Control Team Research Articles

A multimodal approach to reduce the incidence of peripheral venous cannula bacteraemias and improve patient safety.

Incidence of peripheral venous cannula (PVC) bacteraemia have been rising in a trust in the south-west of England, with a 267% increase noted over the 2022/23 financial year compared with the previous year. To use a multimodal approach to reduce the incidence of PVC bacteraemia and improve patient safety. The initiative consisted of an educational poster highlighting the severity of infection associated with PVCs alongside key prevention messages rooted in Trust policy. Teaching sessions, complementing the poster, were delivered by the infection prevention and control team to each clinical area. The data showed that the provision of further educational resources and wider support resulted in a 54.5% decrease in the incidence of PVC bacteraemia in 2023/24 compared with the previous year. An audit undertaken in the fourth quarter of 2023/24 (January-March) found zero cases of PVC bacteraemia for the first time in 2 years. Dedication and collaborative working are vital for securing the success of quality improvement projects. PVC-related bacteraemias and the severity of infection remain an under-acknowledged and under-recognised topic within health care, with further research required.

Impact of an electronic surveillance system on compliance with isolation precaution measures: an interrupted time series study

Background Electronic surveillance systems (ESSs) may assist infection prevention and control (IPC) teams in detecting and monitoring patients infected or colonised by pathogens to prevent healthcare-associated infections. We aimed to assess the impact of implementing an ESS on compliance with isolation precaution measures for bacterial infections or colonizations. Methods A quasi-experimental before-after study was conducted using interrupted time series analysis from 1 March 2018 to 31 July 2024 at the University Hospital of Nancy (France). The ESS was implemented in October 2022. The results of audits conducted by IPC nurses to investigate isolation measures for inpatients that required isolation precautions were aggregated monthly. Results 1379 audits were included in the study. The implementation of the ESS had no significant immediate impact on isolation measures, except for an increase in the presence of adequate hand hygiene products (+10.1%, p < 0.01). After the COVID-19 period, all isolation measures decreased. The implementation of the ESS was associated with positive changes in trends of isolation measures, particularly for the prescription of isolation precautions (+1.1%/month, p < 0.01), the isolation signage (+1.2%/month, p < 0.001), the hand hygiene products (+0.8%/month, p < 0.01), and full compliance with isolation measures (+1.1%/month, p < 0.0001). The audit rate significantly increased in the first 7 months of ESS use but then decreased. Conclusions The positive impact of ESS on compliance with isolation measures was likely due to the increased presence and communication of the IPC team in care wards, which was facilitated by the time saved in the surveillance and detection of carriers through the ESS.

P23 Optimised Patient centred Team based Interdisciplinary Management Approach to UTI—OPTIMA-UTI: an antimicrobial management team and infection prevention and control team collaborative

P23 Optimised Patient centred Team based Interdisciplinary Management Approach to UTI—OPTIMA-UTI: an antimicrobial management team and infection prevention and control team collaborative

Tax Aspect, Governance Mechanism, and New Bank Discretion: Restructuring &amp; Covid-19 Effect

This study investigates the influence of deferred tax expenses and tax retention on earnings management with banking governance mechanisms as moderating variables. The sample for this study comprises 124 data points from banks listed on the IDX between 2019 and 2022. The effects of credit restructuring and the global SARS-CoV-2 pandemic were examined using a moderated regression analysis with a fixed effect model (FEM). The results reveal that deferred tax expenses have a positive impact on discretionary provision, while tax planning has no effect. Additionally, an independent commissioner mitigates the positive effect of deferred tax expenses on earnings management. The study also finds a significant difference in earnings management practices between the pre-Covid-19 period and pandemic periods. These findings suggest that regulators and banking risk control teams should be cautious about tax aspects that may encourage discretionary behavior such as deferred tax liabilities and tax planning during specific periods. Keywords: Deferred Tax Expense, Tax Retention Rate, Governance Mechanism, Earnings Management, Covid-19.

Automated surveillance for surgical site infections (SSI) in hospitals and surveillance networks-expert perspectives for implementation.

