Effective Infection Control Program Research Articles

Infection prevention: laying an essential foundation for quality universal health coverage

Infection prevention: laying an essential foundation for quality universal health coverage

Considerable rate of putative virulent phylo-groups in fecal carriage of extended-spectrum β-lactamase producing Escherichia coli

Extended-Spectrum Beta–lactamase producing Enterobacteriales (ESBL-PE) in fecal carriage have become a global health concern. Detection of putative virulent ESBL-producing E.coli (ESBL-EC) isolates among asymptomatic carriers is a threatening issue in public health. The aim of this study was to investigate the intestinal carriage of ESBL-EC, phylo-groups and clonal relatedness among putative virulent groups of ESBL-EC isolated from fecal carriages. A total of 120 rectal swabs; 50.8% (61/120) from inpatients of intensive care unit (ICU) and 49.2% (59/120) from outpatients were collected. The ESBL-EC screening was performed by using MacConkey agar supplemented with cefotaxime. PCR assays were applied for determination of phylo-groups, detection of ESBL and carbapenemase genes. Conjugation experiment, plasmid replicon typing and Multilocus Sequence Typing (MLST) were performed for putative virulent phylo-groups. Totally, of 120 studied individuals, 60.0% (72/120) were carrier for ESBL-EC. The rate of blaCTX-M-15, blaTEM, blaSHV was 90.2% (65/72), 50.0% (36/72) and 5.5% (4/72), respectively. The frequency of phylo-groups A, B1, B2, C, D, and F were 20.8% (15/72), 6.9% (5/72), 20.8% (15/72), 2.7% (2/72), 13.8 (10/72) and 12.5% (9/72), respectively. In conjugation experiments, of 6 tested isolates, 5 had conjugative plasmids. The most prevalent plasmid types belonged to IncF incompatibility groups. The MLST analysis showed that the main sequence types among ESBL-EC isolates were ST769 and ST472. The current study provides novel information about the presence of the ESBL-EC isolates, particularly putative virulent phylo-groups among fecal carriages in Iran. Our data revealed that there was almost high ST heterogeneity among putative ESBL-EC isolates. In order to implementation of effective infection control program, detection of fecal carriage in appropriate time typically at the beginning of admission to the hospital is recommended.

Economics of preventing healthcare-associated infections

Introduction: Healthcare-associated infections (HCAIs) contribute to significant morbidity, mortality and economic costs. There are many different ways of preventing hospital infections. An effective infection control programme (ICP) should be a cost-effective medical intervention. Hence, the current study was undertaken to determine the cost-effectiveness of the ICP for the years 2015–2016 and 2014–2015 in comparison to 2013–2014. Methodology: This study was conducted in a 400-bedded super speciality hospital. The infection control budget for the years 2013–2014, 2014–2015 and 2015–2016 was calculated. Incremental cost-effectiveness ratio (ICER) was calculated as the difference in cost between two interventions divided by the difference in health benefit obtained. Results: The total expense incurred on the ICP in the year 2013–2014 was Rs. 1,640,162. In the years 2014–2015 and 2015–2016, the ICP was upgraded with an incremental budget of Rs. 816,208 and Rs. 1,025,730, respectively. There was a significant reduction in HCAI rates in the years 2014–2015 and 2015–2016. The ICER for the years 2014–2015 and 2015–2016 was 68,017.33 and 60,337.05, respectively. Based on the analysis, the ICP for the year 2015–2016 was more cost-effective. Conclusion: The incremental budgeting for the new ICP for the year 2015–2016 proved to be a more efficient and cost-beneficial intervention for infection control.

Fully automated healthcare-acquired infection surveillance: Where in the world are we?

Introduction: Surveillance of healthcare-associated infections (HAI) is one of the cornerstones of an effective infection prevention and control (IPC) programme. Over time, mandatory requirements have increased. However, manual surveillance is labour-intensive, and thus most institutions are restricted in the amount and scope of surveillance that they perform. Furthermore, many of the HAI definitions contain subjective components that require interpretation.

How does it feel to be ‘on the other side’?

