Pub Date : 2024-07-02DOI: 10.1016/j.ajic.2024.06.018
Fangli Zhao, Nan Zhang, Yadi Wu, Zhiyang Dou, Bing Cao, Yingjie Luo, Yan Lu, Li Du, Shenglan Xiao
Background: Dental outpatient departments, characterized by close proximity and unmasked patients, present a considerable risk of respiratory infections for health care workers (HCWs). However, the lack of comprehensive data on close contact (<1.5m) between HCWs and patients poses a significant obstacle to the development of targeted control strategies.
Methods: An observation study was conducted at a hospital in Shenzhen, China, utilizing depth cameras with machine learning to capture close-contact behaviors of patients with HCWs. Additionally, questionnaires were administered to collect patient demographics.
Results: The study included 200 patients, 10 dental practitioners, and 10 nurses. Patients had significantly higher close-contact rates with dental practitioners (97.5%) compared with nurses (72.8%, P < .001). The reason for the visit significantly influenced patient-practitioner (P = .018) and patient-nurse (P = .007) close-contact time, with the highest values observed in prosthodontics and orthodontics patients. Furthermore, patient age also significantly impacted the close-contact rate with nurses (P = .024), with the highest rate observed in patients below 14 years old at 85% [interquartile range: 70-93].
Conclusions: Dental outpatient departments exhibit high HCW-patient close-contact rates, influenced by visit purpose and patient age. Enhanced infection control measures are warranted, particularly for prosthodontics and orthodontics patients or those below 14 years old.
{"title":"What influences the close contact between health care workers and patients? An observational study in a hospital dental outpatient department.","authors":"Fangli Zhao, Nan Zhang, Yadi Wu, Zhiyang Dou, Bing Cao, Yingjie Luo, Yan Lu, Li Du, Shenglan Xiao","doi":"10.1016/j.ajic.2024.06.018","DOIUrl":"10.1016/j.ajic.2024.06.018","url":null,"abstract":"<p><strong>Background: </strong>Dental outpatient departments, characterized by close proximity and unmasked patients, present a considerable risk of respiratory infections for health care workers (HCWs). However, the lack of comprehensive data on close contact (<1.5m) between HCWs and patients poses a significant obstacle to the development of targeted control strategies.</p><p><strong>Methods: </strong>An observation study was conducted at a hospital in Shenzhen, China, utilizing depth cameras with machine learning to capture close-contact behaviors of patients with HCWs. Additionally, questionnaires were administered to collect patient demographics.</p><p><strong>Results: </strong>The study included 200 patients, 10 dental practitioners, and 10 nurses. Patients had significantly higher close-contact rates with dental practitioners (97.5%) compared with nurses (72.8%, P < .001). The reason for the visit significantly influenced patient-practitioner (P = .018) and patient-nurse (P = .007) close-contact time, with the highest values observed in prosthodontics and orthodontics patients. Furthermore, patient age also significantly impacted the close-contact rate with nurses (P = .024), with the highest rate observed in patients below 14 years old at 85% [interquartile range: 70-93].</p><p><strong>Conclusions: </strong>Dental outpatient departments exhibit high HCW-patient close-contact rates, influenced by visit purpose and patient age. Enhanced infection control measures are warranted, particularly for prosthodontics and orthodontics patients or those below 14 years old.</p>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141533355","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-02DOI: 10.1016/j.ajic.2024.06.023
Inge Rogers, Michelle A Barron
Laboratory algorithms using Acid-Fast Bacilli staining and Mycobacterium tuberculosis (Mtb) polymerase chain reaction (PCR) are often used to remove isolation precautions. A retrospective case review of 52 patients with culture-confirmed pulmonary Mtb revealed 4 subjects with negative sputum Acid-Fast Bacilli smears and negative Mtb PCRs. All had significant risk factors for Mtb and had a positive interferon-gamma release assay. A negative PCR test result does not exclude an Mtb diagnosis.
