Cases Of Nosocomial Infection Research Articles

Beyond the distance between juridic and scientific decision-making process: An evidence-based prediction algorithm for professional liability assessment in healthcare-associated infections

BackgroundHAIs (Healthcare-Acquired-Infections) have been recently the subject of judgment n. 6386 pronounced on 3rd March 2023 by the Italian Supreme Court. This sentence provided three criteria to determine whether a health facility is responsible for the patient contracting a nosocomial infection, i.e. time criterion, topographical criterion and clinical criterion. Accordingly, the healthcare facility is obliged to prove the fulfillment of a series of preventive hygiene measures specifically detailed by the legislator. Herein, the positive predictive value of these criteria (“juridic criteria”) in the identification of professional liability for nosocomial infections was evaluated in comparison with clinical criteria reviewed by Infectious Disease specialists (“Infectious-Disease criteria”, i.e. presence of a Multidrug Resistant Organism (MDRO); development of surgical site infection; inadequate antibiotic therapy; inadequate disinfection). MethodsTwo retrospective cohorts were compared from the Portal of Telematic Services of the Ministry of Justice; 51 patients were extrapolated from Italian judgments concerning claims for Gram-negative nosocomial infections in the three-year period 2020–2022. On the other side, from the electronic database of University Hospital of Bari we extracted 349 patients affected by Gram-negative infections in the same timespan. Both “juridic” criteria and “Infectious-Disease” criteria were then applied to the full cohort after stratification for cohort of origin and after stratification for nosocomial or non-nosocomial infections. Predictive value of criteria was evaluated through receiver operating characteristic (ROC) curves and area under the curve (AUC). ResultsOverall, the incidence of definite nosocomial infections (according to final judgement or clinical records discharge letter) was 84 % in juridic cohort and 46 % in “real-world” series.Data suggested that the presence of all three juridic criteria [ROC AUC = 0.944 (95%CI = 0.924–0.963)] or the four clinical criteria [ROC AUC = 0.948 (95%CI = 0.928–0.969)] predicted well a case of nosocomial infection with professional liability.Moreover, by summarizing both criteria in a single classification system, the generated ROC curve (was the one with the highest AUC [0.9488 (95%CI = 0.928–0.969)].Accordingly, further tests were performed, evaluating the predictive value of one juridic criterium plus at one of more Infectious-Disease criteria. Interestingly, the ROCs curves demonstrated that the presence of at least 1 juridic criteria plus at least 2 Infectious Disease criteria reached a predictive value comparable to 2 or 3 juridic criteria. ConclusionsThe results highlight the efficiency of new criteria laid down in the judgment of the Italian Supreme Court to attribute liability for nosocomial infection despite the disputed distance between juridic and scientific decision-making process. In addition, the use of a combined score combining “juridic” and “Infectious-Disease” criteria provides a high-quality tool to be used by technical consultants to make up for lack of clinical documentation by passing judgments concerning litigation about professional liability in case of nosocomial infections. This sheds light on the possibility to face worldwide judicial inquiries with scientific rigor.

A questionnaire survey of infection control measures during the coronavirus infectious disease 2019 pandemic era

ObjectiveTo clarify the infection control measures required in the event of a new infectious disease outbreak, we conducted a questionnaire survey on the infection control measures implemented against coronavirus disease 2019 (COVID-19). MethodsAn invitation to participate in this survey was sent to the heads of 2689 facilities affiliated with the members of the Japanese Society for Infection Prevention and Control in February 2023, requesting responses to the online survey using Google Forms by March 2023. ResultsSix hundred and forty-five facilities, including 20 clinics and 625 hospitals, participated in the survey. This survey revealed that various infection control measures were implemented, including universal masking in the non-COVID-19 ward (96.5 %), screening tests for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on scheduled admission (89.0 %), SARS-CoV-2 tests (98.7 %), and isolation in private rooms (76.5 %) for inpatients with fever. However, nosocomial infections and clusters of COVID-19 occurred in 94.4 % and 90.9 % of cases during the investigation period, respectively. One of the reasons for these results is that healthcare personnel (HCP) and patients were common index cases of nosocomial infections, and the most common cause of clusters was the work of symptomatic HCPs. These results suggest that HCPs should understand that they can be index cases or spreaders. On the other hand, the most common support from external facilities was healthcare centers, followed by physicians or nurses from other hospitals. ConclusionIn response to the emergence of infections, it is important to consider implementing infection control measures for HCPs and patients.

