Surveillance Cultures Research Articles

The incidence and risk factors of intraoperative bacterial contamination in primary total knee arthroplasty

BackgroundInfection is a devasting complication after arthroplasty. Identifying potential sources contributing to intraoperative bacterial transmission can help to reduce surgical-site infections.ObjectiveThe aim of this study was to identify the incidence and risk factors of intraoperative bacterial contamination (IBC) in primary total knee arthroplasty (TKA) procedures.MethodsActive surveillance cultures were used to detect IBC from 125 consecutive unilateral primary TKAs. The cultures were taken from different sites (surgical instruments, gloves of surgeons and surgical incisions) at different time points (before surgery, 30 min and at the end of the surgery) during arthroplasty procedures. Patient characteristics, including age, height, body weight, body mass index, comorbidity of diabetes mellitus, operative duration, intraoperative blood loss, types of prophylactic antibiotics were recorded. The white blood cell level before, the 3rd and 7th day after surgery were measured and recorded. In addition, patients were also followed for fever and surgical-site infections within 14 days after surgery.ResultsIn total, 1,000 cultures were taken. 91 (9.1%) of them showed an IBC. None of bacterial cultures of gloves and instruments before surgery were positive. At 30 min from the beginning of the procedure, 29 cultures (7.7%) from 16 patients (12.8%) showed a contamination. At the end of the surgery, 62 cultures (16.5%) from 32 patients (25.6%) showed a contamination. There were 15 cases (12.0%) of fever within 14 days after surgery, of which 11 cases with IBC, and 4 cases without IBC. No postoperative surgical-site infection occurred in all consecutive unilateral primary TKAs. The binomial logistic regression analyses confirmed that operative duration was the risk factor of IBC [OR 1.137 (95% CI 1.023 to 1.322), p = 0.014]. Moreover, compared to control group, the patients with IBC had a greater change of white blood cell level in the 3rd day after surgery (p = 0.022), and a higher risk of fever within 14 days after surgery (p < 0.001).ConclusionThe bacterial contamination rate during primary TKA is relatively high, despite the practice of standard preventive measures. Intraoperative bacterial contamination increases with long operating time, which may be one of the factors contributing to fever and leukocytosis after surgery.

Microbiological surveillance result of endoscopes after INTERCEPT Foam Spray: a quasi-experimental pilot study in Singapore.

This study aimed to assess the impact of INTERCEPT Foam Spray (IFS) application on delayed endoscope reprocessing through microbiological surveillance culture (MSC). A quasi-experimental, matched-comparison pilot study was conducted using gastrointestinal endoscopy. IFS was applied to the endoscopes after precleaning and before reprocessing the next day. An equal number of endoscopes, matched by endoscope type, were subjected to routine reprocessing. The MSC were subjected to high-level disinfection to detect any contamination. Data were analyzed using the chi-square test or Fisher exact test (categorical data) and Student t-test (continuous data). In total, 150 MSCs were collected from 42 endoscopes. Positive MSCs were observed in 4.0% (4/75) of the sprayed group and 1.3% (1/75) of the control group (95% confidence interval [CI], 30.34-0.31; p>0.05), all of which were contributed by colonoscopes. Colonoscope were more prone to positive MSC (mean difference in percentage, p<0.05). Mean spraying hours were not associated with detected growth (11.7% vs. 13.6; 95% CI, 1.43 to -5.27; p>0.05), with environmental and skin flora being the primary contaminants. IFS may be applied when delayed endoscope processing is necessary, but with caution when applied to colonoscopes. However, further research is warranted to verify the result.

Intensive care unit admission rates and factors associated following Autologous stem cell transplantation-real-world experience from a tertiary center in rural India.

