Infection, disease & health最新文献

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.

Background: Hand hygiene (HH) is an essential element of infection prevention and control programs. Direct observation of adherence to the 5 moments for HH is considered the gold standard in compliance monitoring. However, as direct observation introduces potential bias, other strategies have been proposed to supplement HH compliance data in healthcare facilities. This study evaluated the accuracy of an automatic counting system (MEZRIT™) to detect when a HH product (soap or alcohol-based hand rub) was dispensed, and thus measure product usage as opposed to compliance with the 5 moments for HH.

Methods: A quasi-experimental study was conducted in a nursing simulation lab where seven participants undertook basic nursing tasks which included performing HH. Sensors were attached to soap and alcohol-based hand rub dispensers to record the time at which a product was dispensed. HH events were video recorded (time-stamped) and validated against timestamps from the automatic counting system.

Results: 260 HH events were detected by the automatic counting system and confirmed by video recordings. 5182 non-HH events were calculated from analysis of the video recordings. The automatic counting system had 90 % sensitivity (95%CI 85.8-93.1 %), and 100 % specificity (95%CI 99.9-100 %). This model generated a positive predictive value of 100 % (95%Cl 98.4-100 %), and a negative predictive value of 99.5 % (95%CI 99.3-99.7 %).

Conclusion: The MEZRIT™ system accurately identified 90 % of HH events and excluded 100 % of non-HH events. The real-time monitoring of HH product usage may be beneficial in responding quickly to changes in product usage.

Background: Despite the uncertainty raised by several studies regarding the practicality of Point-of-Care Testing (POCT) in hospital settings, the urgency prompted by the COVID-19 pandemic led many hospitals to invest in these rapid diagnostics. As the COVID-19 pandemic showcased the potential of POCT in emergency situations, an urgent call arises to leverage the successes and lessons learned for the long-term benefit of healthcare systems, particularly in preparation for the next pandemic of viral respiratory nature.

Methods: We conducted semi-structured interviews with nine emergency care and hospital laboratory stakeholders with expertise and responsibility over POCT operations within hospital systems during the COVID-19 pandemic in Maryland, USA. The grounded theory approach was utilized, and the transcripts were thematically analyzed through an iterative process.

Results: Three distinct themes were identified as barriers to POCT implementation: Regulatory barriers encompassed inconsistencies between the federal and state regulations and a regulatory structure that lags technological advancements. Staffing and operational barriers comprised a shortage of POCT workforce including nurses and Point of Care coordinators. Economic barriers were linked to the overall cost of integrating new POCT devices into the existing testing menu at emergency departments.

Conclusion: We conclude with strategies, including policy considerations, to enable and sustain decentralized POCT programs within hospitals. Some of these strategies include expanding the workforce trained in the regulatory procedures required to support POCT; harmonizing state and federal regulations for diagnostic testing, especially for FDA-waived POCT; and sustained funding for POCT development and use for public health preparedness.

Background: The COVID-19 pandemic highlighted the vital role of Infection Prevention and Control Professionals (IPCPs) in safeguarding public health. Amid rapidly evolving guidelines, critical personal protective equipment shortages, and surging workloads, IPCPs encountered unprecedented moral and ethical dilemmas. However, their experiences, ethical challenges, and the resulting moral distress remain understudied.

Methods: A scoping review following Arksey and O'Malley's methodology was conducted to examine current research on ethical challenges and moral distress among IPCPs. Searches in CINAHL, MEDLINE via OVID, Emcare, Scopus, and Korea Citation Index yielded two extracted articles.

Results: Common themes included high workload, increased recognition, pressure to deliver accurate and timely information, need for peer support, and evidence-based practice. Differences in nationality, role discretion, and administrative systems led to varied experiences. District Medical Officers in Norway experienced more decision-making responsibilities and resulting ethical dilemmas in the context of broader communities and municipalities. The experiences of IPCPs were confined to their respective healthcare facilities.

Conclusion: There is a dearth of available research reporting the moral distress experienced by IPCPs whilst there is a plethora for those seen as "frontline" workers. Given the integral decision-making and implementation roles of these health professionals, and the burdens of ethical dilemmas they experienced in pandemic preparedness and response, further research is imperative to inform strategies to build moral resilience in the future.

