Comprehensive Infection Control Program Research Articles

Antibiotic management programme in a tertiary intensive care unit: effects of a carbapenem-restricted period on clinical and laboratory parameters and costs of infections

Carbapenems are antibiotics used for serious infections. The consumption of carbapenems has increased worldwide due to increasing microbial resistance. To investigate the effects of a carbapenem-restricted antimicrobial stewardship programme (ASP) on changes in the resistance profiles of infectious agents, the amount of antibiotics used, length of stay in the intensive care unit (ICU), mortality, and costs. Patients hospitalized in ICU between July 1st, 2020 and May 1st, 2021 were divided into two periods: the carbapenem-non-restricted period (CNRP); and the carbapenem-restricted period (CRP) in which alternative antibiotics to carbapenems were preferred during infection. The defined daily dose (DDD) per 100 patient-day methodology was used to calculate the antibiotic consumption. Of the 572 patients included in the study, 62.2% were male, and mean age was 70.5 years. In the blood culture the most frequently Gram-negative agent was Acinetobacter baumannii (25%). A.baumannii bloodstream infections with multidrug-resistant and extensively drug resistant micro-organisms were significantly different between the two periods (CNRP: 95.6% (N= 22), CRP: 66.6% (N= 8); P= 0.04). There was a gradual decrease in the incidence density and rate of nosocomial infection (P= 0.06), and a significant decrease in meropenem consumption between the two periods (CNRP vs CRP: 21.19 vs 6.37 DDD per 100 patient-days respectively; P= 0.007). ASP yielded US$8,600 of antibiotic cost savings and a total of 14% patient cost savings (P < 0.05) per patient. Combining an effective ASP with a comprehensive infection control programme may mitigate the emergence of antimicrobial-resistant bacteria.

Awareness on the Waste Management Practices and Causes for Increased Urban Waste Generation among the General Public in Western Province, Sri Lanka

he upsurge in waste generation and improper management of waste possess serious issues to individuals‘ health and the environment. The administration of waste holds a crucial part in waste organization and proper waste management practices are essential to control the increase of urban waste and associated hazards. The present study aimed to assess the awareness on causes for increased urban waste and the practices of the general public on waste management. A descriptive cross-sectional study in Western Province, Sri Lanka was conducted among males and females within the age group of 20 to 60. 150 individuals were recruited using the quota sampling method and a self-administered questionnaire was distributed in English, Sinhala, and Tamil languages. Additionally, using SPSS software, the results were statistically analyzed. As per the data that was analyzed, 51.3% of the respondents were between the ages of 20 and 30. Most of the participants, 87.3% were aware of the increase in urban waste, and 88.6% stated the management of waste can hold a positive impact on suitable development. However, 40.6% have stated industrial waste as the major source associated with the surging urban waste indicating the unawareness of household waste as the primary source. Furthermore, though 84.6% divide inorganic and organic waste, according to 64% of participants, e-waste is not discarded using proper channels. Thus, there is an increased risk of health implications as e-waste chemical constituents could be hazardous to both human health and the environment. In the opinion of 89.3%, further training on waste management should be carried out while 52% of the respondents have declared not attaining any practices on waste management. Hence, an increase in the urban waste can be visible as the participants were inexperienced and unfamiliar with efficient waste disposal and management methods. The evidence that is currently available from this study suggests that there is a need to enhance community awareness, encourage training, and change people's attitudes regarding waste. A comprehensive infection control program combined with safe disposal of waste is recommended to achieve sustainable and economically viable waste management. &#x0D; Keywords: Urban, Waste management, e-waste, Training

Evaluation of Nurses' Awareness of Preventive Measures for Infection Control at Primary Health Care Centers in Al-Ramadi City