This work aims at providing practical recommendations for implementing automated surveillance (AS) of surgical site infections (SSI) in hospitals and surveillance networks. It also provides an overview of the steps, choices, and obstacles that need to be taken into consideration when implementing such surveillance. Hands-on experience with existing automated surveillance systems of SSI (AS SSI systems) in Denmark, France, the Netherlands and Spain is described regarding trend monitoring, benchmarking, quality control, and research for surveillance purposes. Between April and October 2023, specific aspects/options of various surveillance purposes for AS SSI were identified during regular meetings of the SSI working group in the PRAISE (Providing a Roadmap for Automated Infection Surveillance in Europe) network. Expert discussions provided the basis for this perspective article. Decisions for implementation of AS SSI systems highly depend on the purpose of the surveillance. AS SSI systems presented here differ according to study population, setting, central or local implementation; the level of automation, design, and the data sources used. However, similarities were found for the rationales of automation, design principles and obstacles that were identified. There was consensus among all the experts that shortcomings in interoperability of databases, limited time, a want of commitment on the part of stakeholders, and a shortage of resources for information technology (IT) specialists represent the main obstacles for implementing AS SSI. To overcome obstacles, various solutions were reported, including training in the development of AS systems and the interpretation of AS SSI results, early consultation of end-users, and regular exchanges between management levels, IT departments, infection prevention and control (IPC) teams, and clinicians. Clarity on the intended application (e.g. purpose of surveillance) and information on the availability of electronic and structured data are crucial first steps necessary for guiding decisions on the design of AS systems. Adequate resources for IT specialists and regular communication between management, IT departments, IPC teams, and clinicians were identified as essential for successful implementation. This perspective article may be helpful for a wider implementation of more homogeneous AS SSI systems in Europe.

Roles of Pharmacy, Medicine, Nursing, Laboratory, Anesthesia, Urology, Public Health, and Occupational Health, Infection Control, and Hospital Management, in the Integration of Telehealth in Saudi Arabia: A Comprehensive Review

Different sectors have contributed to successfully integrating telehealth services into the Saudi healthcare system during the emergent need for high-quality health services. Hence, this review attempts to assess different sectors and their professionals for their contribution toward the implementation and sustainability of telehealth services, including pharmacy, medicine, nursing, laboratory services, anesthesia, urology, public health, occupational health, infection control, and hospital management. Each sector offers a unique contribution to the emergence and continuity of telehealth services, and physicians have implemented telehealth for diagnosis while maintaining chronic patients at home with distant control. Pharmacists have started providing medication support through telehealth, and physicians have extended their use by treating chronic patients through teleconsulting. Hospital nurses have improved their professional access by providing virtual education and consulting to treat chronic patients. Laboratory services enable fast and accurate diagnosis, and anesthesiologists have begun to use it for preoperative and postoperative assessments. Urologists have integrated telehealth into the management of chronic patients. Public health professionals provide telehealth services for health promotion, disease prevention, and management. Occupational health practitioners provided remote ergonomic consultation. Infection prevention and control teams delivered training sessions and telehealth surveillance of hygiene-related practices. In addition, initiatives to plan and create a system for telehealth implementation are a significant contribution to hospital management. The incorporation of telehealth across professional silos has increased the quality-of-care delivery, enhanced patient empowerment, and built system resilience in Saudi Arabia. This multidisciplinary collaboration thus underscores how furthering telehealth services can only be realized through cooperation to ensure equitable access and advance healthcare modernization under any national initiative.

Protocol for COACH, an evidence-based intervention for improved head impact safety in youth American football developed using a community-engaged approach.