Introduction: This presentation is a reflection on my experience of being a patient having an elective surgical procedure within a public hospital in NSW, Australia. I consider my observations on some important components of an effective infection prevention and control programme. I also reflect on what may be a previously under-acknowledged factor in the transmission of pathogens in hospitals; the patients themselves.

Human resources estimates and funding for antibiotic stewardship teams are urgently needed

Human resources estimates and funding for antibiotic stewardship teams are urgently needed

Resourcing hospital infection prevention and control units in Australia: A discussion paper

Abstract Background Infection control professionals (ICPs) are critical in maintaining high standards of quality patient care. Until recently, little was known about the scope of practice, structures, resources and priorities for ICPs and infection control units more generally. Over the past three years we have undertaken a program of work to explore these issues. The purpose of this discussion paper is to synthesise these results and outline implications for the Australian infection control community. Methods We undertook a survey of individual ICPs in Australian and New Zealand and a survey of hospital infection control units within Australia. To understand how our research program could be used to inform and be of value, we also convened a stakeholder workshop to discuss how data from our studies could be translated into meaningfully constructed findings. A synthesis of the findings from the two surveys and the workshop was undertaken and this formed the basis of this discussion paper. Results We were able for the first time, to comprehensively report on infection control staffing levels, priorities and barriers within Australia. We identified considerable variability in the scope, experience and expertise of ICPs and the potential value that credentialing has with respect to effective infection control programs. We were however, unable to develop recommendations with respect to staffing. Conclusion The findings of our work may be used in designing and justifying business cases for infection prevention and control resources. There is also a need to undertake a similar study in settings other than hospitals.

Core components for effective infection prevention and control programmes: new WHO evidence-based recommendations

Health care-associated infections (HAI) are a major public health problem with a significant impact on morbidity, mortality and quality of life. They represent also an important economic burden to health systems worldwide. However, a large proportion of HAI are preventable through effective infection prevention and control (IPC) measures. Improvements in IPC at the national and facility level are critical for the successful containment of antimicrobial resistance and the prevention of HAI, including outbreaks of highly transmissible diseases through high quality care within the context of universal health coverage. Given the limited availability of IPC evidence-based guidance and standards, the World Health Organization (WHO) decided to prioritize the development of global recommendations on the core components of effective IPC programmes both at the national and acute health care facility level, based on systematic literature reviews and expert consensus. The aim of the guideline development process was to identify the evidence and evaluate its quality, consider patient values and preferences, resource implications, and the feasibility and acceptability of the recommendations. As a result, 11 recommendations and three good practice statements are presented here, including a summary of the supporting evidence, and form the substance of a new WHO IPC guideline.

Strategies in developing an effective infection prevention and control program

Strategies in developing an effective infection prevention and control program

Staphylococcus aureus Surface Colonization of Medical Equipment and Environment, Implication in Hospital- Community Epidemiology

Staphylococcus aureus has been known to be a predominant nosocomial infection occurring majorly among immune-compromised patients in hospital environments and other health care facilities. This study was carried out to identify the prevalence of Staphylococcus aureus on fomites in both male and female orthopedic wards, Radiology Department and the hospital environment at the Obafemi Awolowo University Teaching Hospital Complex (OAUTHC), Ile-Ife, Nigeria. Standard conventional methods of microbial analysis in isolation of S. aureus including catalase, coagulase and DNase tests as well as the antibiograms of the isolates from fomites were determined. Out of 34 (thirty-four) samples collected, 11 samples were confirmed positive for S. aureus isolates with the female ward constituting of 45.5%. Pure cultures of S. aureus isolated were 100% susceptible to both ciprofloxacin and pefloxacin, 69% resistant to amoxicillin and ampiclox, 80% to septrin, 54% erythromycin, 31% streptomycin, 38% rocephin and 15% to gentamycin used. Periodic routine disinfection of hospital environment should be implemented in order to reduce the risk of infection among patients and staff. Protocols to reduce the transmission may need to be extended to hospital beds, trolleys, nurse desk, tables and taps. Frequent need for strict compliance to effective Infection Control Program must be maintained.

Prevalence of latent tuberculosis infection among tuberculosis laboratory workers in Iran.