Objective: To assess nurses' awareness working in the primary health care field towards preventive measures for infection control in primary health care centers in Ramadi city. Methodology: A descriptive study was conducted during the period from 10 April to 15 August 2021. The instruments was constructed by the researcher to reach the aims of the study using a non-probability sampling: purposive sample consist of (60) nurses working in the field of primary health care. A two-part questionnaire was used in the study, the first part contains information about the demographic data of nurses in healthcare centers and the second part contains selected questions about their awareness and knowledge regarding infection control procedures. Data were analyzed by descriptive and inferential statistics (t-test and correlational statistics) using SPSS software. Results: The study found that the majority of the study sample (70 percent) were male, (50 percent) were in the age groups (30-39 years), (53.3 percent) were in the preparatory nursing, (50 percent) were about (16-20) years of the employee, and (76.7 percent) did not have a special training course, indicating that most nurses working in the healthcare field have a low level of infection control practice. The study concluded that nurses' awareness of preventive measures for infection control was at a low level. Conclusion: According to the findings of this study, the majority of nurses working in primary health care centers had a poor level of awareness toward infection control. Recommendation: In order to ensure compliance with infection control measures by nurses working in basic health care, the current study advocated the establishment and execution of a comprehensive infection control program in primary health care centers. Keyword: Awareness, Preventive measures, Infection control, Primary healthcare centers.

The status of infection prevention and control structures in Eastern China based on the IPCAF tool of the World Health Organization

BackgroundThe burden of healthcare-associated infections (HAIs) and the spread of antimicrobial resistance can be potentially preventable through comprehensive infection prevention and control (IPC) programs. However, information on the current state of IPC implementation is rare in China.MethodsA cross-sectional study was conducted in Zhejiang province, China, from April to June 2021. The Zhejiang nosocomial infection control and quality improvement center (NICQI) cooperated with 11 municipal NICQI centers to introduce the purpose of this study and invite all licensed secondary and tertiary hospitals in Zhejiang province through WeChat group. The questionnaire had three sections, including information about participating hospitals, demographic information about IPs, and the Chinese version of the Infection Prevention and Control Assessment Framework that covered eight core components (CC).ResultsOf the 382 hospitals invited, 222 (58.1% response rate) accepted and completed the online questionnaire. The overall median score of the participating hospitals was 682 (630–723), which corresponded to an advanced level of IPC. There was a significant difference in scores between hospitals types (P < 0.001). Profound differences were revealed regarding the scores of the individual components, with CC2 (IPC guidelines) and CC6 (Monitoring/audit of IPC practices and feedback) having the highest (100) and lowest (65) median scores, respectively. Only 23 (10.4%) hospitals reported assessing facility safety culture.ConclusionsIPC structures are at a relatively high level in acute care hospitals in Eastern China. The identified potential areas for improvement were similar to those identified in developed countries, particularly regarding multimodal strategies for implementation and safety culture construction. Meanwhile, the Chinese government should pay more attention to IPC resources and practices among secondary care hospitals.

Individual, social, and environmental factors for infection risk among home healthcare patients: A multi-method study.

There has been limited research into the individual, social, and environmental factors for infection risk among patients in the home healthcare (HHC) setting, where the infection is a leading cause of hospitalisation. The aims of this study were to (1) explore nurse perceptions of individual, social, and environmental factors for infection risk among HHC patients; and (2) identify the frequency of environmental barriers to infection prevention and control in HHC. Data were collected in 2017-2018 and included qualitative interviews with HHC nurses (n=50) and structured observations of nurse visits to patients' homes (n=400). Thematic analyses of interviews with nurses suggested they perceived infection risk among patients as being influenced by knowledge of and attitudes towards infection prevention and engagement in hygiene practices, receipt of support from informal caregivers and nurse interventions aimed at cultivating infection control knowledge and practices, and the home environment. Statistical analyses of observation checklists revealed nurses encountered an average of 1.7 environmental barriers upon each home visit. Frequent environmental barriers observed during visits to HHC patients included clutter (39.5%), poor lighting (38.8%), dirtiness (28.5%), and pets (17.2%). Additional research is needed to clarify inter-relationships among these factors and identify strategies for addressing each as part of a comprehensive infection control program in HHC.