Subconcussive, repetitive head impacts sustained in collision sports may negatively affect brain health. American football practices are controlled environments amenable to intervention. Engaging community members is essential for successful development, implementation, and sustainability of viable interventions. The objective of this study is to develop and pilot test an evidence-based intervention to reduce head impact exposure in youth American football (i.e., football), using a community-engaged approach. This manuscript describes the co-design of the intervention and associated implementation plan and the study protocol for evaluating the effectiveness and feasibility of the intervention and implementation plan. In the first part of this study, focus groups with parents and coaches, and individual interviews with organizational leaders associated with two teams at the middle school level were conducted. An anonymous survey assessing beliefs and perceptions of non-concussive head impacts was given to parents, coaches, and organizational leaders within the local youth football league. Following the football season, qualitative and quantitative data describing determinants of head acceleration events in football were shared with 12 stakeholders of coaches, league and school administrators, parents, an athletic trainer, and local university player development director. Together, we co-designed COACH (COmmunities Aligned to reduce Concussion and Head impact exposure) and implementation plan using a strategic planning approach. The preliminary effectiveness and feasibility were assessed in the second part of this study. Youth football players participating on the teams in year 1 (control teams) were fitted with mouthpiece-based head kinematic sensors which measure head acceleration events (HAEs). HAEs were collected and quantified during team activities. Preliminary effectiveness of the intervention to reduce HAEs was measured among two new teams pilot testing COACH with mouthpiece-based sensors, while simultaneously monitoring implementation of the intervention. We report our study design and evaluation, and opportunities and challenges with our approach. The results will inform a future full-scale pragmatic trial to assess the implementation and effectiveness of the intervention program. NCT04908930.

Assessment of dental clinics’ infection control function using a checklist during the COVID-19 pandemic

IntroductionThe heightened risk of COVID-19 transmission during dental procedures has been a major concern in dentistry. To curb the spread of the virus, breaking the chain of transmission is paramount. This study aimed to assess infection control function in dental clinics using a supervisory checklist developed specifically during the COVID-19 pandemic.MethodIn April 2020, Alborz University of Medical Sciences introduced a 46-item checklist to guide infection control. Regular inspections of clinics began in June 2020 and continued every 6 months. Inspectors, accompanied by either the clinic manager or the infection control team, completed the checklist to evaluate protocol adherence. This retrospective cross-sectional study presents findings from the initial round of inspections.ResultsClinics were categorized as adherent or non-adherent based on achieving at least 50% of the total checklist score. Of the 76 clinics evaluated, 66 (86.8%) met the adherence criteria. The highest compliance was observed in question 12 (separation of employee and patient restrooms), with 81.6% adherence. The lowest compliance was in question 31 (use of disposable waterproof shoe covers), with only 26.3% adherence.ConclusionOver 80% of dental clinics demonstrated satisfactory adherence to COVID-19 infection control protocols. However, to further mitigate the spread of COVID-19, particularly its more contagious variants, enhancing compliance across all infection control measures remains essential.

A 4-year outbreak of MRSA ST72-MRSA-IV spa type t1597 in a surgical high dependency unit in Ireland linked to repeated healthcare worker recolonisation

Patients undergoing cardiac surgery are identified as high risk for Staphylococcus aureus infection, including MRSA. An outbreak of MRSA was identified when two patients experienced MRSA infection concurrently in a cardiothoracic high dependency unit with uncommon detection of MRSA previously and an established screening programme. An outbreak control team was convened and interventions applied including refresher training in hand and environmental hygiene, review of practice with regard to aseptic access of medical devices and consideration of antibiotic use in the unit. MRSA isolates were referred to the Irish National MRSA Reference Laboratory where spa typing assigned all isolates to t1597 and whole genome sequencing assigned them to multilocus sequence type ST72-MRSA-IV. Recovery of this strain from only this unit in Ireland and infrequent reporting in Europe prompted staff MRSA screening with two staff members found to harbour the outbreak strain. Despite successful decolonisation, recolonisation and further transmission to patients occurred. In the clinical unit in which this outbreak occurred, the usual control measures to prevent spread of MRSA were in place. Recent Joint Healthcare Infection Society and Infection Prevention Society Guidance does not recommend routine staff screening for MRSA but does support its consideration in an outbreak of an unusual strain. In total, 9 patients and 2 staff were affected by this outbreak. There were 4 infections and 3 deaths. Sustained outbreak closure was necessary to protect certain national clinical programmes and was achievable only when colonised staff were no longer working in the unit.