Infectious and other complications can necessitate admission to the intensive care unit (ICU) in autologous stem cell transplantation (ASCT). Data on need for ICU care, impact of various pre- and peri-transplant characteristics on requirement of ICU care and outcomes are scarce from the developing world. A retrospective case record review of ASCT cases was conducted. Pre- and peri-transplant characteristics like infection within 4weeks of transplant, mucositis, surveillance culture positivity, peri-transplant infections, comorbidity, and time to neutrophil and platelet engraftment were noted. A total of 109 patients underwent 109 ASCTs. Most common diagnosis was the plasma cell disorder in 75 (69%) patients. Forty-eight (45%) patients had peri-transplant infections. Fifteen (14%) patients had infections with multi-drug resistant (MDR) organisms. Fifteen (14%) patients required ICU care, the most common reason being hypotension in nine patients (8.3%). Four patients (3.7%) required non-invasive ventilation, and one (0.9%) required invasive ventilation. Mortality rate was 1.8% (two patients). Factors associated with the need for ICU care were time to platelet engraftment (median 15days among those required ICU care versus 13days who did not, p = 0.04) and presence of peri-transplant infection showed a trend toward ICU care need (19% among those required ICU care versus 7% in those who did not, p = 0.05). Delayed platelet engraftment was associated with the need for ICU care and peri-transplant infections were associated with a trend toward need for ICU care.

A-288 Active Surveillance Cultures: Frequency of Microorganisms and Phenotypic Resistance Profile From Brazilian Public Hospitals After COVID-19 Pandemic Peak

Abstract Background Surveillance cultures are routinely used by public health authorities to screen for multidrug-resistant bacteria. Recently, the overuse of antibiotics intensified by the COVID-19 pandemic worldwide brought concerns about potential impacts on the acquisition and/or selective pressure of resistance genes, that in general carried by plasmids, which contribute to the rapid resistance spread within specific bacterial populations. The purpose of this study was to determine the prevalence of multidrug-resistant (MDR) organisms recovered from surveillance cultures (rectal, anal, nasal, and axillary) isolated from several Brazilian public hospitals. Methods Surveillance samples were analyzed from 1st January to 31st December 2023. All the swab samples were collected from patients admitted from high-risk settings or transferred from areas with high rates of MDR organisms. All clinical specimens were inoculated onto a selective media (ChromID media, bioMerieux) and incubated at 35±2°C for 18-24 h. The screening test was performed to Gram-negative bacilli (GNB) using the antibiotics ertapenem, imipenem and meropenem and for Gram-positive Cocci (GPC) screening was tested oxacillin (methicillin) and vancomycin using disc diffusion method. Bacteria identification was performed by MALDI-TOF mass spectrometry (Vitek-MS and bioMerieux) and as required, the minimal inhibitory concentrations (MIC) of antibiotics were determined using the Vitek 2 System (bioMerieux). Results A total of 71,064 rectal swab samples were processed. 4,652/71,064 (6.5%) samples showed positive results for the presence of 5.255 MDR microorganisms. Out of which, 4,477/5,255 (85.2%) were Gram-negative Bacilli (GNB) and 778/5,255 (14.8%) were Gram-positive Cocci (GPC). The majority of the isolated carbapenems resistance was Klebsiella spp. [2,791/5,255 (53.1%)], which the Klebsiella pneumoniae was the predominant species, followed by Acinetobacter baumannii [1,268/5,255 (24.1%)], Pseudomonas aeruginosa [263/5,255 (5%)], Enterobacter spp. [96/5255 (1.8%)], Serratia spp. [31/5,255 (0.6%)], Citrobacter spp. [22/5,255 (0.4%)], and others BGN [6/5,255 (0.2%)]. The resistance to vancomycin and methicillin were observed in 10% (525/5,255) of Enterococcus spp. and 4.8% (253/5,255) of Staphylococcus aureus, respectively. Conclusions The study found that K. pneumoniae carbapenem-resistant and Enterococcus spp. vancomycin-resistant were the main Gram-negative and Gram-positive organisms recovered from surveillance culture samples. However, our data draws attention to the increased cases of carbapenem-resistant Acinetobacter baumannii as the second most frequent pathogen isolated from surveillance samples after the last wave of COVID-19 pandemic. Active surveillance culture for target microorganisms followed by contact precautions to minimize the chance of transmitting MDR organisms from colonized to non-colonized patients consist of an important activity of infection control policy.

