Healthcare-associated Infection Rates Research Articles

Surveillance of multi-resistant microrganisms and epidemiological investigation of intensive care unit patients

It is of great importance to detect the presence of microorganisms in healthcare services. On this basis, strategies should be developed to maintain safety inside the hospital environment by preventing the transmission of microorganisms, thus preventing healthcare-associated infections (HAI). In the Intensive Care Unit (ICU), the precocious detection of infection and/or colonization by multidrug-resistant (MDR) microorganisms is key. For this reason, the routine monitoring of patients that are infected or colonized by MDR microorganisms is mandatory. In this context, this study aimed to evaluate the performance of epidemiological surveillance swabs and microbiological cultures in ICU patients in a university public hospital in Belo Horizonte, Minas Gerais State, Brazil. Medical records of patients admitted to the ICU from January 1st, 2018 to December 31st, 2020, submitted to epidemiological surveillance cultures, and presenting factors correlated to the development of HAI were evaluated. This was a descriptive, retrospective and observational, non-interventional study. The study population was composed mainly of male patients (66.3%), with a mean age of 59 years, coming from the Medical Clinic department, and septicemia was the main cause of hospitalization in the ICU. The analyses showed that 9.5% of the patients were colonized by MDR microorganisms. The samples were collected at the ICU, and a higher frequency of gram-negative bacteria was observed, including A. baumannii, P. aeruginosa, K. pneumoniae, and carbapenem-resistant Enterobacteriaceae. The most frequently prescribed antimicrobials were β-lactams and glycopeptides, and the same patient was treated using more than one class of antimicrobials. The surveillance culture is key to understanding the microbiological profile of the institution. The collection of swabs and microbiological cultures from different sites could be used to adopt routines and recommend measures aimed at controlling and reducing the HAI rates as well as the emergence of MDR outbreaks. These procedures could contribute to the creation and maintenance of a safe and effective healthcare service.

IMPACT OF COVID-19 PANDEMIC ON HEALTHCARE ASSOCIATED INFECTIONS: A STUDY FROM A TERTIARY CARE TEACHING INSTITUTE FROM NORTH INDIA

Background: The disease COVID-19 caused by SARS CoV-2 is highly contagious and strict infection control strategies have been adopted to limit the spread of this virus. We studied the impact of COVID-19 prevention and control measures on the rates of other healthcare associated infections (HCAI). Aims and Objectives: Impact of COVID-19 prevention and control measures on the rates of other HCAIs. Study Design: This retrospective study was conducted in the department of microbiology, tertiary care teaching hospital during 2019 and 2020. Material and Methods: Strict Infection prevention and control measures were implemented since 2020 including segregation of patients with respiratory symptoms, mandatory use of mask and strict adherence to standard precautions like hand hygiene. The rates of HCAIs were compared during pre- and post-pandemic periods. Results: Total number of samples were 14,778 and 12,018 in the years 2019 and 2020 respectively. Out of 14,778 samples 271 (1.83%) were found to be positive for HCAI in 2019, while 224 (1.86 %) out of 12,018 samples were found to be positive for HCAI in the year 2020. Conclusion: This study concluded reduction in the rate of SSI during the COVID-19 in the year 2020. Adherence to strict hand hygiene practices was one of the most important factors in preventing SSI.

2042. Impact of the COVID-19 Pandemic on Healthcare-Associated Infections (HAI) by Race and Ethnicity in a Large Network of Community Hospitals: A Call to Action

Abstract Background Inequities in healthcare among racial and ethnic minorities are globally recognized. The focus has centered on access to healthcare, equitable treatment, and optimizing outcomes. However, there has been relatively little investigation into potential racial and ethnic disparities in HAI. Methods We performed a retrospective cohort analysis of select HAI prospectively-collected by a network of community hospitals in the southeastern US, including central line-associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and laboratory-identified Clostridioides difficile infection (CDI). Outcomes were stratified by race/ethnicity as captured in the electronic medical record. We defined the pre-pandemic period from 1/1/2019 to 2/29/2020 and the pandemic period from 3/1/2020 to 6/30/2021. Outcomes were reported by race/ethnicity as a proportion of the total events. Relative rates were compared using Poisson regression. Results Overall, relatively few facilities consistently collect race/ethnicity information in surveillance databases within this hospital network (< 40%). Among 21 reporting hospitals, a greater proportion of CLABSI occurred in Black patients relative to White patients in both study periods (pre-pandemic, 49% vs 38%; during pandemic, 47% vs 31%; respectively, Figure 1a), while a higher proportion of CAUTI and CDI occurred in White patients (Figures 1b-c). Black patients had a 30% higher likelihood of CLABSI than White patients in the pre-COVID period (RR, 1.30; 95% CI, 0.83-2.05), which was not statistically significant (Table 1). However, this risk significantly increased to 51% after the start of the pandemic (RR, 1.51; 95% CI, 1.02-2.24). Similar trends were not observed in other HAI (Tables 2-3). Conclusion We found differences in HAI rates by race/ethnicity in a network of community hospitals. Black patients had higher likelihood of CLABSI, and this likelihood increased during the pandemic. Patient safety events, including HAI, may differ across racial and ethnic groups and negatively impact health outcomes. Disclosures Sonali D. Advani, MBBS, MPH, FIDSA, Locus Biosciences: Advisor/Consultant|Locus Biosciences: Honoraria|Sysmex America: Advisor/Consultant.

