Existing Infection Control Measures Research Articles

Assessment of Infection Control Measures and Risk Factors at Kampala International University Teaching Hospital in Bushenyi District: A Study on Staff Awareness and Implementation

This research delved into the critical role of infection prevention and control in enhancing hospital care quality, particularly at Kampala International University Teaching Hospital. The primary aim was twofold: to identify risk factors associated with inadequate infection control and to evaluate the utilization of existing infection control measures among hospital staff. Conducted as a descriptive cross-sectional study within the hospital premises in Bushenyi District, the research engaged 100 respondents comprising various staff members employed at the institution, assessing their awareness of infection control through structured questionnaires. Although random sampling of 10 staff members was instrumental in refining the questionnaire for suitability, their results weren't incorporated into this study's findings. The respondent demographics showcased a predominant representation of nurses, with a majority being female employees and nearly four-fifths having worked at the hospital for less than four years. Notably, half of the respondents identified airborne infections as the most prevalent in the hospital setting. The study highlighted a positive inclination toward infection control tasks, with over 80% of participants acknowledging the effectiveness of infection control practices in curtailing the spread of infections among patients. Despite this awareness, the findings indicated a moderate level of overall awareness regarding infection control measures. While more than half of the respondents expressed favorable views on infection control practices and the utilization of available resources such as gloves, aprons, and hand hygiene, the implementation and adherence to standard precautions fell short of optimal levels. In conclusion, the study revealed a moderate level of awareness regarding infection control measures among hospital staff, with a majority holding positive attitudes toward the utilization of available resources. However, the actual implementation and adherence to standard precautions appeared suboptimal, signaling the need for enhanced efforts to bolster practice and compliance within the hospital setting. Keywords: Infection, Infection control, Waste management, Hand washing.

Molecular Epidemiological Investigation and Management of Outbreak Caused by Carbapenem-Resistant Acinetobacter baumannii in a Neonatal Intensive Care Unit.

The present study describes an epidemiological investigation into a carbapenem-resistant Acinetobacter baumannii (CRAB) outbreak, which had occurred in a neonatal intensive care unit (NICU), and the subsequent strengthening of infection control interventions. Upon the onset of the outbreak, existing infection control interventions were reviewed, and a set of containment measures were instituted. All CRAB isolates were characterized in terms of antimicrobial susceptibility testing and their genetic relatedness. The investigation process identified gaps within the NICU's existing infection control measures, which had likely resulted in the outbreak. CRAB was isolated from nine preterm infants: five colonized and four infected. All five colonized patients were discharged well. However, three out of four of the infected infants died. Outbreak investigation and genomic subtyping of environmental swabs revealed that mini syringe drivers shared between patients and a sink in the milk preparation room had served as CRAB reservoirs with possible transmission via the hands of healthcare workers. Implementation of immediate actions such as reinforcement of hand hygiene practices, intensified environmental cleaning, geographical cohorting, reviewing of milk handling practices and sink management protocol had resulted in no further CRAB isolation. The CRAB outbreak in the NICU underlines the importance of consistent compliance with infection-control interventions. Integration of epidemiological and microbiological data, together with comprehensive preventive measures, successfully brought the outbreak to a halt.

Lessons learned: use of WGS in real-time investigation of suspected intrahospital SARS-CoV-2 outbreaks

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been a continuing source of hospital-acquired infection and outbreaks. At Akershus University Hospital in Norway, traditional contact tracing has been combined with whole-genome sequencing (WGS) surveillance in real-time to investigate potential hospital outbreaks. To describe the advantages and challenges encountered when using WGS as a real-time tool in hospital outbreak investigation and surveillance during the SARS-CoV-2 pandemic. Routine contact tracing in the hospital was performed for all healthcare workers (HCWs) who tested positive for SARS-CoV-2. Viral RNA from all positive patient and HCW samples was sequenced in real-time using nanopore sequencing and the ARTIC Network protocol. Suspected outbreaks involving five or more individuals with viral sequences were described. Nine outbreaks were suspected based on contact tracing, and one outbreak was suspected based on WGS results. Five outbreaks were confirmed; of these, two outbreaks were supported but could not be confirmed by WGS with high confidence, one outbreak was found to consist of two different lineages, and two outbreaks were refuted. WGS is a valuable tool in hospital outbreak investigations when combined with traditional contact tracing. Inclusion of WGS data improved outbreak demarcation, identified unknown transmission chains, and highlighted weaknesses in existing infection control measures.

