Infection, disease & health最新文献

Background: Healthcare-associated infections pose a significant global health challenge. While evidence-based infection prevention and control (IPC) interventions are widely implemented, their implementation may be influenced by religious factors. This scoping review aimed to examine the religious factors that influence IPC practices among healthcare providers.

Method: A systematic search was conducted in CINAHL, Emcare, Scopus, and Web of Science databases. Given the anticipated paucity of literature, there were no date limiters. Articles demonstrating a direct relationship between religion and IPC practices in healthcare settings were included. Data extraction and quality appraisal were performed independently by multiple researchers.

Results: Thirteen articles met the inclusion criteria. Three main themes emerged: 1) religious rituals and influence, 2) use of alcohol, and 3) "bare below the elbows" principle. Religious practices were found to act as both enablers and barriers to IPC compliance. The use of alcohol-based hand rubs presented challenges for some religious groups, while religious dress codes conflicted with the "bare below the elbows" principle.

Conclusion: This review highlights the complex interplay between religion and IPC practices. Findings suggest the need for culturally sensitive IPC strategies that respect religious beliefs while maintaining effective IPC measures. Further research is needed to develop inclusive policies and educational programs that address these religious factors in healthcare settings.

Background: Escherichia coli (E. coli) is a common pathogen responsible for various infections, particularly in healthcare settings. Its antibiotic resistance and susceptibility patterns are crucial for effective treatment. This study aims to assess the prevalence of E. coli in clinical samples and evaluate its antibiotic resistance patterns at SRM Medical Hospital and Research Center from 2022 to 2023.

Methods: A retrospective study was conducted using microbiological records from 30,838 clinical samples collected over two years. Positive E. coli isolates were identified and subjected to antimicrobial susceptibility testing. Demographic data, including age and sex, were analysed. Resistance patterns were assessed using the Vitek 2 system and disc diffusion methods as per CLSI guidelines.

Results: Out of 30,838 samples, 8694 yielded positive cultures, with 2597 E. coli isolates. Most isolates (69.6 %) were from urine, followed by exudate (20.4 %) and blood (6.8 %). E. coli infection was more prevalent in females (60.92 %) and individuals aged 41-70 years (48.97 %) (p < 0.001). High resistance was observed for amoxicillin-clavulanate (32 %) and ciprofloxacin (17.98 %), with high susceptibility to colistin (90.98 %) and piperacillin-tazobactam (90 %).

Conclusion: This study highlights the prevalence of E. coli, especially in urine samples and among females and older adults. High resistance to commonly used antibiotics emphasizes the need for regular susceptibility testing and antimicrobial stewardship.

Clinical implication: This study emphasizes the need for ongoing antibiotic resistance monitoring and customized treatment strategies to combat E. coli infections. Future efforts should focus on enhancing antimicrobial stewardship programs to reduce the spread of resistant strains.

Background: Antimicrobial resistance is a public health problem. Methicillin-resistant Staphylococcus aureus (MRSA) is one of the microorganisms most responsible for illness and death. The aim was to characterize the infections caused by S. aureus and to determine the factors associated with in-hospital mortality in patients treated in a highly complex clinic in Colombia.

Methods: This was a longitudinal retrospective observational study of patients with culture-confirmed S. aureus infections who received hospital care between 2018 and 2023. Follow-up was carried out until the patients died or were discharged from the clinic. Descriptive, bivariate and multivariate analysis was performed.

Results: A total of 361 patients were included; 62.6 % were men, and the mean age was 49.2 years. Most patients were diagnosed with skin and soft tissue infections (51.0 %) and bacteremia (25.5 %). The most used antibiotics were clindamycin (53.5 %) and vancomycin (42.7 %). A total of 46.3 % had MRSA infections and 25.8 % were resistant to clindamycin, 37.7 % of the patients received care in the intensive care unit, 33.2 % had sepsis, 19.1 % required invasive mechanical ventilation, and 13.9 % died. Higher Charlson comorbidity index (aOR:1.45; 95%CI:1.04-2.02), higher Pitt Bacteremia Score (aOR:1,72; 95%CI:1.21-2.46) and bacteremia (aOR:5.30; 95%CI:1.44-19.41) increased the probability of death. Those who were empirically managed with antibiotics that had coverage for MRSA (aOR:0.03; 95%CI:0.00-0.24) and higher levels of hemoglobin (aOR:0.75; 95%CI:0.65-0.87) had a lower risk of death.