1215. Variation in Hand Hygiene Improvement After Implementation of an Electronic Hand Hygiene System During the COVID-19 Pandemic

Abstract Background Electronic hand hygiene (HH) monitoring systems have many potential advantages but there are limited data on wide-scale implementation of these systems. TableHand Hygiene Observations, Improvement in Adherence Rates and SIR Trends by Hospital Methods We deployed an electronic HH monitoring system in over 2,100 acute and critical care rooms across 9 hospitals in an academic health system. Badges with a Bluetooth beacon were issued to over 7,000 healthcare workers. Deployment began in early 2020 and was interrupted by the pandemic. The rollout of interventions to improve HH adherence was managed at the hospital level. Healthcare-associated infections (HAIs) were determined by the infection prevention team using standard CDC definitions. Hospital-level HH adherence rates were compared to a composite SIR including SIRs for CLABSI, CAUTI, hospital-onset MRSA bloodstream infections and hospital-onset Clostridiodes difficile infections. Results Between January 2020 and April 2022, there were over 36 million hand hygiene opportunities with an average of 19 observations per staffed room per day. Overall HH adherence improved from 46% to 60%, with significant variation by hospital (4 improving by >25% and 3 by < 5%). Hospitals whose implementation was most delayed showed the least improvement. Preliminary analysis found no relationship between hand hygiene improvement and the SIR composite aggregated by calendar year. Conclusion Despite the challenges of large-scale implementation of an electronic HH system during a pandemic, we demonstrated an overall improvement in HH adherence. The wide variation in improvement among hospitals was due to timing of implementation, variation in the dedicated hospital-specific project management resources and leadership engagement. In addition to technology, successful implementation of electronic HH systems requires dedicated resources and culture change. Pandemic-related staffing challenges, disruption of standard HAI prevention efforts and intensive device utilization confounded our ability to show a relationship between HH adherence and HAI rates. Disclosures All Authors: No reported disclosures.

1764. Accuracy of Penicillin Allergy Risk Severity Documentation in Surgical Patients

Abstract Background Clinical guidelines for antimicrobial prophylaxis recommend use of cefazolin for most surgical procedures. Patients who are labeled penicillin (PCN) allergic are often prescribed second line agents, though cross-reactivity is less than 1%. PCN allergic patients have significantly higher rates of readmissions and healthcare-associated infections. Allergy documentation in the medical record is often incomplete or inaccurate, and many allergies can be de-labeled through history alone. Our study aimed to investigate accuracy of allergy risk assessment in PCN allergic patients and the impact on surgical antibiotic prophylaxis for quality improvement. Methods This was a retrospective observational cohort study among adult patients with a reported PCN allergy who underwent a surgical procedure from 3/2019-2/2020 at a single academic institution. The primary outcome was incidence of appropriate documentation of allergy risk severity. Secondary outcomes included receipt of beta-lactam for surgical prophylaxis and incidence of documentation to reflect tolerance. Allergy risk classification was considered appropriate if it aligned with institutional guidelines (Table 1). Results Of 2647 patients who underwent surgical procedures, 330 (12%) reported PCN allergy. Allergy risk severity was appropriately documented in 136 (41%) patients. 150 (45%) were mislabeled as “high” or “unknown” risk compared to reported reaction. 191 (58%) patients with reported PCN allergies received beta-lactam antibiotics peri-operatively. Allergy history had been updated to reflect tolerance in only 6% of patients who received cefazolin for surgical prophylaxis and in 21% who had received beta-lactams previously (Table 2). Table 2:Primary and Secondary Outcomes Conclusion Inaccurate documentation of allergy risk results in decreased first-line antimicrobial use in patients with reported PCN allergies. Documented PCN allergy risk severity was often incorrect and over 100 additional patients could have been labeled “low risk” based on reported reaction. 72% of patients could have received first-line beta-lactam prophylaxis per institutional guidelines. Interventions targeting allergy history documentation alone could positively impact antibiotic selection. Disclosures All Authors: No reported disclosures.