Prevention of SARS-CoV-2 (COVID-19) transmission in residential aged care using ultraviolet light (PETRA): a two-arm crossover randomised controlled trial protocol

BackgroundSARS-CoV-2 poses a considerable threat to those living in residential aged care facilities (RACF). RACF COVID-19 outbreaks have been characterised by the rapid spread of infection and high rates of severe disease and associated mortality. Despite a growing body of evidence supporting airborne transmission of SARS-CoV-2, current infection control measures in RACF including hand hygiene, social distancing, and sterilisation of surfaces, focus on contact and droplet transmission. Germicidal ultraviolet (GUV) light has been used widely to prevent airborne pathogen transmission. Our aim is to investigate the efficacy of GUV technology in reducing the risk of SARS-CoV-2 infection in RACF.MethodsA multicentre, two-arm double-crossover, randomised controlled trial will be conducted to determine the efficacy of GUV devices to reduce respiratory viral transmission in RACF, as an adjunct to existing infection control measures. The study will be conducted in partnership with three aged care providers in metropolitan and regional South Australia. RACF will be separated into paired within-site zones, then randomised to intervention order (GUV or control). The initial 6-week period will be followed by a 2-week washout before crossover to the second 6-week period. After accounting for estimated within-zone and within-facility correlations of infection, and baseline infection rates (10 per 100 person-days), a sample size of n = 8 zones (n = 40 residents/zone) will provide 89% power to detect a 50% reduction in symptomatic infection rate. The primary outcome will be the incidence rate ratio of combined symptomatic respiratory infections for intervention versus control. Secondary outcomes include incidence rates of hospitalisation for complications associated with respiratory infection; respiratory virus detection in facility air and fomite samples; rates of laboratory confirmed respiratory illnesses and genomic characteristics.DiscussionMeasures that can be deployed rapidly into RACF, that avoid the requirement for changes in resident and staff behaviour, and that are effective in reducing the risk of airborne SARS-CoV-2 transmission, would provide considerable benefit in safeguarding a highly vulnerable population. In addition, such measures might substantially reduce rates of other respiratory viruses, which contribute considerably to resident morbidity and mortality.Trial registration Australian and New Zealand Clinical Trials Registry ACTRN12621000567820 (registered on 14th May, 2021).

Improvement of Infection Control Measures during Dental Manipulations

When performing dental manipulations, infection control plays a special role, since its violation will negate all the efforts of the dentist, as well as allow various infectious and bacterial complications to develop in the body, as a result of which the patient's health will be significantly harmed.
 Infection control in dentistry is especially important at the present stage, when the spread of coronavirus infection has not yet been stopped, and the world is already experiencing the third wave of COVID-19. So, today it is very important to evaluate the existing infection control measures taken in dental health organizations, both private and public, and to investigate the measures proposed in the literature to reduce the transmission of both the new coronavirus and other infectious diseases to patients.
 Infection control measures in dentistry are aimed at minimizing the cross-transmission of mainly blood-borne pathogens. However, the high degree of contagion of the new coronavirus, as well as the possibility of the appearance of such viruses in the future, makes specialists already think about the need to improve infection control measures in order to preserve the health of patients and make dental manipulations as safe as possible for them. This is especially important for elderly patients, in whom complications from coronavirus-like infectious diseases can be fatal.
 In dental practice, many people are at risk, such as the practitioner, assistants, patients, administrative staff, cleaners, and possibly accompanying people. Standard precautions are usually not sufficient during the active spread of infections, so it is important to use proper PPE and follow hand hygiene. The sequence of consultations and scheduling of appointments with patients, as well as making changes to the waiting area, are also important. To minimize aerosol contamination, mouthwash should be performed before treatment. It should be taken into account that fans with NERA filters can significantly reduce the number of aerosols and, accordingly, reduce the level of pathogenicity of viruses.
 The aim of the work is to consider the measures proposed in the publications aimed at improving the measures of infection control during dental manipulations.

Forecasting the SARS COVID-19 pandemic and critical care resources threshold in the Gulf Cooperation Council (GCC) countries: population analysis of aggregate data

ObjectiveTo generate cross-national forecasts of COVID-19 trajectories and quantify the associated impact on essential critical care resources for disease management in Gulf Cooperation Council (GCC) countries.DesignPopulation-level aggregate analysis.SettingBahrain, Kuwait, Oman,...

P163 UV-C decontamination reduces cystic fibrosis clinic room bacterial counts over existing infection control measures

P163 UV-C decontamination reduces cystic fibrosis clinic room bacterial counts over existing infection control measures

Diverse Genetic Background of Multidrug-Resistant Pseudomonas aeruginosa from Mainland China, and Emergence of an Extensively Drug-Resistant ST292 Clone in Kunming.

