American journal of infection control最新文献

Background: To investigate and determine the cause of an increase of isolation of Mycobacterium mucogenicum in broncho-alveolar lavage samples in a tertiary hospital.

Methods: Outbreak investigation including 30 patients who underwent bronchoscopy procedures in a minor procedural area of a university-affiliated, tertiary-care medical center between January and October 2022. The investigation included epidemiological analysis and response, environmental sampling, and whole genome sequencing (WGS) of clinical and environmental isolates.

Results: Environmental sampling identified M mucogenicum group from procedure room sinks, sterile processing sinks, bronchoscopes, and ice machine water. WGS of 9 patient isolates and 5 environmental isolates revealed clonal relatedness (0-5 single nucleotide polymorphisms) between patient isolates and potable water isolates. No patients developed active infections requiring treatment.

Conclusions: A pseudo-outbreak of M mucogenicum group was linked to ice used to cool saline used to vasoconstrict biopsy collection sites in bronchoscopy procedures. WGS provided high-resolution evidence of the transmission source, distinguishing between multiple strains present in the environment. Implementation of modified processes for saline handling, equipment reprocessing, and prevention of supply contamination from potable water sources successfully addressed the source of contamination.

Acupuncture, a traditional Chinese therapy involving needle insertion at specific points, is a treatment that is used by millions of people in the US each year and is increasingly integrated into conventional healthcare settings. While generally considered safe, viral and bacterial infections linked to acupuncture have been reported, often due to lapses in infection control practices. This study reviewed publicly available disciplinary records from US state acupuncture boards to identify infection control-related variances. Seven states reported 28 disciplinary cases between 1997 and 2024, with a total of 44 variances that were categorized into eight groups. Improper sharps disposal was the most frequent issue and often co-occurred with other variances, suggesting it may indicate broader infection control deficiencies. Although such cases were uncommon, the findings underscore the need for consistent enforcement of infection prevention standards and improved patient education to recognize and question unsafe practices. Patients who have adverse events or observe unsafe practices should be empowered to seek treatment and report their experience to their state licensing board or the National Certification Commission for Acupuncture and Oriental Medicine.

Background: We describe a multifaceted intervention deployed amidst a blood culture (BC) bottle shortage and its impact on BC yields.

Methods: Cross-sectional study conducted at a large safety-net hospital. BC bottle conservation strategies focused on improving blood volume collection, discouraging orders for low-yield conditions, limiting BC orders to 1 set per patient and restricting repeat BC to greater than 48-hour intervals. Trends in BC positivity rates and bloodstream infection events were analyzed using control charts, with a 13-month baseline period, and 12-month intervention period.

Results: A total of 35,449 BCs were analyzed. The overall median percent positivity increased from 8.6% to 12.6% (P = .001). In the Emergency Department, the median percent positivity rose from 12.4% to 14.3% (P = .03); in Intensive Care Units (ICU), from 6.8% to 11.6% (P = .001); and in Medical-Surgical units, from 4.9% to 9.0% (P = .001). No significant variability in the counts of positive BCs was observed. The median blood volume per set increased from 5.7 to 7.5 mL (P = .001). Vancomycin use and acute ICU transfers remained stable.

Conclusions: The implementation of BC bottle conservation measures did not negatively impact BC yields or patient safety indicators. Prospective studies are needed to re-evaluate traditional BC ordering and collection practices.

Background: Methicillin-resistant Staphylococcus aureus (MRSA) remains a critical pathogen in diabetic foot infections (DFIs), contributing to prolonged hospitalizations, and morbidity. MRSA nares colonization screening has shown utility in the negative predictive (NPV) value of MRSA infections, though its role in DFIs remains under-characterized.

Methods: This retrospective cohort study analyzed 57,213 hospitalized patients with DFIs across 9 U.S. census regions to evaluate implications of MRSA nares screening for DFIs and to assess regional variations in outcomes. NPV was calculated regionally. Multivariable logistic regression assessed independent predictors of 30-day mortality.

Results: MRSA wound culture positivity ranged from 16.1-24.3%. NPV ranged from 86.4% (East South-Central region) to 91.7% (West North Central region), with most regions clustering between 88% and 91%. MRSA nares positivity was associated with 38% increased odds of 30-day mortality (OR 1.38, 95%CI 1.23-1.56).

Conclusions: MRSA nares screening demonstrates high NPV across all regions, supporting its role as a valuable tool for de-escalating empiric anti-MRSA therapy in DFIs. Its limited PPV necessitates confirmatory cultures for positive cases. MRSA nares colonization also serves as an independent predictor of short-term mortality, suggesting its potential use in prognostic risk stratification.