1203. Assessment of Infection Prevention and Control Programs in Acute Care Facilities in Central and South America

Abstract Background Little is known about the development of Infection Prevention and Control (IPC) programs in Latin American hospitals despite alarming rates of multidrug resistant healthcare-associated infections (HAIs) in the region. The aim of this study was to identify gaps in implementation of hospital IPC programs in Latin America. Methods We conducted a cross-sectional survey using a self-assessment tool (Spanish version) adapted from the World Health Organization (WHO) Infection Prevention and Control Assessment Framework (IPCAF) in March 2022. The survey was deployed to 40 hospitals in Panama, Guatemala, Ecuador, and Argentina through a regional research network. The instrument has 8 components (score 0-100), with 800 as maximum overall score. Facility IPC program implementation is categorized into four levels based on the final score: inadequate (0–200), basic (201–400), intermediate (401–600), or advanced (601–800). Median scores, overall and by component, were calculated. Additionally, for each question, we estimated the proportion of hospitals that met criteria stratified by private and public hospitals. Results Thirty five hospitals (14 private and 21 public) completed the evaluation (88% response rate), 83% were academic, and 14% were < 110 bed-hospitals. Overall, 57% of hospitals fell in the “Advanced” category (percentile [p]10: 518; p 50 614; p90 744). The median score for each component is shown in the Figure. IPC education and training, and workload, staffing and bed occupancy had the lowest median scores (Figure). In general, public hospitals had lower scores than private hospitals (Figure). Most hospitals performed surveillance for HAIs and hand hygiene, although fewer monitored compliance with adherence to prevention bundles or communicate these data to front-line workers. Additional gaps were identified, principally between private and public hospitals (Table). Figure: Median score for individual IPCAF component for all hospitals, private and public heathcare facilities. Conclusion While most participating hospitals were considered “advanced” based on the IPCAF score, several gaps were identified, which differed between public and private hospitals. Insufficient IPC education and training, workload, staffing and bed occupancy, multimodal strategies and lack of leadership support may be barriers to effective IPC programs in the region. Disclosures All Authors: No reported disclosures.

1188. Efficacy of Copper Impregnated Self-Sanitizing Surface Against Clostridioides difficile Spores

Abstract Background Clostridioides difficile (C. diff) is one of the most common causes of healthcare-associated infections (HAIs), leading to increased hospital stay, cost, and mortality. Elimination of C. diff spores is difficult as they are resistant to kill by common hospital grade disinfectants. Copper impregnated self-sanitizing surfaces (SSSCu) provide continuous reduction of vegetative pathogens, potentially lowering the risk of infections, but their efficacy on C. diff spores has not been previously evaluated. Methods Control (no copper) and copper coupons containing 20% copper-oxide were inoculated with varying C. diff spore loads ranging from 105 to 107 spores, prepared using environmental protection agency protocol, with or without 5% fetal bovine serum (FBS) soil load. After 4 hours of contact time, the C. diff spores were recovered and tested for viability. The efficacy of copper (log10 kill) was estimated using a Bayesian linear multilevel model. Results After 4 hours, the copper coupons, at mean initial spore load (6.67 log10) and no soil load, had a mean 1.21 (95% uncertainty interval: 1.13 - 1.31) log10 reduction compared to control coupons. With soil load, the treatment effect of copper decreased by 0.50 (95% uncertainty interval: 0.37 - 0.64) log10. Also, for each additional standard deviation (SD) increase in initial spore load there was a 0.59 (95% uncertainty interval: 0.47 - 0.72) log10 decrease in the treatment effect of copper. The soil load in combination with increasing initial spore load further decreased the treatment effect of copper by an additional 0.19 (95% uncertainty interval: 0.01 - 0.38) log10 for each SD increase in initial spore load. Conclusion Copper coupons can substantially reduce C. diff spores after 4 hours by 50%-97% depending on the initial spore concentration and presence or absence of organic material. Higher initial spore loads or excess organic material may prevent the spores from coming in contact with the copper-impregnated surface thus decreasing the kill efficacy. Continuous sporicidal effect of copper-impregnated surfaces might prevent transmission of spores and help reduce HAIs. Further studies are needed to evaluate the efficacy on C. diff HAI rates. Disclosures Piyali Chatterjee, PhD, AHRQ Grant # 1R03HS027667-01: Grant/Research Support|AHRQ Grant # 1R03HS027667-01: Central Texas Veterans Health Care System Chetan Jinadatha, MD, MPH, AHRQ R01 Grant-5R01HS025598: Grant/Research Support|EOS Surfaces: Copper Coupons and materials for testing.