Identifying Importation and Asymptomatic Spreaders of Multi-drug Resistant Organisms in Hospital Settings.

Healthcare-associated infections (HAIs) due to multi-drug resistant organisms (MDROs) are a significant burden to the healthcare system. Patients are sometimes already infected at the time of admission to the hospital (referred to as "importation"), and additional patients might get infected in the hospital through transmission ("nosocomial infection"). Since many of these importation and nosocomial infection cases may present no symptoms (i.e., "asymptomatic"), rapidly identifying them is difficult since testing is limited and incurs significant delays. Although there has been a lot of work on examining the utility of both mathematical models of transmission and machine learning for identifying patients at risk of MDRO infections in recent years, these methods have limited performance and suffer from different drawbacks: Transmission modeling-based methods do not make full use of rich data contained in electronic health records (EHR), while machine learning-based methods typically lack information about mechanistic processes. In this work, we propose NEURABM, a new framework which integrates both neural networks and agent-based models (ABM) to combine the advantages of both modeling-based and machine learning-based methods. NEURABM simultaneously learns a neural network model for patient-level prediction of importation, as well as the ABM model which is used for identifying infections. Our results demonstrate that NEURABM identifies importation and nosocomial infection cases more accurately than existing methods.

Management of adverse events in a Moroccan regional hospital: a state of art and perspectives.

the risk management system is useful to identify, analyze, and reduce the risk occurrence of adverse events (AEs) in health services. This system suggests useful improvements to patients and to the whole institution and also contributes to the acquisition of a collective and organizational safety culture. This study presented a state of the art of the management of AEs identified in different services of a regional hospital in the north of Morocco. this is a retrospective cross-sectional exploratory study carried out from 2017 to 2019 using observations and semi-structured interviews, which were recorded, re-transcribed, and analyzed. Data was also collected from audit reports, results of investigations of the nosocomial infection control committee and the risk management commission, AEs declaration sheets, and meetings reports. a number of 83 AEs were recorded, 10 of which were urgent. The reported events were related to care, infection risk, the drugs circuit, and medico-technical events. Two hundred cases of nosocomial infections were also recorded, of which 75 occurred in the intensive care unit and 35 in the maternity service. Surgical site infections were the most frequently reported complication. Adverse events were related to organizational failure, equipment problems, and errors related to professional practices. our findings may guide the improvement of the event management system in order to reduce the occurrence of future incidents. Thus, improving the risk management system requires setting up training strategies for staff on the importance of this system and its mode of operation.

Use of Metagenomic Next-Generation Sequencing to Identify Pathogens Involved in Central Nervous System Infections.

Application of metagenomic next-generation sequencing (mNGS) in identifying nosocomial central nervous system (CNS) infections in critical care units remains understudied. We conducted a retrospective analysis of microbiological results through both mNGS and routine examination of cerebrospinal fluid (CSF) samples from patients with nosocomial CNS infections. The aim of this study was to assess the clinical diagnostic effect of nosocomial mNGS in this population. The study included 26 cases of nosocomial CNS infections in total. A total of 69.2% (18/26) of the samples tested positive for mNGS, which is substantially greater than the 7.7% (2/26; p<0.05) detected through conventional techniques. Administration of antibiotics before culture is most likely the cause of the low CSF culture rate. Twenty-five pathogenic strains that were missed by standard testing. Three pathogens that were consistent with the mNGS results were positive by routine tests. Eight cases were negative by mNGS due to low pathogen CSF titres. Compared to traditional testing, mNGS demonstrated 100% sensitivity and 33.3% specificity in diagnosing CNS infections. The thirty-day mortality rate was 26.9% (7/26). Routine microbiologic testing frequently falls short of detecting all neuroinvasive pathogens. Our research suggests that mNGS offers an alternative means of detecting nosocomial CNS infections. By applying mNGS to CSF samples from patients with meningitis or encephalitis, we were able to improve the ability to diagnose nosocomial neurologic infections.