{"title":"Evaluating the role of Mycobacterium tuberculosis PCR in ruling out active tuberculosis.","authors":"Inge Rogers, Michelle A Barron","doi":"10.1016/j.ajic.2024.06.023","DOIUrl":"10.1016/j.ajic.2024.06.023","url":null,"abstract":"<p><p>Laboratory algorithms using Acid-Fast Bacilli staining and Mycobacterium tuberculosis (Mtb) polymerase chain reaction (PCR) are often used to remove isolation precautions. A retrospective case review of 52 patients with culture-confirmed pulmonary Mtb revealed 4 subjects with negative sputum Acid-Fast Bacilli smears and negative Mtb PCRs. All had significant risk factors for Mtb and had a positive interferon-gamma release assay. A negative PCR test result does not exclude an Mtb diagnosis.</p>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-07-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141533354","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-07-01DOI: 10.1016/j.ajic.2024.07.005
Jamie Patrianakos, B. A. Longo, Scott C. Williams
{"title":"Successful Practices to Reduce Central Line-Associated Bloodstream Infections Post-Pandemic: A Qualitative Study","authors":"Jamie Patrianakos, B. A. Longo, Scott C. Williams","doi":"10.1016/j.ajic.2024.07.005","DOIUrl":"https://doi.org/10.1016/j.ajic.2024.07.005","url":null,"abstract":"","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141713699","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-29DOI: 10.1016/j.ajic.2024.06.009
Background
Gastrointestinal endoscopic procedures (GIEP's) are an essential part of patient care both diagnostically and therapeutically. Post-GIEP infections may be higher than previously reported and may not have been accurately captured in the past. The aim of this study was to determine the incidence and associated factors of bacteremia associated with GIEP's.
Methods
This is retrospective study of GIEPs performed over a five-year period (2018-2022) at an academic medical center. Electronic health records (EHR) identified GIEPs and positive blood cultures within 30 days of procedure. Statistical analysis was performed using non-parametric testing to compare variables due to the small number of positive blood cultures.
Results
EHR identified 18,986 GIEP’s and 52 true and unique bacteremia out of 17,093 blood cultures during the five-year study period. The highest rate of positive blood culture of 2.84% (18/ 634) was associated with ERCP and the lowest 0.08% (7/ 9029) was associated with colonoscopy.
Discussion
Our study showed a reflection of the endemic rate of bacteremia post GIEP’s. Our study cannot differentiate endogenous infection versus contaminated (exogenous) endoscopes. ERCP procedures are disproportionately associated with higher incidence of bacteremia.
Conclusions
Clinical surveillance in non-outbreak settings is essential for estimating GIEP related infections. It should be combined with endoscopic reprocessing audits for appropriate prevention of GIEP associated infections.
{"title":"Gastrointestinal endoscopy 30-day-associated bacteremia: Nonoutbreak 5-year review in an inner-city, tertiary-care hospital","authors":"","doi":"10.1016/j.ajic.2024.06.009","DOIUrl":"10.1016/j.ajic.2024.06.009","url":null,"abstract":"<div><h3>Background</h3><p>Gastrointestinal endoscopic procedures (GIEP's) are an essential part of patient care both diagnostically and therapeutically. Post-GIEP infections may be higher than previously reported and may not have been accurately captured in the past. The aim of this study was to determine the incidence and associated factors of bacteremia associated with GIEP's.</p></div><div><h3>Methods</h3><p>This is retrospective study of GIEPs performed over a five-year period (2018-2022) at an academic medical center. Electronic health records (EHR) identified GIEPs and positive blood cultures within 30 days of procedure. Statistical analysis was performed using non-parametric testing to compare variables due to the small number of positive blood cultures.</p></div><div><h3>Results</h3><p><span>EHR identified 18,986 GIEP’s and 52 true and unique bacteremia out of 17,093 blood cultures during the five-year study period. The highest rate of positive blood culture of 2.84% (18/ 634) was associated with </span>ERCP<span> and the lowest 0.08% (7/ 9029) was associated with colonoscopy.</span></p></div><div><h3>Discussion</h3><p>Our study showed a reflection of the endemic rate of bacteremia post GIEP’s. Our study cannot differentiate endogenous infection versus contaminated (exogenous) endoscopes. ERCP procedures are disproportionately associated with higher incidence of bacteremia.</p></div><div><h3>Conclusions</h3><p>Clinical surveillance in non-outbreak settings is essential for estimating GIEP related infections. It should be combined with endoscopic reprocessing audits for appropriate prevention of GIEP associated infections.</p></div>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141475739","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-28DOI: 10.1016/j.ajic.2024.06.020
Jeongyoung Lee, Eun Ju Kim, Young-Ju Lim, Eun Ok Kim, Seongman Bae, Jiwon Jung, Sung-Han Kim
Background: We aimed to evaluate the performance of ceiling-mounted UV-C lamps.