Decision-making during training of a Swedish navy command and control team: a quantitative study of workload effects.

The study compared two simulation environments for training of Swedish naval Command and Control teams by using indirect measures, including workload, combat readiness, and situation awareness. The literature explains simulation-based training as providing a safe avenue to practice relevant scenarios. Fidelity, the degree of realism in the simulation, and workload, the equilibrium between demands and assigned tasks, are crucial factors examined in this study of low- and high-fidelity naval simulations. This study was conducted to better understand the effects of various training methods. An experimental design with repeated measures was used with three consecutive escalating parts. The subjective, multidimensional assessment tool, NASA-Task Load Index was used to rate perceived workload. Combat readiness of the ship and mental demand yielded significant results. For combat readiness of the ship, there was a difference between the low and the high-fidelity setting, for the initial part of the scenario p = 0.037 and for the second part p = 0.028. Mental demand was experienced as higher in the low-fidelity setting, p = 0.036. Notably, the simulated internal battle training for onboard command teams in a low-fidelity setting was found to induce a level of stress comparable with that experienced in a high-fidelity setting. The results indicate that low-fidelity training results in a workload not distinguishable from high-fidelity training and has practical implications for increased use of low-fidelity training as part of (naval) command team training programmes.

EDI&amp;S SO05 Barriers to delivering a net zero NHS: An evaluation of Sustainability in Surgery across the Midlands

Abstract Background The healthcare sector is under increasing scrutiny for contributing approximately 4.6% of the UK’s total carbon footprint and 25% of the public sector’s carbon footprint. With support from the UK Health Alliance on Climate Change, the NHS aims to reach a net zero carbon target by 2045 through its Greener NHS campaign. This study aimed to identify key barriers to implementing sustainable practices in the surgical environment. It involved reviewing Green Plans published by Integrated Care Systems (ICSs) in the Midlands, conducting a thematic analysis of relevant literature, and surveying key stakeholders within NHS Trusts in the Midlands. Method Between June and September 2023, Green Plans from 11 ICSs across the Midlands were evaluated by two reviewers for the inclusion of the "key areas of focus" outlined by the NHS Green Plan Guidance. Additionally, three computerised searches were conducted using Ovid MEDLINE and Embase to retrieve abstracts published before May 2023 on reusable surgical gowns, re-sterilisation of surgical energy devices, and operating theatre waste management. Three reviewers screened the abstracts to identify barriers to implementing change. Based on these findings, a framework was developed for the “Supporting a Greener NHS Survey” and disseminated to key stakeholders in the Midlands. Results A heat map was created to assess compliance of each Green Plan with NHS England guidance (Figure 1). The literature search yielded 82 abstracts and key barriers to sustainability were identified as infection control, cost implications, instrument damage, and waste management practices. The survey received 89 responses; 45% did not use reusable drapes at their Trust, 35% did not use reusable gowns, 46% did not use reusable laparoscopic ports, and 59% didn’t know whether their energy devices were recyclable. Key barriers to implementing sustainable change included surgeon preference, financial constraints, and infection control concerns. Conclusion The literature analysis and survey of stakeholders in the Midlands identified several barriers to implementing sustainable changes. With national, regional and local organisational impetus coupled with clinical leadership commitment to sustainability, these barriers can be overcome with multi-disciplinary involvement. By investing in comprehensive training programmes and implementing rigorous quality control measures with input from infection prevention and control teams, clinical leaders and clinicians are best placed to help overcome these barriers and promote sustainability in the surgical environment.

