Acquisition Of Healthcare-associated Infection Research Articles

Antibiotic resistance pattern of waterborne causative agents of healthcare-associated infections: A call for biofilm control in hospital water systems

BackgroundIn recent years, the global spread of antimicrobial resistance has become a concerning issue, often referred to as a “silent pandemic”. Healthcare-associated infections (HAIs) caused by antibiotic-resistant bacteria (ARB) are a recurring problem, with some originating from waterborne route. The study aimed to investigate the presence of clinically relevant opportunistic bacteria and antibiotic resistance genes (ARGs) in hospital water distribution systems (WDSs). MethodsWater and biofilm samples (n = 192) were collected from nine hospitals in Isfahan and Kashan, located in central Iran, between May 2022 and June 2023. The samples were analyzed to determine the presence and quantities of opportunistic bacteria and ARGs using cultural and molecular methods. ResultsStaphylococcus spp. were highly detected in WDS samples (90 isolates), with 33 % of them harboring mecA gene. However, the occurrences of E. coli (1 isolate), Acinetobacter baumannii (3 isolates), and Pseudomonas aeruginosa (14 isolates) were low. Moreover, several Gram-negative bacteria containing ARGs were identified in the samples, mainly belonging to Stenotrophomonas, Sphingomonas and Brevundimonas genera. Various ARGs, as well as intI1, were found in hospital WDSs (ranging from 14 % to 60 %), with higher occurrences in the biofilm samples. ConclusionOur results underscore the importance of biofilms in water taps as hotspots for the dissemination of opportunistic bacteria and ARG within hospital environments. The identification of multiple opportunistic bacteria and ARGs raises concerns about the potential exposure and acquisition of HAIs, emphasizing the need for proactive measures, particularly in controlling biofilms, to mitigate infection risks in healthcare settings.

The effects of a novel, continuous disinfectant technology on methicillin-resistant Staphylococcus aureus (MRSA), fungi, and aerobic bacteria in 2 separate intensive care units in 2 different states: An experimental design with observed impact on health care associated infections (HAIs)

Hospitals are exposed to abundant contamination sources with limited remediation strategies. Without new countermeasures or treatments, the risk of health care-associated infections will remain high. This study explored the impact of advanced photohydrolysis continuous disinfection technology on hospital environmental bioburden. Two acute care intensive care units in different locations (ie, Kentucky, Louisiana) during different time periodswere sampled every 4 weeks for 4 months for colony-forming units (CFUs) of methicillin-resistant Staphylococcus aureus (MRSA) and fungi on surfaces and floors and fungi and aerobic bacteria in theair. At both sites, surface testing showed greater than 98% reduction in mean fungi and MRSA CFUs. Floor results had reductions by more than 96% for fungi and MRSA at both sites. Aerobic bacterial air and fungal CFUs had reductions up to 72% and 89%, respectively. HAIs declined 70% when postactivation data were compared to preactivation data. The continuous nature of advanced photohydrolysis decontamination, its ability to be used in occupied rooms, and its independence of human resourcesprovidean innovative intervention for complex healthcare environments. This study is on the pioneering edge of demonstrating that continuous decontamination can reduce surface, floor, and air contamination and thereby reduce the acquisition of HAIs.

Personalized infection prevention and control: identifying patients at risk of healthcare-associated infection

Few healthcare-associated infection (HAI) studies focus on risk of HAI at the point of admission. Understanding this will enable planning and management of care with infection prevention at the heart of the patient journey from the point of admission. To determine intrinsic characteristics of patients at hospital admission and extrinsic events, during the two years preceding admission, that increase risk of developing HAI. An incidence survey of adults within two hospitals in NHS Scotland was undertaken for one year in 2018/19 as part of the Evaluation of Cost of Nosocomial Infection (ECONI) study. The primary outcome measure was developing any HAI using recognized case definitions. The cohort was derived from routine hospital episode data and linkage to community dispensed prescribing data. The risk factors present on admission observed as being the most significant for the acquisition of HAI were: being treated in a teaching hospital, increasing age, comorbidities of cancer, cardiovascular disease, chronic renal failure and diabetes; and emergency admission. Relative risk of developing HAI increased with intensive care unit, high-dependency unit, and surgical specialties, and surgery <30 days before admission and a total length of stay of >30 days in the two years to admission. Targeting patients at risk of HAI from the point of admission maximizes the potential for prevention, especially when extrinsic risk factors are known and managed. This study proposes a new approach to infection prevention and control (IPC), identifying those patients at greatest risk of developing a particular type of HAI who might be potential candidates for personalized IPC interventions.