1199. Implementation of a Nasal Antiseptic Decolonization Program Reduces the Occurrence of Healthcare-Associated Infections in the Adult Intensive Care Unit Setting

Abstract Background Universal decolonization programs effectively reduce methicillin-resistant Staphylococcus aureus (MRSA) infections, bloodstream infections, and healthcare costs. However, universal decolonization programs that utilize mupirocin may promote antimicrobial resistance. Non-antibiotic interventions, such as nasal antiseptic decolonization, can contribute to the prevention of healthcare-associated infections (HAIs). A large hospital system sought to evaluate the impact of a universal nasal antiseptic program on HAIs in the adult intensive care unit (ICU) setting. Methods A nasal antisepsis decolonization quality improvement project (QIP) was implemented to reduce ICU HAIs by applying a 62% nasal antiseptic swab with emollients bilaterally to the nares every 12 hours for all adult ICU patients. The program was piloted across nine ICUs at three large hospitals from November 2021 to January 2022 and captured data from 12,404 patient days and 4,058 treatment days. Central line-associated blood stream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and MRSA bacteremia rates were compared a) between treated and non-treated patients during the QIP period and b) to rates during a three-month period prior to the QIP. Results The results of the pilot program indicated that patients who received treatment with the 62% nasal swab developed fewer HAIs than patients who did not receive the treatment. Two HAIs occurred in the treatment group (two CAUTIs) compared to 14 HAIs in the non-treatment group (three CAUTIs, nine CLABSIs, and two MRSA bacteremia). Figures 1 and 2 below demonstrate HAI rates in the non-treatment and the treatment groups. Figure 1Figure 2 Conclusion Based on pilot results, the system approved implementation of a universal nasal antisepsis program using the 62% alcohol based nasal swab with emollients for expansion to all adult critical care units. Considerations for the future implementation of the program include broadening patient inclusion and performing ongoing HAI surveillance of treated and untreated patient groups. Disclosures All Authors: No reported disclosures.

Outcomes of Beta-Lactam Allergic and Non-Beta-Lactam Allergic Patients with Intra-Abdominal Infection: A Case-Control Study.

In the case of intra-abdominal infections (IAI) in beta-lactam (BL) allergic patients, empiric antimicrobial therapy without BL is recommended; however, data regarding the outcome with alternative regimens are scarce. This study aimed to compare the outcomes of BL allergic (BLA) patients with IAI to those who were non-BLA (NBLA). We conducted a case-control study in a French teaching hospital, between 1 January 2016 and 31 August 2021. BLA patients with IAI treated with fluoroquinolone or aztreonam and metronidazole were matched with controls treated with BL, on age, sex, disease severity, IAI localization, and healthcare-associated infection (HAI) status. We compared rates of therapeutic failures, adverse events, and HAI, and then assessed factors associated with therapeutic failure using a logistic regression model. The therapeutic failure rate was 14% (p > 0.99) in both groups of 43 patients, and there was no significant difference in the adverse events rate (p > 0.99) and HAI rate (p = 0.154). Factors independently associated with therapeutic failure were higher BMI (OR 1.16; 95%CI [1.00-1.36]; p = 0.041), longer hospital length of stay (OR 1,20; 95%CI [1.08-1.41]; p = 0.006), and inadequate empiric antimicrobial therapy (OR 11.71; 95%CI [1.43-132.46]; p = 0.025). The outcomes of BLA patients with IAI treated without BL were the same as those for NBLA patients treated with BL.

Covid-period-associated changes in organism profile of neonatal sepsis in a tertiary center from East India.

Neonatal sepsis is a major cause of morbidity and mortality with a higher burden from the low- and middle-income countries. The coronavirus disease 2019 (Covid 19) pandemic has impacted healthcare in various ways including healthcare-associated infections (HAI). The objective of the present study was to determine changes in organism profile and incidence rates of HAI in neonates admitted to the index hospital during the pandemic and compared it with the data from the pre-pandemic period. The study design was a retrospective, observational analysis of data from neonates with culture-positive sepsis, in a tertiary care children's hospital, between January 2018 and December 2021. Pre-Covid (January 2018 to December 2019) and Covid period data (January 2020 to December 2021) were analyzed for the significance of change. The prevalence of culture-positive sepsis, in pre-Covid and Covid periods, was 19.55% [95% confidence interval (95% CI) 17.13-21.52)] and 18.36% (CI 16.05-20.74), respectively. HAI rates/1000 patient days increased slightly during the Covid pandemic [7.2% (95% CI 6.98-10.08) to 9.8% (95% CI 9.78-13.67)] mainly due to an increase in fungal HAI (26% pre- vs. 41.5% Covid period). However, the proportion of Gram-negative (GN) infections fell significantly (70.5% vs. 48.6%) during the same period. In the pre-Covid period, Klebsiella followed by Burkholderia cepacia, Acinetobacter spp and Pseudomonas, were the major HAI isolates. During the Covid period, there was a decline in these isolates and Burkholderia spp was not detected. All fungal isolates were Candida species. The case fatality ratio (CFR) from HAI decreased significantly from 38% to 15.45%, mainly due to a decrease in GN HAI. During Covid pandemic, there was a significant decline in GN HAI and CFR from HAI, due to improved compliance with infection control measures in the neonatal intensive care unit (NICU). At the same time, there was a rise in the fungal HAI, possibly because of a higher proportion of premature, and sick neonates with longer hospital stay and more invasive procedures. Consolidations of gains in infection control and restriction of invasive procedures could help to minimize HAI in NICUs.

