Healthcare-related Infections Research Articles

Readmission, healthcare consumption, and mortality in Clostridioides difficile infection hospitalizations: a nationwide cohort study.

Despite being the most common healthcare-related infection in the US, nationwide data on readmission, healthcare consumption, and mortality in Clostridioides difficile infection (CDI) remain limited. We examined these outcomes in a US-based cohort of patients with CDI. We queried the 2017 Nationwide Readmission Database using ICD-10-CM codes to identify all adult patients admitted with a principal diagnosis of CDI. Primary outcomes were 30- and 90-day readmission rates. Secondary outcomes included mortality rates and healthcare consumption. Of the 83,865 patients discharged from an index hospitalization for CDI, 22.37% were readmitted within 30days, and an additional 15.01% were readmitted within 90days. Recurrent CDI was responsible for more than 30% of readmissions at both 30 and 90days. Compared to the index hospitalization, readmissions were characterized by higher mortality (1.41% index vs. 4.86% 30-day vs. 4.40% 90-day) and increased hospital length of stay and charges. Medicaid insurance (HR 1.16), cirrhosis (HR 1.31), Type 1 diabetes mellitus (HR 1.38), and end-stage renal disease (HR 1.36) were independently associated with 30-day readmission (all p < 0.01), with similar findings in 90-day readmissions. In a large cohort of patients hospitalized for CDI, we found that approximately 1 in 5 were readmitted within 30-days, and more than 1 in 3 within 90-days. Readmission was characterized by increased mortality and greater healthcare consumption. Additionally, we found independent associations for readmission that may help identify patients at high-risk. Prospective investigation is needed to identify means to reduce the healthcare consumption and mortality in CDI.

Outbreak of KPC-2 producing Serratia marcescens MDR in a tertiary hospital in the Midwest region, Brazil

About 700,000 deaths per year worldwide are caused of Healthcare-related infections (HAI). Result in significant patient morbidity and mortality, being is ranked the fourth leading cause of death in Brazil. Usually, HAI are caused by multidrug-resistance microorganisms (MDR), as well as Serratia marcescens, that is associated with healthcare-related infections causing high patient mortality and morbidity. This paper describes an outbreak of S. marcescens MDR carrier gene blaKPC-2 in a university hospital, with the need to broadly combat horizontal transmission of this bacterium between patients, as well as the need to optimize treatment with other antimicrobial classes due to resistance of this microorganism to polymyxins. Ten isolates were analyzed for the presence of carbapenemic resistance gene blaKPC-2. This gene was detected in all isolates, with a corresponding high patient mortality rate, highlighting the importance of its molecular detection, which corroborates the resistance of S. marcescens to carbapenem antibiotics. The detection of this gene is necessary due to the importance to broadly combat horizontal transmission of this bacterium between patients, as well as the need to optimize treatment with other antimicrobial agents due to its resistance to polymyxins.

Factors related to mortality by pneumonia unrelated to mechanical ventilation

Objective: to analyze the factors related to mortality by nosocomial pneumonia unrelated to mechanical ventilation. Methods: retrospective cohort study with a sample acquired using the 538 notification forms for health care-related infections. The relative risk was calculated and a multivariable analysis was carried out using Poisson regression with a significance level of 5%. Results: the multivariable analysis showed that being under 59 years old and taking only one antimicrobial drug were protective factors against death. The main microorganisms responsible for the increase in the risk of death were: Acinetobacter baumannii, Klebsiella pneumoniae and species of Candida (Candida spp). Conclusion: the factors related to mortality were being 60 years old or older, using two or more antimicrobial substances, and being affected by the microorganisms Acinetobacter baumannii, Klebsiella pneumonia, and species of Candida (Candida spp).