Nosocomial infections in patients admitted in medical intensive care units in a tertiary health center in Western part of India and their hematological correlation

Background and Aim: Acquired infections (AIs) in medical intensive care units (MICUs) have become serious threats with increasing mortality and morbidity more so in the developing countries. The most common reason is lack of efficient infection control protocols. The national nosocomial infections surveillance system defines a nosocomial infection as a localized or systemic condition that results from adverse reaction to the presence of infectious agents or their toxins that were not present or incubating at the time of admission to the hospital. Critically ill patients are at increased risk of acquiring nosocomial infections because of their lower immune status. These infections being opportunistic, microbes of low virulence cause also cause disease in hospital patients whose immune systems are impaired. This study was conducted to study the association of leukocytosis in relation to nosocomial infections in MICU. Methods: A retrospective study was conducted at the MICU under the Department of Anesthesiology in collaboration with the Department of Microbiology and Department of Pathology of Mahatma Gandhi Medical College and Hospital, Navi Mumbai over six months. All the patients who were admitted in MICU and stayed for more than 48 hours were included in the present study. Results: A total of 805 patients were admitted in the MICU from January 1st to June 30th, 2017, for a period of 6 months. Out of 805 cases, 27 patients developed nosocomial infections amounting to 3.3% with male-to-female ratio of 2.8:1. The age of the patient ranged from 15 to 85 years with the mean age of 50 years. Male predominance was seen with 74% cases with mean age of 48.5 years. Maximum cases were seen in the geriatric age group mainly 6th to 7th decade comprising of 40.7% of all cases. In our study, bloodstream infection was the most common finding constituting 100% of the cases, followed by urinary tract infections. All the cases of nosocomial infections showed polymorphonuclear leukocytosis with shift to left. In our study, diabetes mellitus followed by hypertension and chronic kidney disease was the major contributory comorbidities comprising of 29.6%, 29.6%, and 22.2%, respectively. In our study, the invasive devices contributed to the overall outcome of the patients. Urinary catheters (all cases) were the most prevalent invasive device followed closely by Ryle’s tube (90%) and endotracheal tube (60%). Conclusions: Intensive care units (ICUs) comprise of less than 10% of the total hospital beds but contribute &gt;20% of all the nosocomial infections acquired in the hospital. World Health Organization (WHO) estimates the burden of nosocomial infections in hospitalized patients to be 7–12% globally, in contrast to the figures from India being alarmingly high varying from 11–83%.

WORK ORGANIZATION OF A CENTRAL STERILIZATION DEPARTMENT IN A PEDIATRIC EMERGENCY MEDICAL INSTITUTION (Part 1)

Background. Sterilization of medical devices is one of the most important measures of non-specific prophylaxis aimed at preventing infections associated with the provision of medical care. Sterilization of medical devices is one of the main measures to ensure the safe provision of medical care, an important stage in the system of infection control and epidemiological safety, in accordance with the requirements of which the work on the prevention of nosocomial infection is carried out.. There have been numerous cases of nosocomial infections transmitted through medical devices. Strict observance of all norms and rules of sterilization measures, especially in a pediatric emergency medical organization, is of great importance in the nonspecific prevention of infection associated with the provision of medical care. Strict implementation of the rules for organisation of the central sterilization department in a pediatric emergency medical institution plays an important role in the prevention of infections associated with the provision of medical care to children and makes it possible to fully avoid nosocomial infections in both patients and staff of a medical organization. To carry out measures to properly organise the work of the central sterilization department, a number of administrative, organizational and anti-epidemic measures are required in a medical organization. Aim. To determine the work organisation features of the central sterilization department in a medical institution of the pediatric emergency care proRle. Materials and Methods. The materials presented in the publication were obtained by analyzing the work of the central sterilization department of the Research Institute of Emergency Pediatric Surgery and Traumatology. Results. It has been established that the personnel of the central sterilization department of the Research Institute of Emergency Pediatric Surgery and Traumatology, its material resources and technical equipment comply with the requirements of sanitary rules SP 2.1.3678-20 "Sanitary and epidemiological requirements for the operation of premises, buildings, structures, equipment and transport, as well as the conditions of activity of business entities selling goods, performing work or providing services" and other regulatory and legal documents regulating the work of the central sterilization department in a medical organization. Conclusions. The organization of medical devices sterilization in the central sterilization department of the Research Institute of Emergency Pediatric Surgery and Traumatology allows to perform sanitary and hygienic (prophylactic) and anti-epidemic measures in order to prevent infections associated with the provision of quality medical care a to patients.

