American journal of infection control最新文献

Infection prevention observations in clinic and procedure areas is a growing area of interest and concern. Infection prevention guidance for observations in an in vitro fertilization clinic are challenging. This is related to care of the mom and the embryo. This article introduces an in vitro fertilization clinic and areas of consideration when performing an observation of best practices.

Background: The rate of antibiotic treatment for catheter-associated asymptomatic bacteriuria (CA-ASB) remains high.

Methods: We conducted a retrospective study involving hospitalized patients with multidrug-resistant Pseudomonas aeruginosa (MDRP) CA-ASB. Cox proportional hazards regression models were used to identify predictors for subsequent symptomatic infections in patients with MDRP CA-ASB. The probability of remaining free from symptomatic infection was analyzed using Kaplan-Meier curves.

Results: The study cohort comprised 139 patients with MDRP CA-ASB. Subsequent symptomatic MDRP infections were observed in 37 (26.6%) patients. Multivariate analysis revealed that underlying urologic diseases (hazard ratio [HR]=2.17, 95% confidence interval [CI]=1.01-4.66, P=.047), active antibiotic treatment for MDRP (HR=2.34, 95% CI=1.02-5.38, P=.046), and recurrent bacteriuria (HR=3.57, 95% CI=1.73-7.38, P=.001) were independent predictors for subsequent symptomatic infections. The Kaplan-Meier analysis demonstrated a significantly lower cumulative proportion of symptomatic infection-free patients among those receiving active antibiotic therapy for MDRP CA-ASB than among those who did not (41.7% vs 76.4%, P=.006, log-rank test).

Conclusions: These findings support the current guidelines against routine antibiotic therapy, even for MDRP CA-ASB, and emphasize the need for close monitoring and timely intervention in high-risk populations.

Antimicrobial resistance and other emerging health care complexities continue to challenge infection prevention and control resources. The Veterans Health Administration developed a comprehensive prevention approach to address multidrug-resistant organisms (MDROs), including a unique staffing model to complement infection preventionists. In particular, the MDRO Prevention Coordinator was established to support MDRO prevention initiatives. Alternative staffing models, including to support pathogen-specific needs in an era of antimicrobial resistance, are vital for adaptable and sustainable infection prevention and control programs.

Background: Health care-associated infections (HAIs) contribute to patient morbidity and mortality. Hand hygiene is essential for preventing HAIs, but training can fail to transfer to clinical practice. Experiential learning through virtual reality (VR) may improve adherence by offering realistic practice opportunities and feedback.

Methods: We developed and evaluated a VR-based training program that uses the World Health Organization's (WHO) "My Five Moments for Hand Hygiene" framework to provide feedback about pathogen transmission and hand hygiene adherence in 4 clinical scenarios. Sixty-eight registered nurses from 4 hospitals in the United States completed the VR training program. Using the Theory of Planned Behavior, we assessed behavioral determinants (intention, attitudes, subjective norms, and perceived behavioral control [self-efficacy]) of hand hygiene adherence pre-, midway, and post training. We also measured overall adherence to the Five Moments in each scenario.

Results: From the beginning to the end of the training program, self-efficacy scores and overall hand hygiene adherence in VR increased linearly by 11% (P=.02) and 68% (P<.001), respectively.

Conclusions: Our findings support VR as an educational tool for enhancing hand hygiene practices of health care workers. Future research should assess the transfer of training to clinical settings and its impact on real-world adherence and HAIs.

We report the management of a New Delhi metallo-β-lactamase-producing Klebsiella pneumoniae outbreak in a surgical intensive care unit over 1 year. New Delhi metallo-β-lactamase-producing Enterobacterales were isolated from sink traps. The installation of new sink traps closed the outbreak. Environmental reservoirs should be considered for any persistent carbapenemase-producing Enterobacterales outbreak.

Background: Personal protective equipment doffing protocols can reduce risks of pathogen self-contamination. Powered air-purifying respirators may increase these risks. This study compares viral contamination and errors during simulated doffing of single-layer versus double-layer hood powered air-purifying respirators.

Methods: Eight participants performed 2 simulations (video recorded for failure modes [FMs] and effects analysis): 1 single-layer hood (laid over Tyvek suit) and 1 double-layer hood (top laid over and bottom tucked into suit). Hoods were contaminated with viruses. After doffing, inner gloves, face, hands, and scrubs were sampled.

Results: Virus contaminated at least 1 site in 6/8 single- and 5/8 double-layer simulations. Virus-contaminated inner gloves in single- (6 participants, median 5.42 × 10⁴ plaque-forming units) and double-layer (2 participants, median 7.23 × 10² plaque-forming units) simulations, and hands of 2 participants in single-layer simulations. Single-layer doffing had 13 FMs; double had 31.

Discussion: Double-layer doffing reduced inner glove contamination. The double-layer protocol may reduce glove-face shield contact but allow more opportunities for error. Double-layer doffing errors may less frequently lead to contamination than single layer.

Conclusions: Contamination and FMs may differ between double- and single-layer doffing. Although inner glove contamination was reduced, double-layer doffing may need redesign to reduce FMs and contamination.

Background: Health care-associated infections pose a significant global challenge, highlighting the need for enhanced knowledge and practices among health care professionals. This study investigates the impact of clinical observations on nursing students' compliance with standard precautions.

Methods: Employing a cross-sectional descriptive design, the study surveyed 405 nursing students using a "Personal Information Form," the "Nurses' Observations on Infection Control and Prevention Questionnaire," the "Standard Precautions Scale," and the "Factors Affecting Compliance with Standard Precautions Scale."

Results: The mean scores for the Nurses' Observations on Infection Control and Prevention Questionnaire, the Standard Precautions Scale, and the Factors Affecting Compliance with Standard Precautions Scale were 33.39 ± 12.98, 10.93 ± 4.79, and 53.38 ± 10.35, respectively. A significant negative correlation was found between students' observations on infection control and their compliance with standard precautions (r = -0.254, P < .01), with their observations explaining only 6% of the variance in compliance.

Discussion: The findings suggest that the influence of nursing students' observations during clinical practice on their compliance to standard precautions is minimal.

Conclusions: This study highlights the necessity of developing more effective strategies to improve nursing students' compliance to standard precautions, extending beyond observational learning alone.

Background: The study aimed at developing and validating a bilingual competency self-assessment tool for infection prevention and control practitioners based on the core competencies proposed by the World Health Organization.

Methods: The study was conducted from December 2021 to June 2023. The bilingual tool (Brazilian Portuguese and English versions) was developed according to 4 stages: (1) conceptual framework establishment and item generation; (2) content validity; (3) response process validity; and (4) internal structure validity.

Results: The Brazilian Portuguese version of the tool was organized into 5 areas, 36 items, and a Cronbach's alpha coefficient between 0.89 and 0.97; the English version of the tool was organized into 5 areas, 37 items, and a Cronbach's alpha coefficient between 0.91 and 0.98.

Discussion: The bilingual tool gathers evidence of content validity and internal structure validity.

Conclusions: The current evidence suggests that these are the first self-assessment tools that have utilized the core competencies proposed by the World Health Organization as a conceptual basis. Such tools can be applied in countries of all income classifications, which makes it possible to design educational initiatives and enhance core competencies.