For a better understanding of the multidrug resistant Pseudomonas aeruginosa (MDR-PA) epidemiology in mainland China, a nationwide surveillance network of 27 tertiary hospitals was established. Non-duplicate MDR-PA isolates from 254 cases of nosocomial infections, were collected during the period August 2011 to July 2012. Minimum inhibitory concentrations (MICs) of nine antimicrobial agents were determined by broth micro-dilution method according to the CLSI guidelines [M7-A10]. Genotyping analysis was performed by multilocus sequence typing (MLST) and pulsed-field gel electrophoresis (PFGE). The presence of acquired carbapenemases was also determined by molecular approaches for 233 carbapenem-resistant isolates. Carbapenemase genes were detected in 19 (8.2%) isolates, with 13 of these isolates encoding IMP-type enzymes, five with VIM-2, and one with KPC-2. MLST analysis revealed significant genetic diversity among the MDR-PA isolates studied, and 91 STs (including 17 novel STs) were identified. However, a long-term outbreak of an emerging extensively drug-resistant (XDR) ST292/PFGE genotype A clone was detected in a hospital from Southwest China. This study has demonstrated that MDR-PA in mainland China have evolved from diverse genetic backgrounds. Evidence of clonal dissemination of the organism and nosocomial outbreaks in some regions, suggest a need to strengthen existing infection control measures.

Prevalence and associated factors of hepatitis C virus infection among renal disease patients on maintenance hemodialysis in three health centers in Aden, Yemen: a cross sectional study.

We aimed to assess the prevalence and factors associated with positive anti-hepatitis C virus (HCV) antibodies among patients on maintenance hemodialysis (HD) in three centers in Aden, Yemen. The data from 219 patients and their records over the period between 2000-2013, was extracted and analyzed. The mean ± SD age of the patients was 47.08 ± 13.9 years; 74.4% of them were married and 14.6% were employed. The prevalence of validated anti-HCV-positive cases was 40.2% (95%CI 33.64%-46.73%). The mean ± SD duration on HD of all the patients was 35.09 ± 38 months. On bivariate analysis, the duration on HD and attending more than one center for HD associated significantly with anti-HCV positivity (P <0.05). On multivariate fully adjusted Poisson regression modelling, controlled for age, Patients attending more than one center and those who underwent HD for longer durations were more likely to be positive for anti- HCV antibodies [P = 0.004, adjusted prevalence rate ratio (APRR) = 1.87, 95% confidence interval (CI): 1.22-2.88; P = 0.0005, APRR = 1.01, 95% CI: 1.00-1.02. In this study sample, the prevalence of HCV was significant. Patients attending more than one center and those who underwent HD for longer durations were found to be more likely to contract HCV. Enhancing existing infection control measures and allocating more resources to HD centers therefore warrants consideration.

Economic Impact of Outbreaks of Norovirus Infection in Hospitals

Norovirus is highly infectious and can spread rapidly in healthcare settings, consuming resources and resulting in longer hospital stays. Although the economic impact of specific past outbreaks has been reported (eg, a 2007 outbreak of norovirus infection at Johns Hopkins Hospital cost an estimated $650,000), these costs may not be generalizable. We developed an economic computer simulation model to assist policy makers, hospital administrators, infection control professionals, and other healthcare workers in determining how much to invest in norovirus prevention and control interventions above and beyond existing infection control measures.

An outbreak of Clostridium difficile-associated disease (CDAD) in a German university hospital