Background: The COVID-19 pandemic placed considerable strain on the infection control professional workforce, who were at the forefront of pandemic response in their organisations and beyond. In order to support infection control professionals and inform future initiatives, it is important to further understand the infection control workforce. The objective of this study was to determine stress and resilience levels, personality traits and workforce intentions of infection control professionals in Australia and New Zealand.

Methods: We undertook an anonymous, cross-sectional online survey of infection control professionals in Australia and New Zealand. Validated tools, the brief resilience tool, workforce stressor tool and the Big Five personality test, were used to evaluate levels of stress, resilience and personality traits.

Results: Three hundred and fifty-six infection control professionals started the survey, with representation from all Australian jurisdictions and New Zealand. The mean stress score was 4.28 (SD 3.39) and 3.34 (SD 0.65) for resilience. Younger participants and those with less experience in infection control had higher levels of stress and lower levels of resilience. Individual personality traits vary by age, level of education and credentialing status. Approximately one-fifth of participants indicated that they planned to leave the IC workforce in the next three years.

Conclusions: Our study was the largest published study involving infection control professionals in Australia and New Zealand. Findings highlight the need for mentoring, peer support and wellbeing initiatives to support the profession. Understanding personality traits may also be beneficial for further enhancing communication and interpersonal relationships.

Introduction: Mobile phones, contaminated with pathogenic microorganisms, have the potential to act as "trojan horses". The microbial signatures present on their surfaces most probably vary across different geographical regions. As a result, mobile phones belonging to international conference attendees may serve as a model for global microbial dissemination, posing potential risks to public health and biosecurity.

Aim: This study aimed to profile the microbes present on mobile phones belonging to delegates attending an international scientific conference through use of metagenomic shotgun DNA sequencing.

Methods: Twenty mobile phones, representing ten different geographical zones from around the world, were swabbed and pooled together into ten geographical-specific samples for high definition next-generation DNA sequencing. WONCA council members were invited to participate and provided verbal consent. Following DNA extraction, next generation sequencing, to a depth of approximately 10Gbp per sample, was undertaken on a v1.5 Illumina NovaSeq6000 system. Bioinformatic analysis was performed via the CosmosID platform.

Results: A total of 2204 microbial hits were accumulated across 20 mobile phones inclusive of 882 bacteria, 1229 viruses, 88 fungi and 5 protozoa. Of particular concern was the identification of 65 distinct antibiotic resistance genes and 86 virulence genes. Plant, animal and human pathogens, including ESKAPE and HACEK bacteria were found on mobile phones.

Discussion/conclusion: Mobile phones of international attendees are contaminated with many & varied microorganisms. Further research is required to characterize the risks these devices pose for biosecurity and public health. Development of new policies which appropriately address and prevent such risks maybe warranted.

Background: Healthcare-associated infections and antibiotic resistance worsen globally. Antibiotic stewardship programs (ASP) aim to optimise infection treatment and curb resistance, yet implementation hurdles persist. This study examined ASP challenges in ICUs.

Methods: This study employed a qualitative methodological design to evaluate the implementation process of an antibiotic stewardship program (ASP) in eight intensive care units (ICUs) across Argentina. Thirty-four semi-structured interviews with healthcare workers (HCWs) were conducted. Interviews were analysed guided by Normalisation Process Theory, examining coherence, cognitive participation, collective action, and reflexive monitoring constructs.

Results: Key challenges included insufficient human resources, lack of institutional support, and resistance to change, particularly among staff not initially involved in the study. Despite these challenges, the program saw partial success in improving ICU practices, particularly in antibiotic use and communication across departments. The main strategy implemented in this quality improvement collaborative was the use of improvement cycles, which served as the central component for driving change. However, participation in improvement cycles was inconsistent, and sustainability post-intervention remains uncertain due to workload pressures and the need for continuous education. Concerns about workload and communication barriers persisted. Many participants did not perceive training as a separate component, which led to low engagement. Resistance to change became evident during modifications to clinical guidelines. The intervention had a positive impact on various processes, including communication and record keeping.

Conclusion: This study underscores the persistent challenges in implementing ASPs in healthcare, emphasising the need for enhanced collaboration, workforce capacity building, and evidence-based practices to overcome barriers and optimize antimicrobial use to improve patient outcomes.