Current Status of Infection Control Practice in Surgical Settings of Leading Academic and Private Service Hospitals in Dhaka, Bangladesh

Health-Care Associated Infection (HCAI) is such a risk and 1.4 millions of people worldwide suffer from HCAIs at any time. To describe the current practice for prevention of health-care associated infections in surgical settings of academic and private hospitals in Dhaka and to propose intervention for improving the conditions with existing resources. This is a descriptive type of exploratory, cross-sectional study and was designed to focus on various dimensions of infection prevention and control that includes- optimum designing of care settings, existing systems, clean-hygienic physical environment and safe practices. This study revealed that uninterrupted water supply and natural ventilation, two basic structural facilities of pivotal importance in infection control engineering were present on all premises under study. However, inadequate toilet and hand washing basins, absence of isolation room, overcrowding of wards was found to pose continuous threat to infection in most of the inpatient wards. Absence of explicit and comprehensive infection control program, clear and current policies on various infection control interventions like hand hygiene, isolation precaution, environmental cleaning, prevention and management of blood borne pathogen, antibiotic usage, injection safety and management of job related illness was revealed from this study. None of the other hospitals maintained post exposure evaluation and follow-up procedures. Although healthcare workers were formally trained in the following matters, unsafe practices for injection, improper use of personal protective equipment, low level of adherence to hand hygiene and cough etiquette were frequently observed during the study. From this study it can be concluded that academic and private hospitals, whether it is government, autonomous or private could not establish the policy, infrastructure, program, processes and safety culture in terms of standard infection prevention and control interventions, except one private service hospital.

1. Incidence of Nosocomial COVID-19 in Patients Hospitalized at a Large U.S. Academic Medical Center

BackgroundMany patients are avoiding essential care for fear of contracting Covid-19 in healthcare settings. However, the incidence of nosocomial Covid-19 infection in U.S. acute care hospitals is unknown.MethodsWe conducted an observational study of all patients admitted to Brigham and Women’s Hospital in Boston, Massachusetts between March 7 (when the first Covid-19 patient was admitted) and May 30, 2020. During this period, a comprehensive infection control program was implemented including dedicated Covid-19 units with airborne infection isolation rooms, personal protective equipment (PPE) in accordance with CDC recommendations, PPE donning and doffing monitors, universal masking, restriction of visitors, and liberal RT-PCR testing of symptomatic and asymptomatic patients. We reviewed the medical records of all patients who tested positive for SARS-CoV-2 by RT-PCR on hospital day 3 or later or within 14 days of hospital discharge to determine whether infection was community or hospital-acquired based on timing of RT-PCR tests, clinical course, and exposures.ResultsOver the 12-week period, 9,149 patients were admitted, in whom 7,394 SARS-CoV-2 RT-PCR tests were performed and 697 Covid-19 cases were confirmed, translating into a total 8,656 days of Covid-19-related care (Figure). The inpatient Covid-19 census peaked at 171 on April 21. Twelve of the 697 Covid-19 patients (1.7%) were first diagnosed by RT-PCR on hospital day 3 or later (median 4 days, range 3–15 days). Of these, only one was deemed hospital-acquired and was most likely acquired from his pre-symptomatic spouse who was visiting daily and diagnosed with Covid-19 before visitor restrictions were implemented. Amongst 8,370 non-Covid-19 patients discharged through June 17, 11 (0.1%) subsequently tested positive within 14 days (median time to diagnosis 6 days, range 1–14). Only one was deemed likely to have been hospital-acquired, albeit with no known exposures.Figure. Timeline of implementation of major infection control policies and cumulative number of hospitalized COVID-19 cases (total and hospital-onset) ConclusionNosocomial Covid-19 infection was exceedingly rare during the height of the pandemic in a hospital with rigorous infection control measures. Our findings may inform practices in other institutions and provide reassurance to patients regarding the safety of receiving care in acute care hospitals.Disclosures All Authors: No reported disclosures

Antimicrobial Resistance and Molecular Epidemiology of Corynebacterium striatum Isolated in a Tertiary Hospital in Turkey.