Environmental surveillance of SARS-CoV-2 for outbreak detection in hospital: A single centre prospective study

BackgroundHealthcare facilities remain at risk of Coronavirus Disease 2019 (COVID-19) outbreaks. Proactive surveillance strategies can potentially mitigate the risk of these outbreaks. ObjectiveTo determine whether results from the environmental detection of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) from floor swabs could be provided to the Infection Prevention and Control (IPAC) team in near real-time. MethodsWe conducted a 9-week prospective study at a rehabilitation hospital in Toronto, Canada. Beginning in October 2023, we swabbed the hallways and adjoining areas of one of the floors of the hospital. This floor consisted of two separate units: the Medical Rehab Unit and the Transitional Care Unit, each accommodating 32 patients. Swabs were assayed for SARS-CoV-2 by quantitative reverse-transcriptase polymerase chain reaction (RT-qPCR). Results from the floor swabs, including percentage positivity for SARS-CoV-2 and number of viral RNA copies, were sent to the hospital's infection control team twice-weekly. Number of patients with COVID-19, confirmed and suspected COVID-19 outbreaks, and acute transfers to another hospital were recorded over the study duration. ResultsA total of 465 swabs were collected, and 232 (50%) were positive for SARS-CoV-2. The turnaround time from floor swabbing to the results being provided to IPAC ranged from 1–6 days with an average turnaround time of 1.9 days (interquartile range: 1 to 2 days). Swab positivity in the Medical Rehab Unit (65%, 95% CI: 58–71%) was significantly greater than the Transitional Care Unit (38%, 95% CI: 32–44%). During the study period there were 4 patients diagnosed with COVID-19 on the Medical Rehab Unit and none on the Transitional Care Unit. There was one suspected COVID-19 outbreak on the Medical Rehab Unit: three COVID-19 cases were identified within six days; all patients on the unit were tested for COVID-19; no further cases were identified and no outbreak was declared. During the suspected outbreak, the percentage of floor swabs positive for SARS-CoV-2 peaked, at 100% in the Medical Rehab Unit. ConclusionFloor swabs were provided to IPAC in almost real-time; however, delays in shipments in some instances led to delays in the results being made available. Larger studies over an extended timeframe are needed to better understand whether environmental surveillance can aid IPAC decision-making.

Efficiency of a Long-term Infectious Diseases Consultation and Antimicrobial Stewardship Program at a Japanese Cancer Center: An Interrupted Time-Series Analysis.

Patients with cancer are particularly susceptible to developing drug-resistant organisms due to the high frequency of infections during cancer treatment and the use of broad-spectrum antimicrobial agents. Therefore, patients with cancer are ideal candidates for an antimicrobial stewardship program (ASP); however, no established ASPs specifically target these patients. In this study, we evaluated the effect of a 46-month ASP intervention and infectious diseases consultation using a unique antimicrobial quality measure. Our single-center, retrospective, observational study was conducted from 1 April 2018 to 31 January 2024 and evaluated 2 phases: preintervention (antimicrobial notification by the infection control team) and postintervention (implementation of ASP and establishment of the infectious diseases consultation service). The days of therapy (DOT) for 3 intravenous carbapenems significantly decreased, and the DOT of narrow-spectrum antimicrobials significantly increased after the intervention. A significant reduction was observed in the length of hospital stay, with no change in the incidence of hospital-acquired resistant microorganisms. All-cause in-hospital mortality rates and the 30-day mortality rate among patients with bacteremia episodes were numerically reduced, although not significantly, compared to the preintervention period. The rate of appropriate use of antimicrobial agents increased significantly during the late postintervention period (1 April 2021 to 31 January 2024). Our intervention was associated with the promotion of appropriate use of antimicrobial agents and a reduction in the length of hospital stay. These findings can help establish safer cancer treatments and improve patient prognosis.

Microbiology testing capacity and antimicrobial drug resistance in surgical-site infections: a post-hoc, prospective, secondary analysis of the FALCON randomised trial in seven low-income and middle-income countries