We investigated an outbreak of Clostridium difficile (CD)associated disease (CDAD) in a cardiac surgical department that took place between January 25th and April 28th 2007 at Hannover Medical School, Germany. Immediate infection control measures such as changing the surface disinfectant from an alcohol-based glucoprotamine to an oxygen-active disinfectant cleaner and the primary education of staff were proved to be insufficient to control the outbreak. Therefore, a “CD infection control bundle” was created consisting of: (a) implementation of a CDAD outbreak team; (b) education on hand hygiene; (c) the aim of early case finding as soon as clinical symptoms of CDAD were noticed; (d) daily control of microbiological results; (e) suggesting proper antimicrobial therapy of patients on the ward avoiding high-risk substances; (f) reinforcement of currently existing infection control measures, such as including the isolation of CDAD cases in single rooms; (g) and, finally, interim closure of the unit for any new admissions. For the treatment of CDAD, initially, metronidazole and, in the case of failure of initial therapy, oral vancomycin were used. A case–control study was performed. Cases were defined as proposed by the ECDC: (a) onset of diarrhoea ≥48 h after admission or ≥4 weeks after the most recent discharge and (b) positive enzyme-immunoassay (EIA) for CD toxins A or B in stool samples (RIDASCREEN® Clostridium difficile Toxin A/B test, R-Biopharm, Glasgow, United Kingdom) or the culturing of toxin-producing CD (Clostridium difficile-selective media, Oxoid, Hampshire, United Kingdom). The results of Gram strain, colony morphology and biochemical testing with the RapID II ANA System® (Remel, Lenexa, USA) were used for species determination. Cultured strains were examined by pulsed field gel electrophoresis (PFGE) using GelCompar II® software (Applied Maths NV, Sint-Martens-Latern, Belgium) and by polymerase chain reaction (PCR) ribotyping, as described by others [1]. Antimicrobial susceptibility testing was performed by E-test® (AB Biodisk, Solna, Sweden) on agar plates containing vitamin K1, haemin and 5% defibrinated sheep red blood cells (Inverness Medical Deutschland, Cologne, Germany). Breakpoint minimal inhibitory concentrations (MICs) were ≥8 μg/mL for fluoroquinolones (FQ) [2] and ≥4 μg/mL for erythromycin [3]. Severe CDAD was defined as readmission because of relapse, necessity of intensive care because of CDAD, surgical procedure due to CDAD or CDAD contributing to the patient’s death within 30 days after diagnosis [4–6]. Controls were diarrhoeal patients admitted to the same unit during the same time period but were negative for CD toxin EIA, including CD culture (= confirmed CD negative) and negative for other gastrointestinal infectious agents. Age, gender, co-morbidities, underlying diseases, endoscopic procedures, history of antimicrobial exposure, readmission and relapse of CDAD in both groups were Eur J Clin Microbiol Infect Dis (2009) 28:543–545 DOI 10.1007/s10096-008-0655-7

Microbial contamination of hospital bed handsets

Hospital bed handsets, including nurse call equipment and television controls, have been found to contain biologic material and may be contaminated with microbes. The aim of this study was to assess the microbial contamination of hospital bed handsets. Hospital bed handsets were removed from 115 randomly chosen rooms in a suburban hospital. The handsets were transported to the laboratory in a sterile fashion and opened using a sterile technique, and cultures were obtained from both the anterior and posterior surfaces of the units. The cultures of 12 units (10.4%) revealed no microorganisms. One hundred three units (89.6%) had cultures that grew microorganisms. Of the handsets that were found to contain microorganisms, 48 units (46.6%) had only 1 microorganism, and 55 units (53.4%) had multiple organisms, including 33 units (32.0%) with 2 microorganisms, 21 units (20.4%) with 3 microorganisms, and 1 unit (1.0%) with 4 microorganisms. The microorganisms identified included 90 isolates (87.4%) of coagulase-negative staphylococcus, 51 isolates (49.5%) of bacillus species, 13 isolates (12.6%) of fungal species, 8 isolates (7.8%) of nonhemolytic streptococcus species, 7 isolates (6.8%) of alpha-hemolytic streptococcus species, 1 isolate (1.0%) of Staphylococcus aureus, and 1 isolate (1.0%) of methicillin-resistant Staphylococcus aureus. Hospital bed handsets were found to have a high incidence of contamination with bacteria and fungus and were found to contain organisms that are known to be the etiologic agents in nosocomial infections. Because of the frequency and duration of contact between hospital patients and hospital bed handsets, existing infection control measures should be studied that could reduce the level of contamination of such handsets or that could isolate the handsets from the patient.

Methicillin-resistant Staphylococcus aureus and its relationship to antimicrobial use: possible implications for control.

The control of methicillin-resistant Staphylococcus aureus (MRSA) is still an unresolved issue in numerous healthcare institutions worldwide. Guidelines for the control of MRSA in hospitals focus on measures to control cross-transmission and prevent colonization, but rarely specifically mention the control of antimicrobial use. We reviewed the different types of evidence for a causal relationship between MRSA and antimicrobial use by classifying them in four categories: consistent associations, dose-effect relationships, concomitant variations, and arguments to support a plausible biological model to explain this relationship. Although the relative participation of cross-transmission and antimicrobial selection pressure in the level of MRSA observed in a healthcare setting remains to be determined, we found lines of evidence to support the existence of a relationship between MRSA and antimicrobial use in each of the four categories. This review points out the relative lack of studies specifically designed to investigate this aspect of MRSA epidemiology and the need to implement such studies quickly. In the meantime, the results presented here should encourage the implementation of antimicrobial-use improvement programs in hospitals in addition to existing infection control measures, which are still a priority in countries with high MRSA prevalence.