A-285 Adoption of 2023 CLSI Revised Aminoglycoside Clinical Breakpoints on Carbapenem Resistant Enterobacterales Isolates Identified at a Commercial Reference Laboratory in Korea, Republic of

Abstract Background The incidence of carbapenem resistant Enterobacterales (CRE) has been rapidly increasing as a nationally notifiable communicable disease since 2017 in Korea. The therapeutic options available for these pathogens are extremely limited. Several new drugs developed to treat CRE infections was recently introduced in Korea, but was not widely used. Instead, aminoglycoside is used as one of current available antimicrobials in CRE infections. The Clinical and Laboratory Standards Institute (CLSI) publishes revised aminoglycoside breakpoints in Enterobacterales in 2023. The purpose of this study was to evaluate the adoption of changing the aminoglycoside breakpoint in a commercial reference laboratory. Methods We retrospectively evaluated aminoglycosides (amikacin, gentamicin, tobramycin) for 1,393 CRE isolates not including surveillance culture identified by MALDI-TOF MS (Bruker Daltonik, Bremen, Germany) from January to December in 2023 at a commercial reference laboratory in Korea. Antimicrobial susceptibility testing was performed using a N415 card on the VITEK2 XL (bioMerieux, France). Susceptibilities of aminoglycoside were assessed based on previous breakpoints in CLSI M100-S32 in 2022 as well as the current breakpoints from the most recent CLSI MIC breakpoints in 2023. Results We evaluated 1,393 CRE isolates. Most isolates were Klebsiella pneumoniae [n=876 (62.9%)] and Escherichia coli [n=322 (23.1%)] followed by Citrobacter koseri [n=76 (5.5%)] The new aminoglycoside breakpoints reduced the percentage of strains that were previously judged to be susceptible by CLSI M100-S32 from 87.5% (1,219/1,393) to 71.2% (992/1,393) in amikacin, from 45.5 (634/1,393) to 44.8% (624/1,393) in gentamicin and from 23.3% (323/1,385) to 21.4% (297/1,385) in tobramycin, respectively. In meropenem resistant 56 isolates with MIC≤8 mg/L available of meropenem in combination with a second agent, frequently polymyxins or aminoglycosides, the new aminoglycoside breakpoints reduced the percentage of strains that were previously judged to be susceptible from 92.9% (52/56) to 64.3% (36/56) in amikacin and from 64.3% (36/56) to 60.7% (34/56) in gentamicin, respectively. There was no difference in tobramycin. Conclusions Our results show decreased susceptibility of aminoglycoside especially for amikacin in CRE isolates tested. Amikacin is commonly used to treat CRE infections, either alone or as part of combination therapy. Although our study has no correlation with clinical outcomes, we found microbiology laboratories should adopt the updated breakpoints.

Cumulative incidence of vancomycin-resistant Enterococcus faecium detection by patient characteristics or possible exposures: prioritization of patients for active screening culture

The target population for active surveillance culture (ASC) of vancomycin-resistant Enterococcus species (VRE) by stool or rectal swabs has not been fully determined during VRE outbreaks in healthcare settings in non-VRE endemic situation. We evaluated cumulative incidences of VRE detection during a vancomycin-resistant Enterococcus faecium outbreak to determine reasonable target populations for ASC. Cases included inpatients whose first VRE-positive sample was obtained at Shizuoka General Hospital between February 2022 and January 2023, during which we conducted admission screening for possible high-risk patients, biweekly screening of all inpatients, admission and discharge screening in the high-care unit, and screening of contacts in each ward by using stool or rectal samples. We calculated cumulative incidences of VRE detection for those screened by patient characteristics or possible exposure. Among 60 cases identified, 55 (92%) were by ASC. Cumulative incidence was higher for contacts (6.4%, 15/234) than for those identified by other screening methods (0.5%, 40/8565). Among the patients identified through admission screening, those previously hospitalized in areas of reported VRE outbreaks had the highest cumulative incidence (6.6%, 5/78) followed by patients requiring toilet assistance (3.7%, 6/161). A bundle approach including ASC and prompt contact precautions by the hospital infection control team, local public health centre, and local and national infection control experts helped terminate the outbreak in seven months. Patients with contacts, prior hospitalization in areas with known VRE outbreaks, and who need toilet assistance appear to be high-risk populations for VRE detection and are candidates for ASC.

