American journal of infection control最新文献

Background: Accurate surveillance for health care-associated infections (HAIs) is essential for infection prevention and regulatory compliance. Despite the availability of National Healthcare Safety Network (NHSN) definitions, variation in application persists, and formal training is not universally required. This study evaluated whether structured surveillance training with annual competency testing improves infection preventionists' (IPs') accuracy in applying standardized HAI definitions over time.

Methods: This longitudinal observational study analyzed annual surveillance test scores from 69 IPs employed by a single consulting company between 2019 and 2024. All IPs completed standardized onboarding and annual competency tests using a validated 20-question case-scenario test bank. Linear mixed-effects models assessed the association between repeated testing and surveillance performance.

Results: Repeat testers achieved significantly higher mean scores (mean = 0.83, SD = 0.12) compared to first-time testers (mean = 0.66, SD = 0.18; P < .001). Years of experience significantly predicted higher scores (β = 0.15, P < .001), while certification, surveillance hours, and facility type did not. A nonsignificant upward trend in scores was observed among repeat testers over time.

Conclusions: Structured, repeated surveillance training and testing were associated with improved HAI coding accuracy. These findings support the integration of ongoing competency assessments into infection prevention programs to strengthen data quality and standardization.

Background: Personal protective equipment (PPE) is crucial for healthcare personnel to protect against infections from exposure to body fluids containing bloodborne pathogens such as Ebola, HIV, Hepatitis B, and Hepatitis C. Despite advancements in PPE materials, interface regions, particularly the junction between gloves and protective clothing, remain vulnerable to fluid leakage. Although taping these interfaces is a common practice, its efficacy has not been thoroughly evaluated. This study examined the barrier performance of various tape models applied at the glove-protective clothing interface using a quantitative fluid leakage test.

Methods: Five tape models; Gorilla Crystal Clear, 3M Contractor Grade Multi-Use Duct tape, Kappler Chemtape, 3M Durapore Surgical tape, and 3M Nexcare tape were evaluated under controlled conditions using a robotic arm that simulated healthcare personnel movements. A 5-second soak exposure followed by motion sequences was conducted, and fluid penetration was quantified by measuring absorption by the inner cotton sleeve. One-way analysis of variance and post-hoc comparisons determined differences among tape models.

Results: Gorilla Crystal Clear Tape significantly reduced fluid leakage compared to all other models. 3M Durapore showed the highest leakage, while 3M Nexcare performed moderately.

Conclusions: Taping significantly decreases fluid leakage at the glove-protective clothing interface, though performance depends on tape type. Some tapes may damage garments during removal, underscoring the need to balance barrier efficacy with ease of doffing in PPE use.

Background: Hand hygiene is vital to infection prevention, but sustaining high compliance remains an ongoing challenge. This project aimed to determine if a culturally focused hand hygiene program, leveraging existing resources and context-driven data, could sustain high compliance in an acute care hospital setting.

Methods: In June 2023, our tertiary acute care hospital implemented a hand hygiene program targeting roots of non-compliance. Light-duty nurses and patient care technicians observed compliance through security cameras, provided real-time feedback, and acted as cultural change agents. Context-specific data were leveraged to create targeted education and recognition programs. Results were analyzed using an interrupted time series analysis, logistic regression, and a decision tree algorithm to assess impact and predictors of compliance.

Results: 191,403 observations were collected across 11 inpatient units. Overall post-implementation compliance improved by 11.6% (effect size: 0.34). Improvements were observed across all units, roles, and shifts. Significant predictors of compliance were identified, including staff roles and shifts. Improvements were resilient to the hourly census and showed a 54% reduction in the variance of compliance.

Conclusion: Our program sustainably improved and stabilized hand hygiene compliance. The approach offers a practical and scalable model for institutions seeking to overcome common challenges to achieve sustainable compliance.

Background: Patients' hands can serve as reservoirs for health care-associated and transient pathogens, both of which can contribute to illness and transmission. Most hand hygiene programs target health care workers, even though transient bacteria on patients' hands are removable with proper technique. While inpatient initiatives such as the Patients' 4 Moments for Hand Hygiene have reduced contamination, little is known about outpatient settings or the effect of just-in-time education.

Methods: We conducted a prospective before-after pilot study of 61 outpatients at a Veterans Affairs medical center. Each participant provided bilateral hand cultures before and after alcohol-based handrub (ABHR) use, accompanied by just-in-time education based on the Visitors' 4 Moments framework.

Results: Before ABHR, 52 of 61 patients (85.2%) had bacterial growth, commonly nonenteric gram-negative rods (27.9%), Enterococcus species (23.0%), and Staphylococcus aureus (16.4%). Health care-associated pathogens included methicillin-resistant S aureus (3.3%) and carbapenem-resistant Enterobacteriaceae (6.6%). After ABHR, 67.2% had no detectable growth (P < .001). Residual growth reflected low-density transient flora.

Conclusions: Outpatients frequently carry transient and health care-associated bacteria capable of causing infection but largely removable with effective ABHR use. A brief, just-in-time education intervention significantly reduced hand contamination, supporting patient-centered hand hygiene as a feasible, low-cost strategy to interrupt transmission in ambulatory care settings.

Background: Clinical decision support tools (ie, electronic alerts) can improve outcomes for patients with Staphylococcus aureus bacteremia (SAB) in hospitals with on-site infectious disease (ID) specialists. However, many rural hospitals lack on-site ID consultants and/or electronic health record (EHR) interoperability, presenting challenges for SAB patient care.

Methods: We conducted qualitative interviews with rural hospital employees about SAB management processes and needs and elicited feedback on an EHR alert used at a large urban hospital with on-site ID specialists. We used a rapid qualitative inquiry process to identify interview themes.

Results: Rural hospitals had wide variation in existing availability of ID consultations and processes for seeking consultations. Participants provided suggestions for tailoring and implementing an electronic alert encouraging ID consultation within rural hospital work systems.

Discussion: Increasing ID consultations, including through EHR alerts in rural hospitals, has many barriers. An EHR alert providing first-line guidance on urgency, therapy, and communication may support guideline-concordant care for SAB within the unique workflows of smaller and more rural hospitals.

Conclusions: Electronic alerts, while useful in hospitals with on-site ID specialists to encourage ID consultations, will need to be tailored and implemented in rural hospitals to achieve similar clinical decision support results.