Healthcare infection最新文献

Background

Healthcare Infection, the official publication of the Australasian College for Infection Prevention Control, is an international, peer-reviewed journal. This paper presents an analysis of the publication scholarship trends of articles published within Healthcare Infection, providing insight into future publication trends.

Methods

A cross-sectional study design was used to explore published articles over a 12-year period, between 2002 and 2015. A content analysis was performed to examine the key thematic characteristics of all published articles. Citation data from articles published between 2011 and 2015 were extracted from Scopus.

Results

A total of 345 articles were published in Healthcare Infection during this time. The topics and content of the publications varied considerably. Approximately half the published articles were original research of which the majority were low level evidence. Other articles comprised discussion papers, review articles and editorials.

Conclusion

In recent years, there has been an increase in international collaborations and diversification of topics published, including urinary tract infection, sharps injuries, health economics, and antibiotic resistance and stewardship.

Introduction

A standardised approach to evaluating environmental cleanliness is important to ensure consistency of assessor training, allow benchmarking of results between facilities, ensure consistency of the assessment of the environment and assist in meeting national accreditation standards. This paper describes the development process and the findings of the first 12 months of data following the introduction of a standardised program for evaluating environmental cleanliness within Tasmanian healthcare facilities using two different evaluation methods.

Methods

Evaluation of environmental cleanliness was undertaken as part of a structured program and involved the use of an ultraviolet solution and fluorescent light in addition to a visual assessment. Twelve Tasmanian hospitals participated in this study.

Results

A total of 290 fluorescent light assessments and 232 visual inspections were conducted. Using the fluorescent light assessment, the percentage of correctly cleaned items increased from a baseline of 82.3% to 85.4% overthe 12-month study period. Using the visual assessment, 92.5% ofitems were deemed acceptable during the study period.

Conclusions

Our multi-centred study identified a high baseline level of cleanliness using a fluorescent light. We identified that objects were frequently deemed to be visually acceptable, yet may not have been cleaned. The project was supported by a range of online tools for data submission, training tools and a formal assessment of auditors.

Introduction

We report a retrospective case-control series of a vancomycin-resistant Enterococcus faecium (VRE) bacteraemia outbreak at a tertiary metropolitan hospital in Queensland, Australia. The outbreak occurred on a haematology ward between 8 and 14 February 2014, 6 weeks after a ward relocation. The aim was to determine risk factors related to progression from colonisation with VRE to bacteraemia.

Methods

The cases were patients with haematological malignancy and proven catheter-related VRE bacteraemia. Matched controls were selected from the same ward with similar underlying haematological diagnoses and proven gastrointestinal VRE colonisation without invasive infection.

Results

This study suggests that female sex, recent administration of total parenteral nutrition, right-sided catheter placement with odds ratios (OR) 1.99, gastrointestinal disruption (OR: 1.91), and dexamethasone administration (OR: 2.37) are potential risk factors for progression from colonisation to infection. Notably, given the small sample size, the 95% confidence intervals are wide ranging from 0.02 to 222.

Conclusion

While progression from colonisation with VRE to invasive disease is likely to be a complex multifactorial process, the results of this study suggest certain clinical variables that warrant enhanced vigilance to reduce this occurrence. Interestingly, recent relocation of the haematology ward may play a significant role in this outbreak. This study highlights the importance of good infection control practice and the need for additional studies to further delineate risk factors for invasive VRE infection.

Objective

To examine microorganisms and their antibiotic susceptibility from corneal specimens for community-acquired microbial keratitis at the Royal Victorian Eye and Ear Hospital.

Methods

A retrospective review of microbiological results from January to April 2014 was undertaken. Patients’ medical records were identified from the hospital's dispensing records of ofloxacin eye drops. Corresponding microbiology results from corneal specimens (species of isolated organisms and antibiotic susceptibilities) were recorded.

Results

There were 164 patients included in the study, of which 85 cultured positive, typical for corneal specimens. Of these, 75% were Gram-positive bacteria, 16% Gram-negative and 2% fungi. The commonest organisms were Staphylococcus sp. (46%) and Streptococcus sp. (10%). Of the 76 cases where fluoroquinolone susceptibility was tested, five (6.6%) demonstrated antibiotic resistance (minimal inhibitory concentration≥4.0 μg/mL), significantly higher than the 0% reported in 2000 (P = 0.002). All Staphylococcus isolates resistant to ciprofloxacin were resistant to cefazolin but susceptible to vancomycin. In ciprofloxacin-resistant isolates of streptococci, susceptibility to cefazolin and vancomycin was observed.

Conclusions

Most organisms identified on corneal specimens were Gram-positive. Susceptibility to fluoroquinolones was still high, although a trend for increasing ciprofloxacin resistance was noted. Further investigation is necessary to investigate if this reflects a wider antibiotic resistance prevalent within the community.

Introduction

Sri Lanka is a moderate burden middle-income setting where healthcare workers (HCWs) are not routinely screened for TB infection, even in moderate to high transmission risk settings. This study evaluated the use of a commercial interferon gamma release assay (IGRA) in HCW screening in comparison to the tuberculin skin test (TST) in a regional chest clinic.

