Prevention Of Healthcare-associated Infections Research Articles

Impact of COVID-19 on healthcare-associated infections and antimicrobial use in Italy, 2022

IntroductionWe aimed to assess the impact of COVID-19 on healthcare associated infection (HAI) transmission and antimicrobial use (AMU) prevalence during the later stages of the pandemic. MethodsA point prevalence survey (PPS) was conducted among 325 acute-care hospitals of 19/21 regions of Italy, during November 2022. Non COVID-19 patients were matched to COVID-19 patients according to age, sex, and severity of underlying conditions. HAI and AMU prevalence were calculated as the percentage of patients with at least one HAI or prescribed at least one antimicrobial over all included patients, respectively. ResultsIn total, 60403 patients were included, 1897 (3.14%) of which were classified as COVID-19 patients. Crude HAI prevalence was significantly higher among COVID-19 patients compared to non COVID-19 patients (9.54% vs. 8.01%, prevalence rate ratio, PRR 1.19, 95% confidence interval, CI 1.04–1.38, p<0.05), and remained higher in the matched sample, however statistical significance was not maintained: odds ratio (OR) 1.25 (95% CI 0.99 – 1.59, p 0.067). AMU prevalence was significantly higher among COVID-19 patients prior to matching (46.39% vs. 41.52%, PRR 1.21, 95% CI 1.11-1.32, p<0.001), and significantly lower after matching: OR 0.77 (95% CI 0.66-0.89, p < 0.001). ConclusionsCOVID-19 patients could be at higher HAI risk due to underlying clinical conditions and to the intensity of healthcare needs. Further efforts should be dedicated to antimicrobial stewardship among COVID-19 patients.

Ten years of hand hygiene excellence: a summary of outcomes, and a comparison of indicators, from award-winning hospitals worldwide.

Hand hygiene is a crucial measure for the prevention of healthcare-associated infections (HAIs). The Hand Hygiene Excellence Award (HHEA) is an international programme acknowledging healthcare facilities for their leadership in implementing hand hygiene improvement programmes, including the World Health Organisation's Multimodal Improvement Strategy. This study aimed at summarising the results of the HHEA campaign between 2010 and 2021 and investigating the relationship between different hand hygiene parameters based on data from participating healthcare facilities. A retrospective analysis was performed on datasets from HHEA forms, including data on hand hygiene compliance, alcohol-based handrub (ABHR) consumption, and Hand Hygiene Self-Assessment Framework (HHSAF) scores. Descriptive statistics were reported for each variable. The correlation between variables was inspected through Kendall's test, while possible non-linear relationships between hand hygiene compliance, ABHR consumption and HHSAF scores were sought through the Locally Estimated Scatterplot Smoothing or logistic regression models. A tree-structured partitioning model was developed to further confirm the obtained findings. Ninety-seven healthcare facilities from 28 countries in three world regions (Asia-Pacific, Europe, Latin America) were awarded the HHEA and thus included in the analysis. HHSAF scores indicated an advanced hand hygiene promotion level (median 445 points, IQR 395-480). System change (100 [95-100] points) and institutional safety climate (85 [70-95] points) showed the highest and lowest score, respectively. In most cases, hand hygiene compliance was above 70%, with heterogeneity between countries. ABHR consumption above 20 millilitres per patient-day (ml/PD) was widely reported, with overall increasing trends. HHSAF scores were positively correlated with hand hygiene compliance (τ = 0.211, p = 0.007). We observed a positive correlation between compliance rates and ABHR consumption (τ = 0.193, p < 0.001), although the average predicted consumption was stable around 55-60ml/PD for compliance rates above 80-85%. Logistic regression and partitioning tree analyses revealed that higher HHSAF scores were more likely in the high-ABHR consumption group at cut-offs around 57-59ml/PD. Ten years after its inception, the HHEA proves to be a valuable hand hygiene improvement programme in healthcare facilities worldwide. Consistent results were provided by the different hand hygiene indicators and the HHSAF score represents a valuable proxy measure of hand hygiene compliance.

