Efficacy Of Infection Control Measures Research Articles

Pattern of bacterial infections in neutropenic febrile patients (experience of the Specialized BMT center - Medical city complex - Baghdad, Iraq)

Abstract: BACKGROUND: Infectious complications occur in most of the patients undergoing hemopietic stem cell transplantation (HSCT), these carry high risk of mortality mainly due to Gram-negative bacteria unless effective antibiotic treatment is provided. OBJECTIVES: The aims of the study were to review bacterial isolates from different samples in febrile neutropenic patients underwent HSCT in terms of incidence, types, and antimicrobial resistance, and to assess the efficacy of infection control measures used in transplantation ward. PATIENTS AND METHODS: This is retrospective study. The medical records of a total of 82 patients who underwent HSCT in the Specialized BMT Center, Baghdad Medical City, in 2021 and 2022 were reviewed; for any patient with neutropenic fever (NF), the clinical assessment was made, and samples were taken for culture any sensitivity before starting empirical antibiotics. The study was reviewed by the ethical committee of the hematology transplant center in the Medical City Complex, and since the study is retrospective, no consent is needed from the patient. RESULTS: There were 57 patients who developed NF, two at the time of collection, while 55 patients during transplant. In 16 patients, there was a clinical focus for NF, most commonly respiratory. From 175 samples sent for culture and sensitivity, bacterial growth was detected in 103 samples, and the incidence of bloodstream infection was 53%. Polymicrbial bacterial growth was detected in 6 patients with NF. Gram-positive bacteria were slightly more common than Gram negative. Staphylococcus epidermidis and Burkholderia cepacia were the most common Gram positive and Gram negative, respectively. An increasing number of patients admitted to transplant centers were associated with more infections. Ten out of 13 bacteria were multidrug resistant (MDR). Only two patients died from infection posttransplant. CONCLUSIONS: The predominance of Gram-positive cocci and Burkholderia cepacia complex supported the need to review the adherence to infection control policy. The empirical antibiotic protocol should be guided by local antibiogram, and since the high rate of blood stream infection (BSI) with MDR pathogens, a de-escalating strategy utilizing carbapenems – as advised by the ECIL-4 guidelines – would be more appropriate while awaiting culture result. The ability to quickly identify infections and their susceptibility profile is still crucial for choosing antibiotic therapy.

The Current Multicountry Monkeypox Outbreak: What Water Professionals Should Know

Recent water sector safety concerns during the COVID-19 pandemic highlight the need for industry-focused reviews of emerging pathogens to support evidence-based utility decision-making. Between May 7 and August 20, 2022, more than 41 358 cases of human monkeypox were reported globally from over 87 countries in which the disease is not endemic. Given that the presence and persistence of monkeypox virus (MPXV) in feces, water, and wastewater has not been investigated, we summarize the available evidence on MPXV and related orthopoxviruses to provide sector-wide recommendations and identify knowledge gaps. On the basis of the information available to date, this outbreak is unlikely to pose an exposure and transmission risk from wastewater, biosolids, or water due to the absence of any evidence to date that suggests that infectious MPXV is present in wastewater or biosolids or has caused human cases, clusters, or outbreaks from exposure to these sources. In addition, remaining smallpox vaccine immunity in the population, availability of vaccines and treatments, susceptibility of poxviruses to disinfection (e.g., UV and chlorine), and evidence from health care confirming the efficacy of infection control measures all suggest that current treatment and recommended wastewater worker protection practices are sufficient to protect public and occupational health.

Efficacy of Infection Control Measures in Managing Outbreaks of Multidrug-Resistant Organisms in Burn Units.