Background: We hypothesized that an ultraviolet-C (UV-C) light wand would be as efficacious as a disinfectant wipe for disinfection of portable equipment with the potential for lower carbon and plastic footprints.

Methods: We tested the efficacy of a UV-C wand against methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile spores on steel disks and inoculated computer keyboards. The efficacy of the UV-C wand was compared to a quaternary ammonium-alcohol wipe for disinfection of portable equipment and keyboards. We calculated potential reductions in carbon and plastic footprints if this device replaced ready-to-use wipes.

Results: On disks, 20- and 40-second UV-C exposures reduced MRSA and C difficile spores by > 3 log₁₀. On inoculated computer keys, 20- and 40-second cycles distributed over the entire keyboard reduced MRSA, but not C difficile spores, by > 3 log₁₀. On real-world equipment, a 40-second UV-C exposure was as efficacious as the disinfectant wipe in reducing vegetative pathogens and total aerobic colony counts, but less efficacious in reducing aerobic colonies to undetectable levels. We estimated that use of the device could substantially reduce carbon and plastic footprints.

Conclusions: Use of the UV-C device rather than ready-to-use disinfectant wipes for shared equipment could substantially reduce plastic and carbon footprints.

Background: Burkholderia cepacia complex (BCC) is a cause of health care-associated infections in immunocompromised patients and people with cystic fibrosis (PwCF). This report summarizes a B contaminans pseudo-outbreak related to improper laboratory processes affecting surgical specimens from immunocompetent individuals and respiratory cultures from PwCF.

Methods: In October 2024, an increase in BCC isolates involving surgical, respiratory, and urine specimens occurred at an academic tertiary hospital. An investigation was launched involving the electronic clinical surveillance system, environmental surveillance, and review of laboratory processes. Species identification and genotyping was performed with randomly amplified polymorphic DNA (RAPD) typing. Whole genome sequencing (WGS) was completed for clonality analysis.

Results: A total of 19 BCC isolates were included, 17 collected for clinical indications and 2 from reagents during the investigation. BCC was recovered from phosphate-buffered saline (PBS) used for rehydrating surgical samples and Sputolysin (dithiothreitol) diluted with PBS and used to liquify respiratory samples. Species analysis revealed B contaminans in surgical, respiratory, and reagent samples. RAPD typing and WGS confirmed clonality, suggesting that PBS was a source of extrinsic contamination.

Conclusions: This investigation underscores the role of multidisciplinary collaboration, robust electronic health information systems, and microbial genomic tools in infection prevention and control, ensuring timely interventions and patient safety.

Central line-associated bloodstream infection prevention remains challenging in clinical settings. This experience describes how barriers identified through a needs assessment in Brazilian hospitals were translated into a tailored serious game to support catheter care practices. Using the Octalysis Framework, real-world challenges were converted into interactive missions simulating catheter care. This approach illustrates how context-specific barriers can be operationalized into an educational tool to support health care workers' adherence to central line-associated bloodstream infection prevention measures.

Background: In early 2018, we detected an increase in surgical site infections (SSI) after total knee arthroplasty in a tertiary hospital in Barcelona. We implemented an infection prevention and control (IPC) intervention reinforcing preventive bundles and reorganizing surgical schedules for high-risk patients and senior surgeons. We aimed to identify SSI-associated factors and evaluate the IPC intervention's impact.

Methods: We conducted a retrospective cohort study in 2018 with 90-day follow-up. SSI rates were compared pre- and post-intervention. Preintervention risk factors were assessed using Cox models. Differences in associated factor distributions were estimated. Kaplan-Meier and log-rank tests evaluated incidence, and a sensitivity analysis was stratified by American Society of Anesthesiologists (ASA) and National Nosocomial Infection Surveillance (NNIS) risk.

Results: Among 463 patients, overall SSI incidence was 0.52 per 1,000 patient-days. Incidence significantly declined postintervention (pre: 0.75; post: 0.26; P = .030). Obesity (HR: 3.63; 95% CI: 1.02-12.86) and afternoon surgery (HR: 3.02; 95% CI: 1.02-8.92) were associated. High ASA, NNIS risk, and inadequate prophylaxis significantly decreased (P < .001). The intervention reduced SSI risk by 66% (HR: 0.34; 95% CI: 0.13-0.94; P = .037). A nonsignificant reduction was seen in high-risk strata.

Conclusions: Our study showed the impact of an IPC intervention addressing associated factors and significantly reducing SSI incidence rates.