Device Exposure and Patient Risk Factors' Impact on the Healthcare-Associated Infection Rates in PICUs.

Healthcare-associated infections related to device use (DA-HAIs) are a serious public health problem since they increase mortality, length of hospital stay and healthcare costs. We performed a multicenter, prospective study analyzing critically ill pediatric patients admitted to 26 Spanish pediatric intensive care units (PICUs) over a 3-month period each year from 2014 to 2019. To make comparisons and evaluate the influence of HAI Zero Bundles (care bundles that intend to reduce the DA-HAI rates to zero) on PICU HAI rates, the analysis was divided into two periods: 2014-2016 and 2017-2019 (once most of the units had incorporated all the Zero Bundles). A total of 11,260 pediatric patients were included. There were 390 episodes of HAIs in 317 patients and the overall rate of HAIs was 6.3 per 1000 patient days. The DA-HAI distribution was: 2.46/1000 CVC days for central-line-associated bloodstream infections (CLABSIs), 5.75/1000 MV days for ventilator-associated pneumonia (VAP) and 3.6/1000 UC days for catheter-associated urinary tract infections (CAUTIs). Comparing the two periods, the HAI rate decreased (p = 0.061) as well as HAI episodes (p = 0.011). The results demonstrate that exposure to devices constitutes an extrinsic risk factor for acquiring HAIs. The multivariate analysis highlights previous bacterial colonization by multidrug-resistant (MDR) bacteria as the most important extrinsic risk factor for HAIs (OR 20.4; 95%CI 14.3-29.1). In conclusion, HAI Zero Bundles have been shown to decrease HAI rates, and the focus should be on the prompt removal of devices, especially in children with important intrinsic risk factors.

INTERNET OF THINGS-ASSISTED LORAWAN-ENABLED HAND HYGIENE MONITORING AND TRACKING SYSTEM FOR PREVENTING COMMUNITY-ACQUIRED PNEUMONIA AND HEALTHCARE-ASSOCIATED INFECTIONS

Healthcare-associated infections (HAI) are a primary concern in critical care units, dialysis centers, and nursing stations. Practicing Alcohol-Based Hand Hygiene (ABH) is predicted to reduce the risk of disease transmission. Recent technological breakthroughs in the Internet of Things (IoT) and Long Range communication (LoRa) protocols provide cutting-edge solutions to reduce HAIs, particularly community and hospital-acquired pneumonia. This research uses an IoT-enabled LoRa network to monitor and track hand hygiene practices to avoid pneumonia and other HAI infections. The ABH dispenser can recognize the subjects, activate the hand sanitizer, permit the subject admission, and record hand-washing activities to a server powered by an NVIDIA Jetson Nano Graphical Processing Unit computer. All the data, with a user ID and GPS location, is deployed in a cloud server and an application server for storage and display and relayed to a LoRa gateway using the ESP32 IoT platform equipped with a LoRaWAN and short-range Bluetooth Low Energy. A series of field tests was conducted in various hospital buildings and simulated scenarios. Real-world LoRa network situations have brought an overall success rate of 92%, whereas laboratory testing has an overall success rate of 98%. As individuals grew more conscious of the need for personal and institutional hygiene during the Covid-19 pandemic, the frequency of HAIs increased. The IoT-enabled intelligent ABH network is a cost-effective infection prevention and control mechanism, and it reduces pneumonia, HAI rate, and stress of healthcare workers and critical care unit patients.

