Comprehensive Infection Control Research Articles

Controversies in airway management of COVID-19 patients: updated information and international expert consensus recommendations

Controversies in airway management of COVID-19 patients: updated information and international expert consensus recommendations

Características clínicas y microbiológicas de infecciones por Klebsiella pneumoniae productora de carbapenemasa MBL, tipo NDM, Hospital Geriátrico San Isidro Labrador EsSalud, 2018

Objective: To determine the clinical and microbiological characteristics of seven (7) cases of New Delhi MBL (NDM)producing Klebsiella pneumoniae nosocomial infections at the Hospital Geriatrico San Isidro Labrador (HG SIL) from February to May 2018. Materials and methods: A descriptive and retrospective study conducted in elderly people with urinary infections, pneumonia, sacral ulcers and surgical wound infection who received multiple non-protocolized antibiotic therapy. The methods used to detect MBLs in the Klebsiella pneumoniae isolates that showed decreased sensitivity to carbapenems were the phenylboronic acid-based (PBA) and ethylenediaminetetraacetic acid-based (EDTA) double disk tests. The identification of the NDM gene was performed by polymerase chain reaction at the Instituto Nacional de Salud. Results: In total, the seven cases were positive for the NDM gene and resistant to meropenem, which confirmed the epidemic outbreak. Mortality accounted for 28.6 % (2 of 7 patients) of the cases. However, due to the presence of comorbidities in all cases, the attributable mortality could not be determined. Conclusions: Labs have a key initial role for detecting and classifying the carbapenemases and the measures of comprehensive control of infections. The aforementioned cases are the first ones reported in our healthcare network.

Nosocomial Transmission of Coronavirus Disease 2019: A Retrospective Study of 66 Hospital-acquired Cases in a London Teaching Hospital.

COVID-19 can cause deadly healthcare-associated outbreaks. In a major London teaching hospital, 66/435 (15%) of COVID-19 inpatient cases between 2 March and 12 April 2020 were definitely or probably hospital-acquired, through varied transmission routes. The case fatality was 36%. Nosocomial infection rates fell following comprehensive infection prevention and control measures.

Cross-contamination and infection control in intraoral digital imaging: a comprehensive review.

Dental health care workers are subjected to various infectious disease agents that are present in patients' saliva and blood which make infection control and universal prevention methods indispensable to the dental practice given that some of these diseases cause loss of work and time for dental staff and patients; some of them cause serious morbidity; and some of them currently have a poor prognosis and no effective treatments. Although dental radiographic procedures are not invasive, and there are no incidents such as injuries caused by dental instruments, they are a potential infection source because of contamination with saliva and blood, and comprehensive infection control procedures also apply to the radiology clinic. In addition, contact with a large number of patients in dental schools and clinics in a short period of time, and the fact that radiographic procedures are performed in the same environment as other dental procedures in dental offices increase the significance of infection control in dental radiology. Major advances in computer technology have enabled digital imaging systems to develop rapidly and to become common in dental practice as an alternative to conventional film-based imaging. The use of digital sensors in dental radiology introduced unique infection control challenges and required the revision and modification of existing infection control techniques. In this review, studies concerning the risk of cross-contamination and challenges of infection control with digital image sensors are comprehensively reviewed and infection control protocols that should be followed in intraoral digital imaging using both direct and indirect systems are thoroughly examined.

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.

Inclusion of Real-Time Hand Hygiene Observation and Feedback in a Multimodal Hand Hygiene Improvement Strategy in Low-Resource Settings

