Healthcare infection最新文献

Background

The ability of doctors to ‘speak up’ when a medical error occurs is a cornerstone of patient safety. Hand hygiene (HH) is one of the simplest methods of reducing patient harm and represents a behavioural model in which to observe medical staff interaction. Our hypothesis is that the hierarchical structure amongst doctors prevents them from speaking up, which in turn contributes to poor HH compliance.

Methods

Ananonymous survey was administered to doctors employed in a health service in Melbourne, Australia. Questions included: willingness to prompt doctors to perform HH, reasons for not speaking up, perceived reactions of a doctor being prompted to perform HH and perceived reaction if they were asked to perform HH.

Results

One hundred and sixty-three doctors completed the questionnaire. Willingness to prompt a doctor to perform HH decreased as the questioned doctor's seniority increased, with 88.5% willing to ask an intern but only 40.4% willing to ask a consultant. The main reason for not asking a senior doctor was not wanting to speak up to a superior.

Conclusions

Our study highlights a steep medical hierarchy, with less than half of the doctors willing to question seniors, even when they noticed an error occurring.Wesuggest that if acquired, the skills needed to respectfully prompt HH are transferrable to many other patient safety initiatives.

Background

Most of the world's bacteria live in biofilms, three-dimensional clusters attached to surfaces.Manyhospital-acquired infections are associated with biofilm infections of implantable medical devices such as orthopaedic prostheses and intravascular catheters. Within biofilms, bacteria are significantly less susceptible to antibiotics and host defences, making biofilm infections difficult to diagnose and treat, and often necessitating removal of the infected implant.

Method

In this review article we describe the process of biofilm formation, quorum sensing, and biofilm infection of the healthcare environment, surgical instruments and implantable medical devices.

Conclusion

The inability to treat biofilm-infected devices means that therapies targeting biofilm-specific processes and targeting prevention of biofilm formation are required.

There are enormous challenges facing infection control in the 21st century. Countries across the world are confronted by ageing populations, restricted healthcare resources, demands for modern medicine and increasing antimicrobial resistance. Problempathogens in the community are set to invade hospitals, and those created in hospitals are seeding into the community. Continued consumption of antimicrobial agents is generating and consolidating resistance to nearly all classes of drugs. New resistance mechanisms arising in one locality rapidly spread across the ‘global village’ courtesy of migration, conflict and international travel. We are facing unprecedented threats to the management of infection both in healthcare and communities across the world. This review summarises the current challenges for infection control and proposes a range of solutions encompassing novel strategies and technologies aimed at protecting us against untreatable infection.

Background

Environmental cleaning and disinfection is well known as an essential part of preventing hospital-acquired infections. We describe the observation of two outbreaks of nosocomial infections with different pathogens in a tertiary care teaching hospital in Germany. Cleaning and disinfection procedures were essential measures to stop the outbreaks.

Methods

We used a standardised procedure for dealing with the outbreaks. One of the most important measures was a change in the cleaning and disinfection process which was conducted by staff with special training in disinfection. After disposal of all single-use materials, a scrub-wipe disinfection processwith high concentrations (3%) of an oxygen radical-producing substance was performed in the affected rooms, followed by nebulisation with the same product (3%). Finally, the room was cleaned again with another scrub-wipe process at routine concentration (0.5%).

Results

After changing the routine cleaning and disinfection procedure (twice daily with a 0.5% concentration of a radical-producing substance performed by housekeeping) to a 3-step cleaning process using a higher concentration (3%) of the substance performed by workers specially trained in disinfection, the outbreaks stopped.

Conclusion

In combination with a multidisciplinary coordination team and training, the cleaning and disinfection process was one of the most important steps in stopping outbreaks of nosocomial infections.

Contamination of the surface environment in hospital rooms plays an important role in the transmission of several key healthcare-associated pathogens including Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), Acinetobacter spp. and norovirus. Clostridium difficile is especially important as it is now the most common healthcare-associated pathogen in the United States. It may cause serious disease, especially in older individuals, it may survive for long periods of time in the environment and it is relatively resistant to many commonly used antiseptics and disinfectants.

Evidence that the contaminated surface environment is important in the transmission of C. difficile includes the following: (1) environmental contamination is frequent in the rooms of patients with C. difficile infection (CDI), (2) the hands/gloves of healthcare personnel are as likely to become contaminated from contact with the environment as from direct contact with the patient, (3) the higher the frequency of environmental contamination, the more frequent the contamination of the hands/gloves of healthcare providers, (4) patients admitted to a room previously occupied by a patient with CDI have an increased risk of developing C. difficile infection, and (5) improved cleaning/disinfection of the environment has led to a decrease in the incidence of C. difficile transmission.

Key measures to prevent C. difficile transmission and infection include antibiotic stewardship (minimising antibiotic use), placing patients with CDI on contact precautions, and proper cleaning and disinfection of the surfaces in hospital rooms daily and at discharge using a sporicidal disinfectant or a ‘no-touch’ method (e.g. ultraviolet light).

Background

The environment has increasingly been shown to be involved in transmission of healthcare-associated infections, but data on environmental cleanliness assessment are relatively sparse.

Method

Environmental samples were collected from 18 high touch surfaces in 10 different acute care hospital rooms before cleaning to provide data on the rank order of cleanliness by site using both adenosine triphosphate (ATP) detection and quantitative microbiology. In addition, pre-and post-cleaning pooled samples of surfaces from 10 rooms were analysed by culture and sensitivity analysis to detect organisms of concern in the hospital.

Results

Four surfaces were ranked in the top six for contamination by both ATP and culture detection (bedrail control panel, nurse call light, patient phone, and bedrail). Additionally, the top three areas for cleanliness were identical between the two methods (main light switch, mattress, and bathroom interior door handle). Overall, quantitative microbiology andATPanalysisshowed directional agreement in assessment of environmental cleanliness with higher ATP readings found on surfaces designated as ‘dirty’ by quantitative microbiology. Several organisms of concern for hospital infection control were seldomdetected in the pre-cleaning environmental samples, and not at all in the post-cleaning samples.

Conclusions

In this study environmental bioburden decreased after cleaning, and few hazardous nosocomial organisms were noted. Although quantitative microbiology and ATP detection measure somewhat different aspects of environmental contamination, they both generally agree in distinguishing clean from dirty surfaces.