Prevalence of nosocomial infections in Lordegan Shohada hospital from 2017 to 2022

Introduction: Healthcare-acquired infections or nosocomial infections are a common problem in all countries. Objectives: The aim of this study was to conduct an epidemiological evaluation of nosocomial infections in Lordegan Shohada hospital from 2017 to 2022. Methods: This study was descriptive-analytical cross-sectional. The case finding was based on Centers for Disease Control (CDC) definitions for nosocomial infection and the nosocomial infection questionnaire of the Ministry of Health and medical treatment of Iran. Cases of nosocomial infection were confirmed based on clinical findings and tests then registered in the Iranian nosocomial infection surveillance system. Results: Overall, 48343 patients were at risk for nosocomial infections during the study period; of these, 274 (0.6%) cases of nosocomial infections were detected, of which 132 were men (48%), and 142(52%) were women. The most common type of nosocomial infection in this study was surgical site infections (0.33%), pneumonia (0.27%), and ventilator-associated events (0.10). The highest rate of nosocomial infection was reported from intensive care units (0.2). Conclusion: The prevalence of nosocomial infections in this center has been low compared to the global norm. This is not the reason that the majority of nosocomial infections are low. The most important reason was the irrational use of antibiotics and, therefore, the hiding of infection cases. The prevalence of microbial resistance is increasing since this issue is worrying in nosocomial infection control.

Correlation between Knowledge and Attitude with The Practice of Using PPE among Professional Dental Students at Jember University Dental Hospital, Indonesia: A Cross-Sectional Study

Background: Hundreds of millions of nosocomial infection cases are estimated yearly worldwide. Nosocomial infections significantly lead to death and financial losses in the healthcare system. There is a need for infection mitigation, one of them is using Personal Protective Equipment (PPE). The importance of using PPE is still not supported by its compliance. Aim and Objective: This study aims to determine the relationship between knowledge and attitude toward PPE use among professional dental students at RSGM Universitas Jember. Materials and Method: The research method uses quantitative observational analytics cross-sectionally with questionnaires given through google forms and checklists filled out by researchers during observation. Variable involvement consists of knowledge, attitude, and practice in using PPE. It took 132 professional dental students as the respondents whose selection was done by stratified random sampling. Data analysis was performed univariate and bivariate using Microsoft Excel and the chi-square test on SPSS. Results: 81.8% of respondents had a good level of knowledge of PPE use, 81.1% of respondents had a positive attitude towards using PPE, and there were 22% of respondents who were not compliant using PPE. Respondents who did not comply with PPE came from dental treatment-producing aerosols. There was a relationship between knowledge and PPE use (p-value 0.002), but no relationship was found between attitude and PPE use (p-value 0.792). Conclusion: There was a relationship between knowledge and PPE use but no relationship between attitude and PPE use.

Epidemiology of nosocomial Staphylococcus epidermidis and Acinetobacter baumannii infections in a neonatal intensive care unit.