Conclusion: MRSA infections are frequent, with significant resistance to clindamycin. The identification of variables associated with a higher risk of dying may be useful for establishing protocols in hospitals that reduce this outcome.

Background: Visitor restrictions and mask-wearing may reduce hospital-acquired infections (HAI) as part of infection control bundles. The impact of a strict visitor policy and compulsory surgical mask wearing implemented during the SARS-CoV-2 pandemic, but prior to any local community circulating SARS-CoV-2, on the rates of hospital-acquired respiratory viral infections (HA-RVI) was assessed.

Methods: Retrospective audit of a local HAI database for HA-RVI from 1st April 2019 to 29th March 2021 in a tertiary children's hospital. HA-RVI were standardized against occupied bed days (OBD) and admitted community acquired infections (CAI). Rates of HA-RVI were compared during 52 weeks of SARS-CoV-2-associated enhanced control periods (visitor restrictions with and without universal surgical masking), against 52 weeks standard practice. Total respiratory virus infections, respiratory syncytial virus (RSV), and rhinovirus infections were analysed.

Results: Comparing standard practice with enhanced measures, 42 v 15 HA-RVI and 1517 v 691 CAI were noted. Enhanced infection controls resulted in significant reductions in total HA-RVI when adjusted for OBD (p = 0.0038) and CAI (p = 0.0122). Non-significant decreases were seen in hospital-acquired respiratory syncytial virus (HA-RSV) adjusted for both CAI and OBD. Visitor restrictions combined with universal surgical masks significantly decreased adjusted total HA-RVI compared with visitor restrictions alone (adjusted for OBD p = 0.0123; adjusted for CAI p = 0.0429). HA-RSV decreased non-significantly when mask wearing was combined with visitor restrictions compared with visitor restrictions alone. HA-rhinovirus infections did not decrease with the addition of masks to visitor restrictions.

Conclusion: Enhanced infection control measures introduced with SARS-CoV-2 pandemic decreased some HA-RVI. Universal surgical mask wearing decreased HAI rates more than visitor restrictions alone, except for rhinovirus where the HAI rate remained unchanged.

Background: The escalating threat of global infectious disease outbreaks has underscored the imperative for robust infection prevention and control (IPC) measures, particularly within the high-risk context of residential care facilities. This research aimed to investigate the experiences and roles of IPC professionals (IPCPs) in such settings during global outbreaks.

Methods: Utilising an integrative review methodology, four electronic databases - Medline, CINAHL, Embase, and Scopus - were searched from 2003 onwards for relevant papers. A two-tiered independent screening approach was employed to select eligible articles, followed by a consensus-based appraisal and thematic analysis of included studies.

Results: The final review encompassed eight articles. IPCPs faced systemic organisational and ground-level operational hurdles, including inequitable access to resources, and lack of training and outbreak preparedness. External and internal variables impacted the effectiveness of outbreak responses, affecting resident and occupational health, and perceptions of IPC over time.

Conclusions: The review identified systemic challenges IPCPs face in residential care during outbreaks, including resource inequity and lack of standardised training. Centralised resources and standardised educational benchmarks may help to mitigate these issues. Policy changes are required to enhance healthcare readiness, quality, and research in residential care settings.

Background: Children spend almost one-third of their waking hours at school. Streptococcus pyogenes (Strep A) is a common childhood bacterial infection that can progress to causing serious disease. We aimed to detect Strep A in classrooms by using environmental settle plates and swabbing of high-touch surfaces in two remote schools in the Kimberley, Western Australia.

Methods: Twelve classrooms in two schools participated in 2021 and 2022. Seven horse-blood agar plates containing colistin and nalidixic acid (HBA-CNA) were placed in each occupied classroom at varied heights for 4 h, and 20 high-touch items were swabbed and later cultured on HBA-CNA plates. The primary outcome of each sample was presence or absence of Strep A. Identified Strep A isolates were whole genome sequenced (WGS) to assess for similarity between host-derived and environmental strains.

