American journal of infection control最新文献

We conducted a retrospective study to evaluate the performance of 5 large language models in detecting surgical site infections (SSIs), compared with manual surveillance by an infection preventionist nurse. Forty abdominal surgery patients were included. Manual review achieved 100% diagnostic accuracy. All large language models demonstrated high accuracy (90%-95%) and strong agreement with manual review (κ = 0.80-0.90), with no statistically significant differences in performance (P > .05). AI-based tools may enhance the efficiency of surgical site infection surveillance.

Background: Hand hygiene is the cornerstone of infection prevention; however, many health care institutions struggle to achieve consistently high health care personnel (HCP) compliance. Engaging patients/visitors in hand hygiene interventions is an important strategy to improve accountability and compliance.

Methods: We piloted a program enabling patients/visitors to audit HCP hand hygiene practices across 3 acute care hospitals and a pediatric/adolescent behavioral health hospital. An initial pilot ran from August 2024 to January 2025 in 1 outpatient clinic and 5 inpatient units across 4 hospitals before being expanded to all inpatient units and select on-site outpatient areas across these hospitals. Patient/visitor participants submitted anonymous audits via QR code or paper forms, documenting HCP hand hygiene and comfort prompting staff to perform hand hygiene.

Results: Participants completed 360 hand hygiene audits, with observed HCP compliance of 86% (286/326), aligning with staff-reported compliance of 88% (126,653/144,214). HCP compliance observed by patients/visitors varied by hospital (77%-97%). 78% (254/324) of participants reported feeling comfortable prompting HCP to perform hand hygiene. Discomfort was associated with lower observed compliance across all sites.

Conclusions: Patient and visitor auditing of HCP hand hygiene is feasible, acceptable, and may enhance accountability, representing a scalable, patient-centered adjunct to traditional compliance programs.

Background: To estimate the global prevalence of carbapenem-resistant Enterobacteriaceae (CRE) colonization and identify study-level factors associated with variation in reported rates.

Methods: We conducted a systematic review and meta-analysis. Data were extracted on study characteristics, diagnostic methods, CRE species, carbapenemase genes, and risk factor analysis. Pooled prevalence was calculated using a random-effects model. Subgroup analyses and meta-regression were conducted to explore sources of heterogeneity.

Results: Across 89 studies (116,743 participants), pooled CRE colonization prevalence was 14% (95% CI: 11%-18%; I² = 99.96%), peaking at 33% in 2017 and declining to 8% in 2023. Vietnam had the highest (43%), US had the lowest (5%). Hospital-based (18%) and universal screening (20%) yielded higher prevalence than community-based (3%) and targeted/systematic sampling (3%-15%). Hospital setting was the only significant predictor of higher prevalence (coefficient = 0.14; P = .009). Klebsiella pneumoniae (52.8%) and Escherichia coli (44.9%) were the most common organisms; NDM (45.6%) and OXA-type (36.3%) were predominant carbapenemase genes.

Conclusions: CRE colonization remains a global concern, particularly in health care settings with screening protocols. Geographic and methodological variability underscores the need for standardized surveillance and targeted control strategies. Molecular surveillance is essential to monitor resistance determinants evolution.

Background: While screening-automated surveillance systems (SASS) for surgical site infections (SSIs) are widely used in high-resource settings, adoption remains limited in low- and middle-income countries, including Thailand. This study aimed to develop and validate an automated surveillance model tailored to the Thai health care context. Routine SSI surveillance following coronary artery bypass graft surgery in Thailand relies on direct method surveillance systems (DMSS), which are labor-intensive and require manual record review.

Methods: A retrospective validation study was conducted at a tertiary care hospital performing ∼120 coronary artery bypass graft procedures annually. Data from January 2020 to April 2022, when both DMSS and SASS were active, were analyzed to assess diagnostic performance and workload reduction.

Results: Among 4 algorithms tested, the "Possible SSI Surveillance Code" algorithm achieved 100% sensitivity (95% CI: 78.47-100), 91.69% specificity (95% CI: 88.18-94.23), a positive predictive value of 34.15% (95% CI: 21.56-49.45), and a negative predictive value of 100% (95% CI: 98.27-100). It also reduced manual workload by 87.91%.

Conclusions: SASS demonstrated high diagnostic accuracy and substantial workload reduction compared to DMSS. The selected algorithm provides a scalable model for enhancing SSI surveillance in low- and middle-income country settings and advancing digital health transformation.

Background: Home health care (HHC) patients face elevated infection risks, yet adherence to infection prevention and control (IPC) practices by patients and caregivers remains understudied. This study assessed IPC-related knowledge, attitudes and practices in this population.

Methods: Surveys were administered to HHC patients at high/very high infection risk or their family caregivers from two large Medicare-certified HHC agencies in New York State.

Results: Among 250 respondents (132 HHC patients, 118 caregivers), participants demonstrated adequate IPC knowledge (mean proportion = 0.77), attitudes (mean proportion = 0.88), and adherence (mean proportion = 0.79). However, handwashing knowledge needed improvement (mean proportion = 0.63). Regression analyses showed higher IPC knowledge and more favorable attitudes predicted better IPC practice adherence.

Discussion: Unlike prior research among HHC nurses where only attitudes predicted practices, both knowledge and attitudes were associated with adherence among patients and caregivers.