Methods: This study was conducted in an empty room with UV-C lamps in the biocontainment unit of a tertiary care hospital in South Korea. Each pathogen (Staphylococcus aureus, Escherichia coli, Candida krusei, Bacillus cereus, and Mycobacterium peregrinum) was inoculated on blood agar plates and placed in 20 selected places from the UV-C lamp, and irradiation was applied for 15 min. As a control group, the bacterial solution was diluted 10,000 times and UV was not applied.
Results: A mean ± SD of 5.95 ± 0.91 log reduction was observed with UV irradiation compared with the control. The log reduction was greatest for S. aureus [median, 7.05 (IQR, 6.49-7.26)] and least for M. peregrinum [median, 4.88 (IQR, 4.58-5.24)]. The degree of log reduction was inversely proportional to the square of the distance from the UV-C lamp (R2 = -0.12, P < .001).
Conclusions: In this study, ceiling-mounted UV-C demonstrated effective disinfection of at least 4-log reduction of the test organisms within a 4-m distance. Mounted UV-C lighting is a considerable option for improving surface disinfection.
{"title":"Effectiveness of ceiling-mounted ultraviolet-C lamps: An experimental study in a biocontainment unit of a tertiary care hospital.","authors":"Jeongyoung Lee, Eun Ju Kim, Young-Ju Lim, Eun Ok Kim, Seongman Bae, Jiwon Jung, Sung-Han Kim","doi":"10.1016/j.ajic.2024.06.020","DOIUrl":"10.1016/j.ajic.2024.06.020","url":null,"abstract":"<p><strong>Background: </strong>We aimed to evaluate the performance of ceiling-mounted UV-C lamps.</p><p><strong>Methods: </strong>This study was conducted in an empty room with UV-C lamps in the biocontainment unit of a tertiary care hospital in South Korea. Each pathogen (Staphylococcus aureus, Escherichia coli, Candida krusei, Bacillus cereus, and Mycobacterium peregrinum) was inoculated on blood agar plates and placed in 20 selected places from the UV-C lamp, and irradiation was applied for 15 min. As a control group, the bacterial solution was diluted 10,000 times and UV was not applied.</p><p><strong>Results: </strong>A mean ± SD of 5.95 ± 0.91 log reduction was observed with UV irradiation compared with the control. The log reduction was greatest for S. aureus [median, 7.05 (IQR, 6.49-7.26)] and least for M. peregrinum [median, 4.88 (IQR, 4.58-5.24)]. The degree of log reduction was inversely proportional to the square of the distance from the UV-C lamp (R<sup>2</sup> = -0.12, P < .001).</p><p><strong>Conclusions: </strong>In this study, ceiling-mounted UV-C demonstrated effective disinfection of at least 4-log reduction of the test organisms within a 4-m distance. Mounted UV-C lighting is a considerable option for improving surface disinfection.</p>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-06-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141465603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-27DOI: 10.1016/j.ajic.2024.04.181
Background
Inappropriate testing for Clostridiodes difficile infection (CDI) increases health care onset cases and contributes to overdiagnosis and overtreatment of patients in a community health care system.
Methods
An electronic smart order set for the testing of CDI was created and implemented to improve the appropriateness of testing. A retrospective review of patients who were tested for CDI, pre and post, was conducted to determine if inappropriate stool testing for CDI decreased post-implementation of the order set.
Results
224 patients were tested for CDI during the study period with the post-implementation period having a higher proportion of patients who met appropriate testing criteria defined by presence of diarrhea (80.5% vs 61.3%; P = .002). The rate of inappropriate CDI stool testing decreased from 31.1% to 11.0% after implementation (P < .001). A higher proportion of CDI patients were readmitted within 30 days of discharge (54.2% vs 33.0%; P = 0.001) during the post-implementation period.
Conclusions
There was a significant reduction in inappropriate CDI testing following the implementation of the order set. There was an observed increase in the proportion of patients who underwent recent gastrointestinal surgery which may have contributed to the increase in 30-day readmission rates during the post-implementation period.