Multidrug-resistant organisms (MDROs) pose a significant threat to severe burn victims and represents a clear epidemic hazard in burn units. Several infection control measures have been implemented to control and manage the outbreaks of MDRO. The efficiency of those measures, however, remains controversial and an area of debate. A systematic review was conducted to evaluate the efficacy of infection control measures and the necessity of closing burn units in dealing with MDRO outbreaks. Peer-reviewed articles were identified using PubMed, EMBASE, and Cochrane Central Register of Controlled Trials databases, focusing on infection control measures to manage MDRO outbreaks in burn units. Twenty-one studies that reported MDRO outbreaks in burn units met the inclusion criteria. The outbreaks were successfully controlled with interventions in 17 units (81%), partially controlled in 1 unit (4.7%), and uncontrolled in 3 units (14.3%). Infection control measures were implemented by screening patient (19 units), screening health care worker (17 units), obtaining environmental cultures (16 units), providing ongoing staff education (13 units), cohort or isolation (17 units), preemptive barrier precautions (10 units), improving hand hygiene (15 units), and enhanced cleaning and environmental disinfection (17 units). Closure of burn units occurred in 8 units, with outbreaks controlled in 6 of the units (75%). The reasons for unit closure include decontamination (4 units; 50%), outbreak investigation (1 unit; 12.5%), and uncontrolled outbreaks (3 units; 37.5%). The incidence of infection was significantly decreased in 4 units after the closure but rose again after reopening in 1 of the units. In 3 units, the spread was halted by other control measures, including change of hydrotherapy facilities, identification of staff transmission, and unit structure remodeling. Proper infection control measures play an important role in managing MDRO outbreaks in burn units. Temporary closure of burn units may be necessary to control the spread of nosocomial, and this option should be considered when other measures are ineffective.

Seroprevalence of hepatitis C infection in patients undergoing haemodialysis in a tertiary care centre

Introduction: Hepatitis C virus (HCV) infection is a major health problem among these patients in developing countries like India. This could be either due to a non-adherence to strict infection control measures or the unavailability of vaccine to prevent HCV infection.Objectives of the Study: This study aims to estimate the prevalence of HCV infection in patients undergoing haemodialysis and assess the major risk factors, the efficacy of infection control measures in the dialysis unit by studying the seroconversion rates from HCV negative to HCV positive and also formulate ways to prevent the nosocomial spread of HCV infection in the dialysis unit.Materials and Methods: This was a cross-sectional study carried out among 250 patients undergoing haemodialysis in the dialysis unit of a tertiary care centre. They were tested for the presence of anti-HCV antibody by enzyme linked immunosorbent assay.Results: The seroprevalence of HCV infection among the patients undergoing haemodialysis as per this study is 4.8%. The risk factors identified were age >50, prolonged duration of dialysis and multiple blood transfusions. One significant observation was of the probability of lateral spread of HCV infection within the dialysis unit.Conclusions: Although there is no consensus regarding machine dedication between HCV non-infected and HCV-infected patients, we found that using dedicated HD machines had an important role in reducing HCV transmission in our dialysis unit. However, risk prevails if any seronegative patient acts as HCV carrier.

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

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

Consecutive yearly outbreaks of respiratory syncytial virus in a haemato-oncology ward and efficacy of infection control measures

SummaryBackgroundRespiratory syncytial virus (RSV) causes significant respiratory tract infection in immunosuppressed patients.AimTo describe two consecutive yearly outbreaks of RSV in our haemato-oncology ward.MethodsHaematology patients presenting with respiratory symptoms were screened by polymerase chain reaction for viral respiratory pathogens using a saline gargle.FindingsNone of our patients had undergone bone marrow transplant but all had underlying haematological malignancies. Eight patients were affected in the first outbreak (mortality rate: 37.5%) and 12 patients were affected in the second (mortality rate: 8.3%). Extensive infection control measures were implemented in both outbreaks and were successful in preventing further cross-transmission.ConclusionThere was significant learning from both outbreaks and actions implemented with the aim of reducing the likelihood and impact of future outbreaks.

The global spread of Middle East respiratory syndrome: an analysis fusing traditional epidemiological tracing and molecular phylodynamics.