Although Corynebacterium striatum is part of the human flora, it has recently drawn attention both for its multidrug resistance and its role as an invasive infection/outbreak agent. This cross-sectional study aimed to determine the antimicrobial resistance and clonal relationships among C. striatum strains. In total, 81 C. striatum strains were identified using Phoenix-100TM (BD, Sparks, MD, USA). The antimicrobial resistance of the strains was determined using the Kirby–Bauer disk diffusion method. Clonal relatedness among the strains was performed via arbitrarily primed polymerase chain reaction (AP-PCR). All 81 C. striatum strains were resistant to penicillin, cefotaxime, ciprofloxacin, and tetracycline, but susceptible to vancomycin and linezolid. The resistance rates to gentamicin, erythromycin, and clindamycin were 34.6%, 79%, and 87.7% respectively. AP-PCR results showed no predominant clone among the C. striatum strains. Corynebacterium striatum is reportedly the cause of an increasing number of invasive infections/outbreaks. Moreover, treatment options are limited. The study showed that vancomycin, linezolid, and gentamicin can be selected for the empirical treatment of C. striatum infections. Although no single-clone outbreak was observed in our hospital, small clonal circulations were observed within some units, indicating cross-contamination. Therefore, a comprehensive infection control program is warranted in future.

Abstracts from the 5th International Conference on Prevention & Infection Control (ICPIC 2019)

Introduction: The efficacy of comprehensive Infection Prevention and Control Programs (IPCP) to reduce infection rates is well established. However, the evaluation of these programmes to achieve the best performance remains an issue. In this sense, researchers have worked on developing tools for evaluation IPC. Objectives: To compare three existing IPCP evaluation tools applied in healthcare facilities in Brazil. Methods: Cross-sectional, descriptive, quantitative approach, conducted using three tools concurrently. The tools were: 1.Infection Prevention and Control Programme Evaluation (IPCPE) from Australia; 2.Operating Guides of IPCP indicators (OGIPCP) from Brazil; 3.Assessment tool for hospital IPCP (IPCAF) from World Health Organization. Infection control practitioners (ICP) were recruited using snowball technique. Each ICP applied the tools to their setting. Data collection was performed by using a standardized semi-structured questionnaire, including 35 Likert scale items to inform the feasibility and comprehensiveness of tools. Results: Among invited ICP, 12 participants applied all evaluation tools. The average experience in infection prevention was 8 years (range 1.5 to 15 years). The average time to apply the evaluation tools were: IPCPE: 3h, OGIPCP: 1h, and IPCAF 1.5h. The majority of positive agreements regarding comprehensiveness were obtained by IPCPE (100% of positive agreement in 10 questions), followed by IPCAF (100% of positive agreement in 9 questions). Time spent applying the tools was only considered acceptable for OGIPCP and IPCAF. No tool achieved 100% agreement in 10 questions regarding comprehensiveness to assess the support of microbiology and other services to the IPCP, and links with public health. None of the tools achieved 100% agreement to recommend their use in extra-hospital settings such as primary care. Conclusion: Both IPCPE and IPCAF were considered as more comprehensive, but still lacking potential to access all relevant issues for IPCP. IPCAF and OGIPCP were considered less time consuming. Next, we will perform a qualitative approach to better understand the improvement gaps.

Strategies to control antibiotic resistance: results from a survey in Italian children's hospitals.

Antimicrobial stewardship programs and comprehensive infection control programs represent the main strategies to limit the emergence and transmission of multi-drug resistant bacteria in hospital settings. The purpose of this study was to describe strategies implemented in Italian children's hospitals for controlling antibiotic resistance. Cross sectional multicenter study. Four tertiary care Italian children's hospitals were invited to participate in a survey aimed at collecting information on activities implemented as of December 2015 using a self-administered online questionnaire. The questionnaire was divided in three sections focalizing on: i) policies for prevention and control of hospital-acquired infection, ii) prevention and control of multi-drug resistant bacteria, and iii) antibiotic prescribing policies and Antimicrobial stewardship programs. Questionnaires were compiled between May and July 2016. All hospitals had multidisciplinary infection control committee, procedures on hand hygiene, isolation measures, disinfection/sterilization, waste disposal and prevention on infections associated to invasive procedures. All sites screened patients for multi-drug resistant bacteria colonization in selected units, and adopted contact precautions for colonized patients. Screening during hospitalization, or in case of infections in the same ward were not universally implemented. All hospitals had policies on surgical prophylaxis, while policies on medical prophylaxis and treatment of bacterial infections varied among sites. Two sites recommended to review the appropriateness of antibiotic prescribing after 48-72 hours and one recommended de-escalation therapy. This study highlighted several areas of improvement, such as actions for screening patients in case of occurrence of multi-drug resistant bacteria, antimicrobial stewardship programs and implementation of policies targeting antibiotic prescriptions for therapeutic purposes and medical prophylaxis.