Patient Safety Goals’ Level of Attainment in Selected Tertiary Hospitals in Manila, Philippines: A Preliminary Study

Background: Continuous efforts in the implementation of the National Patient Safety Goals (PSG) as a framework to guide the service providers have been made. However,there are reported incidents of untoward patient outcomes due to wrong medication administration, wrong site of surgical operation, acquisition of healthcare-associated infections, adverse reactions, and incidence of fall.Purpose: This study aimed to evaluate the PSGs’ level of attainment in selected tertiary hospitals in Metro Manila, Philippines. Methods: This study employed a field, descriptive and historical research survey conducted in three tertiary hospitals in Metro Manila. The participants were nurses having at least one year of experience in their current workplace (n=214). The sets of questionnaires used to get the data include the demographic profile and PSGs indicators adapted from the National Patient Safety Goals (NPSGs). Data responses were analyzed with descriptive statistics and One-Way ANOVA. Results: Based on the findings, the PSGs level of attainment obtained high extent with overall mean average: PSG 1 (M=4.35), PSG 2 (M=3.97), PSG 3 (M=4.07), PSG 4 (M=3.61), PSG 5 (M=3.89), PSG 6 (M=3.77) and PSG7 (M=4.20). Furthermore, there were significant differences on PSG 3 and PSG 4 with p-values of 0.00 and 0.02 respectively, which were tested at 0.05 level of significance. Others PSGs showed no significant differences. Conclusion: The results indicate that the selected hospitals in Metropolitan Manila, Philippines have a high level of attainment for patient safety goals and remains at the core of health service delivery in each organization. It is recommended that the hospital further enhance the knowledge, skills, and attitudes towards a sustained patient safety culture through continuing education programs, benchmarking, institutionalization, and accreditation.

Effect of poly-hexamethylene biguanide hydrochloride (PHMB) treated non-sterile medical gloves upon the transmission of Streptococcus pyogenes, carbapenem-resistant E. coli, MRSA and Klebsiella pneumoniae from contact surfaces

BackgroundReduction of accidental contamination of the near-patient environment has potential to reduce acquisition of healthcare-associated infection(s). Although medical gloves should be removed when soiled or touching the environment, compliance is variable. The use of antimicrobial-impregnated medical gloves could reduce the horizontal-transfer of bacterial contamination between surfaces.AimDetermine the activity of antimicrobial-impregnated gloves against common hospital pathogens: Streptococcus pyogenes, carbapenem-resistant E.coli (CREC), MRSA and ESBL-producing Klebsiella pneumoniae.MethodsFingerpads (~1cm2) of PHMB-treated and untreated gloves were inoculated with 10 μL (~104 colony-forming-units [cfu]) of test-bacteria prepared in heavy-soiling (0.5%BSA), blood or distilled-water (no-soiling) and sampled after 0.25, 1, 10 or 15 min contact-time.Donor surfaces (~1cm2 computer-keys) contaminated with wet/dry inoculum were touched with the fingerpad of treated/untreated gloves and subsequently pressed onto recipient (uncontaminated) computer-keys.ResultsApproximately 4.50log10cfu of all bacteria persisted after 15 min on untreated gloves regardless of soil-type. In the absence of soiling, PHMB-treated gloves reduced surface-contamination by ~4.5log10cfu (>99.99%) within 10 min of contact-time but only ~2.5log10 (>99.9%) and ~1.0log10 reduction respectively when heavy-soiling or blood was present.Gloves became highly-contaminated (~4.52log10–4.91log10cfu) when handling recently-contaminated computer-keys. Untreated gloves contaminated “recipient” surfaces (~4.5log10cfu) while PHMB-treated gloves transferred fewer bacteria (2.4–3.6log10cfu). When surface contamination was dry, PHMB gloves transferred fewer bacteria (0.3–0.6log10cfu) to “recipient” surfaces than untreated gloves (1.0–1.9log10; P < 0.05).ConclusionsAntimicrobial-impregnated gloves may be useful in preventing dissemination of organisms in the near-patient environment during routine care. However they are not a substitute for appropriate hand-hygiene procedures.