Level of implementation of multimodal strategies for infection prevention and control interventions and prevalence of healthcare-associated infections in Northern Italy

BackgroundIn November 2022, Italy participated in the third edition of the European Centre for disease prevention and control (ECDC) point prevalence survey (PPS) of healthcare-associated infections (HAIs) in acute-care hospitals. A questionnaire based on the WHO infection prevention and control assessment framework (IPCAF) was included, which aims to investigate multimodal strategies for the implementation of IPC interventions.MethodsA PPS was conducted using the ECDC PPS protocol version 6.0. The Regional health authority of the region of Piedmont, in north-western Italy, chose to enlist all public acute-care hospitals. Data were collected within one day per each ward, within 3 weeks in each hospital, at hospital, ward and patient level. A score between 0–1 or 0–2 was assigned to each of the 9 items in the IPCAF questionnaire, with 14 points representing the best possible score. HAI prevalence was calculated at the hospital-level as the percentage of patients with at least one HAI over all included patients. Relations between HAI prevalence, IPCAF score, and other hospital-level variables were assessed using Spearman's Rho coefficient.ResultsIn total, 42 acute-care hospitals of the region of Piedmont were involved, with a total of 6865 included patients. All participant hospitals reported they employed multimodal strategies to implement IPC interventions. The median IPCAF overall score was 11/14 (interquartile range, IQR: 9.25–12). The multimodal strategy with the highest level of adherence was education and training, followed by communication and reminders. Strategies with the lowest level of adherence were safety climate and culture of change, and system change. Overall HAI prevalence was 8.06%. A weak to moderate inverse relation was found between IPCAF score and HAI prevalence (Spearman’s Rho -0.340, p 0.034). No other significant correlation was found.ConclusionsThis study found a high self-reported overall level of implementation of multimodal strategies for IPC in the region. Results of this study suggest the relevance of the multimodal approach and the validity of the IPCAF score in measuring IPC programs, in terms of effectiveness of preventing HAI transmission.

Assessment of Infection Control Practices among Healthcare Workers Working at Tertiary Care Hospital of Larkana, Sindh: A Cross Sectional Survey

Background: The increasing prevalence of healthcare-associated infections (HCAIs) represents a significant challenge to patient safety worldwide, particularly in tertiary care settings where the risk of transmission is heightened. Effective infection prevention and control (IPC) practices, including hand hygiene, are pivotal in mitigating these risks. Despite the critical importance of these measures, adherence varies significantly across different healthcare settings, especially in low and middle-income countries. Objective: This study aims to assess the knowledge, attitudes, and self-reported practices related to infection control among healthcare workers in a tertiary care hospital in Larkana, with a specific focus on hand hygiene practices. The study seeks to identify gaps in knowledge and practice that could be targeted to improve overall IPC measures within the hospital. Methods: A cross-sectional survey was conducted among healthcare workers at a tertiary care hospital in Larkana, utilizing a WHO-validated self-administered questionnaire. The survey covered various aspects of IPC, including hand hygiene knowledge, attitudes towards infection control, and self-reported adherence to IPC practices. The participants included doctors, nurses, paramedics, pharmacists, and technicians, with data collected on demographic details, professional roles, and specific IPC practices. Results: Out of 317 respondents, a substantial proportion, 65.93% (209 participants), reported routinely using alcohol-based hand rubs, indicating good practice adherence. Furthermore, 88.32% (280 participants) demonstrated sufficient knowledge on the correct handwashing technique as recommended by the WHO. Comparative analysis within the professional groups revealed that doctors and technicians were more likely to report higher adherence to hand hygiene practices than other healthcare workers. Conclusion: The study underscores a generally high level of knowledge and adherence to hand hygiene practices among healthcare workers in the surveyed tertiary care hospital in Larkana. Despite these positive findings, the variability in self-reported practices across different professional groups suggests the need for targeted educational and policy interventions to ensure uniform IPC compliance.