Hand hygiene and HAI transmission in Piedmont, Italy: an observational study, 2017-2019

Abstract Background Hand hygiene (HH) is one of the most important measures to prevent healthcare-associated infections (HAIs). Several indicators have been proposed to measure HH practices, including alcohol-based handrub consumption (AHC). The objective of this study was to evaluate whether AHC is associated with HAI transmission. Methods All 25 public hospitals/trusts of Piedmont, in Northern Italy, are required to provide data each year concerning HAIs and infection prevention and control (IPC) activities, as part of a mandatory regional indicator system. Data on AHC and HAIs were extracted from reports provided concerning the years 2017-2019. The mean annual AHC for each facility was expressed as liters per patient-day. The rate of hospital-wide Methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteriaceae (CRE) infections was calculated per 1000 patient-days (pd). Mean ventilation-associated infections (VAP) for 1000 days of ventilation (vd) and mean catheter-related bloodstream infections (CR-BSI) for 1000 days of catheterization (cd) were calculated for intensive care units (ICUs). Spearman's correlational analysis was conducted between AHC and HAIs: hospital-level, ICU-level. Results Hospital-level: mean AHC was 15.4 liters/pd; mean HAI rate was 39.6/1000 pd (MRSA) and 18.5/1000 pd (CRE). No significant correlation was found. ICU-level: mean AHC was 39.6 liters/pd; mean HAI rate was 1.7/1000 cd (CR-BSI) and 8.2/1000 vd (VAP). A moderate correlation was found between AHC and CR-BSI rate (Spearman's ρ -0.55, p 0.022). Concerning AHC and VAP, higher AHC was reported from facilities with lower VAP rates, however no significant correlation was found (Spearman's ρ -0.203, p 0.451). Conclusions Results of this study support the validity of AHC as an indicator of IPC practices in ICUs. The hospital-level analysis could have been affected by important differences in AHC among ward types. Key messages

Prevalence of healthcare-associated infections in public hospitals in New Zealand, 2021

There are no contemporary data on healthcare-associated infections (HAIs) in New Zealand. To determine the epidemiology of HAIs, prevalence of medical devices, and microbiology of HAIs in adults in public hospitals in New Zealand. Point prevalence survey. Surveyors reviewed patients aged ≥18 years using the HAI definitions of the European Centres for Disease Prevention and Control. Device use and microbiology of HAIs were recorded. In total, 5468 patients were surveyed; 361 patients (6.6%) had 423 HAIs (7.7 HAIs per 100 patients). The most common HAIs were: surgical site infections (N=104, 25%), urinary tract infections (N=80, 19%), pneumonia (N=75, 18%) and bloodstream infections (N=55, 13%). Overall, 3585 patients (66%) had at least one device, with 2922 (53%) patients having a peripheral intravenous catheter. Sixty-nine (16%) HAIs were device-associated. On multi-variable analysis, independent risk factors for HAIs included the presence of a peripheral [odds ratio (OR) 2.0] or central (OR 5.7) intravenous catheter and clinical service. HAI rates were higher in surgical patients (OR 1.8), intensive care unit patients (OR 2.6) and rehabilitation/older persons' health patients (OR 2.4) compared with general medicine patients (P≤0.01 for all groups). In total, 301 organisms were identified. Clostridioides difficile infection was uncommon, accounting for 1.7% of all HAIs. Forty-two isolates (14%) were drug-resistant, and most (N=33, 79%) were Enterobacterales. This study established the most common HAIs and their risk factors in New Zealand. The high prevalence of device use underscores the need to ensure that proven multi-modal prevention interventions are in place. However, as less than half of HAIs are device- or surgery-associated, other intervention strategies will be required to reduce their burden.

"PERSISTENT POST-COVID IMMUNOSUPPRESSION AND HEALTHCARE- ASSOCIATED INFECTIONS - POSSIBLE MECHANISMS AND IMPLICATIONS IN MULTIDRUG-RESISTANT INFECTIONS"

One of the main concerns of the medical community during the COVID-19 pandemic has been the management of the immunosuppression accompanying the disease, particularly in ICU (Intensive Care Unit) patients. More recently, the focus has shifted towards the management of the persistent immunosuppression post-acute COVID-19 and its complications. The rate of healthcare-associated infections (HAIs) had been declining before the pandemic, but has since started to increase once more. Due to multiple factors – unnecessary antibiotherapy, disorganized medical facilities, inadequate personal protection equipment etc. – there have been increasing reports of coinfections and secondary infections with multidrug-resistant bacteria in COVID-19 patients. We present a case report of a patient with no history of clinically overt immunosuppression before developing critical SARS-CoV-2 pneumonia. The patient had no need for antibiotic treatment during his hospitalization and was discharged in a stable state, being consequently readmitted multiple times for different healthcare-associated multidrug-resistant infections, over time developing other hospital-related complications. The case raises a discussion about the bidirectional relationship between post-COVID immunosuppression and the possible inadvertent excess in antibiotic therapy that has accompanied the pandemic.