{"title":"Impact of an electronic smart order-set for diagnostic stewardship of Clostridiodes difficile infection (CDI) in a community healthcare system in South Florida","authors":"","doi":"10.1016/j.ajic.2024.04.181","DOIUrl":"10.1016/j.ajic.2024.04.181","url":null,"abstract":"<div><h3>Background</h3><p>Inappropriate testing for <em>Clostridiodes difficile</em> infection (CDI) increases health care onset cases and contributes to overdiagnosis and overtreatment of patients in a community health care system.</p></div><div><h3>Methods</h3><p>An electronic smart order set for the testing of CDI was created and implemented to improve the appropriateness of testing. A retrospective review of patients who were tested for CDI, pre and post, was conducted to determine if inappropriate stool testing for CDI decreased post-implementation of the order set.</p></div><div><h3>Results</h3><p>224 patients were tested for CDI during the study period with the post-implementation period having a higher proportion of patients who met appropriate testing criteria defined by presence of diarrhea (80.5% vs 61.3%; <em>P</em> = .002). The rate of inappropriate CDI stool testing decreased from 31.1% to 11.0% after implementation (<em>P</em> < .001). A higher proportion of CDI patients were readmitted within 30 days of discharge (54.2% vs 33.0%; <em>P</em> = 0.001) during the post-implementation period.</p></div><div><h3>Conclusions</h3><p>There was a significant reduction in inappropriate CDI testing following the implementation of the order set. There was an observed increase in the proportion of patients who underwent recent gastrointestinal surgery which may have contributed to the increase in 30-day readmission rates during the post-implementation period.</p></div>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141454651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-27DOI: 10.1016/j.ajic.2024.06.019
Adam Fabiani, Nicola Aversana, Marilena Santoro, Dario Calandrino, Paolo Liotta, Gianfranco Sanson
Background: Although widely used in clinical practice, long peripheral (LPCs) and midline catheters (MCs) are often misclassified because of their similar characteristics. Comparative studies on these devices are lacking. This study aimed to explore complications risks in polyurethane LPCs and MCs.
Methods: Prospective cohort study. Catheter-failure within 30days was the primary outcome, catheter-related bloodstream infection (CR-BSI), thrombosis, and fibroblastic sleeve were secondary outcomes. The average number of drugs infused per day was computed to measure the overall intensity of catheters' use.
Results: The catheter-failure incidence was 5.7 and 3.4/1,000 catheter-days for LPCs and MCs, respectively. MCs were associated with an adjusted lower risk of catheter-failure (hazard ratio 0.311, 95% confidence interval 0.106-0.917, P = .034). The daily number of drugs infused was higher for MCs (P < .001) and was associated with a greater risk catheter-failure risk (P = .021). Sensitivity analysis showed a decreased catheter-failure risk for MCs starting from day-10 from positioning. The incidence of CR-BSI (0.9 vs 0.0/1,000 catheter-days), thrombosis (8.7 vs 3.5/1,000 catheter-days), and fibroblastic sleeve (14.0 vs 8.1/1,000 catheters-days) was higher for LPC catheters.
Conclusions: Despite more intensive drug administration, MCs were associated with a longer uncomplicated indwelling time.
背景:尽管长外周导管(LPC)和中线导管(MC)被广泛应用于临床实践,但由于它们具有相似的特征,因此经常被误分。目前还缺乏比较这些设备相关并发症的研究。本研究旨在探讨与聚氨酯长外周导管和中线导管相关的并发症风险:方法:前瞻性队列研究。纳入研究期间插入的所有 LPC 和 MC。30天内导管故障是主要结果,导管相关血流感染、血栓形成和纤维套管是次要结果。作为导管留置期间使用强度的衡量标准,计算了每天平均输注的药物数量:结果:LPC 和 MC 的导管故障发生率分别为 5.7 和 3.4/1000 个导管日。经调整后,MC 的导管故障风险更低(HR 0.311;95% CI 0.106-0.917;P=0.034)。MC每天平均输注的药物数量更高(导管定位后的第p天)。LPCs导管的导管相关血流感染(0.9 vs 0.0/1000导管日)、血栓形成(8.7 vs 3.5/1000导管日)和纤维套管(14.0 vs 8.1/1000导管日)发生率更高:结论:尽管给药强度更大,但 MC 型导管的无并发症留置时间更长。