This study aimed to investigate epidemiology of Staphylococcus epidermidis (S. epidermidis) and Acinetobacter baumannii (A. baumannii) infections in neonatal intensive care unit (NICU) in a period of 8 years. This retrospective cohort study was conducted on 46 cases of nosocomial infection by S. epidermidis, and 44 neonates with A. baumannii in NICU of Valiasr hospital, Iran. The trend of A. baumannii and S. epidermidis infection were as follows: 1 and 7 in 2014, 11 and 7 in 2015, 20 and 11 in 2016, 1 and 4 in 2017, 4 and 6 in 2018, 4 and 4 in 2019, 0 and 1 in 2020, and 3 and 6 in 2021-March 2022 respectively. Mortality proportion (%) in neonates with S. epidermidis and A. baumannii infection was at 8.3 and 32.1, respectively. There was a strong positive correlation between number of infected neonates in month and average of prescribed antibiotics before incidence of infection in every baby in that month. Fluconazole prescription before incidence of infection were associated with the A. baumannii infection in month too. Amikacin prescription had adjusted correlation on increasing of A. baumannii and S. epidermidis infection in month. It seems reducing of hospitalization duration and medication prescriptions management plays an important role in reducing of nosocomial infections.

Fanny pack transmission of carbapenem-resistant Acinetobacter baumannii

Background: Carbapenem-resistant Acinetobacter baumannii (CRAB) is a gram-negative coccobacillus that has garnered notoriety as a formidable cause of nosocomial infection with significant mortality. This organism poses a significant threat due to its multitude of resistance mechanisms and ability to endure within the environment. In the summer of 2022, a 350-bed acute-care hospital identified an outbreak of CRAB among critically ill patients in the intensive care unit (ICU) and intensive nursing care unit (INCU). Here, we report actions taken to contain the outbreak and to identify a common environmental source. Methods: In total, 7 nosocomial CRAB infection cases were identified by the infection prevention team between July and September 2022. A multidisciplinary team reviewed the cases using relevant medical history and available microbial susceptibilities. Clinical culture sites include 1 PICC tip, 1 urine sample, 1 peritoneal fluid samples, 5 wounds, and 1 sputum sample. Of 7 infections, 6 met the criteria for hospital onset, with an average time to infection from admission of 61 days. We quickly initiated universal contact precautions in the ICU and INCU for 6 weeks, enhanced daily cleaning of high-touch surfaces, provided staff and visitor education, conducted adenosine triphosphate (ATP) testing, collected observations, and performed selective environmental culturing based on observations. Results: In total, 71 environmental specimens were collected for culture. All were negative with the exception of 1 isolate obtained from the fanny pack of a wound-care nurse that was positive for CRAB. Also, 4 available patient isolates and the environmental isolate were sent to New York State Department of Health Wadsworth Center (NYSDOH Wadsworth) for genome sequencing, and relation to the same cluster was confirmed. Of 7 isolates, 6 were confirmed to express the blaOXA-23 resistance mechanism (1 was not available for testing). Subsequently, chart review identified that a wound-care nurse had had contact with all 7 patients within 30 days of their infections. Conclusions: After initiation of the described action plan, no further transmission was identified in the ICU or INCU. Real-time observation and environmental culturing was critical in identifying the epidemiological link, and this finding speaks to the ability of this organism to persist on a surface for a substantial length of time. Fanny pack use for transport of patient-care supplies was identified as a high-risk practice due to the inability to be properly disinfected between rooms and limited laundering. Fanny packs are no longer permitted in clinical spaces at this facility.Disclosures: None

Nosocomial Infections in the Intensive Care Unit of Saint Louis Regional Hospital: Status Report and Prognostic Factors of Mortality

Introduction: Nosocomial infection or infection associated with care is a serious concern in intensive care units. It is a serious infection because of its frequency, incidence and additional cost. The objective of the study was to determine the epidemiological, clinical, therapeutic and evolutionary aspects of nosocomial infections in the intensive care unit of the regional hospital of Saint Louis. Materials and Methods: A one year retrospective, descriptive and analytical study of all cases of nosocomial infections found during the study period. We analyzed anamnestic, clinical, therapeutic, evolutionary and prognostic data. Results: 28 cases of nosocomial infections out of 243 hospitalized patients, an incidence of nosocomial infection of 11.5%. The mean age of the patients was 37.57 years with a standard deviation of 20.5 years. The reasons for admission were altered consciousness (28.5%), postoperative follow-up (21.4%), and acute respiratory failure (14.2%). Invasive procedures were represented by bladder catheterization (100%), central venous catheterization (64%), oro-tracheal intubation (39.2%), hemodynamic support (28.5%), extra-renal purification and parenteral nutritional support in respectively 10.7% and 7%. Pneumonia acquired under mechanical ventilation represented 28.5% of the infections identified, bacteremia 21%, urinary and neuro-meningeal infections 18% each and surgical site infections 14%. The germs identified were gram-negative bacilli (75%) (8 pseudomonas and 13 enterobacteria), gram-positive cocci in 25% of cases (5 staphylococci aureus Meti S and 2 staphylococci Meti R). The rate of microbial resistance was 35.7%. The average length of hospitalization was 16 days (Extreme = 60 -3 days). The mortality rate was 35%. Discussion/Conclusion: Nosocomial infections in the ICU are frequent and are associated with high morbidity and mortality. Effective preventive measures are the key to improve the prognosis.