Staphylococcus aureus infections among children receiving a solid organ transplant: clinical features, epidemiology, and antimicrobial susceptibility.

Staphylococcus aureus is among the most common causes of healthcare-associated infection (HAI) in the United States. Patients who have received a solid organ transplant (SOT) represent a unique population for the acquisition of HAIs, given their preoperative organ failure, immunosuppression, and need for invasive procedures. However, limited literature is published on S.aureus infections among children with SOT. We describe the epidemiology, antimicrobial susceptibility, and clinical features of S.aureus infections among pediatric SOT recipients. An ongoing prospective S.aureus surveillance database from 2001 to 2012 was searched for infections in patients with a history of SOT at Texas Children's Hospital. Medical records and antibiotic susceptibility profiles were reviewed; specific attention was applied to the time since transplantation to infection. Out of the total of 696 transplants performed during the study period, 38 pediatric SOT recipients developed 41 S.aureus infections; the highest incidence of infection was among heart recipients. Overall, the most common infectious diagnoses were skin-and-soft-tissue infections (66.1%), followed by bacteremia (15.3%). Among isolates in SOT patients, 47.5%, 16.9%, and 6.7% were resistant to methicillin, clindamycin, or mupirocin, respectively. Three infections (7.3%) occurred in the early post-transplant period (<1month), all of which were bacteremia (P=0.007) and all caused by methicillin-susceptible S.aureus (MSSA). The majority of infections (90.2%) occurred in the late post-transplant period (>6months). In 10 cases (16.9%), S.aureus infection was associated with graft rejection during the same admission. S.aureus represents an important cause of morbidity in pediatric SOT recipients. While the majority of infections occurred late after transplant (>6months), those acquired in the early post-transplant period were more often invasive and caused by MSSA in our hospital. Physicians caring for SOT recipients should be aware of the risks posed by this pathogen and the potential concomitant morbidity including graft rejection.

The Role of Facility Design in Preventing Healthcare-Associated Infection: Interventions, Conclusions, and Research Needs

OBJECTIVE: To summarize the findings and provide recommendations based on the multidisciplinary literature review and industry scan, focusing on the links between the built environment and healthcare-associated infections. To propose a research agenda in order to increase informed design decisions and advance the evidence base. BACKGROUND: The HAI-Design project explores the research linking a range of design interventions to healthcare-associated infection. The multidisciplinary team evaluated over 3,800 articles and conducted interviews with a range of stakeholders including CEOs, architects, designers, physicians and other healthcare experts, the results of which are featured in this special Supplement as topical papers. TOPICAL HEADINGS: The four topical papers describing the role of the built environment in the acquisition of healthcare-associated infections are summarized. The evidence evaluating the strategies for intervention through the built environment is analyzed, and a research agenda is proposed. CONCLUSIONS: While the evidence base supporting the efficacy of strategies and technologies continues to grow, there are currently few data that demonstrate a reduction in infection rates. The need for multidisciplinary collaboration and increased efforts to standardize the evaluation of environmental studies are essential to overcome the many challenges and improve the reliability of data