Hand hygiene adherence monitoring and feedback can reduce health care-acquired infections in hospitals. Few low-cost hand hygiene adherence monitoring tools exist in low-resource settings. To pilot an open-source application for mobile devices and an interactive analytical dashboard for the collection and visualization of health care workers' hand hygiene adherence data. This prospective multicenter quality improvement study evaluated preintervention and postintervention adherence with the 5 Moments for Hand Hygiene, as suggested by the World Health Organization, among health care workers from April 23 to May 25, 2018. A novel data collection form, the Hand Hygiene Observation Tool, was developed in open-source software and used to measure adherence with hand hygiene guidelines among health care workers in the inpatient therapeutic feeding center and pediatric ward of Anka General Hospital, Anka, Nigeria, and the postoperative ward of Noma Children's Hospital, Sokoto, Nigeria. Qualitative data were analyzed throughout data collection and used for immediate feedback to staff. A more formal analysis of the data was conducted during October 2018. Multimodal hand hygiene improvement strategy with increased availability and accessibility of alcohol-based hand sanitizer, staff training and education, and evaluation and feedback in near real-time. Hand hygiene adherence before and after the intervention in 3 hospital wards, stratified by health care worker role, ward, and moment of hand hygiene. A total of 686 preintervention adherence observations and 673 postintervention adherence observations were conducted. After the intervention, overall hand hygiene adherence increased from 32.4% to 57.4%. Adherence increased in both wards in Anka General Hospital (inpatient therapeutic feeding center, 24.3% [54 of 222 moments] to 63.7% [163 of 256 moments]; P < .001; pediatric ward, 50.9% [132 of 259 moments] to 68.8% [135 of 196 moments]; P < .001). Adherence among nurses in Anka General Hospital also increased in both wards (inpatient therapeutic feeding center, 17.7% [28 of 158 moments] to 71.2% [79 of 111 moments]; P < .001; pediatric ward, 45.9% [68 of 148 moments] to 68.4% [78 of 114 moments]; P < .001). In Noma Children's Hospital, the overall adherence increased from 17.6% (36 of 205 moments) to 39.8% (88 of 221 moments) (P < .001). Adherence among nurses in Noma Children's Hospital increased from 11.5% (14 of 122 moments) to 61.4% (78 of 126 moments) (P < .001). Adherence among Noma Children's Hospital physicians decreased from 34.2% (13 of 38 moments) to 8.6% (7 of 81 moments). Lowest overall adherence after the intervention occurred before patient contact (53.1% [85 of 160 moments]), before aseptic procedure (58.3% [21 of 36 moments]), and after touching a patient's surroundings (47.1% [124 of 263 moments]). This study suggests that tools for the collection and rapid visualization of hand hygiene adherence data are feasible in low-resource settings. The novel tool used in this study may contribute to comprehensive infection prevention and control strategies and strengthening of hand hygiene behavior among all health care workers in health care facilities in humanitarian and low-resource settings.

Methods of Preventing Hospital Acquired Infection

Hospital-acquired infections can increase the rate of morbidity and mortality as well as medical costs. Nosocomial infection is spread by various ways such as surgical, intravenous catheters, surface contact (like as hands) and also through the air. Some interventions include appropriate hand and surface decontamination, sufficient staffing, improved ventilator management, usage of coated central venous and urinary catheters have all been linked with considerably lower rate of nosocomial infection. Multiple interventions simultaneously are required for comprehensive infection control and multiple actions may be given better outcome rather than a single action. Some multiple infection control protocols will possibly show more effective result instead of employing a single or few strategies. Several non-pharmacological interventions to prevent HAIs will reduce the requirement for prolonged or multiple-drug antibiotic courses for infected patients. And lower antibiotic usage will decrease risk of antibiotic-resistant organisms and may improve effectiveness of antibiotics therapy to patients with acquired infections.

Acinetobacter baumannii infection in a medical intensive care unit: The impact of strict infection control.

Background Acinetobacter baumannii is a waterborne organism that preferentially colonises aquatic environments. Infections usually involve organ systems that have a high fluid content. Multidrug-resistant (MDR) A. baumannii is recognised to be among the most difficult antimicrobial-resistant Gram-negative bacilli to prevent and treat in the nosocomial setting. Objectives To determine the utility of concomitant implementation of a strict antimicrobial stewardship programme and comprehensive infection control measures to control MDR A. baumannii in a medical intensive care unit (ICU). Methods We retrospectively compared the relative incidence of A. baumannii infections in our unit over a 1-year period before (2012) and after (2016) the implementation of strict infection control bundles. Patients with A. baumannii infections were identified using the microbiology database of the National Health Laboratory Service’s central data warehouse. The total number of admissions and clinical data were derived from the ICU registry. Results A. baumannii was isolated from 43/263 patients (16.35%) in 2012 compared with 37/348 patients in 2016 (10.63%, p=0.03; relative risk reduction=35%). We found almost 100% sensitivity to colistin and tigecycline, but 90% resistance to carbapenem antibiotics. Conclusion The introduction of strict infection control bundles had a statistically significant and clinically meaningful impact on the incidence of nosocomial A. baumannii infection in the medical ICU.