Surgical-site infection (SSI) is one of the most common health-care-associated infections, substantially contributing to antibiotic use. Targeted antibiotic prophylaxis to prevent SSIs and effective treatment are crucial to controlling antimicrobial resistance (AMR). This study aimed to describe the testing capacity and multidrug resistance (MDR) of SSI microorganisms in low-income and middle-income countries (LMICs). This analysis included patients undergoing abdominal surgery in seven LMICs (Benin, Ghana, India, Mexico, Nigeria, Rwanda, and South Africa) as part of the FALCON randomised controlled trial. Wound swabs were collected from patients diagnosed with SSI, as per US Centers for Disease Control and Prevention (CDC) definition. Data on microorganism species and MDR, as per CDC and European Centre for Disease Prevention and Control definitions, were analysed alongside hospital-level data on local microbiological practices. An adjusted analysis was performed to identify perioperative factors associated with MDR. Testing capacity was assessed by the completion of swab testing in positively diagnosed SSIs. Between Dec 10, 2018, and Sept 7, 2020, 5788 patients were recruited to the FALCON trial. 1163 patients were diagnosed with an SSI, of whom 905 (77·8%) received prophylactic antibiotics before surgery. In patients with SSIs, 935 of 1163 (80·4%) did not have a wound swab; 195 were from hospitals not performing swabs (15 hospitals) and 740 were from hospitals with capacity but no swab performed (35 hospitals). Of 228 patients swabbed, 200 (88·5%) had microorganisms detected. Escherichia coli (89 of 200, 37·9%) was the most common microorganism and 116 of 200 (58·0%) patients were not covered by the perioperative prophylactic antibiotic. MDR was found in 102 of 147 (69·4%) patients for whom data were available to determine MDR status. Adjusted analysis found that appropriate prophylactic antibiotic coverage (adjusted odds ratio 0·43, 95% CI 0·19-0·96) and regular availability of infection control teams (0·32, 0·11-0·93) were associated with a significant reduction in MDR. Targeted perioperative antibiotic prophylaxis during contaminated abdominal surgery is insufficient in LMICs, with very few SSI organisms undergoing formal diagnosis. Expansion of testing capacity, development of local guidelines, and implementation of infection control teams could support the prevention of SSI through directed antibiotic prophylaxis, subsequently reducing the burden of MDR. National Institute for Health and Care Research. For the French and Spanish translations of the abstract see Supplementary Materials section.

Community Healthcare-Associated Infections: Enhancing Control with Software and Tailored Protocols

Abstract Issue/Problem Healthcare-associated infections are major global public health challenges. In Portugal, the prevalence of resistant Enterobacteriaceae is particularly alarming. Studies typically focus on hospitals and long-term care facilities, neglecting community settings where patients, particularly the elderly with multiple comorbidities, often transition between hospital and home. Description of the problem Effective control measures are vital across all healthcare environments. In home care, sporadic implementation of Contact Precautions, due to the lack of specific guidelines and challenges in accessing colonization information, has been a major gap. This project aimed to close this gap by integrating a software, previously used only in hospitals, to enhance infection control in domiciliary care. The intervention adapted contact transmission-based precautions for home settings and used data from the previous year’s infections and colonization to tailor recommendations for each patient, preventing transmission between homes and enhancing caregiver education. Results Preliminary data from a two-month monitoring period involved 40 patients under the care of three domiciliary teams. Eleven had records of infections involving 19 microorganisms, including 7 Enterobacteriaceae, five of which were carbapenemase producers. This led to five customized recommendations for improved precautions. The intervention also heightened nurses’ awareness of patients’ microbiological histories, evidenced by increased inquiries to the infection control team. Lessons Adapting measures to the unique dynamics of home care, distinct from hospital settings, is critical. Involvement of care teams in decision-making ensures practical adherence and enhances measure effectiveness. Regular monitoring is crucial for compliance, making this approach a model for other settings. Key messages • Adapting hospital protocols to community settings and offering close support to caregiving teams increases compliance. • Implementing software that facilitates communication about infection and colonization enhances infection control effectiveness in community settings.

