American journal of infection control最新文献

Background: Hospital-acquired infections (HAIs) increase morbidity, mortality, and health care costs. Effective hand hygiene (HH) is crucial for prevention, but achieving high compliance remains challenge. This study explores using machine learning to integrate an electronic HH auditing system with electronic health records to predict HAIs.

Methods: A retrospective cohort study was conducted at a Brazilian hospital during 2017-2020. HH compliance was recorded electronically, and patient data were collected from electronic health records. The primary outcomes were HAIs per CDC/National Healthcare Safety Network surveillance definitions. Machine learning algorithms, balanced with Random Over Sampling Examples (ROSE), were utilized for predictive modeling, including generalized linear models (GLM); generalized additive models for location, scale, and shape (GAMLSS); random forest; support vector machine; and extreme gradient boosting (XGboost).

Results: 125 of 6,253 patients (2%) developed HAIs and 920,489 HH opportunities (49.3% compliance) were analyzed. A direct correlation between HH compliance and HAIs was observed. The GLM algorithm with ROSE demonstrated superior performance, with 84.2% sensitivity, 82.9% specificity, and a 93% AUC.

Conclusions: Integrating electronic HH auditing systems with electronic health records and using machine learning models can enhance infection control surveillance and predict patient outcomes. Further research is needed to validate these findings and integrate them into clinical practice.

Background: This study explores the infrastructural and organizational risk factors for health care-associated (HCA) Clostridioides difficile infections (CDIs) and methicillin-resistant Staphylococcus aureus (MRSA) in hospitals.

Methods: This is a retrospective observational study involving all eligible inpatient units from 12 hospitals in British Columbia, Canada, from April 1, 2020 to September 16, 2021. The outcomes were the average HCA CDI or MRSA rates. Covariates included, but were not limited to, infection control factors (eg, hand hygiene rate), infrastructural factors (eg, unit age), and organizational factors (eg, hallway bed utilization). Multivariable regression was performed to identify statistically significant risk factors.

Results: Older units were associated with higher HCA CDI rates (adjusted relative risk [aRR]: 0.012; 95% confidence interval (CI) [0.004, 0.020]). Higher HCA MRSA rates were associated with decreased hand hygiene rate (aRR: -0.035; 95% CI [-0.063, -0.008]), higher MRSA bioburden (aRR: 9.008; 95% CI [5.586, 12.429]), increased utilization of hallway beds (aRR: 0.680; 95% CI [0.094, 1.267]), increased nursing overtime rate (aRR: 5.018; 95% CI [1.210, 8.826]), and not keeping the clean supply room door closed (aRR: -0.283; 95% CI [-0.536, -0.03]).

Conclusions: The study confirmed the multifaceted nature of infection prevention and emphasized the importance of interdepartmental collaboration to improve patient safety.

Background: New elastomeric half-mask respirator (EHMR) models without exhalation valves (EVs) or with exhalation valve filters (EVFs) are facilitating expanded use in health settings to reduce workers' exposure to airborne hazards while acting as source control to prevent pathogen spread. The physical comfort of new models has not been assessed in comparison to previously used EHMRs with EVs.

Methods: Researchers assessed 1,962 health care and emergency medical service personnels' self-reported adverse experiences from 2 cohorts while wearing EHMR models with EVs (cohort 1, n = 1,080) and without EVs or with EVFs (cohort 2, n = 882). Fisher exact test identified differences between the cohorts accounting for organizational factors when possible.

Results: Cohort 1 respondents experienced communication challenges and discomfort when wearing the EHMR > 1 hour statistically significantly more often than cohort 2. Cohort 2 respondents reported statistically significantly more instances of difficulty breathing, moisture buildup, being uncomfortable to wear < 1 hour, and being uncomfortably warm.

Conclusions: Discomfort is prevalent among end users and more often among those wearing EHMRs without an EV/with an EVF. As EHMR research and development advances, prevalence in use may increase for emergency and routine situations. Organizations may not only need guidance about respirator selection but also model-specific selection.

Background: We aimed to determine the prevalence of genes associated with high-level mupirocin and biocide resistance in methicillin-resistant Staphylococcus aureus (MRSA) isolates among hospitalized patients and to characterize their genomic and epidemiologic features.

Methods: Study conducted on an integrated health system. Clinical cultures with MRSA from hospitalized patients collected between March 1, 2023, and January 20, 2024 underwent prospective whole-genome sequencing, including assessment for the presence of markers of resistance against mupirocin (mupA) and biocides (qac). Demographic and clinical characteristics were reviewed.

Results: We analyzed 463 MRSA isolates. The overall prevalence of mupA(+), qacA(+), and qacC(+) genes was 22.0%, 2.4%, and 19.0%, respectively. Most mupA(+) isolates belonged to ST8, but ST8732 (a novel variant of ST8) had the highest prevalence of mupA(+) isolates at 95%. Patients mupA(+) were older, and none of the isolates from pediatric patients harbored this gene.