BackgroundSince its discovery in 2012, over 1700 confirmed cases of Middle East Respiratory Syndrome (MERS) have been documented worldwide and more than a third of those cases have died. While the greatest number of cases has occurred in Saudi Arabia, the recent export of MERS-coronavirus (MERS-CoV) to Republic of Korea showed that a pandemic is a possibility that cannot be ignored. Due to the deficit of knowledge in transmission methodology, targeted treatment and possible vaccines, understanding this virus should be a priority. Our aim was to combine epidemiological data from literature with genetic information from viruses sequenced around the world to present a phylodynamic picture of MERS spread molecular level to global scale.MethodsWe performed a qualitative meta-analysis of all laboratory confirmed cases worldwide to date based on literature, with emphasis on international transmission and healthcare associated infections. In parallel, we used publicly available MERS-CoV genomes from GenBank to create a phylogeographic tree, detailing geospatial timeline of viral evolution.ResultsSeveral healthcare associated outbreaks starting with the retrospectively identified hospital outbreak in Jordan to the most recent outbreak in Riyadh, Saudi Arabia have occurred. MERS has also crossed many oceans, entering multiple nations in eight waves between 2012 and 2015. In this paper, the spatiotemporal history of MERS cases, as documented epidemiologically, was examined by Bayesian phylogenetic analysis. Distribution of sequences into geographic clusters and interleaving of MERS-CoV sequences from camels among those isolated from humans indicated that multiple zoonotic introductions occurred in endemic nations. We also report a summary of basic reproduction numbers for MERS-CoV in humans and camels.ConclusionTogether, these analyses can help us identify factors associated with viral evolution and spread as well as establish efficacy of infection control measures. The results are especially pertinent to countries without current MERS-CoV endemic, since their unfamiliarity makes them particularly susceptible to uncontrollable spread of a virus that may be imported by travelers.Electronic supplementary materialThe online version of this article (doi:10.1186/s41256-016-0014-7) contains supplementary material, which is available to authorized users.

Infection Risk in Sterile Operative Procedures.

The main objective of hospital hygiene and infection prevention is to protect patients from preventable nosocomial infections. It was recently stated that the proper goal should be for zero infection rates in sterile surgical procedures. In this article, we attempt to determine whether this demand is supported by the available literature. We systematically searched the Medline and EMBASE databases for studies published in the last 10 years on the efficacy of infection control measures and carried out a meta-analysis according to the PRISMA tool. We used the following search terms: "aseptic surgery," "intervention," "surgical site infection," "nosocomial infection," "intervention," and "prevention." 2277 articles were retrieved, of which 204 were acquired in full text and analyzed. The quantitative analysis included 7 prospective cohort studies on the reduction of nosocomial infection rates after aseptic surgery. The measures used included training sessions, antibiotic prophylaxis, and operative-site disinfection and cleaning techniques. These interventions succeeded in reducing postoperative wound infections (relative risk (RR] 0.99 [0.98; 1.00]). Subgroup analyses on antibiotic prophylaxis (RR 0.99 [0.98; 1.01]) and noncontrolled trials (RR 0.97 [0.92; 1.02]) revealed small, insignificant effects. A multimodal approach with the participation of specialists from various disciplines can further reduce the rate of postoperative infection. A reduction to zero is not realistic and is not supported by available evidence.