A prolonged outbreak of tuberculosis associated with an intellectual disability daycentre in Ireland

Abstract One of the factors impeding tuberculosis elimination in low burden countries is its persistence and concentration in vulnerable populations. This is a complex, prolonged Tuberculosis (TB) outbreak in a daycentre for adults with intellectual disability in Ireland. This is a particularly vulnerable population with special considerations for Public Health (PH) management. There are eight cases of active TB, 46 cases of Latent TB Infection (LTBI) and a cumulative total of 116 contacts associated with this outbreak, with diagnosis spanning 15 years. The last three cases were identical on Whole Genome Sequencing. The index case was an Irish-born, Caucasian, social care worker, with smear positive pulmonary TB, who was symptomatic in the facility for three months prior to diagnosis. Case 2 was a household contact of the index case and the other 6 cases were Service Users (SUs) at the facility. At least five of the subsequent seven cases are secondary cases of the index case. Significant to this outbreak was the change in Irish guidance, 2010, relating to the management of contacts of cases. Following the notification of the most recent case, July 2023, the Outbreak Control Team decided a retrospective review be conducted of all SU contacts of the seven cases associated with the facility. The contacts were stratified according to hierarchical risk. A total of six contacts met the criteria for review and offered screening, re-screening or treatment as appropriate. In this outbreak 21.8% of the total contacts and 16.1% of SU contacts completed treatment for LTBI. The significance of this outbreak lies in its duration, infectivity of the index case and particular vulnerabilities of the SUs. There were issues with overcrowding and difficulties in relation to symptom recognition, diagnosis and treatment. The PH team tailored their approach to meet the SU needs, demonstrating the importance of person-centred contact tracing in the disruption of transmission. Key messages • A factor impeding tuberculosis elimination in low burden countries is it’s persistence and concentration in vulnerable populations. • Adapting a patient-centred approach to contact tracing can lead to higher participation rate and the disruption of infection transmission.

Investigating Transmission Patterns and Genome Sequencing of SARS-CoV-2 in University College Dublin

Abstract Background This study describes the investigation and management of multiple outbreaks of SARS-Cov2 during the second and third wave of the pandemic at University College Dublin, Ireland from September 2020 to September 2021. Methods Relevant data were gathered as part of the public health outbreak investigations led by the UCD Internal Covid Control Team (ICCT) in collaboration with the public health teams of the Health Service Executive (HSE). Results are presented for PCR (polymerase chain reaction) confirmed cases and their close contacts, reported to the UCD ICCT between September 2020 to September 2021. Results There were 214 cases notified to ICCT. Among these, 153 cases were in residence on-campus cases. 73 epidemiologically linked clusters identified, where the number of cases linked with each cluster varied between 1 to 27. Additional cases during this period had no obvious epidemiological link to the identified clusters. Of 902 close contacts with PCR test results, 31.5% (n = 284) tested positive. 77% (n = 219) self-reported with mild to moderately symptoms while 23% (n = 65) self-reported as asymptomatic. Retrospective Whole Genome Sequence (WGS) analysis was undertaken after the outbreaks had subsided. The test positive cases were grouped into 6 clusters, and it was shown that many of the apparent sporadic cases were included in these clusters. Conclusions The proportion of close contacts testing positive varied significantly throughout the pandemic, with testing policy and type of exposure having the greatest impact. Whole genome sequencing can give a better understanding of webs of transmission to complement epidemiological investigations. It is now possible to undertake sequencing in real time where it can make a contribution to outbreak control and resolution. Public Health professionals should become familiar with WGS and bioinformatics as useful tools in their armory for the control of all communicable diseases not only SARS-CoV-2. Key messages • Combined epidemiological investigations and Whole Genome Sequencing (WGS) provide crucial insights into campus COVID-19 outbreaks, guiding effective control measures. • WGS integration enhances understanding of transmission patterns, identifies clusters, and equips public health professionals with data-driven approaches for outbreak management beyond SARS-CoV-2.

Feta safe than sorry - gastroenteritis outbreak associated with contaminated cheese