Neonatal innate immunity in the development of childhood respiratory disease

Transmission of health care-associated infections (HAIs) has been primarily attributed to health care workers, and hand hygiene is considered the most important means to reduce transmission. Whereas hand hygiene research has focused on reducing health care worker hand contamination and improving hand hygiene compliance, contamination of patients’ hands and their role in the transmission of HAIs remains unknown.Patients’ hands were sampled by a “glove juice” recovery method and enumerated for the presence of common health care-associated pathogens. Patient demographics and other covariates were collected to determine their association with patient hand contamination. Patient attitudes and practices toward hand hygiene were also surveyed and analyzed.Of the 100 patients in the study, 39% of hands were contaminated with at least 1 pathogenic organism, and 8% were contaminated with 2 or more pathogens 48 hours after admission. Patient admission from or discharge to an outside institution and self-reported functional limitations were the only covariates that were significantly associated with hand contamination.Pathogenic organisms can be frequently detected on hands of acute care patients. Future studies are needed to better understand the relationship between patient hand contamination and the acquisition of HAIs in addition to the role patient hand hygiene can play in reducing HAIs.

Patients’ potential role in the transmission of health care-associated infections: Prevalence of contamination with bacterial pathogens and patient attitudes toward hand hygiene

Transmission of health care-associated infections (HAIs) has been primarily attributed to health care workers, and hand hygiene is considered the most important means to reduce transmission. Whereas hand hygiene research has focused on reducing health care worker hand contamination and improving hand hygiene compliance, contamination of patients' hands and their role in the transmission of HAIs remains unknown. Patients' hands were sampled by a "glove juice" recovery method and enumerated for the presence of common health care-associated pathogens. Patient demographics and other covariates were collected to determine their association with patient hand contamination. Patient attitudes and practices toward hand hygiene were also surveyed and analyzed. Of the 100 patients in the study, 39% of hands were contaminated with at least 1 pathogenic organism, and 8% were contaminated with 2 or more pathogens 48 hours after admission. Patient admission from or discharge to an outside institution and self-reported functional limitations were the only covariates that were significantly associated with hand contamination. Pathogenic organisms can be frequently detected on hands of acute care patients. Future studies are needed to better understand the relationship between patient hand contamination and the acquisition of HAIs in addition to the role patient hand hygiene can play in reducing HAIs.

P06.04 Costs of antibiotics consumption in neonatal intensive care units in Poland

Background: Rapid and accurate identification of meticillinresistant Staphylococcus aureus (MRSA) in hospital admissions is essential for timely decisions on optimal treatment, isolation/bioburden reduction, reducing the potential for cross transmission/self acquisition of healthcare-associated infections (HCAI) and cost containment. The NHS is expected to face a £15bn budget shortfall due to effects of recession. We present the cost effectiveness of the second year of a rapid MRSA screening programme which was implemented at Blackpool Victoria Hospital and the economic advantages of continuing the service despite a 15% cut in overall budget. Methods: A thorough clinico-economic dissection included cost analyses (total cost of the service [equipment, consumables, salaries]; estimated savings from reduction in infections including bacteraemia; collateral benefits of the programme); clinical implications, patient and staff feedback. Latest details to be presented. Results: At time of analysis – 78% (9 bacteraemias against 40 in 07–08) reduction in first year 08–09 [45% – post 48h]. 5 bacteraemias were recorded between Apr-Nov 09, of which 20% were post-48 hrs. The cost of service over 18-mths was less than £591,332. Estimated savings from the overall 30% reduction in all MRSA infections over the previous 18 mths ranged from £806,000 (using £2,000/infection including bacteraemia) to £2,014,597 (using £4,999/infection including bacteraemia) models. 51% reduction in glycopeptide unit-days and spend. Total 31,867 tests were performed and 96% patients could be re-assured of their negative MRSA status within an av 5h turn-around-time. Conclusions: Rapidly available MRSA results are routinely used to compliment clinical decision making and optimise treatment in our hospital. The key to success in this model was the teamwork between management, clinical & ICT. A sound business case and return on investment for the use of rapid diagnostic methods in our hospital can be made.

P24.18 Risk factors associated with resistance to 3rd gen cephalosporins in Enterobacteriaceae isolates from intensive care unit patients in Saudi Arabia

P24.18 Risk factors associated with resistance to 3rd gen cephalosporins in Enterobacteriaceae isolates from intensive care unit patients in Saudi Arabia

SHEA/APIC guideline: infection prevention and control in the long-term care facility, July 2008.

SHEA/APIC guideline: infection prevention and control in the long-term care facility, July 2008.