Methods

HCWs (n = 39) serving at the study clinic, where over 500 TB patients are registered and treated every year, were screened for LTBI with both the TST and an IGRA. Factors associated with positive test results as well as agreement between the two tests were evaluated.

Results

47.2% of HCWs screened were TST positive (10mmcut-off) and positivity was associated with working in poorly ventilated areas (P = 0.019, OR 5.133 (95% CI 1.23 – 21.35)), although not associated with working in the sputum laboratory or TB treatment room, age or gender. IGRA positivity was significantly lower, 15.7%(P = 0.003). Positivity was associated with male gender (P = 0.046) and a shorter duration of service at the chest clinic (P = 0.036), though it was not associated with work in risk areas. Agreement between tests (TST 10mm cut-off) was fair with a kappa of 0.30 (P = 0.013). Positive IGRA results were seen only in TST-positive subjects who had a TST reading of >15mm.

Conclusions

Occupational and non-occupational factors associated with TST and IGRA positivity differed between tests. Short duration of service was associated with IGRA positivity. The IGRA showed no advantage over the TST as a test for LTBI in this setting.

Antimicrobial prescribing practices are influenced by many factors, including culture and societal norms. Sociological researchers have previously proposed dimensions by which cultures may be defined. We sought to examine the association between cultural dimensions and the proportion of surgical prophylaxis inappropriately continued for longer than 24 h (PAP >24) by evaluating published European Centre for Disease Prevention and Control point-prevalence data from European countries. A negative correlation between individualism and PAP >24 was evident, whereas power distance and PAP >24 were positively correlated. A positive correlation was also observed between uncertainty avoidance and PAP >24. Findings imply that prolonged surgical antibiotic prophylaxis is associated with collectivism viz. a preference for a tight-knit societal framework. The impact of societal and cultural factors on antimicrobial prescribing has not been thoroughly evaluated in Australia, and these potential influences require further consideration in formulating targeted interventions for improved prescribing practices.

Introduction

While there is literature on the implementation and efficacy of antimicrobial stewardship (AMS) programs in the public hospital setting, there is little concerning their implementation in the private hospital setting. Resources to guide the implementation of such programs often fail to take into consideration the resource limitations and cultural barriers faced by private hospitals. In this paper we discuss the main obstacles encountered when implementing an AMS program at a private hospital and methods that were used to overcome them.

Methods

In 2012, St Vincent's Private Hospital Melbourne implemented an AMS program that was tailored to suit the requirements and limitations faced by private hospitals. Baseline data was collected to determine areas of priority. Cultural barriers were overcome by forming relationships between AMS and non-AMS personnel, involving key clinical stakeholders when developing hospital policies, and having ample support from hospital executives. We also modified our approach to conventional AMS interventions so that typically resource-intensive projects could be carried out with minimal resources, such as the restriction of antimicrobials via a two-stage post-prescription review model.

Results

Through our AMS program, we have been able to implement multiple initiatives including a formulary restriction, significantly reduce aminoglycoside use, develop hospital guidelines and regularly contribute data to national surveillance programs.

Conclusion

While there are guidelines available to help develop an AMS program, these guidelines need to be adapted to suit different hospital settings. Private hospitals present a unique challenge in the implementation of AMS programs. Identifying and addressing barriers specific to an individual institution is vital.

Background

As of 2012, a downward trend in infection rates for hospital onset of both Clostridium difficile infections and methicillin-resistant Staphylococcus aureus bloodstream infections (2% and 4% decrease respectively) has been noted. Despite the success with these two organisms, several infectious pathogens in the healthcare setting have not decreased. This lack of downward trend highlights the importance of continuing to find and assess rapid detection methods to help confirm that hospital cleaning efforts meet and exceed standards of cleanliness demonstrated to reduce numbers of healthcare- associated infections (HAIs) of these pathogens.

Methods

This study set out to determine the effectiveness of the swab 3M™ Clean-Trace™ Adenosine Triphosphate (ATP) System over time by comparing the ATP measurements of the culturable organisms to the corresponding quantitative microbiology. The organisms evaluated included: Acinetobacter baumannii, Bacillus anthracis Sterne endospores and vegetative cells, Candida albicans, Clostridium difficile, Escherichia coli, Enterococcus faecalis, methicillin-resistant Staphylococcus aureus and Mycobacterium smegmatis.

Results

A combined organisms analysis did not demonstrate a significant reduction in measured ATP levels over the course of the organisms’ exposures in a controlled environment. The quantitative microbiology did, however, demonstrate a large initial organism die-off within the first 60 min (P < 0.001) of controlled environmental exposure, although the trend did not continue over the remaining 3 h of observation. The live versus dead experimental design yielded 100% microbial kill and a one log reduction (P < 0.019) between pre-exposure and post-exposure ATP measurements.

Conclusions

This study did not demonstrate a significant effect of time in reducing ATP measures over the time periods evaluated. ATP measurements were approximately the same, regardless of the initial organism die-off. Additionally, the live versus dead analysis confirms that ATP bioluminescence is not sensitive enough to distinguish between viable organisms and organic debris remnants on sterilised equipment.