Effectiveness of preventive measures for hemato-oncologic patients undergoing stem cell transplantation during a period of hospital construction

Aspergillus spp are ubiquitous spore-forming fungi. Construction work, renovation, demolition, or excavation activities within a hospital or in surrounding areas increase the risk for aspergillus infection in susceptible patients and are the main cause of nosocomial aspergillus outbreaks. We investigated the efficacy of infection control measures on the frequency of fungal infection among hemato-oncologic patients undergoing stem cell transplantation during excavation and construction work of an adjacent hospital building. Clinical isolates from these patients obtained before and during the excavation and construction period were analyzed. Preventive measures consisted in the implementation of a multibarrier concept to protect these patients from fungal infection. There was no record of any clinical isolate of Aspergillus spp in the observation period before the beginning of the groundwork. However, 3 clinically significant isolates of Aspergillus spp were detected in respiratory tract specimen of 2 patients after the beginning of excavation and demolition work, which were found to be community acquired. Although our data cannot demonstrate the efficacy of infection control measures during construction work, it can be concluded that excavation work close to immunocompromised patients is safe if a bundle of preventive measures is implemented before groundwork.

Investigation of an Outbreak of Carbapenem-resistant Acinetobacter baumannii in the Medical Intensive Care Unit and Efficacy of Infection Control Measures

Investigation of an Outbreak of Carbapenem-resistant Acinetobacter baumannii in the Medical Intensive Care Unit and Efficacy of Infection Control Measures

Long-term control of hospital-wide, endemic multidrug-resistant Acinetobacter baumannii through a comprehensive “bundle” approach

Acinetobacter baumannii (Ab) is emerging as a multidrug-resistant (MDR) nosocomial pathogen of considerable clinical importance. Data on the efficacy of infection control measures in endemic situations are lacking. Here, we investigated the impact of a long-term multifaceted "bundle" approach in controlling endemic MDR Ab in a 950-bed tertiary care center. Ongoing staff education, promotion of hand hygiene, strict Contact and Isolation Precautions, environmental cleaning, and targeted active surveillance in high-risk areas during periods of likely transmission and contamination were initiated in this program. To assess the efficacy of our interventions, we recorded (before and after the intervention) the epidemiologic and clinical features of MDR Ab infections and determined the clonal relationship among MDR Ab bloodstream isolates by pulsed-field gel electrophoresis. Before the "bundle" was instituted, the rate of colonization/infection was 0.82 cases per 100 admissions (1994-1995). Colonization/infection rates showed a sustained decrease after implementation of the control program in 1995 to 0.46 in 1996-1997 and to 0.21 in 1998-2003 (P < .001). Coincident with the institution of this program, the rate of bacteremia because of MDR Ab decreased 6-fold during the 8-year observation period. A notable change in the clonal distribution of the MDR Ab isolates was also demonstrated. The implementation of a comprehensive and multifaceted infection control program ("bundle") in a tertiary care center effectively controlled the spread and clinical impact of MDR Ab.

Évaluation du test IDI-MRSA sur une collection de souches de Staphylococcus aureus résistants à la méticilline d'acquisition communautaire et sur des prélèvements de portage

The efficacy of infection control measures against MRSA is linked to the rapid detection of MRSA. With the conventional diagnosis by culture the response delays vary from 48 to 72 hours. In contrast molecular techniques give results within hours. The objective of the present study is to perform the IDI-MRSA PCR test (BD Diagnostic GeneOhm) on a collection of characterized community-acquired MRSA (CA-MRSA) isolates and on carriage specimens. COLLECTION OF ISOLATES: Fifty-two isolates of CA-MRSA previously characterised by their toxinotype and SCCmec type cassette were analysed. All of them were identified as MRSA by the IDI-MRSA test. Seventy screening specimens from 35 different patients were tested in comparison with the culture on specific media (MRSA ID, BioMérieux). Among those 70 specimens, 24 were from nose, 25 from cutaneous sites (axillar; groin) and 21 from other sites. Sensitivity and specificity were 86.4 and 91.3% respectively; positive and negative predictive values were 93.3 and 82.6% respectively. Three of four false-positive results came from specimens collected during a decolonisation treatment. Without taking account those specimens, specificity and positive predictive reach 97.9 and 95% respectively. This study shows that IDI-MRSA is an interesting additional test for the diagnosis of MRSA carriage.

Mycobacterium tuberculosis DNA Not Detected by Polymerase Chain Reaction In Air Samples From Hospital Rooms of Tuberculosis Patients.