Farklı Alanlarda Çalışan Hemşirelerin Profesyonel Tutumlarının İzolasyon Önlemleri Uyumlarına Etkisi

Objective: This research was conducted as a descriptive and cross-sectional study in order to determine the effect of professional attitudes of nurses working ın different areas on the compliance of isolation precautions. Materials and Methods: This study was a correlational, cross-sectional and descriptive design and was conducted with 351 nurses employed in a university hospital in the north of Turkey. The data were collected through a questionnaire prepared by the researchers and the Inventory of Professional Attitude at Occupation and a Scale Compliance with Isolation Precautions. The data were collected between March and May 2019. In the analysis of the data, t test, Kruskal-Wallis test, Mann Whitney U test and variance analysis (ANOVA) were used.Results: 94% of the nurses received training on health care-related infections. It was observed that professional attitude at occupation was higher in nurses over the age of 41, single, having a 16-20 years of clinical experience and working as nurse manager, and showed statistically significant difference (p &amp;lt;0.05). In addition, it was observed that nurses working in intensive care units were more compliance with isolation precautions than nurses working in other fields and showed a statistically significant difference (p &amp;lt;0.05). It was detected that scale compliance with isolation precautions mean score of the nurses was 61.16±4.70 and professional attitude at occupation scale mean score was 135.77±17.17, and there was a significant, positively and weak relationship between the two scales (r=0.148, p&amp;lt;0.000).Conclusion: Although the nurses' professional attitude score averages were high, compliance with the isolation measures was above the average. In the study, it was determined that the professional attitude score of the nurses was high, and some sociodemographic characteristics of the nurses affect their professional attitudes.

Effectiveness of fecal microbiota transplant for the treatment of Clostridioides difficile diarrhea: a systematic review and meta-analysis.

Clostridioides difficile is a major cause of health-care related infections and antibiotic-associated diarrhea. High recurrence rates following antibiotic treatment, along with the emergence of hypervirulent and multidrug resistant ribotypes makes essential the development of safe, effective, novel therapies for the treatment of C. difficile infections. The primary outcome evaluated in this meta-analysis was the effectiveness of fecal microbiota transplantation (FMT). Secondary outcomes were the proportion of patients suffering adverse effects along with the most effective administration route. The mean treatment effectiveness was 82% (95% CI: 75-89). Overall, patients receiving FMT via colonoscopy experienced more adverse effects than patients whom received enema, or oral capsules (71·6% vs 40·2%, and 35·3% respectively). Comparing administration of FMT by colonoscopy versus enema resulted in a Hedges' g of -0·74 (95% CI of -0·9 to -0·58), indicating a slight advantage in favor of colonoscopy. The comparison between colonoscopy and capsule returned a Hedges' g of 0·44 (95% CI of 0·20-0·69), indicating that delivery of the FMT by capsule was statistically significantly more effective. FMT provides an effective and safe treatment for C. difficile diarrhea. Further research into the efficacy of different preparation protocols is needed.

Environmental and clinical isolates of Herbaspirillum induce pulmonary infection in mice and its secretome is cytotoxic to human lung cells.

Introduction. In recent years, the Herbaspirillum genus has emerged as a pathogen in healthcare-related infections and has became stablished as an opportunistic pathogen.Hypothesis/Gap Statement. Little is known about the pathogenesis induced by Herbaspirillum genus.Aim. To evaluate the cytotoxic effects of genus Herbaspirillum, its ability to adhere to lung human cells and the ability of environmental and clinical strains of Herbaspirillum to induce pneumonia in mice.Methodology. Environmental and clinical isolates of Herbaspirillum were examined for their cytotoxic effects on the Calu-3 cell lineage. Cytotoxic activity of secretome was tested using MTT/neutral red assays and cell morphology analysis. Herbaspirillum adhesion on Calu-3 cells was assessed using bright-field microscopy and cell-associated bacteria were counted. A mouse model of acute lung infection was done using a clinical and an environmental strain. Adult male mice were used, and the pneumonia was inducted by intra-tracheal inoculation of 108 or 109 bacteria. Mice weight variations were evaluated at the end of the experiment. Bronchoalveolar lavage was collected and evaluated for total and differential cytology. A histological examination of lungs was performed giving a histological score.Results. The secretomes of all the strains induced morphological alterations in cells, but only H. seropedicae SmR1 were cytotoxic in MTT and neutral red assays. Clinical strains of H. frisingense AU14459 and H. hutttiense subsp. huttiense AU11883 exhibited low adherence to lung cells, while SmR1 was non-adhesive. Following intratracheal inoculation, mice treated with 109 c.f.u. of the SmR1 and AU11883 strains lost 18 and 6% of their weight over 7 days, respectively, and presented moderate clinical signs. Infected mice showed inflammatory cell infiltration in the perivascular and peribroncheal/peribronchiolar spaces. Bronchoalveolar fluid of mice inoculated with SmR1 109 c.f.u. presented an increase in total leucocyte cells and in neutrophils population.Conclusion. These in vivo and in vitro results provide insights into how some Herbaspirillum strains cause infection in humans, providing a basis for the characterization of pathogenesis studies on this emerging infectious agent.

