American journal of infection control最新文献

The Infection Control Advocate and Resident Education educational modules integrate and promote infection prevention and control (IPC) measures and residents' rights in nursing homes, targeting long-term care ombudsmen, residents, families, and other resident advocates. Survey respondents (N = 102) reported increased knowledge in understanding IPC and preserving resident rights. Integrating these topics and identifying barriers to promoting IPC is necessary for implementing quality IPC in nursing homes.

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) causes life-threating hospital-acquired. Due to a limited number of Intensive-Care-Unit (ICU) beds, these patients are often treated in high-dependency (HD) non-ICUs within internal-medicine wards (IMW) in Israel. We aimed to assess the effectiveness of a multilayered infection-control intervention on CRAB infection rate in IMWs, especially in its HD non-ICUs with ongoing CRAB transmission.

Methods: A quasi-experimental, before-and-after, interrupted time-series study with control outcomes. We conducted a multilayered intervention over 3.5years, which included 4 phases: (1) Pre intervention; (2) Intervention introduction: introduced enhanced environment cleaning; (3) Intervention phase 1: introduced active surveillance; (4) Intervention phase 2: introduced CRAB-positive patient cohorting, in addition to previous ongoing measures taken.

Results: CRAB was isolated from 204 patients aged 69.8y/o ± 15.86y, 59.8% male, 34.3% had CRAB-positive clinical samples. Mean hospital length-of-stay was 30.5days, with a 30-day postdischarge mortality rate of 55.9%. Mean CRAB clinical cases decreased from 0.89 in preintervention to 0.11 at the end of phase 2, with a change in slope and level after the intervention of P = .02 (CI: -0.204 to -0.040) and P = .004 (CI: -0.013 to -0.003), respectively.

Conclusions: This intervention, including enhanced environment cleaning, active surveillance, and patient cohorting, successfully reduced CRAB acquisition in IMWs and their HD non-ICUs.

Background: Recent analyses suggest that existing infection preventionist (IP) staffing ratios do not reflect the scope of institutional needs after accounting for complexity and non-inpatient locations. We sought to determine the current IP staffing level required to address the complexity and scope of our pediatric ambulatory and procedural operations.

Methods: This needs assessment was adapted from previous analyses by Bartles et al (2018). We surveyed IPs covering ambulatory/procedural locations regarding clinical complexity indicators and estimated hours per week spent engaged in IP activities. The reported hours were used to calculate total IP hours per week and associated full-time equivalents (FTEs).

Results: Half (118/237) of surveyed locations/services reported at least 1 complexity indicator, while nearly 9% (21/237) reported 3 or more complexity indicators. IPs spent 181.0 h/wk focused on ambulatory/procedural locations, equating to 4.5 FTEs.

Discussion: Infection prevention and control leadership used these findings to successfully add 4 IP FTEs to the department. These FTEs will allow increased ambulatory/procedural IP support, improved regulatory readiness, and increased quality improvement initiatives.

Conclusions: Assessing the complexity and scope of pediatric ambulatory/procedural locations can be a valuable tool for (1) advocating for overall IP staffing increases at a system level and (2) determining the distribution of IP time and resources in such locations.

Background: Candida auris (C auris) is an emerging global infectious disease threat, and screening practices for identification of C auris are inconsistent across healthcare facilities. This study describes the utility of expanding a C auris admission screening protocol at an acute care hospital to screen all patients presenting from any skilled nursing facility.

Methods: A retrospective review identified all patients screened on admission for C auris from January 2022 through September 2023. Patients were identified for risk potential, and those deemed high risk were placed on transmission-based precautions while awaiting culture results.

Results: Of the 591 patients screened, 14 cases were identified (2.4%). Nine cases presented with tracheostomies or were ventilator-dependent and classified as high risk. Five cases were considered low risk at the time of screening. Eight of these newly identified cases would not be screened under the prior criteria.

Discussion: This study's findings support prior studies that patients with tracheostomies or were ventilator-dependent have greater risk for C auris colonization. Adopting an expanded admission screening program has allowed the hospital to detect more cases earlier to prevent nosocomial transmissions.

Conclusions: Healthcare facilities should consider initiating or expanding admission screening programs for C auris based on community prevalence rates of C auris.

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: Educating health care staff on infection prevention and control (IPC) is an essential role of infection preventionists (IPs), but the COVID-19 pandemic diverted resources away from IPC education.

Methods: Association for Professionals in Infection Control and Epidemiology members were invited to complete an online survey from spring 2023 to assess current and preferred approaches and tools for training health care personnel on IPC. Vendors, retirees, APIC staff, or those not working in health care or public health were excluded.

Results: In all, 2,432 IPs participated. IPs were more likely to report engaging in impromptu health care worker training (ie, just-in-time teaching and team huddles) versus planned educational activities (ie, learning modules, formal presentations, train-the-trainer, or simulation; Kruskal-Wallis = 288, P < .001). IPs' top preferred teaching methodologies included simulation or interactive activity, and their lowest preferred approach was independent learning modules. IPC training apps were frequently requested technology.

Discussion: IPs ranked simulation as their top preferred teaching method; however, simulation was one of the least frequently used approaches. IP education should include strategies for delivering effective impromptu training and how to develop and implement interactive simulation-based education.

Conclusions: The expressed needs and preferences of IPs should be considered when developing IPC-related teaching and training tools.

The typical duration of positive nucleic acid tests for methicillin-resistant Staphylococcus aureus (MRSA) in the nares of patients receiving systemic anti-MRSA antimicrobials is unknown. In this study, hospitalized adult patients with an initial positive MRSA nares nucleic acid test prescribed systemic anti-MRSA antimicrobials had follow-up testing done 48 to 96 hours later. A positive follow-up test was detected in 100/113 (88.5%), indicating that MRSA nares DNA tests still have utility for screening after patients have initiated anti-MRSA therapy.