Bacteriological Profile and Antimicrobial Resistance Pattern Among Healthcare-Associated Infections in a Pediatric Intensive Care Unit

Healthcare-associated infections (HAIs) are a global public health issue with clinical and socioeconomic consequences. These infections are important indices for the quality of healthcare services which are serious complications that should be addressed in pediatric intensive care units (PICUs). This study aimed to retrospectively examine the bacterial HAIs, the frequency of isolated pathogen microorganisms, the areas of infection, and the antibiotic susceptibility recorded in the surveillance system in our Pediatric Intensive Care Unit for five years between 01.01.2015 and 31.12.2019. Two thousand five hundred forty-five patients were admitted to the pediatric intensive care unit during the study period and treated. One-hundred ninety HAIs were detected in 99 patients. In the study, gram-negative microorganisms were most commonly seen (160/190). Pseudomonas aeruginosa, Acinetobacter baumannii, and Klebsiella spp. were the most common bacteria. Enterococcus spp. and coagulase-negative staphylococci were the most common gram-positive microorganisms. The mortality rate of a bacterial HAI was 40.4%. There was no resistance against vancomycin in Gram-positive microorganisms. The resistance rate against methicillin was 100% in coagulase-negative staphylococci and 50% in S. aureus strains. The cumulative rate of carbapenem resistance was found as 76.1% in Pseudomonas aeruginosa, 45.2% in Klebsiella spp. and 0% in Escherichia coli. In 2019, the resistance rate against colistin in Klebsiella spp. and Pseudomonas aeruginosa were 46.2% (6/13) and 20% (1/5), respectively. The resistance rate against carbapenem and colistin was 81.1% and 0% in Acinetobacter baumannii. It was observed that the use of carbapenem before an infection episode increased significantly, and the rate of carbapenem resistance reached 100% over the years in Pseudomonas aeruginosa and Klebsiella spp. A significant proportion of the isolates were multidrug-resistant strains, significantly threatening survival. Implementation of effective preventive strategies to combat the emergence of antibiotic resistance is urgently needed.

The Nursing Activities Score and its association with healthcare-associated infections in a Brazilian adult intensive care unit

The intensive care unit (ICU) requires a specialized team with adequate human resources, including nursing. For an adequate measurement of the workload of nursing professionals of Brazilian ICUs, the Nursing Activities Score (NAS) has been used to promote better adequacy of work scales. Work overload can increase the incidence of adverse events, including healthcare-associated infections (HAI). Objective: To associate the nursing workload measured by the NAS with the rates of HAI in an Adult ICU of a university hospital, in addition to evaluating the impact of the separation of ICUs by unit, or type of specialization. Method: Data collection was performed at Brazil, in the Adult ICU: stratified by the Surgical, Neurological and Medical specialties; including the calculation of the means of NAS and the monthly rates of HAI of each ICU unit, from 2016 to April 2019. NAS data were collected from secondary spreadsheets, without identification of the patient, and the rates of HAIs were collected from information from the Hospital Infection Control Service. Results: The mean NAS was different for each unit, with Neurological unit with the highest mean. In relation to HAIs, neurological unit patients had a higher incidence of HAIs and patients with HAIs. Pneumonia associated with mechanical ventilation (VAP) was higher in Surgical and Neurological units. Bloodstream and urinary tract infection were higher in the Medical unit. There was a positive correlation for NAS and VAP in the Medical unit and with urinary tract infection in the Surgical unit. In the Neurological unit there was a negative correlation with the rate of HAI and rate of patients with HAI. Conclusion: The mean NAS observed by us was lower when compared to other ICUs and variations may be associated with the type of hospital and clinical profile of patients. It was possible to observe that each unit has its particularity regarding the incidence of HAIs and the association between NAS (nursing workload) and rates, reinforcing the need for stratification and association of indicators per unit.

Health-care-associated bloodstream and urinary tract infections in a network of hospitals in India: a multicentre, hospital-based, prospective surveillance study

Health-care-associated infections (HAIs) cause significant morbidity and mortality globally, including in low-income and middle-income countries (LMICs). Networks of hospitals implementing standardised HAI surveillance can provide valuable data on HAI burden, and identify and monitor HAI prevention gaps. Hospitals in many LMICs use HAI case definitions developed for higher-resourced settings, which require human resources and laboratory and imaging tests that are often not available. A network of 26 tertiary-level hospitals in India was created to implement HAI surveillance and prevention activities. Existing HAI case definitions were modified to facilitate standardised, resource-appropriate surveillance across hospitals. Hospitals identified health-care-associated bloodstream infections and urinary tract infections (UTIs) and reported clinical and microbiological data to the network for analysis. 26 network hospitals reported 2622 health-care-associated bloodstream infections and 737 health-care-associated UTIs from 89 intensive care units (ICUs) between May 1, 2017, and Oct 31, 2018. Central line-associated bloodstream infection rates were highest in neonatal ICUs (>20 per 1000 central line days). Catheter-associated UTI rates were highest in paediatric medical ICUs (4·5 per 1000 urinary catheter days). Klebsiella spp (24·8%) were the most frequent organism in bloodstream infections and Candida spp (29·4%) in UTIs. Carbapenem resistance was common in Gram-negative infections, occurring in 72% of bloodstream infections and 76% of UTIs caused by Klebsiella spp, 77% of bloodstream infections and 76% of UTIs caused by Acinetobacter spp, and 64% of bloodstream infections and 72% of UTIs caused by Pseudomonas spp. The first standardised HAI surveillance network in India has succeeded in implementing locally adapted and context-appropriate protocols consistently across hospitals and has been able to identify a large number of HAIs. Network data show high HAI and antimicrobial resistance rates in tertiary hospitals, showing the importance of implementing multimodal HAI prevention and antimicrobial resistance containment strategies. US Centers for Disease Control and Prevention cooperative agreement with All India Institute of Medical Sciences, New Delhi. For the Hindi translation of the abstract see Supplementary Materials section.

