American journal of infection control最新文献

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: Fit of N95/P2 half-face respirators is critical. No objective ways exist to evaluate their implementation at use. Previously, we showed 26% of health care workers achieve appropriate fit at point of use.

Methods: 657 quantitative fits were conducted on 166 subjects, using 4 different respirator styles. Randomization was performed; controls employing standard "fit-check" and intervention using a infrared video kiosk. Primary outcome was passing rates of quantitative fit, with secondary outcomes of respirator type, gender, race, and previous experience.

Results: Intervention demonstrated significantly higher pass rate (50.6%) compared with controls (30.8%). Odds of passing with kiosk was 2.3 (odds ratios [OR] 2.3, 95% confidence intervals [CI] 1.8-2.9, P < .001). Duckbill style improved the greatest (OR 4.1, 95% CI 2.1-7.9, P < .001), and Tri-fold also showing substantial benefit (OR 2.66, 95% CI 1.4-5.2, P < .001). Gender and race did not influence outcomes when using the kiosk, nor did previous experience.

Conclusions: A custom point-of-use kiosk improved odds of achieving a satisfactory fit of common respirator styles, independent of participant demographics. These findings open the door to addressing a gap in respiratory protection programs by providing individual assessment and interventions that improve worker safety at the time of highest risk.

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: 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: 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: Loose-fitting powered air-purifying respirators (PAPRs) are a popular alternative to the use of filtering facepiece respirators for health care workers. Although PAPRs protect the wearer from aerosol particles, their ability to block infectious aerosol particles exhaled by the wearer from being released into the environment (called source control) is unclear.

Methods: The source control performance of 4 PAPRs with loose-fitting facepieces were tested using a manikin that exhales aerosol particles. The PAPRs were tested by themselves and in combination with a face-worn product intended to provide source control (either a surgical mask or an N95 filtering facepiece respirator).

Results: Two PAPR facepieces with filtration panels significantly reduced the release of exhaled aerosols into the environment, while 3 facepieces without such panels did not. Wearing a surgical mask or respirator under the facepiece significantly improved the source control performance.

Conclusions: Most PAPR facepieces do not block aerosols exhaled by the wearer. Facepieces designed to filter exhaled particles can prevent aerosols from being released into the environment. Wearing a surgical mask or a filtering facepiece respirator under the facepiece can also provide source control, but PAPRs are not typically certified for use with masks and respirators.

Background: Several single-center studies have suggested that eliminating isolation for vancomycin-resistant enterococci (VRE) control in the context of endemic or nonoutbreak settings, has no impact on infection rates. We performed a systematic review and meta-analysis on the impact of discontinuing isolation.

Methods: We searched PubMed, Embase, the Cochrane Library, and Web of Science through April 10, 2024 for studies evaluating discontinuation of isolation for VRE. Subgroup analyses assessed sources of heterogeneity.

Results: Nine studies were included in the final review. Four reported the incidence of hospital-acquired VRE (HA-VRE) infections and 5 reported the incidence of hospital-acquired VRE bloodstream infections (HA-VRE BSI). No significant difference between the rates of HA-VRE infection before and after stopping isolation was observed (risk ratios, 0.93; 95% confidence interval, 0.68-1.26; P = .62), as well as no significant difference on the incidence of HA-VRE BSI (risk ratios, 0.68; 95% confidence interval, 0.44-1.07, P = .09). Furthermore, we conducted 2 subgroup analyses: one stratified by whether the studies were conducted during Coronavirus Disease 19 (COVID-19), and the other stratified by whether clinicians continued to use personal protective equipment. Both analyses revealed no significant differences in the incidence of HA-VRE BSI and termination of isolation between the subgroups.

Conclusions: In the context of endemic or nonoutbreak settings, discontinuation of isolation for VRE patients has not been associated with an increased rate of HA-VRE infections.

Background: Certification in infection control (CIC) is a standardized indicator of the knowledge and competencies essential for effective infection prevention practice. Evidence measuring success of training programs for certfication in infection control is limited.

Methods: From 2017 through 2023, 51 novice infection preventionists (IPs) were enrolled in a training program that combined didactic learning, application of knowledge in practice, and mentorship from advanced-practice and near-peer IPs. Participants were tracked through completion of certification examination and pass rates were compared with rates for 2023 CIC candidates.

Results: All participants engaged in the training program attempted the CIC examination. The training group had a pass rate of 98%. This is 27% higher than the most recent rate published by Certification Board of Infection Control and Epidemiology (CBIC) of 71%.

Discussion: Participants were significantly more likely to pass the CIC exam on the first try, showing that a supported, competency-based training program can be successful in supporting novice IPs in certification success.

Conclusions: Building foundational knowledge on key concepts in infection prevention and control and enhancing learning through supervised, direct application of skills improves CIC certification exam pass rates and supports progression of early career IPs to more independent practice.