Clinico-Bacteriological study of Nosocomial Infections in the Paediatric Intensive Care Unit (PICU)

Background: In this study, we wanted to study the incidence, risk factors and clinical and bacteriological pattern of nosocomial infections in PICU. Methods: This study was conducted in the PICU of 900 bedded Tertiary hospital. 74 suspected cases of nosocomial infections were studied prospectively, identified as per the guidelines laid down by CDC. Results: The incidence of nosocomial infections was 29% (N=255). Bloodstream infections were the most commonly observed in the present study (43.24%, 32/74) followed by Urinary Tract Infection (UTI) (32.43%, 24/74), Nosocomial pneumonia (16.21%, 12/74), and SSI (8.1%, 6/74). There were two patients with more than one nosocomial infections. The average duration of stay in children with NI the overall length of stay was 589 days with an average of 7.95 days compared to 4.63 days in children without NI. Conclusions: The risk of nosocomial infection was directly related to the duration of stay in the PICU and the duration of placement of indwelling catheters /tubes. Age and sex were the important independent risk factors for causing nosocomial infections as the incidence was more in the 2 months age group. BSI occurred more commonly in males while UTI in females. Other risk factors like malnutrition, immuno-compromised status and underlying illness were also associated with nosocomial infections. The most common organism was E. coli (sensitive to amikacin) followed by klebsiella and maximum sensitivity to piperacillin-tazobactam. Length of stay in PICU more in children with NI. There was no significance in mortality between both groups. Abbreviations: NI- Nosocomial infections. PICU- Pediatric intensive care unit. UTI- Urinary tract infections.

A new strategy to prevent biofilm and clot formation in medical devices: The use of atmospheric non-thermal plasma assisted deposition of silver-based nanostructured coatings.

In industrialized countries, health care associated infections, the fourth leading cause of disease, are a major health issue. At least half of all cases of nosocomial infections are associated with medical devices. Antibacterial coatings arise as an important approach to restrict the nosocomial infection rate without side effects and the development of antibiotic resistance. Beside nosocomial infections, clot formation affects cardiovascular medical devices and central venous catheters implants. In order to reduce and prevent such infection, we develop a plasma-assisted process for the deposition of nanostructured functional coatings on flat substrates and mini catheters. Silver nanoparticles (Ag NPs) are synthesized exploiting in-flight plasma-droplet reactions and are embedded in an organic coating deposited through hexamethyldisiloxane (HMDSO) plasma assisted polymerization. Coating stability upon liquid immersion and ethylene oxide (EtO) sterilization is assessed through chemical and morphological analysis carried out by means of Fourier transform infrared spectroscopy (FTIR) and scanning electron microscopy (SEM). In the perspective of future clinical application, an in vitro analysis of anti-biofilm effect has been done. Moreover, we employed a murine model of catheter-associated infection which further highlighted the performance of Ag nanostructured films in counteract biofilm formation. The anti-clot performances coupled by haemo- and cytocompatibility assays have also been performed.

Effective multidimensional approach for practical management of the emergency department in a COVID-19 designated children's hospital in east China during the Omicron pandemic: a cross-sectional study.