Background: As the incidence of tuberculosis (TB) increased in the United States, the risk of occupational and nosocomial TB also increased. Airborne Mycobacterium tuberculosis (MTB) is difficult to measure directly. Quantifying MTB DNA by polymerase chain reaction in air samples obtained from isolation rooms of patients with TB would provide a measure of the number of airborne organisms produced by a patient and the efficacy of ventilation, and might predict when an individual patient is no longer infectious. Methods and Results: The air was sampled through cellulose ester filters from the isolation room of a patient with newly diagnosed pulmonary TB, from a patient on therapy for 14 days, and from adjacent offices, and an attempt was made to detect MTB DNA; however, MTB DNA was detected only on positive control filters. Conclusions: Mycobacterium tuberculosis was not detected by polymerase chain reaction in air samples from the rooms of two patients with pulmonary TB. This may have been due to the large number of room air changes with resultant rapid clearance of airborne droplet nuclei or to the limited air volume sampled. A sensitive molecular assay of airborne MTB could be used to monitor the efficacy of infection control measures by sampling a sufficient volume of isolation room air and could aid in determining when an individual patient was no longer infectious.

Clostridium difficile infection, hospital geography and time-space clustering.

To analyse spatial and temporal relationships of Clostridium difficile-associated disease in an inner-city hospital, we retrospectively evaluated 283 episodes of confirmed C. difficile diarrhoea in the Chelsea and Westminster Hospital between 1995 and 1998, against a background of relatively stable case mix, antibiotic usage and admission numbers, using Knox analysis to determine the presence of disease clustering in time and space. We found five time-space clusters on four medical wards and between two adjacent units. The clusters were not related to the overall case number on single wards, and were separated in time. Knox time-space analysis provides a simple screening tool to identify disease clusters, assess the efficacy of infection control measures and the influence of hospital geography and traffic. The results support the importance of infection control measures in the prevention of C. difficile-related disease.

Significant reduction of methicillin-resistant Staphylococcus aureus bacteremia in geriatric wards after introduction of infection control measures against nosocomial infections.

(1) To investigate the efficacy of infection control measures against methicillin-resistant Staphylococcus aureus (MRSA) bacteremias in geriatric wards. (2) To identify predisposing risk factors for MRSA bacteremia. Cases with nosocomial bacteremias were retrospectively analyzed between January 1991 and March 1995. The study period was divided into four annual periods and the period 1, January to December 1991, was applied as the control. We investigated patients with nosocomial bacteremias in geriatric wards (190 beds) of AINO Memorial Hospital, affiliated with Nagasaki University. A significant reduction in cases with MRSA-induced nosocomial bacteremia was observed after the introduction of a stringent infection control and prevention program (period 1 vs. periods 2, 3, and 4: p<0.00833, p<0.00167, and p<0.00167, respectively). The major source of bacteremia included urinary tract infections, intravenous catheter-related infections, and infected decubitus ulcers. Improvement of decubitus ulcer was associated with a significant reduction in MRSA bacteremia (period 1 vs. periods 2 and 3: p<0.00017 and p<0.00833). Stringent infection control programs, including prevention and treatment of decubitus ulcers, are necessary in geriatric wards to reduce and prevent MRSA bacteremia.