Abstract A gastroenteritis outbreak among attendees at a catered HSE event was notified. No faecal samples were obtained - all cases had recovered. An outbreak control team was convened. A retrospective cohort study hypothesised that “people who attended the HSE event and subsequently became unwell did so as a result of consuming food at the event”. Epidemiological, environmental, and microbiological investigations commenced. An outbreak-specific food questionnaire was distributed. The food business was inspected, obtaining food samples. Survey responses were analysed.The attack rate was 25%. Associations were identified between illness and specific foods. Multivariable regression highlighted: feta salad (OR = 36.22 [95% CI 2.24-585.52] p = 0.01), and turkey (OR = 12.57 [95% CI 1.12-140.58] p = 0.04). Most (93%) turkey consumers had consumed feta salad. Microbiology of unopened feta cheese, sourced by the caterer from a supermarket, was positive for E coli at 1.7 x 105. The Food Safety Authority of Ireland corroborated separate illness complaints from a family consuming the product. The supermarket voluntarily withdrew the product internationally.This outbreak prompted a cross-sectoral food safety investigation. Despite no pathogen detection in a faecal samples, epidemiological evidence led to the withdrawal of contaminated feta by the supermarket, removing over 1000 units from the market, emphasising the importance of epidemiology in protecting public health. Key messages • Epidemiological investigation resulted in mass contaminated cheese withdrawal internationally. • Cross-sectoral work is important to safeguard public health.

A national job profile for infection control nurses in public health: the development and content

Abstract Background The COVID-19 pandemic emphasized the crucial role of infection control nurses (ICNs) in public health. ICNs working in multidisciplinary infection control teams face challenges, such as new infectious disease outbreaks and vaccination hesitancy. Recognizing the complexity in this domain, Dutch ICNs in municipal public health services expressed the need for a national job profile describing their tasks and responsibilities. Methods A mixed methods approach was used to develop a job profile. National and international documents on infection control professionals were studied by desk research. Insights from Dutch infection control professionals and experts were collected through a survey (n = 171), two interactive discussion meetings (18-22 participants) and meetings with an advisory group of stakeholders, including representatives of the Dutch nurses’ association. Descriptive statistics and deductive content analysis were used to analyze the data. Results The diverse methods facilitated the development of a job profile for Dutch ICNs. The profile describes that, within infection control teams, ICNs play a key role in coordinating and monitoring infection control measures. They facilitate collaboration among (at-risk) individuals, the infection control team, and the collaborating partners. Additionally, ICNs identify emerging risks for infection control and coordinate infection prevention activities in collaboration with the infection control team. During large-scale outbreaks, ICNs take a leading role and, where appropriate, delegate tasks such as contact tracing to crisis workers. Conclusions We developed the first job profile that outlines the tasks and responsibilities of ICNs in Dutch public health services. It contributes to strengthening infectious control services to face future challenges. Findings emphasize the ICNs’ pivotal role in coordinating and monitoring infection control efforts, while enhancing collaboration, even during large outbreaks. Key messages • In close collaboration with infection control professionals a robust job profile was developed, describing the tasks and responsibilities of infection control nurses in the Netherlands. • The new job profile contributes to strengthening the position of infection control nurses working in municipal public health services and infection control teams.

The compassionate care framework plus quality control group improves the quality of postoperative nursing management for patients in anorectal surgery: An observational study.

This study aimed to investigate the effectiveness of the joint application of the compassionate care framework (CCF) and a quality control (QC) team in improving the quality of postoperative nursing management for patients in anorectal surgery. Patients who underwent anorectal surgery at the China-Japan Friendship Hospital between May 2022 and December 2022 were selected by convenience sampling. A digital random generator was used for random grouping. The odd numbers entered the control group (n = 53) and the even numbers entered the study group (n = 53). The control group received postoperative traditional nursing, and the study group received postoperative nursing and QC team management. A questionnaire survey was used to analyse patients' satisfaction with nursing. The two groups were compared for nursing quality scores, patient satisfaction with nursing care and incidence of complications. After management, compared with the control group, the study group scored significantly higher for the nursing process, environmental management, emergency response and safety protection (p < 0.05 for all). The study group also exhibited higher satisfaction scores with the nursing process, nurse-patient relationship and service attitude compared with the control group (p < 0.05 for all). The complication incidence rate in the study group was significantly lower than in the control group (p < 0.05). The combined use of the CCF and a QC team can effectively improve the quality of postoperative nursing management for patients in anorectal surgery, reduce the incidence of complications and enhance patient satisfaction with nursing care, thus holding significant potential for wider application.