Characterized by rapid transmission but lower severity, the new Omicron wave brought about an acute increase in local corona virus disease 2019 (COVID-19) cases in Shanghai, followed by stricter infection prevention and control strategies. Inevitably, more time was required for emergency consultation and treatment of children with critical illnesses. Therefore, a multidimensional approach was designed to streamline the emergency service and reduce the incidence of nosocomial infection of sever acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the Omicron wave for the emergency department (ED) at the Children's Hospital of Fudan University (CHFU). A multidimensional approach was implemented in the ED to help achieve a balance between the demand for emergency services and pandemic control, consisting of ED layout adjustment; electronic screening (E-screening) measures; standard management processes for patients, medical staff, and goods transfer; reliable disinfection measures; and a surveillance system for infection prevention and control. To evaluate the effect of the management strategy, the data on nosocomial infection cases and occupational exposure episodes among staff in the ED were collected. The demographic and clinical characteristics of level I/II children by the five-level pediatric triage tool and their mean duration of stay in the resuscitation room were collected. There were 12,114 ED visitors from March 1 to May 31 in 2022, among which 53.24% were medical emergencies (6,449/12,114) and 46.76% were surgical emergencies (5,665/12,114). Twenty-nine patients were sent to the buffer zone, four of whom were transferred to the pediatric intensive care unit (PICU) because of the critical situation. Six patients tested positive for COVID-19 after entering ED, including three in the buffer zone and three in the ED clinic, causing a temporary closure of the ED for disinfection. There were no reports on medical care delays, unintended deaths, staff with COVID-19 infection, or occupational exposures to COVID-19. Our findings highlight the effectiveness of the multidimensional approach, which can simultaneously meet the emergency care needs of patients as well as pandemic prevention and control. However, the results were obtained against the proportional decrease in clinic visitors due to the Shanghai lockdown. Dynamic assessment and further optimization may be adopted to cope with the pre-pandemic visit volume.

Contributory conditions for unexpected COVID-19 cases and nosocomial COVID-19 infection cases identified from systematic investigation in a French University Hospital

IntroductionNosocomial case (NC) of COVID-19 infections is a challenge for hospitals. We report the results of a seven-month prospective cohort study investigating COVID-19 patients to assess unexpected cases (UC) (no COVID-19 precautionary measure application since admission) and NC. Patients and methodsInvestigation by an infection control team of 844 patients with COVID-19 infection hospitalized for more than 24 hours (cases). ResultsA total of 301 UC were identified (31% after contact tracing) with a total of 129 contact patients, and 27 secondary cases for 59 of them. In geriatric wards, 50% of cases were UC. NC represented 18% of cases (37% in geriatric wards), mainly identified after contact tracing of wandering cases. ConclusionA rapid infection control response is essential to contain nosocomial transmission, along with detailed contact tracing and screening policy. Dealing with wandering elderly patients remain challenging for HCWs.

Nosocomial Infection in Veterinary Medicine: A Rare Event or Neglected by Veterinarians?

In humans, nosocomial infections (HI), also known as healthcare-associated infections (HAIs), are those acquired by patient during hospital stay. They are unrelated to the reason for which the patient was hospitalized, and may manifest, mostly due to bacteria, during or after hospitalization. The environment has a strong connection with cases of nosocomial infection in human medicine, however, in veterinary medicine, there is still not much information regarding this connection, since there is no effective data on these infections. The main multidrug-resistant microorganisms involved in nosocomial infections in humans are: Methicillin-resistant Staphylococcus (MRS), Vancomycin-resistant Enterococcus (VRE), Gram-negative bacteria (Enterobacteriaceae family, Pseudomonas aeruginosa and Acinetobacter baumanii) that produce extended-spectrum betalactamase (ESBL) and those producing carbapenemases. As previously mentioned, bacteria are the main microorganisms involved in cases of nosocomial infections, which may come from the patient himself (endogenous contamination) after an immunological decline or come from the environment or cross-contamination (other animals or via health professionals). Generally, the bacteria involved in nosocomial infections are multi-resistant to antimicrobials, especially those most used in hospitals, which makes treatment and patient improvement even more difficult. Despite research related to antimicrobial resistance, the reality of the clinical routine of animals does not seem to be in line with the world reality. There are few studies in veterinary medicine regarding nosocomial infections (some extremely punctual), In the other hand, these infections are already a reality in veterinary hospitals, mainly of small animals, and, unfortunately, they are most of the time neglected due to the difficulty of their traceability or even by the lack of knowledge.