Online monitoring activism: civic surveillance practices as a reaction to the rise of the far-right in the COVID-19 pandemic

ABSTRACT The rise of far-right movements during the COVID-19 pandemic has prompted a new form of individual digital activism: online monitoring activism (OMA). During the pandemic, online monitoring activists systematically collected, processed and published information from far-right Telegram channels and groups. Against the theoretical background of concepts like the monitory democracy and surveillance culture, we conducted eight semi-structured interviews with German online monitoring activists, investigating their motivations, roles, and the intricacies of their monitoring practices. Our findings reveal that online monitoring activists are driven by a sense of duty to counteract anti-democratic tendencies, which they perceive as inadequately addressed by institutional power. They gain localized and thematically specialized expertise that they share within loose networks of like-minded others. We highlight the activists’ liminal identity oscillating between virtuous citizenship and vigilantism, as well as the broader societal implications of their actions. On the one hand, they fulfill the role of active citizenship in monitory democracy; on the other, they also reinforce the transparency imperative and the wish for far-reaching security and control inherent to surveillance culture. The transparency potential afforded by their adversaries’ online connective action and mobilizing efforts legitimizes their surveillance and demands surveillance. Further normative work is needed to critically examine the extent and desirability of increased social control introduced to liberal democracy by online monitoring activism.

Surveillance cultures in adult intensive care units: incidence and factors associated with positivity

Surveillance cultures in adult intensive care units: incidence and factors associated with positivity

Neighborly Surveillance: The Mississippi State Sovereignty Commission and the Development of a Post-Jim Crow Ideological Apparatus

The relations of production in Deep South regions like the Mississippi Delta require a high degree of control over race and class configurations. While the overt, de jure White supremacy that marked the post-Reconstruction era allowed for effective repression of dissent, the promise of federal intervention and grassroots organizing during the years of the civil rights movement required White elites to recalibrate methods of control. By integrating theories of racialization of space, internal colonialism, and Althusser’s (2006) notion of the ideological state apparatus, I suggest that this transition from overt to implicit control was accomplished by creating a culture of neighborly surveillance in which everyday Whites were deputized to surveil and report on civil rights organizing at the grassroots level. By neighborly surveillance, I refer to surveillance between and amongst private citizens enacted outside the purview of the formal state but in the interest of the powerful elite who control the state. I document this process through analysis of the archives of the Mississippi State Sovereignty Commission, an official state agency tasked with spying on and counteracting civil rights activity. These records demonstrate the extent to which non-state actors assumed the roles originally exercised by the de jure Jim Crow regime. Beyond augmenting understandings of the civil rights movement-era US South, this article contributes analytical insights to social and ideological transitions in other post-colonial, post-authoritarian spatial contexts.

Feasibility of Calculating Indicators for Intensive Care Unit Antibiotic Use Based on Routine Electronic Health Record Data.

This study evaluated the feasibility of utilizing routinely collected EHR data to calculate pre-developed quality indicators on antibiotic use. Three out of four indicators were found feasible. Main barriers included local codes for lab tests and surveillance cultures and lack of data on empirical prescription. Future studies should include data from multiple ICUs to test the variations in QIs between ICUs.

The Telecommunications Act, 2023: Solidarity Between Democracy and Totalitarianism

ABSTRACT With the coming of a surveillance culture, even minute aspects of human life are being observed, collected, analyzed, and stored by institutions in charge of surveillance. On the other hand, the same does not apply to the institutions which are surveillant of the lives of individuals. Such phenomenon can be observed via various technologies of power prevalent in societies. One such technology of power is legislation passed by the State to access, control, analyze, disseminate, or store the personal information of citizens. This article analyses the Telecommunications Act, 2023 which has been hailed as a move towards decolonization by repealing the former colonial laws over telecom services. The article discusses various attributes of the 2023 Act to analyze the means through which the usage of biometric systems of identification leads to violation of the fundamental right to privacy, as envisaged by the apex court of India in the landmark judgment of Justice K S Puttaswamy (Retd) v Union of India and other judgments before and after. The article also argues how the works of Giorgio Agamben and Didier Bigo on a permanent state of emergency being materialized through surveillance of minute aspects of human life and consequently marks a shift towards totalitarian tendencies of governance.