Results: During two visits to each participating Kimberley school in June 2021 and September 2022, the point prevalence of Strep A positive throat swab ranged between 3/34 (8.8 %) and 5/21 (23.8 %); Strep A impetigo was lower at between 0/43 (0 %) and 2/23 (8.7 %). Strep A was detected from 4/240 (2 %) environmental swabs collected across 3/12 (25 %) classrooms but not cultured from any of the classroom settle plates. Whole genome sequencing identified environmental emm types to also be those strains in circulation.

Conclusions: There was little evidence to support fomite, droplet or airborne Strep A in classrooms as major modes of transmission among children. Further work is required to determine if classrooms play a role in the transmission of Strep A between students.

Background: Older people living in residential aged care are vulnerable to infections. High quality infection prevention and control (IPC) practice is therefore vital in this setting. It is important to assess current IPC practice to identify areas where best practice is lacking, and where improvement efforts could most effectively be targeted. The aim of this study was to identify evidence-practice gaps in IPC practice in residential aged care.

Methods: This study used two scenarios to assess use of a range of standard and transmission-based precautions in residential aged care. Systematic methods were used to design the scenarios. Twenty-seven staff from four residential aged care facilities participated in semi-structured interviews. Participants were presented with the scenarios and asked what IPC actions they would take in everyday practice. Individual and team-based practice was explored. Participants reported practices were then compared to evidence-based practice.

Results: Results from both scenarios were combined and a total of 11 evidence-practice gaps identified. These included gaps in performing hand hygiene before touching a resident (for example, when helping a resident transfer) and not donning protective eyewear or face shield before taking a nasal/throat swab on the resident with suspected respiratory viral infection.

Conclusion: The use of scenarios provided a practical and acceptable method to rapidly assess a range of IPC practices among a diverse group of participants. The IPC evidence-practice gaps identified will be used in the next phase of work where barriers to uptake of the identified IPC evidence-practice gaps will be explored.

Background: Student nurses are vulnerable to blood-borne infections from needle stick injuries (NSIs) during clinical training. To stay safe from the threats, they; must comprehend every facet of NSIs. The study's objectives were to determine the level; of knowledge among student nurses about NSIs and to examine their prevalence and; prevention strategies in Palestine.

Methods: A descriptive, cross-sectional design was employed on a sample of 449 student nurses through an online anonymous survey between February 20, 2024, and March 20, 2024. The three questionnaire parts assessed the demographics of the students, the nurses' knowledge of NSIs, their exposure to NSIs, and their use of preventative measures. The data; were analyzed using SPSS Version 26.

Results: A total of 449 students answered the questionnaire; 345 (76.8 %) were female and their average age was 21.08 (SD = 2.47) years. Out of ten, the average score for total knowledge was 7.04 (SD = 1.51). Nearly 105 students (23.4 %) reported having been exposed to NSIs at least once and most of them were junior students 67 (63.8 %). Of these, 69.5 % happened in open hospital units, while the technique of withdrawing blood caused 41.9 % of NSIs, and 67.6 % of students didn't report the incident of injury.

Conclusion: Training programs are necessary to reduce the risk of blood-borne disease transmission and improve workplace safety for nursing students. Clinical nursing administrators should create practical plans to lower the incidence of NSIs.

Background: Carbapenemase-producing Enterobacterales (CPE) are an emerging public health concern globally as they are resistant to a broad spectrum of antibiotics. Colonisation with CPE typically requires patients to be managed under 'contact precautions', which creates additional physical bed demands in healthcare facilities.

Methods: This study examined the potential impact of revised isolation guidelines introduced in late 2023 in Victoria, Australia, that relaxed the requirement for indefinite isolation of CPE-colonised patients in contact precautions, based on admission of CPE-diagnosed cases prior to the guideline change.

Results & conclusions: Our analysis showed that while the changes result in modest savings in the need for dedicated isolation rooms, they could reduce the duration of time individual patients spend in isolation by up to three weeks. However, ongoing investments to expand isolation capacity would still be required to accommodate the rising incidence of CPE.