Background: To evaluate the influenza-like illness (ILI) and acute respiratory infection (ARI) case definitions in the diagnosis of COVID-19 and influenza in healthcare personnel (HCP).

Methods: We followed a cohort of 5752 HCP from November 2022 to May 2023. Symptomatic HCP were tested for SARS-CoV-2 and influenza by real-time PCR and/or rapid antigen detection test. ILI was defined as the sudden onset of ≥1 systemic symptom and ≥1 respiratory symptom. ARI was defined as the sudden onset of ≥1 respiratory symptom. Patients with respiratory symptoms were grouped either as ILI or as ARI based on the presence of fever, malaise, headache and/or myalgia.

Results: Overall, 466 ILI cases and 383 ARI cases occurred. HCP with ILI had an adjusted odds ratio (aOR) of 22.05 [95% confidence interval (CI): 6.23-78.04] to be diagnosed with influenza. HCP with ARI had an aOR of 2.70 (95% CI: 1.88-3.88) to be diagnosed with COVID-19. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of ILI for influenza were 96.6%, 49.9%, 18.2%, and 99.2%, respectively. The sensitivity, specificity, PPV, and NPV of ARI for COVID-19 were 51.7%, 73.6%, 84.9%, and 34.8%, respectively. ILI and ARI had an overall correct classification rate of 89.6% and 74.1%, respectively.

Conclusion: Our findings support the use of both ILI and ARI case definitions in the diagnosis of influenza and COVID-19 in HCP.

Infection prevention and control programs are vital to ensuring the health and wellbeing of healthcare consumers and staff. Infection control professionals who lead these programs are uniquely positioned with the knowledge, skills and attributes to direct effective infection control practices and policies within their healthcare setting. As with many specialisations, these individuals may choose to undertake a credentialling process, where their expertise and competence are evaluated and formally recognised by a professional body. Globally, there is growing evidence that credentialling improves the standard of practice of infection control professionals, and achieves beneficial outcomes for staff, patients and the broader healthcare systems in which they operate. In Australia, credentialling is a relatively new endeavour emerging in the mid 1990s with the rapidly evolving profile of the infection control professional. In this paper, we detail the history and evolution of credentialling of the infection control professionals in Australia. We also appraise the current three-tier credentialling framework, including its underlying philosophy, how it distinguishes between 'competence' and 'capability', the mechanisms it provides for career development, and its adaptation in response to critical contemporary developments in the field of infection control in Australia, including the expanding diversity of contemporary practice.

Background: Access to arterial circulation through arterial catheters (ACs) is crucial for monitoring and decision-making in intensive care units (ICU) but carries the risk of complications including bloodstream infection (BSI).

Methods: We conducted a secondary analysis of data from four randomised controlled trials in Australian ICUs, investigating the efficacy of different AC interventions. De-identified data were combined into a single dataset, and per-patient outcomes analysed. The primary outcome was AC-BSI, defined as laboratory confirmed bloodstream infection (LCBI) type 1 or 2, with a concurrent local infection. All-cause AC failure was defined as any unplanned removal. AC infection and failure were reported as rates per 1000 catheter days and hours.

Results: Data from 1117 adult patients were analysed. Mean age was 58.8 years (±16.6); and 41% (n = 462) were male. Median AC dwell time was 110 h (IQR 28.3-168.0). There was one case (<0.1%; 0.18/1000 catheter days [95% CI 0.03-1.29]) of AC-BSI, and 14 cases of LCBI (1%; 13 LCBI-1 and 1 LCBI-2; 2.54/1000 catheter days [95% CI 1.51-4.30]). LCBI were most commonly Enterococcus faecalis; Escherichia coli and Klebsiella pneumoniae. There were four cases of local infection (<1%; 0.73/1000 catheter days [95% CI 0.27-1.94]). Overall AC failure rate was 13% (n = 146) or 26.53/1000 catheter days (95% CI 22.56-31.20).

Conclusion: This study identified a relatively low incidence of complications. This is likely reflective of poor monitoring of ACs in intensive care. Better surveillance and a rigorous prospective evaluation of AC outcomes is required to understand the true risk ACs pose to critically ill patients.