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.

Background: Health care workers' suboptimal influenza vaccination rates persist globally despite occupational risks. This study examines how vaccine literacy dimensions influence their vaccination and recommendation behaviors.

Methods: A cross-sectional survey assessed vaccine literacy (fundamental knowledge, core belief, behavioral competency) among 1,725 Chinese health care workers. Multivariate logistic regression analyzed associations with influenza vaccination willingness and recommendation to others.

Results: Only 34.09% exhibited behavioral competency literacy, revealing a knowledge-belief-practice gap. Core belief literacy predicted vaccination willingness (odds ratio [OR] = 2.12, 95%CI: 1.70-2.64) and recommendation (OR = 3.43, 95%CI: 2.54-4.62). Behavioral competency literacy also increased vaccination willingness (OR = 2.30, 95%CI: 1.81-2.93).

Discussion: Core belief is the critical driver bridging knowledge and practice. Nurses showed significantly lower literacy than physicians (OR = 1.35, 95%CI: 1.08-1.70), warranting targeted interventions.

Conclusions: Addressing the "knowledge-belief-practice dissociation" through belief-focused strategies---not merely knowledge dissemination---is essential to improve influenza vaccine uptake among health care workers.

Background: This study was investigating bacterial contamination, particularly Legionella pneumophila and multidrug-resistant Pseudomonas aeruginosa, in outlet water of stationary and portable reverse osmosis (RO) systems used in hemodialysis. Antibiotic resistance, and biofilm-related risks were compared to assess their implications for infection control in clinical settings.

Methods: This study was performed across 3 leading hospital hemodialysis units in Yazd City. Water samples were analyzed for the presence of Staphylococcus aureus, P aeruginosa, L pneumophila, and heterotrophic plate count bacteria.

Results: The output water from 36.11% of RO systems tested positive for L pneumophila, while 15.28% contained P aeruginosa and 6.94% contained heterotrophic bacteria. Portable RO systems showed significantly higher contamination levels of Legionella and heterotrophic bacteria compared to stationary units (P-value = .002). Antibiotic susceptibility testing demonstrated concerning resistance patterns among P aeruginosa isolates: 72.73% were resistant to piperacillin, 63.64% to piperacillin-tazobactam, and 45.46% to imipenem. Notably, 52.2% of isolates exhibited multidrug-resistant profiles.

Conclusions: Portable RO systems demonstrated significantly greater Legionella contamination than stationary units, likely due to biofilm formation. This poses serious infection risks for hemodialysis patients, potentially leading to extended hospitalizations and increased mortality. Mandatory quarterly microbiological monitoring and biofilm-targeted disinfection protocols are recommended for portable systems.

Background: Hospital-acquired pneumonia (HAP) remains a common health care-associated infection worldwide. Understanding risk factors for nonventilated HAP (NVHAP) in postoperative patients is crucial for targeted prevention strategies.

Methods: A retrospective case-control study was conducted from April 2022 to April 2023 in a surgical ward of a university hospital. Cases included patients aged ≥ 18 years diagnosed with NVHAP. Controls were selected based on the closest hospitalization date, matched by sex, age, and surgery type (2 controls per case). Data on patient demographics, surgical procedures, and clinical factors were collected and analyzed.

Results: Out of 1,739 hospitalized patients, 10 developed NVHAP, resulting in a sample of 30 individuals (mean age 63.27 years). Exploratory laparotomy was the most common surgery. Multivariate analysis identified vomiting as the only independent risk factor (P < .001), significantly associated with HAP occurrence.

Discussion: Vomiting was significantly linked to NVHAP, suggesting that management of nausea and vomiting could reduce the risk of bronchopulmonary aspiration and subsequent pneumonia in postoperative patients.

Conclusions: Implementing protocols for early detection and control of nausea and vomiting in surgical patients may decrease NVHAP incidence, emphasizing the need for preventive strategies targeting aspiration risk.

Background: Few studies describe quantitative thresholds for daily device review that attempt to drive a decrease in device utilization (DU) for central venous catheter devices. Increased DU in the period spanning March 2020 through December 2021 paralleled an increased incidence of central line-associated bloodstream infections (CLABSI) within a Medical Surgical Intensive Care Unit (ICU) of an acute care hospital. An intervention tool was developed to foster targeted discussions around DU to ultimately reduce the risk of CLABSI.

Methods: An evidence-based performance improvement initiative was implemented in March 2022 which included the deployment of an ICU Rounding Checklist tool to drive ICU intensivist signature sign-off of standardized device indications in collaboration with ICU nurses.

Results: Significantly fewer central venous catheters were present in ICU patients following implementation of the intervention, χ²(1) = 7.06, P < .01. Concurrently, zero CLABSI events were encountered during the 32-month intervention evaluation period.

Conclusions: In addition to evidence-based bundle compliance elements and leadership visibility of device de-escalation opportunities, hospitals should optimize methods to encourage collaborative discussions between nurses and physicians to impact central venous catheter utilization, reducing the risk of CLABSIs.

Background: During the COVID-19 pandemic, hospitals in South Korea operated various types of negative pressure isolation units (NPIUs), ranging from makeshift conversions to purpose-built wards. While vaccination and personal protective equipment were essential in reducing occupational exposure, the impact of physical infrastructure on the safety of health care workers remains underexplored. This study examined whether nurses' infection risk varied by the level of isolation ward infrastructure.

Methods: Infection data were collected from a public hospital between February 2022 and June 2023. Four ward types were evaluated: general wards and 3 government-classified NPIUs, each differing in infection control infrastructure. Infection rates per 1,000 nurse-days were calculated. Differences across ward types were analyzed using negative binomial regression, post-hoc comparisons, and permutation tests accounting for temporal overlap.

Results: A facility-level gradient in infection risk was observed. The highest rate occurred in a minimally converted unit (21.62), followed by a partially remodeled unit (5.14). A purpose-built NPIU maintained a low infection rate (1.30), comparable to that of the general ward (0.97).

Conclusions: The risk of nurse infection was associated with the level of integrated infection control infrastructure. Purpose-built systems substantially reduced occupational exposure.