Discussion: Through prospective whole-genome sequencing of MRSA isolates, we detected a prevalence of genes conferring mupirocin resistance considerably higher than previously reported, particularly among MRSA ST8 variants.

Conclusions: Our findings highlight the need for monitoring resistance to agents used for the prevention of S aureus infections, as these trends have implications for infection prevention programs and public health at large.

Background: Some medical equipment travels across patient rooms. Nursing and environmental services staff may not always communicate cleaning responsibilities. The purpose of this study was to identify if a portable UV-C tent utilized with a UV-C device (Xenex LightStrike Robot) can effectively disinfect high use equipment.

Methods: Health care equipment were pre-swabbed to determine colony forming units (CFUs). Following UV-C disinfection, a post swab was completed. Standard microbiology techniques were utilized to sample, plate, and count CFUs from these sampled items.

Results: Samples (n=134) had a significant reduction in contamination (17.08 CFUs vs 0.45 CFUs, P<.05) following UV-C treatment. This near elimination of CFUs highlights the effectiveness of UV-C to disinfect high touch surfaces.

Discussion: More work is needed to determine optimal cleaning practices. At the same time, current cleaning practices are sometimes ineffective, additional steps such as UV-C can assist in ensuring adequate disinfection of equipment.

Conclusions: It is important that nurses take steps to break the chain of infection while providing patient care. Policies regarding infection control need to address high touch items and include methods such as the UV-C tent utilized in this study to ensure these items are disinfected reducing the risk of health care associated infections.

Background: Neonatal sepsis is a leading cause of newborn mortality, particularly in low- and middle-income countries. This study examines the bacterial etiologies and antibiotic resistance patterns of neonatal sepsis in a tertiary hospital in Vietnam.

Methods: A prospective cross-sectional study was conducted at National Children's Hospital, Hanoi, Vietnam from January 2021 to December 2022. All neonates with a clinical suspicion of sepsis and a confirmed positive blood culture were identified. Isolated pathogens were identified, and antibiotic susceptibility was assessed using standard protocols.

Results: In total, 202 neonates were diagnosed with proven sepsis. Among these, 75.2% of cases referred from other hospitals. Early-onset sepsis accounted for 15.8% of these infections. Gram-negative bacteria were responsible for 75.7% of the cases, with Klebsiella pneumoniae being the most prevalent pathogen (32.2%), followed by Staphylococcus aureus (14.9%), and both Serratia marcescens and Escherichia coli (10.9% each). Gram-negative bacteria showed significant resistance to third-generation cephalosporins, carbapenems, while gram-positive bacteria demonstrated considerable resistance to clindamycin and oxacillin. However, most gram-positive isolates were susceptible to vancomycin, and gram-negative bacteria had lower resistance to colistin and fosfomycin.

Conclusions: These findings highlight the critical importance of continuous surveillance and tailored antibiotic policies to combat neonatal sepsis effectively.

A cross-sectional study was conducted to evaluate the relationship between Infection Prevention and Control Assessment Framework scores and the incidence of health care-associated infections in tertiary hospitals in Eastern China. The results indicate that hospitals with Infection Prevention and Control Assessment Framework scores above 700 have a lower incidence rate of health care-associated infections (1.31%; 95%CI, 1.15%-1.47%) compared to those with scores below 700 (1.90%; 95%CI, 1.60%-2.21%).

Background: Tuberculosis (TB) Building and Strengthening Infection Control Strategies (TB BASICS) aimed to achieve improvements in TB infection prevention and control (IPC) through structured training and mentorship.

Methods: TB BASICS was implemented in six Chinese provinces from 2017-2019. Standardized, facility-based risk assessments tailored to inpatient, laboratory, and outpatient departments were conducted quarterly for 18 months. Knowledge, attitudes, and practices surveys were administered to healthcare workers (HCW) at nine participating facilities during the first and last assessments. Kruskal-Wallis rank sum test assessed score differences between departments (alpha = 0.05).

Results: Fifty-seven departments received risk assessments. IPC policies and practices improved substantially during follow up. Facility-based assessment scores were significantly lower in outpatient departments than other departments (p <0.05). All indicators achieved at least partial implementation by the final assessment. Low scores persisted for implementing isolation protocols, while personal protective equipment use among staff was consistent among all departments. Overall, we observed minimal change in IPC knowledge among HCW. In general, HCW had favorable views of their own IPC capabilities, but reported limited agency to improve institutional IPC.

Conclusions: TB BASICS demonstrated improvements in TB IPC implementation. Structured training and mentorship engaged HCW to maintain confidence and competency for TB prevention.