Epidemiology and Risk Factors of Nosocomial Infection in Hospitalized Children and Adults: A Review

Nosocomial infections (NI) or healthcare-associated infections (HAI) are infections not present at the time of admission to a hospital and manifest 48 hours after hospital admission. The specific factors contributing to the risk of infection during hospitalization remain unclear. Nosocomial infections are a growing public health threat that increases patient morbidity and mortality. Nosocomial infections (NIs) could lead to considerably longer length of the hospital stays and higher costs. Besides, the unreasonable use of antibiotics could lead to development resistance to different antibiotics and create limited therapeutic options, increased risks of treatment failure and poor patient management. These infections are a serious public health problem affecting both developed and developing countries. This study aimed to investigate the current status and changing trend of NI in various parts of the world, to provide a reference for the prevention and control of healthcare-associated infections.

Hospital Acquired Infections (HAIs) Prevention Practices Among Medical Students in a Teaching Hospital in Jos, Plateau State, Nigeria

Background: The prevention of healthcare-associated infections is central to the provision of safe, high-quality healthcare. Students are a part of the healthcare team and are at increased risk of these infections. This study seeks to assess Hospital Acquired Infections (HAIs) prevention practices among medical students in a Teaching Hospital in Jos, Plateau State, Nigeria. Methods: This was a descriptive cross-sectional study done in July 2019 among medical students using a Multistage sampling technique. Data was collected using a self-administered structured questionnaire and analyzed using the IBM SPSS 28 (Statistical Package for the Social Sciences). Results: Almost all (99.1%) of students claim that they wash their hands before and after seeing patients, 81.9% wash their hands before meals, 57.4% wash their hands before performing invasive bedside procedures, 72.7% wash before and after examining patients, 30.2% wash their hands before &amp;after touching wounds, but not when gloved, 63.9% wash their hands between two different procedures on different patients. Concerning wearing face/nose masks 86.8% said they wore masks when transporting coughing patients out of the ward, 70.3% stated that they wore masks when irrigating septic wounds, 60.7% said they wore face masks whenever they were attending to patients with fecal incontinence, 76.3% said they wore face mask whenever they were delivering a baby of an HIV Positive woman, 51.6% said they wore face mask whenever they were visiting neonatal intensive care unit. The majority of respondents (83.6%) have never sustained a needle stick injury before, main reasons for non-use of PPE include High cost (24.7), PPE Not available (951.1%), difficulty in using (15.1%), No reason (9.1%). Conclusion: Generally, more than a third 150 (68.5%) of respondents had good practice of HAI prevention, while 69 (31.55) had a poor practice of HAIs prevention. There is also a need to ensure that the availability of PPEs, hand washing and waste disposal equipment is ensured, while medical students are also taught the importance of good equipment hygiene.

Validation of the prevalence to incidence conversion method for healthcare associated infections in long-term care facilities.

Residents of long-term care facilities (LTCFs) are a population at high risk of developing severe healthcare associated infections (HAIs). In the assessment of HAIs in acute-care hospitals, selection bias can occur due to cases being over-represented: patients developing HAIs usually have longer lengths of stays compared to controls, and therefore have an increased probability of being sampled in PPS, leading to an overestimation of HAI prevalence. Our hypothesis was that in LTCFs, the opposite may occur: residents developing HAIs either may have a greater chance of being transferred to acute-care facilities or of dying, and therefore could be under-represented in PPS, leading to an underestimation of HAI prevalence. Our aim was to test this hypothesis by comparing HAI rates obtained through longitudinal and cross-sectional studies. Results from two studies conducted simultaneously in four LTCFs in Italy were compared: a longitudinal study promoted by the European Centre for Disease Prevention and Control (ECDC, HALT4 longitudinal study, H4LS), and a PPS. Prevalence was estimated from the PPS and converted into incidence per year using an adapted version of the Rhame and Sudderth formula proposed by the ECDC. Differences between incidence rates calculated from the PPS results and obtained from H4LS were investigated using the Byar method for rate ratio (RR). On the day of the PPS, HAI prevalence was 1.47% (95% confidence interval, CI 0.38-3.97), whereas the H4LS incidence rate was 3.53 per 1000 patient-days (PDs, 95% CI 2.99-4.08). Conversion of prevalence rates obtained through the PPS into incidence using the ECDC formula resulted in a rate of 0.86 per 1000 PDs (95% CI 0-2.68). Comparing the two rates, a RR of 0.24 (95% CI 0.03-2.03, p 0.1649) was found. This study did not find significant differences between HAI incidence estimates obtained from a longitudinal study and through conversion from PPS data. Results of this study support the validity of the ECDC method.