Surveillance and datafication in higher education

It has become a commonplace in educational research and policy discourses to state that digital technology has ‘transformed’ the nature of higher education, and even the university itself, leading to what is claimed to be more interactive or less hierarchical formats and engagement, in which traditional modes of teaching such as the lecture, are claimed to be obsolete. These narratives, arguably, express a widespread desire for ‘transformation’ in the university. In terms of digital education, this has been expressed variously in the apparently benign ideologies of ‘active learning’, ‘connectivism’, and ‘the flipped classroom’, all of which share common values, those which prize student interaction, and observable engagement, both online and in the face-to-face setting. Although these constructs appear to be ‘student centred’ and progressive, critics (e.g. Macfarlane 2017) have pointed out that an emphasis on student performance of a particular form of engagement and identity in higher education may in fact threaten the fundamental values of academic freedom. In parallel, regimes of audit concerning academic performance have become more prevalent in higher education, with metrics measuring publications and impact becoming more influential on academic careers. I have argued elsewhere (Author 2020) that this tendency is greater in the context of digital education, where performativity, surveillance and regulation are intensified via digital technologies, as part of a broader ‘culture of surveillance’ in society (Lyon 2018). As recent commentators have argued (e.g. Williamson 2017a), the increased use of big data to track and monitor student activity, has the effect of ‘datafying’ them as human subjects; the same could be said for the technology of the h-index for academics. In this paper I will combine insights of digital education research, science and technology studies and information science in order to interrogate the nature and effects of this increased ‘datafication’ of higher education, looking at two examples; learner analytics and the author publication metric h-index. I will argue that these two digitally-mediated ‘documenting’ practices share several features; they have a supervisory or surveilling function, they are underpinned by particular ideologies, and they carry normative force regarding the nature of ‘desirable’ subjectivities and practices. I conclude that there is a need to sustain a critical agenda of research around these technologies of surveillance and documentation, particularly in the current context in which ‘discourses of inevitability’ surrounding digitisation of higher education prevail.

Data stories: speculative methods for researching digital surveillance in higher education

Higher education systems have always involved monitoring through data collection, assessment, and evaluation, shaping the intellectual work, and tracking the bodies and activities of students and teachers. However, surveillance in many higher education settings has become increasingly pervasive and fine-grained as monitoring and data-gathering technologies grow in sophistication and as the quantification and measurement of everything from outcomes to student satisfaction to engagement is increasingly valued in universities. Concerns are growing about negative impacts on learning relationships, exploitative commercial uses of collected student data, discriminatory practices, and even political, social, or physical harm inflicted because of surveillance and monitoring. At the same time, the complex surveillance cultures of higher education make it difficult to disentangle personal and collective responsibility, understand the gap between intentions and impacts, or navigate the significant risks that can come, for some, with speaking about these matters. In 2020, a research project was funded to develop a 'data stories tool to support people working and studying in higher education, particularly learning technologists, to develop anonymous speculative stories about what the future of surveillance in higher education might look like, and to draw out themes, concerns about and hopes for that future. The methodology used to design this tool drew from speculative and co-design approaches. This paper discusses how these approaches were mobilised to produce a space for people to make new meanings around surveillance, and to share these with others in a networked environment, in the form of Participatory Speculative Fictions. It discusses a few of the stories produced, and how they shed light on the potential of speculative methods for working with and possibly reconfiguring networked learning futures.

