acinetobacter baumannii. A multifaceted approach and rapid implementation of infection prevention measures were effective in identification and removal of potential environmental reservoirs resulting in the prevention of further transmission.

Background: We developed a virtual reality (VR) education system and evaluated its clinical utility for promoting hand hygiene practices.

Methods: This prospective, 2-week, randomized controlled study conducted at Okayama University Hospital, Japan, from November 2023 to January 2024, involved 22 participants (18 medical students and 4 residents). A fully immersive 360° VR system (VIVE Pro Eye) using a head-mounted display and sensing gloves was used to develop 3 health care tasks in a virtual patient room-Environmental Cleaning, Gauze Exchange, and Urine Collection. After monitoring all participants' baseline usage data of portable hand-rubbing alcohol in the first week, we randomly assigned them into 1:1 groups (VR training and video lecture groups). The primary outcome was differences in hand-rubbed alcohol use before and after intervention.

Results: Before the intervention, alcohol use did not significantly differ between both groups. After the intervention, a significant increase in alcohol use was observed in the VR training group (median: 8.2 g vs 16.2 g; P = .019) but not in the video lecture group.

Conclusions: Our immersive 360° VR education system enhanced hand hygiene practices. Infection prevention and control practitioners and digital technology experts must collaborate to advance the development of superior educational devices and content.

Background: Inpatient psychiatric facilities have an increased risk of infection transmission. This study evaluated the impact of roommate and unit mate exposures on coronavirus disease-2019 (COVID-19) transmission to inform isolation practices.

Methods: A single-center retrospective study was conducted among patients hospitalized in an inpatient behavioral health hospital from July 2020 through August 2023. We compared the risk of COVID-19 acquisition after exposure among patients with a contagious roommate versus those exposed to a contagious unit mate.

Results: During the study period, the conversion rate was 10.05% overall, 24.4% for roommates, and 9.3% for unit mates; patients exposed to a roommate were at 3.14 times higher odds (95% confidence interval, 1.42-6.92) of acquiring COVID-19 after exposure. On unit-stratified analysis, patients exposed to a roommate on the geropsychiatric unit had the highest risk of postexposure conversion compared with unit mate exposed patients (odds ratio 6.38, 95% confidence interval 1.75-23.22). Logistic regression analysis identified a nonsignificant risk associated with increased time in group therapy.

Conclusions: Exposure to a COVID-19-contagious roommate significantly increases the risk of COVID-19 acquisition among exposed patients receiving inpatient psychiatric care. Cohorting contagious and exposed individuals and avoiding multibedded rooms may mitigate COVID-19 transmission risk during psychiatric care.