Exploring homecare leaders’ risk perception and the link to resilience and adaptive capacity: a multiple case study

BackgroundHome-based healthcare is considered crucial for the sustainability of healthcare systems worldwide. In the homecare context, however, adverse events may occur due to error-prone medication management processes and prevalent healthcare-associated infections, falls, and pressure ulcers. When dealing with risks in any form, it is fundamental for leaders to build a shared situational awareness of what is going on and what is at stake to achieve a good outcome. The overall aim of this study was to gain empirical knowledge of leaders’ risk perception and adaptive capacity in homecare services.MethodsThe study applied a multiple case study research design. We investigated risk perception, leadership, sensemaking, and decision-making in the homecare services context in three Norwegian municipalities. Twenty-three leaders were interviewed. The data material was analyzed using thematic analysis and interpreted in a resilience perspective of work-as-imagined versus work-as-done.ResultsThere is an increased demand on homecare services and workers’ struggle to meet society’s high expectations regarding homecare’s responsibilities. The leaders find themselves trying to maneuver in these pressing conditions in alignment with the perceived risks. The themes emerging from analyzed data were: ‘Risk and quality are conceptualized as integral to professional work’, ‘Perceiving and assessing risk imply discussing and consulting each other– no one can do it alone’ and ‘Leaders keep calm and look beyond the budget and quality measures by maneuvering within and around the system’. Different perspectives on patients’ well-being revealed that the leaders have a large responsibility for organizing the healthcare soundly and adequately for each home-dwelling patient. Although the leaders did not use the term risk, discussing concerns and consulting each other was a profound part of the homecare leaders’ sense of professionalism.ConclusionsThe leaders’ construction of a risk picture is based on using multiple signals, such as measurable vital signs and patients’ verbal and nonverbal expressions of their experience of health status. The findings imply a need for more research on how national guidelines and quality measures can be implemented better in a resilience perspective, where adaptive capacity to better align work-as-imagined and work-as-done is crucial for high quality homecare service provision.

Nursing students led simulations to improve healthcare workers’ hand hygiene compliance

Background Hand hygiene compliance (HHC) is recognised as a major factor in the prevention of healthcare-associated infections. Healthcare workers (HCWs) compliance is still suboptimal. Simulation as an educational strategy may contribute to improved performance. Objective This study aimed to assess the effect of simulation interventions led by nursing students on HCWs’ HHC. Method A prospective quasi-experimental design with before and after intervention measurements was implemented in an 1150-bed tertiary hospital. Four consecutive periods, measuring before and after HHC, were examined in four hospital divisions. For each division, unique simulation activities were developed and led by nursing students, educators, and hospital leaders. Sixty seven students and 286 healthcare workers, along with two nurse educators, participated in the simulation sessions. HHC of all HCWs in the divisions was assessed by hospital infection control personnel. Results Hospital HHC rose across the four periods in all four divisions during this study. In three out of four periods and divisions, HHC increased significantly more in the simulation intervention groups compared to the overall hospital improvement. Conclusion Student-led simulation for HCWs is an additional effective method to improve HHC. Nursing managers should consider joining forces with nursing educators to enable students to become agents of change in healthcare settings and encourage further collaboration.