Conclusions: Interventions should enhance IPC knowledge, particularly proper handwashing, and emphasizing infection prevention importance to improve adherence among HHC patients and caregivers, especially older populations.

Background: Health care professionals face a heightened risk of occupational infections, with procedures such as bronchoscopy further increasing this risk by generating aerosols containing diverse microorganisms. This study quantified bioaerosol concentrations during bronchoscopy to evaluate occupational exposure.

Methods: Aerosol samples were collected during routine bronchoscopies in 2 hospitals using personal samplers with quartz filters attached to health care professional's clothing. Samples were cultured on various media, with bacterial colonies identified by 16S rDNA sequencing and fungal colonies by ITS1-2 region sequencing. Respiratory viruses (SARS-CoV-2, influenza A/B, RSV) were detected via RT-PCR.

Results: A total of 44 aerosol samples were collected: 7 pre-procedure, 32 during bronchoscopy, and 5 between patients. From samples taken during bronchoscopies, 287 microbial colonies were isolated. The most abundant bacterial genera were Micrococcus, Staphylococcus, and Bacillus, while fungal genera included Aspergillus, Talaromyces and Cladosporium. Several potentially pathogenic species were identified, such as Staphylococcus aureus, Kocuria rosea, and Kroppenstedtia pulmonis, as well as some pathogenic fungi. A total of 8 previously unsuspected SARS-CoV-2 positive samples were also detected. Our estimates suggest that an interventionalist, without protective equipment, could be exposed to approximately 98.94 CFU/m³ during a typical procedure.

Conclusions: Bronchoscopy generates aerosols containing microorganisms from the oral, nasal, and pulmonary microbiota, as well as potential pathogens. These aerosols can be inhaled by health care workers, representing a risk of occupational infection.

Background: Pandemics pose extraordinary challenges to health care systems. Breakdowns in infection prevention and control measures during such crises can significantly compromise patient outcomes and facilitate the spread of resistant pathogens. This study aimed to describe the characteristics and impact of bacterial and fungal hospital outbreaks during the COVID-19 pandemic.

Methods: This systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines and were registered in PROSPERO (CRD42025648727).

Results: A total of 619 outbreak-related cases were identified (62.9% male; age range: 21-101) in 25 studies. Acinetobacter baumannii was the most frequently reported (n = 320) pathogen with the highest mortality rate (59%), followed by Candida auris (n = 188, 52% mortality). Two-thirds of outbreaks (66.66%) with reported resistance data had all strains multidrug-resistant. Health care worker-related factors, such as a lack of personnel, insufficient training, and increased workload, were mainly cited as contributors to secondary hospital outbreaks. The maintenance of environmental cleaning and disinfection was often prioritized over hand hygiene.

Conclusions: To prevent secondary hospital outbreaks of multidrug-resistant in the future, infection prevention and control programs should be strengthened with increased staff awareness, sustainable environmental hygiene, and antimicrobial stewardship interventions. These findings should be incorporated into pandemic preparedness frameworks and implemented through multidisciplinary audits to ensure sustainability.

Background: Considering the isolation of infected patients and the proportion of critically ill individuals requiring single-room management is crucial when implementing public health measures during nosocomial outbreaks such as coronavirus disease-2019. Using a mathematical model, we aimed to assess the level of hospital occupancy restriction required for the adequate isolation of infected and exposed patients while providing for critically ill patients requiring single-room management.

Methods: Patients were categorized into four groups: susceptible, exposed, infected, and recovered. We modeled a hospital ward with mixed room types, incorporating critically ill patients and sporadic unidentified infections, to evaluate isolation feasibility through simulations.

Results: Simulation results showed that patient isolation became difficult under high-occupancy conditions. The feasibility was also affected by infection control strategies, such as discharging infected or exposed patients and isolating exposed individuals in single rooms.

Discussion: Higher occupancy increases the risk of failed isolation measures, potentially promoting in-hospital transmission. However, this model does not incorporate long-distance airborne transmission or the effects of ventilation, and coronavirus disease-2019 can spread via aerosols.

Conclusions: This model could be a valuable reference for determining appropriate hospital occupancy rates to ensure effective infection control during nosocomial outbreaks.

Objectives: Candidozyma auris (C auris) is a multidrug-resistant fungal pathogen of increasing global concern. We describe the development and validation of an active surveillance program for patients at high risk of C auris colonization in the setting of regionally reported cases of invasive infection.

Methods: From 2021 to 2024, 1,146 surveillance tests were obtained using the BD ESwab collection system. Surveillance testing was performed on the BD MAX PCR platform.

Results: Of 1,146 specimens tested over a 3-year period, only four surveillance tests were positive. Individuals with positive surveillance tests were isolated, and contact tracing of potentially exposures revealed no secondary cases.

Conclusions: This report demonstrates the importance of establishing hyperlocal epidemiology and robust infection prevention practices when determining the prevalence of and responding to emerging pathogens.

Infectious complications are rare after transperineal prostate biopsy, and antibiotic prophylaxis may not be needed for most procedures. We report a case of Staphylococcus epidermidis urinary tract infection and bacteremia after transperineal prostate biopsy. This case highlights the importance of infection control interventions to ensure effective skin preparation prior to transperineal prostate biopsy procedures.