Acinetobacter baumannii infection in a medical intensive care unit: The impact of strict infection control

Background. Acinetobacter baumannii is a waterborne organism that preferentially colonises aquatic environments. Infections usually involve organ systems that have a high fluid content. Multidrug-resistant (MDR) A. baumannii is recognised to be among the most difficult antimicrobial-resistant Gram-negative bacilli to prevent and treat in the nosocomial setting. Objective. To determine the utility of concomitant implementation of a strict antimicrobial stewardship programme and comprehensive infection control measures to control MDR A. baumannii in a medical intensive care unit (ICU). Methods. We retrospectively compared the relative incidence of A. baumannii infections in our unit over a 1-year period before (2012) and after (2016) the implementation of strict infection control bundles. Patients with A. baumannii infections were identified using the microbiology database of the National Health Laboratory Service’s central data warehouse. The total number of admissions and clinical data were derived from the ICU registry. Results. A. baumannii was isolated from 43/263 patients (16.35%) in 2012 compared with 37/348 patients in 2016 (10.63%, p =0.03; relative risk reduction=35%). We found almost 100% sensitivity to colistin and tigecycline, but 90% resistance to carbapenem antibiotics. Conclusion. The introduction of strict infection control bundles had a statistically significant and clinically meaningful impact on the incidence of nosocomial A. baumannii infection in the medical ICU.

Nipah virus disease: A rare and intractable disease.

Nipah virus, an enveloped ribonucleic acid virus, has been a major cause of encephalitis out-breaks with high mortality, primarily in the Indo-Bangladesh regions. Except for the first outbreak in Malaysia-Singapore, which was related to contact with pigs and the outbreak in Philippines associated with horse slaughter, most other outbreaks have affected the Indo- Bangladesh regions. The Indo-Bangladesh outbreaks were associated with consumption of raw date palm sap contaminated by fruit bats and had a very high secondary attack rate. The patient usually presents with fever, encephalitis and/or respiratory involvement with or without thrombocytopenia, leukopenia and transaminitis. Diagnosis can be confirmed by isolation and nucleic acid amplification in the acute phase or antibody detection during the convalescent phase. Treatment is mostly limited to supportive care and syndromic management of acute encephalitis syndrome. Ribavirin, m102.4 monoclonal antibody and favipiravir are the only anti-virals with some activity against Nipah virus. Standard precautions, hand hygiene and personal protective equipments are the cornerstone of comprehensive infection prevention and control strategy. With the recent outbreaks affecting newer geographical areas, there is a need for physicians to be aware of this disease and keep abreast of its current detection and management strategies.

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.

Prevalence of extended-spectrum β-lactamase-producing Klebsiella pneumoniae: First systematic review and meta-analysis from Iran.

Extended-spectrum β-lactamase-producing Klebsiella pneumoniae (ESBL-KP) have emerged as an important pathogen causing severe infections worldwide. Infections due to ESBL-KP are associated with high morbidity and mortality, especially in developing countries such as Iran. The aim of this study was to assess the pooled prevalence of ESBL-KP with different gene variants in Iran. A literature search of Medline (via PubMed), Embase, Web of Science and Iranian Database was performed. A meta-analysis was conducted using Comprehensive Meta-Analysis Software (version 2.2, Biostat). A fixed- or random-effects model was used based on the heterogeneity test. Publication bias was determined using Begg's rank correlation and Egger's weighted regression methods. Among 783 articles identified, 43 studies met the eligibility criteria. The pooled prevalence of ESBL-KP was 43.5% (95% CI 39.3-47.9%) among clinical K. pneumoniae isolates. Among genes encoding ESBLs during 2000-2009, SHV, CTX-M and TEM were found with prevalences of 23.3%, 15.2% and 12.3%, respectively, whilst the prevalences of SHV, CTX-M, TEM and VEB were 24%, 28.1%, 25.2% and 8.3%, respectively, during the period 2010-2018. The prevalence of ESBL-KP has increased steadily in recent years among clinical K. pneumoniae isolates in Iran. Thus, initial identification of ESBL-KP according to Clinical and Laboratory Standards Institute (CLSI) guidelines, proper molecular approaches, and implementation of antimicrobial stewardship programmes in Iranian hospitals together with comprehensive infection control measures are urgently needed to control the dissemination of these strains.

