Staff wearing clean air suits made from tight material affects the level of bacteria in the air in operating rooms. This study investigated the influence of different types of headgear on levels of colony-forming units (CFU) in the air. Wearing no headgear was compared with wearing a disposable cap or a disposable hood, and with results from a previous study with a reusable hood made from the same material as the clean air suit. Tests with five healthy males wearing a clean air suit and different types of headgear were performed in a dispersal chamber according to Annex E in European standard EN 13795-2:2019. The mean source strength value (number of bacteria emitted per second from one person) was 7.3 CFU/s without headgear and 7.2 CFU/S with a surgical cap (P = 0.52). The mean source strength value obtained with a disposable surgical hood was 5.3 CFU/s, which was not significantly lower than that obtained without headgear (P = 0.057). The poor performance of the disposable surgical headgear was likely an effect of both permeable material and design. The mean source strength value with a textile hood in the previous study was 1.0 CFU/s, which was significantly lower than the mean source strength value without headgear (P < 0.01). When high microbial cleanliness of the air in the operating room is required, staff should wear a clean air suit fulfilling the criteria in European standard EN 13795-2, and a hood made of the same material as the rest of the suit.

Standard laboratory tests for surface disinfectants often fail to reflect real-life clinical conditions, potentially overestimating efficacy. Simulated-use testing that incorporates clinical strains, realistic contamination and user application may provide a more accurate reflection of in-use performance in healthcare settings. The aim of this study was to develop and validate a standardized, reproducible Phase 3 Step 1 simulated-use surface disinfection test that incorporates clinically relevant organisms, hospital-representative surfaces, and realistic application methods. Based on EN 16615:2015, the test method was modified to reflect hospital conditions more closely. Clinically isolated outbreak strains of Staphylococcus aureus, Enterococcus faecium and Acinetobacter baumannii were used. Contamination was applied via a touch-transfer method. Surface materials included hospital-relevant substrates, and disinfectant wipes were applied by trained volunteers to simulate routine cleaning practices. The touch-transfer contamination method was reproducible, and no significant differences were observed in drying or water controls across different surfaces. Wiping speed and contact pressure did not correlate with efficacy. However, microbial recovery varied across test runs and participants. The test method presented here allows for efficacy testing of commercial disinfectants. A Phase 3 Step 1 simulated-use test was established, which incorporates micro-organisms isolated from the application area, surfaces representative of the application area, and where the product is applied by trained participants. This internally validated method better represents clinical disinfection practices compared with current standardized tests and may support improved assessment of surface disinfectant efficacy under conditions approximating real-world hospital use.

Healthcare-associated infections (HAIs) are a major global health problem. Gaps in their detection in low- and middle-income countries may be caused by limited surveillance capacity and lack of contextualized surveillance tools. This study aimed to evaluate the prevalence of HAIs and their determinants using contextually adapted HAI case definitions and tools. This was a cross-sectional multi-centre point prevalence survey among adults (≥18 years) and children (≥1 month) from 10 hospitals in Western Sierra Leone. The determinants of HAIs were derived using logistic regression analysis and adjusted relative risks with 95% confidence intervals (CIs) reported as a measure of association, and a P value ≤0.05 was considered statistically significant. Among the 10 hospitals, the mean hospital bed capacity was 109, and the average hand hygiene (HH) compliance was 30.6%. None of the hospitals had a functional bacteriology laboratory. Of the 319 eligible patients, 40 (12.5%) acquired HAIs, with 31 (77.5%) having suspected bloodstream infections. Cigarette smoking (adjusted odds ratio [aOR]: 3.764, 95% CI: 1.07-13.13, P: 0.038), leucopenia (aOR: 0.137, 95% CI: 0.019-1.003, P: 0.05), blood transfusion (aOR: 0.309, 95% CI: 0.126-0.759, P: 0.01), and use of oxygen apparatus (aOR: 0.260, 95% CI: 0.084-0.805, P: 0.02) were shown to be predictors of HAIs. There was a high prevalence of microbiologically unconfirmed HAIs with patient-related factors and service delivery interventions as independent predictors. Fundamental gaps are low HH compliance and limited laboratory capacity to support HAI surveillance. We recommend sustained HH improvement initiatives, strengthening bacteriology capacity for HAI detection, and periodic point prevalence surveys on HAIs as an entry point.