Whole-genome sequencing establishes persistence of biofilm-associated Pseudomonas aeruginosa detected from microbiological surveillance of gastrointestinal endoscopes

BackgroundAn increased incidence of P. aeruginosa in microbiological surveillance (MS) cultures from gastrointestinal endoscopes was detected between March 2020 to March 2023 in Tan Tock Seng Hospital Singapore. The aim of this report is to describe the use of whole-genome sequencing (WGS) in this investigation. MethodsWGS was performed for all P. aeruginosa isolates with pairwise comparison of isolates to assess for genomic linkage. Comprehensive review of reprocessing practices and environmental sampling was performed. FindingsTwenty-two P. aeruginosa isolates were detected from endoscopic MS cultures. Fifteen (68%) isolates were available for WGS. Eighteen pairwise comparisons of isolates were made, of which 10 were found to be genomically linked. One endoscope had P. aeruginosa repeatedly cultured from subsequent MS that were genomically linked and persistent despite repeat endoscopic reprocessing, establishing the persistence of biofilm that could not be eradicated with routine reprocessing. All P. aeruginosa isolates cultured from other different endoscopes were genetically distinct.Investigation into reprocessing practices revealed the use of air/water valves connected to endoscopes during clinical use. Inspection of these valves revealed the presences of cracks and tears. All other environmental samples were negative. ConclusionsThe WGS findings helped to deprioritize common source contamination and supported the hypothesis of biofilm buildup within endoscopes leading to repeatedly positive MS cultures that were genomically linked. This was possibly related to incomplete reprocessing of the damaged air/water valves, resulting in biofilm build up. All faulty valves were changed and subsequently cleaned separately with ultrasonic cleaning followed by sterilization which resolved this incident.

Hospital-Associated Transmission of Candida auris from Adult to Pediatric Patient

Background: Candida auris, an emerging multidrug-resistant fungus, is often difficult to control in hospital outbreaks. We report the hospital investigation and findings of a transmission of C. auris from patients hospitalized in an adult unit to a pediatric unit, the first in Maryland. Methods: Between June and September 2023, C. auris was recovered from two patients admitted to an adult Neuroscience Intensive Care Unit (ICU) and a patient admitted to a pediatric ICU. Infection control initiated an investigation involving staff interviews, observations and chart reviews. Cases were defined as any patient with clinical or surveillance cultures growing C. auris. Point prevalence surveillance was conducted by collecting nares and composite axilla/groin swabs from patients on the affected units. Environmental cultures collected using moistened E-Swabs (Copan, Murrieta, CA) from shared supplies were plated on CHROMagar Candida (BD, Sparks, MD). C. auris isolates from patients hospitalized at the facility between February 2022 and October 2023 were analyzed by WGS for relatedness. WGS was performed using Illumina NextSeq 300 bp paired-end sequencing (Illumina, San Diego, CA). Single nucleotide polymorphism (SNP) analysis was performed by comparing raw reads to the reference C. auris B8441 genome for subsequent clustering analysis (Ares Genetics, Vienna, Austria). Results: WGS demonstrated isolates from two adults and one pediatric patient were less than three SNPs different, suggesting a shared isolate. One additional pediatric case was identified from surveillance cultures collected from 27 patients. Investigation into possible transmission routes revealed healthcare personnel serving both units, specifically clinical teams and continuous electroencephalography (cEEG) technologists. Additionally, cEEG equipment was used on both adult and pediatric patients and twelve equipment surface swabs and three samples each of measuring tape and gel were collected. C. auris was not isolated, however sensitivity of environmental sampling is unclear and suspicion for possible fomite/environmental transmission persisted. Other possible transmission routes included gaps in hand hygiene, isolation, disinfection of shared equipment, and reuse of single-use items. Interventions included improving and monitoring infection prevention practices, educating multi-disciplinary personnel and heightened environmental cleaning. Conclusion: This case highlights the feasibility of transmission of C. auris between patients admitted to a geographically distant unit. Our investigation revealed multiple possible routes of transmission including direct contact (from healthcare personnel or equipment) or indirect environmental sources. Prevention of hospital-associated C. auris transmission likely necessitates meticulous adherence to hand hygiene, contact precautions, and careful cleaning and disinfection of patient environments and equipment used by all disciplines.Disclosure: Patricia Simner: Research Contracts: BD Diagnostics, OpGen Inc., Qiagen Sciences Inc, T2 Diagnostics, Accelerate Diagnostics; Research Collaborators:Ares Genetics, CosmosID, IDbyDNA, Illumina; Consulting: OpGen Inc., BD Diagnostics, Shionogi Inc., GeneCapture, Qiagen Sciences Inc, Entasis, Day Zero Diagnostics, Next Gen Diagnostics