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.

1190. Reduction of Carbapenem-Resistant Enterobacteria (CRE) Infections and Total Polymyxin B Use Due to a Comprehensive Infection Control Strategy in Colombia

BackgroundColombia is an endemic country for CRE infections, with an increased rate of hospital-acquired infection due to this microorganism. Therefore, we have a high empirical use of carbapenem, colistin, and polymyxin B in nosocomial suspected septic patients. Infection control strategies could reduce CRE infection rates and lower antibiotic consumption.MethodsSince 2014, a Comprehensive Infection control strategy was implemented in our hospital. This strategy included: (1) Hospital daily CHX bathing (4% soap or 2% pads) was applied to all patients in our institution (intensive care units and medical/surgical wards). Additionally, recommendations for patient care were provided to patients and family. (2) Active surveillance of perirectal CRE screening was implemented toward high suspected patients. (3) Isolation of all CRE colonized or-infected patient, and gloves use, and alcohol for hand sanitation was reinforced. To evaluate the effectiveness of this strategy, annually nosocomial infection rates due to CRE were compared. Defined daily dose (DDD) of polymyxin B use was obtained annually.ResultsAfter introducing this protocol, we found a progressive decrease in CRE bacteremia from 2.24 infections per 10,000 patients-day in 2014, to 1, 26 during 2015, 0.92 in 2016 and 0.78 infections per 10,000 patients day during 2017. This was also correlated to a decrease in the use of polymyxin in the adult population, DDD drop from 2.36 to 1.06.ConclusionUniversal hospital daily CHX bathing, CRE screening, and Isolation as a comprehensive strategy was effective decreasing CRE nosocomial infections and polymyxin use.Disclosures All authors: No reported disclosures.

1224. Drug-Resistance Dynamics of Staphylococcus aureus at a Tertiary Hospital, Beijing, China: 2013–2017

BackgroundTo understand the drug-resistance dynamics of Staphylococcus aureus and provide references for effective control of methicillin-resistant Staphylococcus aureus (MRSA) infection.MethodsAll data were obtained from the healthcare-associated infection surveillance system. Different strains of S. aureus were identified using the VITEK-2 automated system, the drug susceptibility results of resistance and intermediate were classified into resistance. Chi-square test and variation analyses of S. aureus drug-resistant rate were performed.ResultsFrom 2013 to 2017, 2,289 strains of S. aureus were isolated, and the specimen were mostly collected from sputum (721, 31.50%), wound secretion (211, 9.22%), and blood (210, 9.17%). The resistance rate of S. aureus was highest for tigecycline (94.43% in 2013, 100% in 2017) and penicillin (96.49% in 2013, 95.60% in 2017) (P = 0.028). The resistance rates among other drugs such as clindamycin (65.28% in 2013, 71.39% in 2017) and erythromycin (69.62% in 2013, 62.59% in 2017) were more stable (P = 0.056). However, oxacillin (from 73.68% to 34.47%), gentamicin (from 51.51% to 24.13%), and tetracycline (from 46.78% to 30.81%) showed a declining trend (P = 0.017). Meanwhile, there were almost no S. aureus resistance to linezolid, vancomycin, and nitrofurantoin. During the previous 5-year period, MRSA rates decreased sharply and in 2017 rate was 34.47%. In 2017, MRSA was most frequently isolated in orthopedics, emergency ICU, and respiratory.ConclusionThe reduction in drug-resistant MRSA may be evidence of effective antibiotic administration practice. Whereas more comprehensive infection control measures are needed to prevent the transmission of S. aureus and MRSA.Disclosures All authors: No reported disclosures.