Infection prevention and control practices among health-care workers in tuberculosis clinics in Ondo State, Nigeria

Background: Healthcare-acquired infections are significant causes of morbidity and mortality among hospitalized patients worldwide, most especially in resource-limited settings. Similarly, the tuberculosis (TB) clinic is a high-risk area due to the nature of the clients being managed, and the infectivity of the implicated microorganism. TB infection control is an essential, but often-overlooked, component of a comprehensive infection control program in developing countries like Nigeria. The knowledge and attitude of the relevant health workers would be a determinant of their preventive practice toward preparedness and infection prevention and control (IPC) Objectives: The study assessed IPC practices among health-care workers in TB Clinic, in Ondo State, Nigeria. Methodology: A descriptive crosssectional study was carried out among 400 healthcare workers in selected TB clinics in Ondo State Nigeria, and these were selected using the multistage sampling method. Research instruments used were semi-structured self-administered pretested questionnaire. Data were analyzed using the SPSS software version 23.0. Mean scores were generated for the major outcome variables of knowledge, attitude, and practice of IPC. The P value was assumed significant at values ≤0.05 for all inferential statistics. Results: Mean age of respondents was 34 years ± 8.1 years, majority (83%) of the health-care workers had good knowledge of IPC, another majority (80%) of the health-care workers interviewed had good attitude toward IPC, 314 (78.5%) have read the guideline, while 68% of the health-care workers had good practice. Year of experience, type of facility, and facility settings were statistically significantly associated with respondents' knowledge, attitude, and practice of IPC (P 1 year, and working in a TB facility were significant predictors of good knowledge, attitude, and practice of IPC. Conclusion: There are huge gaps between knowledge and practice of IPC among respondents in this study. Since TB clinics are major sources of cross infection within the hospital setting, stakeholders have significant roles to play in IPC in the health-care setting.

Development of a comprehensive infection control program for a short-term shelter serving trafficked women.

A shelter for trafficked women has unique infection control needs that require a comprehensive infection control plan, balancing the needs of infection prevention with respect for the vulnerable population served. Using a trauma‐informed model and evidence from infection control in other shelter settings, a group of senior baccalaureate students developed a program in a short‐term shelter for commercially sexually exploited individuals that included a written infection control manual, policies and procedures, and staff training. This partnership between academia and a nonprofit agency was an experiential service learning project in the domain of public health nursing, allowing students the opportunity to apply evidence toward a sustainable intervention for the agency.

OI-162 - Implementation of a Comprehensive Infection Control Program at a Behavioral Health Facility after a Norovirus Outbreak

OI-162 - Implementation of a Comprehensive Infection Control Program at a Behavioral Health Facility after a Norovirus Outbreak

Successful control of resistance in&lt;em&gt; Pseudomonas aeruginosa&lt;/em&gt; using antibiotic stewardship and infection control programs at a Chinese university hospital: a 6-year prospective study