OBJECTIVESThe risk of transmission of Mycobacterium tuberculosis from patients to health care workers (HCWs) is a neglected problem in many countries, including Iran. The aim of this study was to estimate the prevalence of latent tuberculosis (TB) infection (LTBI) among TB laboratory staff in Iran, and to elucidate the risk factors associated with LTBI.METHODSAll TB laboratory staff (689 individuals) employed in the TB laboratories of 50 Iranian universities of medical sciences and a random sample consisting of 317 low-risk HCWs were included in this cross-sectional study. Participants with tuberculin skin test indurations of 10 mm or more were considered to have an LTBI.RESULTSThe prevalence of LTBI among TB laboratory staff and low-risk HCWs was 24.83% (95% confidence interval [CI], 21.31 to 27.74%) and 14.82% (95% CI, 11.31 to 19.20%), respectively. No active TB cases were found in either group. After adjusting for potential confounders, TB laboratory staff were more likely to have an LTBI than low-risk HCWs (prevalence odds ratio, 2.06; 95% CI, 1.35 to 3.17).CONCLUSIONSThis study showed that LTBI are an occupational health problem among TB laboratory staff in Iran. This study reinforces the need to design and implement simple, effective, and affordable TB infection control programs in TB laboratories in Iran.

Rapid Molecular Identification of Hospital-Acquired Methicillin Resistant Staphylococcus Aureus (HA-MRSA) Lineages

Background : MRSA infection accounts for high percentage of all S. aureus infections in most healthcare facilities. Epidemiological typing is usually done to identify outbreaks or track local spread of strains, and this helps in infection control programmes. A restriction-modification test (RM test) is a rapid, simple and inexpensive method to classify HA-MRSA strains into their appropriate clonal lineage. Objective(s): Phenotypic and genotypic identification of MRSA isolates from clinical specimens at Fayoum University Hospital (FUH). Detection of mecA and pvl genes by PCR and using RM test to classify HA-MRSA strains into their appropriate clonal lineage were also performed. Methodology: Seventy non duplicated S. aureus isolates collected from various clinical specimens at FUH were screened for methicillin-resistance and antibiotic resistance profile. Duplex PCR reaction was done for mecA and pvl genes detection and three RM tests for detection of MRSA isolates clonal lineage were also performed. Results: MRSA prevalence among clinical S. aureus isolates was 57.1%. 17.5% were pvl + . Five different lineages were detected (CC1, CC5, CC8, CC22 and CC45). Clonal lineage CC22 was the predominant one. CC30/ST36 was not detected at all. Eight isolates (20%) were negative for this test. pvl gene was detected in three different clonal lineages; CC5, CC22 and CC1 in variable proportions. Conclusion: RM tests are simple, easy and inexpensive tests that are suitable for detection of clonal lineages of MRSA isolates at healthcare settings with limited resources. Effective infection control programmes are needed to control the rapidly spreading MRSA at Egyptian hospitals.

Fighting the Battle With-Double Edged Weapons – A Prospective Study

Fighting the Battle With-Double Edged Weapons – A Prospective Study

Plasmid-mediated resistance and virulence mechanisms in the private health sector in KwaZulu-Natal, South Africa: An investigation of methicillin resistant Staphylococcus aureus (MRSA) clinical isolates collected during a three month period.

Due to the lack of information on the plasmid content of MRSA strains in South Africa (SA), this study investigated the resistance and virulence mechanisms of 27 clinical isolates from the private health care sector over a period of 3 months. Plasmids were extracted and the presence of MRSA confirmed by the presence of mecA. The isolates were subjected to antimicrobial susceptibility testing and molecular characterization of common resistance encoding genes and frequently encountered virulence factors by PCR using plasmid DNA as the template. The genetic relatedness between the isolates was determined by pulsed field gel electrophoresis (PFGE). All isolates were plasmid positive, and displayed ampillicin, ciprofloxacin, gentamicin, rifampicin, tetracycline, erythromycin, and clindamycin resistance. They were all fully susceptible to daptomycin, linezolid, vancomycin, tigecycline and fusidic acid. Multidrug resistance (MDR) was found in 74.1% (20/27) of the MRSA isolates. The frequency of the resistance and virulence genes ranged from 100% to 0%. PFGE analysis revealed 10 pulsotypes, designated A-J, which showed correlation with resistance profile of the isolates in each group. Of note, 85.2% (23/27) of the isolates clustered into six major PFGE types giving an indication of similar circulating MRSA clones. This study highlights the genetic diversity and resistance mechanisms in MRSA strains from the private health sector in SA hence the need for implementing effective infection control programs.