Characteristics of NDM-1-producing Klebsiella pneumoniae ST234 and ST1412 isolates spread in a neonatal unit

BackgroundThe emergence of carbapenem-resistant Klebsiella pneumoniae (CR-KP) has become a significant problem worldwide and also being a major threat to children and newborns. Here we report an outbreak of NDM-1-producing K. pneumoniae in a neonatal unit.ResultsSix CR-KP strains, isolated from neonates with symptoms of infection, were identified using a VITEK-2 compact system, and the clinical data were retrieved from the electronic case records. In vitro susceptibility testing with broth dilution method showed that all six K. pneumoniae isolates were resistant to carbapenems and susceptible to colistin, aminoglycosides, fluoroquinolones and tigecycline. Based on the polymerase chain reaction results, each isolate was found to be blaNDM-1 gene positive. Clonal relationships were analysed using pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) and showed that two different PFGE patterns were formed, which belonged to sequence types ST234 and ST1412. Plasmids carrying blaNDM-1 were successfully transferred from four of the six isolates to an Escherichia coli recipient through conjugative assays. S1-PFGE and Southern blot hybridization showed that four NDM-1-producing K. pneumoniae were clonal and carried blaNDM-1 on the same plasmid. The outbreak was effectively controlled by reducing the potential infection sources. All the patients were successfully treated and recovered after receiving an increased dose of carbapenems. Although the source of this outbreak was not clear, comprehensive measures were carried out and the outbreak was effectively controlled.ConclusionsST234 and ST1412 of NDM-1-producing Klebsiella pneumoniae are the resistant clone spread in the neonatal unit, comprehensive infection control measures and optimized carbapenem therapy played an important role in controlling this NDM-1-producing K. pneumoniae outbreak.

Elevating the standard of endoscope processing: Terminal sterilization of duodenoscopes using a hydrogen peroxide–ozone sterilizer

The health care community is increasingly aware of the processing challenges and infection risks associated with duodenoscopes owing to published reports of outbreaks and regulatory recalls. Studies have demonstrated that the current practices are inadequate for consistently producing patient-ready endoscopes. Alternatively, terminal sterilization would offer a greater margin of safety and potentially reduce the risk of patient infection. The purpose of this study was to evaluate the efficacy of a hydrogen peroxide-ozone sterilizer with regulatory clearance for terminal sterilization of duodenoscopes. Validation studies were performed under laboratory simulated-use and clinical in-use conditions. The overkill method study demonstrated a reduction of at least 6-log of Geobacillus stearothermophilus spores at half-cycle, providing a sterility assurance level of 10-6. In addition, the sterilizer achieved a 6-log reduction of G stearothermophilus in the presence of inorganic and organic soils in a simulated-use study. The clinical in-use study confirmed that the sterilizer achieved sterilization of patient-soiled duodenoscopes under actual use conditions. Simulated-use and clinical in-use studies demonstrated the efficacy of a hydrogen peroxide-ozone sterilizer for terminal sterilization of duodenoscopes. This offers health care facilities a viable alternative for duodenoscope processing to enhance patient safety as part of a comprehensive infection control strategy.

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.

Human Papillomavirus Vaccine Completion and Associated Factors Among 13-17 Year-Old Hispanic and Non-Hispanic White Females

Barriers to human papillomavirus (HPV) vaccine acceptability in Israel include Israel's relatively low incidence of cervical cancer; the religiously-based 80% circumcision rate in Israel, which is regarded as contributing to the lower incidence of HPV infection in the country; the fact that HPV vaccine provides immunity against only few virus types; the vaccine's high cost; and the perception that HPV transmission is associated with unacceptable sexual relations. A recent survey has demonstrated that, following media two campaigns, Israeli's level of awareness of the vaccine increased but the actual vaccination rate remained low, at approximately 10%. Survey findings also indicated that an enduring barrier to HPV vaccination is the vaccine's high cost. Recent research on a convenience sample of Israeli undergraduate women 21 to 24 years of age showed that intentions to receive HPV vaccination in the coming year were a function of women's attitudes towards getting vaccinated and their perceptions of social support for doing so. Undergraduate women who intended to be vaccinated perceived the prevention of cervical cancer, avoidance of personal health threat, and avoidance of HPV infection per se to be the advantages of undergoing HPV vaccination. Disadvantages of getting vaccinated included fear of vaccine side effects, cost of the vaccine, and newness of the vaccine, doubts about vaccines, time required to undergo multiple vaccinations, and dislike of injections. Friends’, mothers’ and physicians’ recommendations influenced women's intentions to be vaccinated in the coming year as well.This article forms part of a regional report entitled “Comprehensive Control of HPV Infections and Related Diseases in Israel” Vaccine Volume 31, Supplement 8, 2013. Updates of the progress in the field are presented in a separate monograph entitled “Comprehensive Control of HPV Infections and Related Diseases” Vaccine Volume 30, Supplement 5, 2012.