Evaluation of infection prevention and control programmes according to the European Centre for Disease Prevention and Control and the World Health Organization in Spain 2012–2022: indicators of core component 1

Key and core components of effective infection prevention and control programmes (IPCPs) issued by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) have been described. WHO core component 1 relates to the structure, organization and management of IPCPs. The objective of this study was to assess the status and the time trends of some indicators of core component 1 of IPCPs in acute hospitals in Spain throughout the period 2012-2022. Hospital-level data from the Spanish point prevalence survey for years 2012-2022 were analysed. Core component 1 indicators were calculated and tested for association to healthcare-associated infections (HAIs). In addition, trends were also examined. Overall, 67.0% and 57.2% of Spanish hospitals reported having an annual infection prevention and control (IPC) plan and an annual IPC report that was approved by the hospital managing director, respectively. The global median number of full-time equivalent (FTE) IPC nurses per 250 beds for the period was 0.87 and the global median number of FTE IPC doctors was 0.70. The rates of blood cultures and stool tests for Clostridioides difficile were 39.9 and 6.1 per 1000 patient-days, respectively. No significant correlation was found between core component 1 indicators and HAI prevalence. Spain is currently at a basic level on the structure, organization and management of IPCPs. Profound differences were found between hospitals depending on size and type.

Harnessing of Artificial Intelligence for the Diagnosis and Prevention of Hospital-Acquired Infections: A Systematic Review.

Healthcare-associated infections (HAIs) are the most common adverse events in healthcare and constitute a major global public health concern. Surveillance represents the foundation for the effective prevention and control of HAIs, yet conventional surveillance is costly and labor intensive. Artificial intelligence (AI) and machine learning (ML) have the potential to support the development of HAI surveillance algorithms for the understanding of HAI risk factors, the improvement of patient risk stratification as well as the prediction and timely detection and prevention of infections. AI-supported systems have so far been explored for clinical laboratory testing and imaging diagnosis, antimicrobial resistance profiling, antibiotic discovery and prediction-based clinical decision support tools in terms of HAIs. This review aims to provide a comprehensive summary of the current literature on AI applications in the field of HAIs and discuss the future potentials of this emerging technology in infection practice. Following the PRISMA guidelines, this study examined the articles in databases including PubMed and Scopus until November 2023, which were screened based on the inclusion and exclusion criteria, resulting in 162 included articles. By elucidating the advancements in the field, we aim to highlight the potential applications of AI in the field, report related issues and shortcomings and discuss the future directions.

Effectiveness of hydrogen peroxide wipes for surface disinfection in healthcare facilities.

The correct method of surface disinfection in hospitals is an essential tool in the fight against the spread of healthcare-associated infections caused by multi-resistant microorganisms. Currently, there are many disinfectants on the market that can be used against different microorganisms. However, the effectiveness of different active molecules is controversial in the literature. The aim of this study was to evaluate the effectiveness of wipes based on hydrogen peroxide (1.0 %) and highly specific plant-based surfactants, contained in H2O2TM (Hi-speed H2O2TM) products, against some hospital-associated microorganisms. The effectiveness of the wipes was tested against nosocomial and control strains of methicillin-resistant Staphylococcus aureus, carbapenem-resistant Pseudomonas aeruginosa, Klebsiella pneumoniae carbapenemase, Aspergillus fumigatus and Candida parapsilosis. Specifically, in vitro activity was assessed using three different techniques: stainless steel surface testing, surface diffusion testing and well diffusion test. The three different methods tested confirm the wipes' good effectiveness against the most common multi-resistant bacteria and against fungi. These data show that the tested wipes could be a valid adjunct to the disinfection process and could assist in the prevention of healthcare-associated infections.