Pre- and Post-debridement Wound Cultures in Gustilo Type III Open Tibial Fractures to Predict Wound Infection at a Tertiary Care Hospital.

Gustilo type III open tibial fractures are difficult injuries that carry a higher risk of infection and other consequences. Open-fracture wound microbiology is dynamic and responsible for change over time. Effective antibiotic treatment plans are required, as detrimental microorganisms are often linked to these types of lesions. The study aimed to determine whether pre- and post-debridement wound cultures could predict wound infection in Gustilo type III open tibial fractures. This prospective study was carried out at the National Institute of Traumatology and Orthopaedic Rehabilitation (NITOR) in Dhaka, Bangladesh, on 344 patients who presented to the emergency department with a Gustilo type III open tibial fracture within 24 hours of injury from June 2018 to October 2019. Three successive cultures were carried out: one in the emergency room (surveillance culture), the second at the emergency theater after debridement, and the third in the ward after one week (seven to 10 days). Statistical analyses of the results were conducted using Microsoft Excel (Microsoft Corp., Redmond, WA) and IBM SPSS Statistics for Windows, version 27 (IBM Corp., Armonk, NY). The study included 344 patients with an average age of 37.15 years, with motor vehicle accidents being the primary cause (78.2%). Gustilo type IIIA fractures made up the majority (48.5%), followed by type IIIB fractures (44.8%). A significant reduction in contamination rates was observed from initial admission (48.8%) to post-debridement (36.6%) (p =.001). There was a significant positive correlation between pre-debridement cultures and wound infections (r =.311), as well as between post-debridement cultures and wound infections. The infection rate increased to 61.6% in ward samples, indicating a high rate of hospital-acquired infections. Pseudomonas and Klebsiella species were the most prevalent multidrug-resistant bacteria that caused these infections. The present study provides information on the relationship between contamination and infection. Gram-negative pathogens were dominant in this study, and the results of the antibiograms showed an alarming pattern of resistance. Nosocomial infection demands further urgent study.

:Covert Colonialism: Governance, Surveillance and Political Culture in British Hong Kong, c. 1966–97

:<i>Covert Colonialism: Governance, Surveillance and Political Culture in British Hong Kong, c. 1966–97</i>

Book Review: Covert Colonialism: Governance, Surveillance and Political Culture in British Hong Kong, c. 1966–97 by Florence Mok

Book Review: <i>Covert Colonialism: Governance, Surveillance and Political Culture in British Hong Kong, c. 1966–97</i> by Florence Mok

Large-Scale S. aureus Screening with Molecular Epidemiology; the Role of MSSA and Community MRSA in Hospital Transmissions