{"title":"The longer the catheter, the lower the risk of complications: Results of the HERITAGE study comparing long peripheral and midline catheters.","authors":"Adam Fabiani, Nicola Aversana, Marilena Santoro, Dario Calandrino, Paolo Liotta, Gianfranco Sanson","doi":"10.1016/j.ajic.2024.06.019","DOIUrl":"10.1016/j.ajic.2024.06.019","url":null,"abstract":"<p><strong>Background: </strong>Although widely used in clinical practice, long peripheral (LPCs) and midline catheters (MCs) are often misclassified because of their similar characteristics. Comparative studies on these devices are lacking. This study aimed to explore complications risks in polyurethane LPCs and MCs.</p><p><strong>Methods: </strong>Prospective cohort study. Catheter-failure within 30days was the primary outcome, catheter-related bloodstream infection (CR-BSI), thrombosis, and fibroblastic sleeve were secondary outcomes. The average number of drugs infused per day was computed to measure the overall intensity of catheters' use.</p><p><strong>Results: </strong>The catheter-failure incidence was 5.7 and 3.4/1,000 catheter-days for LPCs and MCs, respectively. MCs were associated with an adjusted lower risk of catheter-failure (hazard ratio 0.311, 95% confidence interval 0.106-0.917, P = .034). The daily number of drugs infused was higher for MCs (P < .001) and was associated with a greater risk catheter-failure risk (P = .021). Sensitivity analysis showed a decreased catheter-failure risk for MCs starting from day-10 from positioning. The incidence of CR-BSI (0.9 vs 0.0/1,000 catheter-days), thrombosis (8.7 vs 3.5/1,000 catheter-days), and fibroblastic sleeve (14.0 vs 8.1/1,000 catheters-days) was higher for LPC catheters.</p><p><strong>Conclusions: </strong>Despite more intensive drug administration, MCs were associated with a longer uncomplicated indwelling time.</p>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141465605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-27DOI: 10.1016/j.ajic.2024.06.015
Nisha Gupta, Shanna Haughton, Sydney Kemper, Monica Koehler, Roula Antoon, Colin G Edwards, Amy Bardin
Background: Candida auris is an emerging multidrug-resistant fungus associated with catheter-related bloodstream infections. In vitro efficacy of chlorhexidine (CHX) and CHX-silver sulfadiazine-impregnated (CHX-S) antimicrobial central venous catheters (CVCs) against C auris was investigated.
Methods: Minimum inhibitory and bactericidal CHX concentrations were determined against 19 C auris isolates. To assess extraluminal efficacy, segments from CVCs impregnated externally (CHX-S1) and both externally and internally (CHX-S2) were plasma-conditioned for 1- and 6-day, and to assess intraluminal efficacy, CHX-S2 CVCs were preconditioned with saline-lock for 6days, followed by 24-hour C auris inoculation and microbial adherence determination on impregnated and nonimpregnated CVCs.
Results: CHX inhibited all C auris isolates with minimum inhibitory and bactericidal concentrations range of 8 to 128 μg/mL. C auris adherence was reduced on CHX-S1 and CHX-S2 extraluminally by 100% on day 1, 86.96% to 100% on day 7, and intraluminally on CHX-S2 by 56.86% to 90.52% on day 7.
Discussion: CHX and CHX-S CVC performance against C auris observed in this study is consistent with antimicrobial benefits observed in prior preclinical and randomized controlled clinical studies.
Conclusions: CHX showed strong inhibitory and cidal effects on C auris. CHX-S CVCs proved highly efficacious against this pathogen under in vitro conditions. Additional studies, however, are required to confirm clinical benefit.