ObjectivePseudomonas aeruginosa is emerging as a highly multidrug-resistant (MDR) nosocomial pathogen. Data on the efficacy of infection control measures in endemic situations are lacking. We investigated the effect of antimicrobial stewardship (AMS) and infection control programs (ICPs) in controlling the resistance of P. aeruginosa at a tertiary hospital center.MethodsSusceptibility and resistance were investigated using broth microdilution, as per the guidelines of the Clinical and Laboratory Standards Institute. Antibiotic use was restricted through AMS, which included a classification management system for antibiotic use. The ICPs included environmental cleaning and disinfection, hand hygiene, active surveillance of P. aeruginosa, and education about infection control.ResultsA total of 2,241 P. aeruginosa isolates were evaluated between 2012 and 2017. Sensitivity and resistance of the isolates to the antipseudomonal antimicrobials colistin and tigecycline were stable. The sensitivity and resistance to other antipseudomonal antimicrobials improved after 2014, after the AMS and ICPs were implemented in 2013. The use of alcohol-based hand gel significantly increased from 0.6 to 10.9 L per 1,000 patient-days (PD) during the study period (P=0.005). The incidence rates of extensively drug-resistant (XDR) and MDR P. aeruginosa showed a sustained decrease from 2013 (4.9 and 22%) to 2017 (1 and 15%), respectively. The yearly consumption of antimicrobial agents also showed a sustained and significant decrease from 45 defined daily doses (DDDs) per 1,000 PD to 38.15 DDDs per 1,000 PD (P=0.04). A significant correlation was found between the incidence rate of MDR P. aeruginosa and the consumption of antimicrobial agents (P=0.01).ConclusionMonitoring of P. aeruginosa, AMS, and comprehensive ICPs could be one of the best and effective methods to prevent the development of resistance in P. aeruginosa.

School Bus Transportation of Children With Special Health Care Needs.

School systems are responsible for ensuring that children with special needs are safely transported on all forms of federally approved transportation provided by the school system. A plan to provide the most current and proper support to children with special transportation needs should be developed by the Individualized Education Program team, including the parent, school transportation director, and school nurse, in conjunction with physician orders and recommendations. With this statement, we provide current guidance for the protection of child passengers with specific health care needs. Guidance that applies to general school transportation should be followed, inclusive of staff training, provision of nurses or aides if needed, and establishment of a written emergency evacuation plan as well as a comprehensive infection control program. Researchers provide the basis for recommendations concerning occupant securement for children in wheelchairs and children with other special needs who are transported on a school bus. Pediatricians can help their patients by being aware of guidance for restraint systems for children with special needs and by remaining informed of new resources. Pediatricians can also play an important role at the state and local level in the development of school bus specifications.

Prevention of Ventilator Associated Pneumonia in an Emergency Intensive Care Unit : An Intervention Study

Background: Ventilator-associated pneumonia is the most frequent hospital acquired infection in ICU among mechanically ventilated patients. The objective of this study was to examine the effect of a series of interventions on VAP rate, MDR rate, antibiotic susceptibility pattern and health care providers’ practices. Methodology: A quasi-experimental study was conducted in three phases: A pre-intervention phase (phase I) including VAP epidemiologic surveillance program, an intervention phase (phase II) including the implementation of a comprehensive infection control program and a post-intervention phase (phase III) including assessment of the effect of the selected interventions. Results: After intervention, VAP rate per one thousand ventilator days showed reduction from 48.8 to 40. There was a significant improvement in the infection control practice of health care providers; the mean percentage of change in total practice was 14.02%. The most common isolated pathogen was Klebsiella, its prevalence decreased from 43% to 37.2% after intervention. During phase (I) 81.4% of isolates were found to be MDR, which decreased to 74.6% in phase III. Conclusion: the study showed a significant reduction in VAP rates with evidence based prevention strategies. Klebsiella was the most prevalent MDR pathogen responsible for VAP. Multifaceted intervention is a key strategy to prevent VAP.

Hepatitis C virus in patients on regular hemodialysis in Beni-Suef Governorate, Egypt.

The prevalence of HCV infection among hemodialysis patients (HD) varies from country to country and from one center to another. Despite the existence of guidelines for a comprehensive infection control program, Egypt is one of the countries with high HCV prevalence. In Egypt, the prevalence of HCV in haemadalysis patients (2015) was 50.7%. (1) To detect the prevalence of hepatitis C virus (HCV) infection and HCV seroconversion among all hemodialysis patients in Beni-Suef governorate, and (2) To detect factors associated with HCV seroconversion. Multicenter retrospective medical records review design was conducted in 13 hemodialysis units in Beni-Suef governorate during May - June 2015; all ESRD (End stage renal disease) patients undergoing hemodialysis were included in the sample. A predesigned questionnaire was used. The prevalence of the HCV at begin of dialysis was 60.9% and the rate of HCV seroconversion was 9.7%. Univariate analysis confirmed that history of blood transfusion, the non-adherence to infection control guidelines, lack of isolation strategies and history of Shistosomiasis were significant risk factors for seroconversion. Meanwhile multivariate logistic regression analysis confirmed that history of blood transfusion, and history of shistosomiasis were significantly associated with HCV seroconversion. HCV infection still remains a predominant problem among patients on maintenance HD in Beni- Suef governorate History of blood transfusion and history of shistosomiasis were significant risk factors for acquiring HCV infection in these patients.