Healthcare-associated infections: prospective rotational surveillance data of a training and research hospital

Aims: Monitoring and prevention of healthcare-associated infections (HAI) are considered to be one of the key measures to improve the effectiveness and quality of healthcare services. This study aimed to ascertain the prevalence of HAI in various hospital departments, identify the causative bacterial profile, risk factors, and the association with mortality. Methods: This prospective study included 3117 patients who were monitored in various departments of a Training and Research Hospital. The identified HAI cases were monitored using an active, prospective, rotational surveillance method. Patient data on HAI was daily recorded on pre-established tracking forms. Results: The mean hospital stay of patients was 9.9±7.5 days. The HAI prevalence was 4.5% and the HAI rate was 5.5%. The HAI rate showed no difference between internal medicine and surgical departments (5.7% vs 5.5%, p&gt;0.05), but it was higher in intensive care units (ICU) (p&lt;0.001). The majority of the isolated agents (65.2%) were gram-negative bacteria. Advanced age, intrinsic risk factors such as malignancy, and invasive procedures (use of central, peripheral, and urinary catheters) were associated to the development of HAI. The frequency of HAI was higher in deceased patients compared to survivors (25.4% vs 4.1%, p&lt;0.001). Conclusion: HAI remains a major concern in hospital settings, particularly in ICU, and strongly correlates with intrinsic risk factors and invasive procedures. Optimized infection control measures with these risk factors can make a significant contribution to improving patient outcomes.

Healthcare-associated infections and antimicrobial use in acute care hospitals in Greece, 2022; results of the third point prevalence survey

BackgroundThe burden of healthcare-associated infections (HAIs) and the extent of antimicrobial use (AU) are periodically recorded through Point Prevalence Surveys (PPS) in acute care hospitals coordinated by the European Centre for Disease Prevention and Control (ECDC). In previous PPSs, Greece demonstrated increased HAI and AU prevalence: 9% and 54.7% in 2011–2012, and 10% and 55.6% in 2016–2017, respectively. The 2022 PPS aimed to estimate HAIs and AU indicators among inpatients, especially amid the COVID-19 pandemic.MethodsA cross-sectional study was conducted in 50 hospitals during October-December 2022, in Greece. Patients admitted before 8.00 a.m. of the survey day were observed. Patients with at least one HAI or receiving at least one antimicrobial agent were included. Data were collected by hospital infection control teams. Hospital and ward-level variables were analysed.ResultsFrom 9,707 inpatients, 1,175 had at least one HAI (12.1%), and 5,376 were receiving at least one antimicrobial (55.4%). Intensive care unit patients had the highest HAI (45.7%) and AU (71.3%) prevalence. Of the 1,408 recorded HAIs, lower respiratory tract (28.9%), bloodstream (20%), and urinary tract infections (13.1%) were the most common. Among 1,259 isolates, Klebsiella (20.5%) and Acinetobacter (12.8%) were most frequently identified. Resistance to first-level antibiotic markers was 69.3%. Among the 9,003 antimicrobials, piperacillin-tazobactam (10.9%), and meropenem (7.7%) were frequently prescribed. The ratio of broad-spectrum to narrow-spectrum antibiotics was 1.4. As defined by the 2021 WHO AWaRe (Access, Watch, Reserve) classification, restricted classes of Watch and Reserve agents comprised 76.7% of antibiotics. Usual indications were treatment of community-acquired infections (34.6%) and HAIs (22.9%). For surgical prophylaxis, cefoxitin was commonly used (20.2%), and typical courses (75.7%) lasted more than one day. HAI and AU prevalence were positively associated with bed occupancy (p = 0.027) and secondary hospitals (p = 0.014), respectively.ConclusionsThe 2022 PPS highlighted the increasing trend of HAI prevalence and high AU prevalence in Greece, the emergence of difficult-to-treat pathogens, and the extensive use of broad-spectrum antimicrobials. Strengthening infection control and antimicrobial stewardship programs in hospital settings is essential.