{"title":"The antimicrobial effectiveness of chlorhexidine and chlorhexidine-silver sulfadiazine-impregnated central venous catheters against the emerging fungal pathogen Candida auris.","authors":"Nisha Gupta, Shanna Haughton, Sydney Kemper, Monica Koehler, Roula Antoon, Colin G Edwards, Amy Bardin","doi":"10.1016/j.ajic.2024.06.015","DOIUrl":"10.1016/j.ajic.2024.06.015","url":null,"abstract":"<p><strong>Background: </strong>Candida auris is an emerging multidrug-resistant fungus associated with catheter-related bloodstream infections. In vitro efficacy of chlorhexidine (CHX) and CHX-silver sulfadiazine-impregnated (CHX-S) antimicrobial central venous catheters (CVCs) against C auris was investigated.</p><p><strong>Methods: </strong>Minimum inhibitory and bactericidal CHX concentrations were determined against 19 C auris isolates. To assess extraluminal efficacy, segments from CVCs impregnated externally (CHX-S1) and both externally and internally (CHX-S2) were plasma-conditioned for 1- and 6-day, and to assess intraluminal efficacy, CHX-S2 CVCs were preconditioned with saline-lock for 6days, followed by 24-hour C auris inoculation and microbial adherence determination on impregnated and nonimpregnated CVCs.</p><p><strong>Results: </strong>CHX inhibited all C auris isolates with minimum inhibitory and bactericidal concentrations range of 8 to 128 μg/mL. C auris adherence was reduced on CHX-S1 and CHX-S2 extraluminally by 100% on day 1, 86.96% to 100% on day 7, and intraluminally on CHX-S2 by 56.86% to 90.52% on day 7.</p><p><strong>Discussion: </strong>CHX and CHX-S CVC performance against C auris observed in this study is consistent with antimicrobial benefits observed in prior preclinical and randomized controlled clinical studies.</p><p><strong>Conclusions: </strong>CHX showed strong inhibitory and cidal effects on C auris. CHX-S CVCs proved highly efficacious against this pathogen under in vitro conditions. Additional studies, however, are required to confirm clinical benefit.</p>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-06-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141465604","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-26DOI: 10.1016/j.ajic.2024.06.016
Kelley Knapek, Emma P Stein, Marybell Bernhardt, John Flanigan, Catherine Lazar, Sara M Reese
Central venous catheters (CVCs) have many benefits in patient care but are associated with increasing risks with catheter duration. A level II trauma-certified community hospital sought to decrease CVC duration utilizing a daily assessment algorithm in the critical care unit. After implementation, CVC days decreased from 490 CVC days per 1,000 patient days to 452 (odds ratio 0.86, P < .01) and catheter duration decreased from 7.71 days to 6.57 (P = .19).
{"title":"Using a standardized algorithm to decrease central venous catheter utilization.","authors":"Kelley Knapek, Emma P Stein, Marybell Bernhardt, John Flanigan, Catherine Lazar, Sara M Reese","doi":"10.1016/j.ajic.2024.06.016","DOIUrl":"10.1016/j.ajic.2024.06.016","url":null,"abstract":"<p><p>Central venous catheters (CVCs) have many benefits in patient care but are associated with increasing risks with catheter duration. A level II trauma-certified community hospital sought to decrease CVC duration utilizing a daily assessment algorithm in the critical care unit. After implementation, CVC days decreased from 490 CVC days per 1,000 patient days to 452 (odds ratio 0.86, P < .01) and catheter duration decreased from 7.71 days to 6.57 (P = .19).</p>","PeriodicalId":7621,"journal":{"name":"American journal of infection control","volume":null,"pages":null},"PeriodicalIF":3.8,"publicationDate":"2024-06-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141465606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2024-06-25DOI: 10.1016/j.ajic.2024.06.017
Ili Margalit, Digbijay Kunwar, Chen Gadot, Marco Meroi, Rebecca Scardellato, Amber Zamir, Anastasia Koutsolioutsou, Elad Goldberg, Elda Righi, Dafna Yahav
Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) has emerged as a significant health care-associated infection carrying substantial mortality. We assessed the clinical impact of active screening cultures for CRAB.
Methods: A systematic review and meta-analysis, aiming to answer 2 questions: (1) Does screening versus no screening improve clinical outcomes? (2) Does positive screening ("CRAB carrier") predict CRAB infections? We searched the literature until January 2024 for comparative studies reporting clinical outcomes (mortality, invasive CRAB infections).
Results: Of 5,407 screened publications, 9 studies (10,865 individuals) were included. Invasive CRAB infection rate was significantly higher among CRAB carriers (OR 11.14, 95% CI 4.95-25.05, with substantial heterogeneity stemming from size rather than direction of the effect). Negative predictive value of noncarriage for invasive infection was 97%. CRAB bloodstream infection rate was significantly higher among carriers (odds ratio 16.23, 95% confidence interval 2.9-110.08). No difference was demonstrated between the groups for CRAB ventilator-associated pneumonia, length of stay, and mortality. Only 1 study reported outcomes for study question #1.
Conclusions: Data to support active CRAB screening are scarce regarding its clinical benefit for patients. Positively screened patients are at significantly higher risk for invasive CRAB infections, with high negative predictive value for noncarriage. This did not translate to reduced mortality.
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