Methicillin-resistant Staphylococcus aureus nasal colonization in a level III neonatal intensive care unit: Incidence and risk factors

To describe epidemiologic features and identify risk factors for methicillin-resistant Staphylococcus aureus (MRSA) acquisition in a level III neonatal intensive care unit (NICU). A prospective, cohort study in a university-affiliated NICU with an infection control program including weekly nasal cultures of all neonates. Demographic, clinical, and microbiologic data were prospectively collected between June 2009 and June 2013. Molecular characterization of MRSA isolates was done by multilocus variable number tandem repeat fingerprinting, staphylococcal cassette chromosome mec typing, and on representative isolates by multilocus sequence typing and spa typing. Of 949 neonates, 217 (22.87%) had a culture growing MRSA, including 117 neonates testing positive at their first sampling. Of these latter infants, 96 (82.05%) were inborn and 59 (50.43%) had been transferred from the nursery. Length of stay and colonization pressure were strong independent predictors of MRSA acquisition. Among MRSA isolates, 7 sequence types were identified, with ST22-IVa, spa type t223, being the predominant strain. In an endemic area, early MRSA acquisition and high colonization pressure, likely related to an influx of colonized infants from a well-infant nursery, can support persistence of MRSA in NICUs. Surveillance, molecular tracking of strains, and reinforcement of infection control practices, involving well-infant nurseries in a comprehensive infection control program, could be helpful in containing MRSA transmission.

Impact of the implementation of an interdisciplinary infection control program to prevent surgical wound infection in pediatric heart surgery.

Surgical site infection (SSI) remains a major source of morbidity, mortality, and increased health care costs in children undergoing heart surgery. The aim of this study was to assess the effectiveness of an intervention program designed to reduce the high incidence of SSI observed at our center in pediatric patients. An interdisciplinary infection control program including pre-, intra-, and postoperative measures was introduced for children undergoing heart surgery with cardiopulmonary bypass. We conducted a quasi-experimental interventional study comparing a pre-intervention cohort (June 2009 to March 2010) and a post-intervention cohort (July 2011 to July 2012). A significant drop in SSI incidence from 10.9 % (95 % CI 4.7-18.8) to 1.92 % (95 % CI 0.4-5.52) was observed. Variables significantly associated with infection risk were median age (14 days in infected vs 2.3 years in non-infected patients; p<0.01), hospitalization unit (10.3 % SSI cumulative incidence in the neonatal intensive care unit vs 0 cases in the pediatric intensive care unit; p<0.01), and median preoperative hospital stay (14 days in infected vs 1 day in non-infected patients; p=0.03). The implementation of a new intervention program was associated with an 82 % (95 % CI 34-94) reduction in SSI incidence in children undergoing heart surgery at our center. • Surgical site infection (SSI) is associated with significant morbidity and mortality following pediatric cardiac surgery. • Younger patients and longer cardiopulmonary bypass times are associated with higher SSI rates. What is New: • Comprehensive infection control program including preoperative, intraoperative and postoperative nonpharmacologic measures is a key factor for the prevention of SSI. • A significant reduction in SSI rates can be achieve despite a narrower-spectrum antibiotic usage.

Reduction of deep surgical site infections in cardiac surgery by introducing a multimodal infection control program

Deep surgical site infections (DSSI) are a major complication after cardiac surgery with a high mortality rate and reported incidences between 0.5 and 5%. Implementing a comprehensive infection control program (ICP) reduces this incidence [1]. The incidence in our hospital varied from 3.1 to 3.8%, which was considered too high. We evaluated the impact of introducing a multimodal ICP on the incidence of DSSI.