Ventilator-Associated Pneumonia in the Neonatal Intensive Care Unit—Incidence and Strategies for Prevention

The second most prevalent healthcare-associated infection in neonatal intensive care units (NICUs) is ventilator-associated pneumonia (VAP). This review aims to update the knowledge regarding the incidence of neonatal VAP and to summarize possible strategies for prevention. The VAP incidence ranges from 1.4 to 7 episodes per 1000 ventilator days in developed countries and from 16.1 to 89 episodes per 1000 ventilator days in developing countries. This nosocomial infection is linked to higher rates of illness, death, and longer hospital stays, which imposes a substantial financial burden on both the healthcare system and families. Due to the complex nature of the pathophysiology of VAP, various approaches for its prevention in the neonatal intensive care unit have been suggested. There are two main categories of preventative measures: those that attempt to reduce infections in general (such as decontamination and hand hygiene) and those that target VAP in particular (such as VAP care bundles, head of bed elevation, and early extubation). Some of the interventions, including practicing good hand hygiene and feeding regimens, are easy to implement and have a significant impact. One of the measures that seems very promising and encompasses a lot of the preventive measures for VAP are the bundles. Some preventive measures still need to be studied.

Surgical Antibiotic Prophylaxis: A Proposal for a Global Evidence-Based Bundle.

In the multimodal strategy context, to implement healthcare-associated infection prevention, bundles are one of the most commonly used methods to adapt guidelines in the local context and transfer best practices into routine clinical care. One of the most important measures to prevent surgical site infections is surgical antibiotic prophylaxis (SAP). This narrative review aims to present a bundle for the correct SAP administration and evaluate the evidence supporting it. Surgical site infection (SSI) prevention guidelines published by the WHO, CDC, NICE, and SHEA/IDSA/APIC/AHA, and the clinical practice guidelines for SAP by ASHP/IDSA/SIS/SHEA, were reviewed. Subsequently, comprehensive searches were also conducted using the PubMed®/MEDLINE and Google Scholar databases, in order to identify further supporting evidence-based documentation. The bundle includes five different measures that may affect proper SAP administration. The measures included may be easily implemented in all hospitals worldwide and are based on minimal drug pharmacokinetics and pharmacodynamics knowledge, which all surgeons should know. Antibiotics for SAP should be prescribed for surgical procedures at high risk for SSIs, such as clean-contaminated and contaminated surgical procedures or for clean surgical procedures where SSIs, even if unlikely, may have devastating consequences, such as in procedures with prosthetic implants. SAP should generally be administered within 60 min before the surgical incision for most antibiotics (including cefazolin). SAP redosing is indicated for surgical procedures exceeding two antibiotic half-lives or for procedures significantly associated with blood loss. In principle, SAP should be discontinued after the surgical procedure. Hospital-based antimicrobial stewardship programmes can optimise the treatment of infections and reduce adverse events associated with antibiotics. In the context of a collaborative and interdisciplinary approach, it is essential to encourage an institutional safety culture in which surgeons are persuaded, rather than compelled, to respect antibiotic prescribing practices. In that context, the proposed bundle contains a set of evidence-based interventions for SAP administration. It is easy to apply, promotes collaboration, and includes measures that can be adequately followed and evaluated in all hospitals worldwide.

Recommendations for the prevention of healthcare-associated infections in nursing homes

Nursing homes (NH) although conceptually they should look as much like a home as possible, NH have unquestionable similarities with a nosocomium as they are places where many patients with underlying diseases and comorbidities accumulate and where the transmission of microorganisms between residents and between residents and caregivers is frequent.We have not found any recommendations specifically aimed at the prevention of nosocomial infections in MRI by the major Public Health Agencies and, therefore, the Health Sciences Foundation (Fundación de Ciencias de la Salud) has convened a series of experts and 14 Spanish scientific societies to discuss recommendations that could guide NH personnel in establishing written programs for the control and reduction of these infections. The present document is the result of these deliberations and contains suggestions for establishing such control programs on a voluntary and flexible basis in NH. We also hope that the document can help the health authorities to encourage this control activity in the different territorial areas of Spain. In our opinion, it is necessary to draw up a written plan and establish the figure of a coordinator or person responsible for implementing these projects. The document includes measures to be implemented and ways of quantifying the reality of different problems and of monitoring the impact of the measures established.

Innovative Techniques for Infection Control and Surveillance in Hospital Settings and Long-Term Care Facilities: A Scoping Review.