Methodology in improving antibiotic implementation policies.

The basic requirements of antibiotic prescribing are components of methodology; knowledge, logical reasoning, and analysis. Antimicrobial drugs are valuable but limited resources, different from other drugs and they are among the most commonly prescribed drugs all over the world. They are the only drugs which do not intentionally affect the patient. They affect the pathogens which invade the host. The emergence and spread of antibiotic-resistant pathogens are accelerated by heavy antibiotic usage. The effective antimicrobial stewardship and infection control program have been shown to limit the emergence of antimicrobial-resistant bacteria. In this respect, education for antibiotic prescribing could be designed by going through the steps of scientific methodology. A defined leadership and a coordinated multidisciplinary approach are necessary for optimizing the indication, selection, dosing, route of administration, and duration of antimicrobial therapy. In scenarios, knowledge is also as important as experience for critical decision making as is designated. In this setting, the prevalence and resistance mechanisms of antimicrobials, and their interactions with other drugs need to be observed. In this respect, infectious disease service should play an important role in improving antimicrobial use by giving advice on the appropriate use of antimicrobial agents, and implementing evidence-based guidelines.

Recent advances in the understanding of antibiotic resistance in Clostridium difficile infection

Clostridium difficile epidemiology has changed in recent years, with the emergence of highly virulent types associated with severe infections, high rates of recurrences and mortality. Antibiotic resistance plays an important role in driving these epidemiological changes and the emergence of new types. While clindamycin resistance was driving historical endemic types, new types are associated with resistance to fluoroquinolones. Furthermore, resistance to multiple antibiotics is a common feature of the newly emergent strains and, in general, of many epidemic isolates. A reduced susceptibility to antibiotics used for C. difficile infection (CDI) treatment, in particular to metronidazole, has recently been described in several studies. Furthermore, an increased number of strains show resistance to rifamycins, used for the treatment of relapsing CDI. Several mechanisms of resistance have been identified in C. difficile, including acquisition of genetic elements and alterations of the antibiotic target sites. The C. difficile genome contains a plethora of mobile genetic elements, many of them involved in antibiotic resistance. Transfer of genetic elements among C. difficile strains or between C. difficile and other bacterial species can occur through different mechanisms that facilitate their spread. Investigations of the fitness cost in C. difficile indicate that both genetic elements and mutations in the molecular targets of antibiotics can be maintained regardless of the burden imposed on fitness, suggesting that resistances may persist in the C. difficile population also in absence of antibiotic selective pressure. The rapid evolution of antibiotic resistance and its composite nature complicate strategies in the treatment and prevention of CDI. The rapid identification of new phenotypic and genotypic traits, the implementation of effective antimicrobial stewardship and infection control programs, and the development of alternative therapies are needed to prevent and contain the spread of resistance and to ensure an efficacious therapy for CDI.

Characteristics of a successful hospital hand hygiene program: an Australian perspective

Abstract Introduction Healthcare-associated infections (HAIs) are the most common adverse health event affecting patients in hospital. Approximately 200 000 HAIs occur in Australian acute care facilities annually with an estimated annual cost of approximately $1 billion. They are largely preventable adverse events, which can be significantly reduced through the implementation of effective infection prevention and control programs and guidelines. Hand hygiene is well established as being fundamental in infection control programs for preventing and controlling HAIs. This paper will describe a successful hand hygiene program introduced into one Australian private hospital. Methods In2009, a323-bed, acute care facility implemented a program based on the Hand Hygiene Australia Hand Hygiene Culture Change Program. The aim of the program was to effect culture change using a structured multimodal approach, improving hand hygiene using the five elements of the World Health Organization (WHO) Multimodal Hand Hygiene Improvement Strategy. Results The program was successful at improving and maintaining hand hygiene compliance from 22% to 71% and this improvement was evidenced by an increase in the usage of alcohol-based handrub from 32 L per 10 000 bed days to 90 L, increases in the volumes of liquid soap used, a decrease in the bed days associated with surgical site infections, and a decrease in Staphylococcus aureus bacteraemia bed days. Conclusions Culture change for improvements in hand hygiene is difficult to achieve but possible to achieve through a structured multimodal whole-of-organisation program approach.