Background: The frequency of Staphylococcus aureus transmission in hospitals is unknown: symptomatic infection may occur months after transmission and colonization, and infection prevention efforts rely on indirect measurements, rather than direct detection of transmission events. We implemented a hospital-based S. aureus screening program, combined with whole genome sequencing of S. aureus surveillance and clinical cultures and data extracted from the electronic health record, to identify S. aureus clonal complex-, patient- and location-specific factors associated with S. aureus transmission in our health system. Methods: Screening S. aureus cultures were obtained at admission by nasal swab for adults admitted to Medicine, Transplant, Oncology and intensive care, and weekly by swab of nares, axilla and groin for children admitted to intensive care and Oncology at NYU Langone Health in New York City. All methicillin-resistant S. aureus (MRSA) from screening and clinical (blood, wound, sputum) cultures and all methicillin-susceptible S. aureus (MSSA) from screening and blood cultures underwent whole genome sequencing. Isolates from distinct patients with &lt; 2 0 single nucleotide pair differences were considered genetically related. Electronic health data was extracted for descriptive statistics and for spatiotemporal plots to assess plausible transmissions. We used REDCap electronic data capture tools hosted at NYU Grossman School of Medicine and SAS software for data analysis to evaluate S. aureus transmissions between November 2022 and November 2023. Results: We analyzed 8,567 S. aureus isolates: including 6,552 screening cultures, 1,008 blood cultures, and 1,007 clinical cultures. We found 424 plausible S. aureus hospital transmissions using sequencing and electronic health data. Screening cultures identified 75% of transmissions that would have otherwise been missed with blood and clinical cultures alone. The majority of positive screening cultures isolated MSSA, but the proportion of transmissions due to MSSA differed by age. In children, MSSA colonization accounted for 62% of transmissions. In adults, only 15% of transmissions were due to MSSA colonization, whereas MRSA colonization accounted for 56% of transmissions. Analysis of adult MRSA isolates by clonal complex found that 45% of transmissions were due to CC8, higher than the 17% among isolates agnostic of transmissions. Emergency departments and the neonatal intensive care unit had the highest number of transmissions. Patients involved in transmissions had longer lengths of stay and frequent hospitalizations. Conclusions: A S. aureus screening program, coupled with genome sequencing and electronic health data, can identify patient group, hospital locations and clonal complexes that are at high risk for S. aureus transmissions.

Relationship between Hand Hygiene and MDRO Acquisition after Implementation of an Electronic Hand Hygiene Monitoring System

Background: Hand hygiene (HH) is fundamental to preventing the transmission of pathogens between patients. Unfortunately, adherence to HH is suboptimal and monitoring adherence is challenging. Electronic HH monitoring systems (EHHMS) are emerging potential solutions to increase the number of HH observations and eliminate the potential for observation bias. This aim of this study is to assess the impact of improved HH adherence after the introduction of an EHHMS on the rates of healthcare facility-onset multidrug-resistant organisms and Clostridioides difficile (HO-MDRO). Methods: We performed a retrospective, quasi-experimental study to evaluate the impact of HH on HO-MDROs across 4 acute care facilities (59 hospital units, 14 of which were ICUs) from January 2021 - September 2022 after implementing an EHHMS in a large academic healthcare system. Clinical cultures from all sources were included; routine surveillance cultures were not collected during this period. HO determination was made using National Healthcare Safety Network (NHSN) definitions. The association between monthly unit-level HH adherence (%) and HO-MDRO rate per 1000 patient-days was assessed using mixed-effects Poisson regression using rate ratios (RR), which accounts for unobserved heterogeneity between units while controlling for number of tests ordered per month per hospital unit. HH adherence was stratified in quartiles (Q1: 24-43%, Q2: 43-51%, Q3: 52-61%, Q4: 61-84%). Results: During the study period, there were 23 million HH opportunities and 1875 MDROs in 772,930 patient-days. HH adherence increased from 41% January 2021 to 57% September 2022. ESBL, MSSA, and CDIFF accounted for most MDROs (Figure 1). The mean monthly HH adherence rate was 52% per unit, with a median of 1.66 (IQR: 0-3.5) MDROs/1000 patient-days. Mixed-effects Poisson regression suggested no significant overall relationship between HH adherence and MDRO rate (Figure 2). A close to null association was observed when comparing quartile two to quartile one (RR: 0.97, 95% CI: 0.82, 1.15), quartile three to quartile one (RR: 0.96, 95% CI: 0.79, 1.17), and quartile four to quartile one (RR: 1.05, 95% CI: 0.86, 1.28). Results were similar across hospitals (Figure 3). Conclusions: Although implementing an EHHMS led to an improvement in HH adherence, we were not able to demonstrate a resultant decrease in HO-MDROs. Potential explanations include the relatively rare outcomes of interest, unrecognized confounders, and the complex interaction between HH and HO-MDROs, since poor HH adherence on a unit may lead to increased attention from infection prevention and therefore increased focus on other MDRO prevention measures.