院内肺炎の発症予防におけるポビドンヨードによる上気道清浄化の有用性

We investigated the efficacy of infection control measures against nosocomial pneumonia in geriatric wards. Cases with nosocomial pneumonia were retrospectively analyzed between January 1991 and March 1995. The study period was divided into four annual periods (periods 1, 2, 3 and 4). Period 1, January to December 1991, was applied as the cotrol. We investigated patients with nosocomial pneumonias in geriatric wards (190 beds) of AINO Memorial Hospital, affiliated with Nagasaki University. During the study period, nosocomial pneumonia significantly diminished. (period 1 vs periods 2, 3 and 4, p < 0.05, p < 0.05, p < 0.05, respectively). Major causative organisms of nosocomial pneumonia were MRSA and Pseudomonas aeruginosa. During the four periods, a significant reduction in cases with MRSA- and P. aeruginosa-induced nosocomial pneumonia was observed (MRSA: period 1 vs periods 2, 3 and 4, p < 0.05, p < 0.05, p < 0.01, respectively; P. aeruginosa: period 1 vs period 3, p < 0.01, period 2 vs periods 3 and 4, p < 0.01, p < 0.05, respectively). On the other hand, the improvement of decubitus ulcers was associated with a significant reduction in nosocomial pneumonia (period 1 vs. periods 2 and 3, p < 0.05 and p < 0.05, respectively). In conclusion, stringent infection control programs, including a cleaning in the upper airways by povidone iodine, are necessary in geriatric wards to reduce and prevent nosocomial pneumonia.

Infection control in outpatient unicomponent penile prosthesis surgery.

The aim of this work is evaluate the efficacy of infection control measures with unicomponent penile implants in two ambulatory surgery units in Cairo and Jeddah. This was a retrospective study of 117 consecutive cases. A patient selection and infection control protocol was followed to implant 12 hydraulic, 53 mechanical and 52 malleable prostheses under local bupivacaine penile ring anesthesia and intravenous propofol. No infection occurred that required prosthesis removal, none required hospitalization or urinary catheterization, one crural and two septal perforations were managed intraoperatively; one case was reoperated upon for mechanical failure, two for oversizing and one for undersizing the girth. We conclude that implantation of unicomponent penile implants under triple antibiotic coverage in an ambulatory surgery setting, with rigid infection control measures appears to be effective in preventing infection.

The intensive care unit: the hottest zone

The intensive care unit is usually the hot zone of antibiotic resistance in a hospital. Reports of outbreaks of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, Enterobacter aerogenes, Stenotrophomonas maltophilia, and Pseudomonas aeruginosa in intensive care units are reviewed. Despite infection control measures bordering on the heroic, including cohorting, contact isolation, intensive microbiologic surveillance with molecular subtyping and re-emphasis of handwashing, these measures were only marginally successful. We cite Farr's Law of Epidemics in suggesting that, over time, the efficacy of infection control measures may be overrated. Innovative measures in prevention of ventilator associated pneumonia continue to be contentious. The efficacy of sulcralfate, antacids, and histamine blockers remain uncertain despite numerous controlled studies. Likewise, most studies (but not all) show that selective digestive decontamination can decrease the incidence of ventilator associated pneumonia, but mortality remains unaffected.

Efficacy of infection control measures during a nosocomial outbreak of disseminated aspergillosis associated with hospital construction.

Efficacy of infection control measures during a nosocomial outbreak of disseminated aspergillosis associated with hospital construction.

Microcomputer surveillance of hospital infections, pathogens and their susceptibility to antimicrobials

In a two-year trial, the dynamics of empirical therapy and prevention of hospital sepsis were positively influenced by managing data generated from past, recent and current patterns of infection. Seventeen application programs were written in DBASE II for a 10 Mbyte Sirius microcomputer. The conclusive bacteriological data emerging from over 200,000 diagnostic specimens were continuously analysed. The main benefits of this development occurred in three areas: 1. (a) Specific and accurate advice for the empirical treatment of all possible presentations of infection was offered to our hospital prescribers in a non-restrictive policy document. Savings from the 1983–1984 antibiotics expenditure are calculated at £63,348. 2. (b) Rapid surveillance of communicable infections allowed the early recognition of infective clusters, thus increasing the efficacy of infection control measures. 3. (c) Electronic validation of signed-out reports, against 94 predictable parameters of bacterial susceptibility and or resistance to nine reference antibiotics has now reduced the likelihood of aberrant or erroneous reports reaching the clinician.