Spread of multidrug-resistant Acinetobacter baumannii and Pseudomonas aeruginosa clones in patients with ventilator-associated pneumonia in an adult intensive care unit at a university hospital

BackgroundIn Brazil, ventilator-associated pneumonia (VAP) caused by carbapenem resistant Acinetobacter baumannii and Pseudomonas aeruginosa isolates are associated with significant mortality, morbidity and costs. Studies on the clonal relatedness of these isolates could lay the foundation for effective infection prevention and control programs. ObjectivesWe sought to study the epidemiological and molecular characteristics of A. baumannii vs. P. aeruginosa VAP in an adult intensive care unit (ICU). MethodsIt was conducted a cohort study of patients with VAP caused by carbapenem resistant A. baumannii and P. aeruginosa during 14 months in an adult ICU. Genomic studies were used to investigate the clonal relatedness of carbapenem resistant OXA-23-producing A. baumannii and P. aeruginosa clinical isolates. The risk factors for acquisition of VAP were also evaluated. Clinical isolates were collected for analysis as were samples from the environment and were typed using pulsed field gel electrophoresis. ResultsMultivariate logistic regression analysis identified trauma diagnosed at admission and inappropriate antimicrobial therapy as independent variables associated with the development of A. baumannii VAP and hemodialysis as independent variable associated with P. aeruginosa VAP. All carbapenem resistant clinical and environmental isolates of A. baumannii were OXA-23 producers. No MBL-producer P. aeruginosa was detected. Molecular typing revealed a polyclonal pattern; however, clone A (clinical) and H (surface) were the most frequent among isolates of A. baumannii tested, with a greater pattern of resistance than other isolates. In P. aeruginosa the most frequent clone I was multi-sensitive. ConclusionThese findings suggest the requirement of constant monitoring of these microorganisms in order to control the spread of these clones in the hospital environment.

Integrating intensive care unit (ICU) surveillance into an ICU clinical care electronic system

The intensive care unit (ICU) is the specialty with the highest prevalence of healthcare-associated infection (HCAI) in European hospitals and therefore a priority for surveillance of HCAI. Whereas surveillance is an essential part of an effective infection prevention and control (IPC) programme, all too often it consumes too much clinician and IPC team time, limiting the time available for quality improvement. The case for electronic surveillance is made in the literature from several countries on this basis. These studies indicate that electronic surveillance can improve validity, reduce time spent on surveillance, and provide opportunities for improvement in clinical decision-making and IPC action arising from surveillance. The Scottish ICU HAI surveillance system was established as part of an integrated audit and clinical care system. Investment in this technology infrastructure reduced the burden of data collection and has resulted in a focus on driving improvement in all Scottish ICUs. The experience in Scotland indicates that several critical components are necessary to optimize ICU HCAI surveillance, including: nationally agreed definitions and methods; national investment in information technology infrastructure to make it easier to follow clinical care pathways; leadership of surveillance by intensivists; piloting and validation to ensure confidence in the system; and strategic integration of national and local programmes. These elements have helped improve surveillance data locally, nationally, and at a European level, allowing clinical attention to be focused on the data rather than on the process of data collection.

What Clean Means: A Collaborative Effort to Reduce Healthcare Associated Infections in United States Veterans Health Administration (VHA) Facilities

Environment of care practices for preventing healthcare-associated infections are recognized as essential components of an effective infection prevention and control program and promote patient safety. Recent literature reveals evidence that many infectious agents can be acquired through contamination of environmental surfaces and equipment located near the patient. Effective environmental hygiene is an integral part in the coordinated approach to prevent transmission of multi-drug resistant organisms. Reliable cleaning practices require staff education.