Healthcare-associated infections (HAIs) pose significant challenges in healthcare systems, with preventable surveillance playing a crucial role. Traditional surveillance, although effective, is resource-intensive. The development of new technologies, such as artificial intelligence (AI), can support traditional surveillance in analysing an increasing amount of health data or meeting patient needs. We conducted a scoping review, following the PRISMA-ScR guideline, searching for studies of new digital technologies applied to the surveillance, control, and prevention of HAIs in hospitals and LTCFs published from 2018 to 4 November 2023. The literature search yielded 1292 articles. After title/abstract screening and full-text screening, 43 articles were included. The mean study duration was 43.7 months. Surgical site infections (SSIs) were the most-investigated HAI and machine learning was the most-applied technology. Three main themes emerged from the thematic analysis: patient empowerment, workload reduction and cost reduction, and improved sensitivity and personalization. Comparative analysis between new technologies and traditional methods showed different population types, with machine learning methods examining larger populations for AI algorithm training. While digital tools show promise in HAI surveillance, especially for SSIs, challenges persist in resource distribution and interdisciplinary integration in healthcare settings, highlighting the need for ongoing development and implementation strategies.

Daily Chlorhexidine Bath for Health Care Associated Infection Prevention (CLEAN-IT): protocol for a multicenter cluster randomized crossover open-label trial.

Critically ill patients are at increased risk of health care-associated infections due to various devices (central line-associated bloodstream infection, catheter-associated urinary tract infection, and ventilator-associated pneumonia), which pose a significant threat to this population. Among several strategies, daily bathing with chlorhexidine digluconate, a water-soluble antiseptic, has been studied as an intervention to decrease the incidence of health care-associated infections in the intensive care unit; however, its ability to reduce all health care-associated infections due to various devices is unclear. We designed the Daily Chlorhexidine Bath for Health Care Associated Infection Prevention (CLEAN-IT) trial to assess whether daily chlorhexidine digluconate bathing reduces the incidence of health care-associated infections in critically ill patients compared with soap and water bathing. The CLEAN-IT trial is a multicenter, open-label, cluster randomized crossover clinical trial. All adult patients admitted to the participating intensive care units will be included in the trial. Each cluster (intensive care unit) will be randomized to perform either initial chlorhexidine digluconate bathing or soap and water bathing with crossover for a period of 3 to 6 months, depending on the time of each center's entrance to the study, with a 1-month washout period between chlorhexidine digluconate bathing and soap and water bathing transitions. The primary outcome is the incidence of health care-associated infections due to devices. The secondary outcomes are the incidence of each specific health care-associated infection, rates of microbiological cultures positive for multidrug-resistant pathogens, antibiotic use, intensive care unit and hospital length of stay, and intensive care unit and hospital mortality. The CLEAN-IT trial will be used to study feasible and affordable interventions that might reduce the health care-associated infection burden in critically ill patients.

Antibiotic stewardship and nosocomial infection prevention in critically ill patients: a quality improvement program.

The objective of this study was to evaluate the impact of the implementation of a bundle of interventions through a "Program for Antibiotic Management and Nosocomial Infection Prevention" in the intensive care unit on antibiotic and devices use and healthcare-associated infections. This was a quasi-experimental study of consecutive series of cases in periods before and after the establishment of protocols and checklists for the use of antibiotics as well as other measures to prevent healthcare-associated infection as part of a quality improvement program. Antimicrobial consumption was assessed by the defined daily dose. A total of 1,056 and 1,323 admissions in the pre-intervention and post-intervention phases, respectively, were evaluated. The defined daily dose per 100 patient-day decreased from 89±8 to 77±11 (p=0.100), with a decrease in carbapenems, glycopeptides, polymyxins, penicillins, and cephalosporins. The rates of ventilator and central venous catheter use decreased from 52.8 to 44.1% and from 76 to 70%, respectively. The rates of healthcare-associated infection decreased from 19.2 to 15.5%. Quality improvement actions focused primarily on antimicrobial management and prevention of healthcare-associated infection are feasible and have the potential to decrease antibiotic use and healthcare-associated infection rates.