A rare case of postsurgical nosocomial infection of Conjunctiva by Trichosporon species.

A rare case of postsurgical nosocomial infection of Conjunctiva by Trichosporon species.

Contamination of Proteus mirabilis harbouring various clinically important antimicrobial resistance genes in retail meat and aquatic products from food markets in China.

Proteus mirabilis is an opportunistic pathogen frequently associated with nosocomial infection and food poisoning cases. Contamination of P. mirabilis in retail meat products may be important transmission routes for human infection with P. mirabilis. In this study a total of 89 P. mirabilis strains were isolated from 347 samples in 14 food markets in China and subjected to whole-genome sequencing. Phylogenetic analysis showed that all 89 strains were divided into 81 different clones (SNPs >5), indicating high genetic diversity of P. mirabilis in food markets. Antimicrobial susceptibility testing showed that 81 (91.01%) strains displayed multidrug resistance profiles. Seventy-three different resistance genes (or variants) were found, including various clinically important antimicrobial resistance genes aac(6')-Ib-cr (77.53%), bla CTX-M (39.33%), fosA3 (30.34%), as well as multiresistance gene cfr (4.50%), tigecycline resistance gene cluster tmexCD3-toprJ1 (4.50%) and carbapenemase gene bla NDM-1 (1.12%). Diverse genetic elements including Tn7 transposon, plasmid, SXT/R391 integrative conjugative element were associated with the horizontal transfer of cfr. tmexCD3-toprJ1 and bla NDM-1 were located on ICEPmiChnJZ26 and Salmonella genomic island 1, respectively. Our study emphasized high contamination of P. mirabilis harbouring various clinically important antimicrobial resistance genes in retail meat and aquatic products, which might be an important issue in terms of food safety and human health.

Nosocomial infection and spread of SARS-CoV-2 infection among hospital staff, patients and caregivers.

There are difficulties in diagnosing nosocomial transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in hospital settings. Furthermore, mortality of cases of nosocomial infection (NI) with SARS-CoV-2 is higher than that of the general infected population. In the early stage of the pandemic in Taiwan, as patients were not tested for SARS-CoV-2 at admission, NIs often go undetected. Strictly applying the systematic polymerase chain reaction (PCR) screening, as a standard infection control measure was subsequently implemented to reduce NI incidence. However, evidence on risk factors for SARS-CoV-2 NIs among healthcare workers (HCWs) and caregivers is limited. To assess NI incidence of SARS-CoV-2 among hospital staff, hospitalized patients, and caregivers, and the transmission routes of clusters of infection. This descriptive retrospective analysis at our hospital from May 15 to August 15, 2021 included data on 132 SARS-CoV-2 NIs cases among hospital staff, inpatients, and caregivers who previously tested negative but subsequently identified with a positive SARS-CoV-2 reverse transcriptase-PCR (RT-PCR) test results, or a hospital staff who tested positive following routine SARS-CoV-2 RT-PCR test. Chi-square tests were performed to compare the differences between hospital staff and private caregivers, and between clusters and sporadic infections. Overall, 9149 patients and 2005 hospital staff members underwent routine SARS-CoV-2 RT-PCR testing, resulting in 12 confirmed cluster and 23 sporadic infections. Among the index cases of the clusters, three (25%) cases were among hospital staff and nine (75%) cases were among other contacts. Among sporadic infections, 21 (91%) cases were among hospital staff and two (9%) cases were among other contacts (P < 0.001). There was an average of 8.08 infections per cluster. The secondary cases of cluster infection were inpatients (45%), hospital staff (30%), and caregivers (25%). Private caregivers constituted 27% and 4% of the clusters and sporadic infections, respectively (P = 0.024); 92.3% of them were infected in the clusters. The mortality rate was 0.0%. The incidence of SARS-CoV-2 infection was relatively high among private caregivers, indicating a need for infection control education in this group, such as social distancing, frequent hand-washing, and wearing PPE.