Academic Medical Centers Experienced Higher Rates of Post-Operative Health-Care–Associated Infections during the COVID-19 Pandemic: A Post Hoc Analysis of an Eastern Association for the Surgery of Trauma Multicenter Trial

Background: We sought to examine health-care-associated infections (HAIs) among patients undergoing an appendectomy at academic medical centers (AMCs) and non-AMCs during the coronavirus disease 2019 (COVID-19) peri-pandemic. We hypothesized that AMCs would have higher rates of post-operative HAIs during the first wave of the pandemic. Patients and Methods: We performed a post hoc analysis of a prospective, observational, multi-center study of patients aged >18 years who underwent an appendectomy for acute appendicitis before (pre-CoV), during (CoV), and after pandemic restrictions were lifted (post-CoV). Patients were grouped according to hospital type (AMC vs. non-AMC). Our primary outcome was the incidence of post-operative HAIs. Results: There were 1,003 patients; 69.5% (n = 697) were treated at AMCs and 30.5% (n = 306) at non-AMCs. Patients at AMCs had greater rates of concomitant COVID-19 infections (5.5% vs. 0.7%; p < 0.0001) and worse operative appendicitis severity (p = 0.01). Greater rates of HAIs were seen at AMCs compared with non-AMCs (4.9% vs. 2%; p = 0.03). Surgical site infections were the most common HAI and occurred more often at AMCs (4.3% vs. 1.6%; p = 0.04). Only during CoV were there more HAIs at AMCs (5.1% vs. 0.3%; p = 0.02). Undergoing surgery at an AMC during CoV was a risk factor for HAIs (adjusted odds ratio [aOR], 8.55; 95% confidence interval [CI], 1.03-71.03; p = 0.04). Conclusions: During the COVID-19 pandemic, appendectomies performed at AMCs were an independent risk factor for post-operative HAIs. Our findings stress the importance of adherence to standard infection prevention efforts during future healthcare crises.

Results of Epidemiological and Microbiological Monitoring of Healthcare- Associated Infections in the Republic of North Ossetia–Alania

Introduction: The complex of exogenous and endogenous risk factors in multidisciplinary hospitals creates conditions for the development of nosocomial infections induced by ESKAPE pathogens. Objective: To establish epidemiological features and etiological significance of antibiotic resistant strains of the leading pathogens inducing hospital-acquired infections and to determine their prevalence in multidisciplinary clinics of the Republic of North Ossetia–Alania. Materials and methods: We analyzed the incidence of nosocomial infections and results of the microbiological monitoring of antimicrobial drug resistance in leading pathogens for the years 2012–2021. Detection of genes encoding the production of metallo-β-lactamases was performed in P. aeruginosa strains, extended-spectrum β-lactamases and PFGE profiles of E. coli and K. pneumoniae strains. Results: In the Republic of North Ossetia–Alania, the average long-term incidence rate of hospital-acquired infections in the study period was 0.74 per 1,000 inpatients. We established that 44.2 % of all such cases were diagnosed in surgical departments, 32.4 % – in maternity departments, 6.6 % – in pediatric departments, and 16.8 % – in other clinical departments. The average long-term incidence rate of nosocomial infections was the highest (0.85 per 1,000 patients) in departments of surgery, the most prevalent being surgical and injection site infections, lower respiratory tract and urinary tract infections. The leading pathogens in the etiological structure were Enterobacteriaceae spp., P. aeruginosa and Staphylococcus spp. The incidence rates estimated based on microbiological monitoring results were on average 2.5 times higher than those registered within the routine surveillance system. Conclusions: Incidence rates of healthcare-associated infections in the Republic of North Ossetia–Alania are comparable to those in the Russian Federation. Patients of surgery departments are at higher risk for nosocomial infections. Optimization of preventive measures requires a risk-based approach that takes into account in-depth microbiological monitoring data on the most common pathogens resistant to drugs of choice in local hospitals.