OZONIZED AND NATURAL COMPOUNDS FOR IN VITRO ACINETOBACTER BAUMANNII TREATMENT

Acinetobacter baumannii stands out as an opportunistic pathogen responsible for Healthcare-Related Infections. This study aimed to evaluate the efficacy of natural oils in natura and ozonated on A. baumannii mortality. The randomized experiment used the A. baumannii strain and natural oils (palm, canola, and coconut) ozonized and in natura (control group). Minimum inhibitory and bactericidal concentrations and chromatography were employed in the study. Through the ozonized and fresh oils antimicrobial action, the natural oils' effectiveness and the bacteria mortality were evaluated. The data was submitted to the Mann-Whitney and Kruskal-Wallis tests. When comparing the natural oils, ozonized canola oil stood out as the most efficient in destroying the bacteria. The other ozonized oils showed a 90% reduction in the microbial load in the first ten minutes of treatment. For use in natura, palm oil stood out with 85.9% microbial load reduction. According to the results obtained, the antibacterial activity of natural oils is remarkable, showing that they were expressively effective in inhibiting the A. baumannii growth, presenting themselves as a new adjuvant therapy antibacterial drug. The study concluded that the ozonized oils are more efficient in both MIC and MBC when compared between the ozonized and the untreated groups. The bacteria are sensitive to the ozonized oils.

Assessment of Knowledge, Attitude and Practice on Prevention of Catheter-associated Urinary Tract Infection (CAUTI) among Health Care Professionals Working in a Tertiary Care Teaching Hospital

Catheter-associated Urinary Tract Infection (CAUTI) is a common healthcare-related infection occurring in patients admitted for various ailments. Approximately 80% of hospital acquired Urinary Tract Infections (UTIs) are catheter associated. The purpose of the current research was to find out the level of knowledge, attitude and practice on prevention of CAUTI among healthcare professionals working in tertiary care hospital. A descriptive study was done among 95 health care working in tertiary care hospital in Chennai. The researchers administered standard questionnaire and statistically explored the knowledge, attitude, and practice levels about prevention of CAUTI among the participants. Among 95 participants, 28.4% and 71.6% of the individuals had moderately adequate knowledge and adequate knowledge about CAUTI. About 4.2% of the participants had unfavourable, 88.4% had moderately favourable and 7.4% had favourable attitude towards prevention of CAUTI. About 4.2% of the individuals had moderately adequate and 95.8% had adequate practice towards the prevention of CAUTI. There was significant correlation between attitude and practice. The professional experience of the participants showed statistically significant association with the level of practice among the demographic variables. In our present study, we found out that health care professionals had adequate knowledge, attitude, and practice on prevention of CAUTI. Medical education programs, frequent auditing with a checklist about catheter care must be conducted to maintain the achieved knowledge and practice levels.

Acquiring Hepatitis-C Viral Infection during Maintenance Hemodialysis Patients at DHQ Hospital Sheikhupura:

Background: End stage kidney disease (ESKD) is one of the end results of chronic kidney disease. In center hemodialysis is the most common renal replacement therapy (RRT) for these patients used in Pakistan. It is associated with increased risk of health care-related infections. Hepatitis-C is the frequent blood born viral infection in hemodialysis center. Its frequency is very high in hemodialysis patients as compared to general and even to thalassemia population.&#x0D; Purpose of the study: To assess the gravity of Hepatitis-C viral infection in hemodialysis patients.&#x0D; Methods: A retrospective cross-sectional study done in dialysis center of DHQ hospital Sheikhupura, Punjab, Pakistan in January 2018. All the patients who had started hemodialysis with HCV negative status and had remained on hemodialysis for more than three months were included in the study. Patients with Hepatitis-C positive status, acute kidney disease and on dialysis less than three months were excluded. All patients were tested by enzymes linked immune-sorbent essay (ELISA) method for HCV status.&#x0D; Results: Out of 153 Hepatitis-C negative patients at the time of initiation of dialysis, 60 (39.21 %) converted positive while 93 (60.78 %) were still HCV negative by ELISA method at the time of study. Number of dialysis were having significant p value.&#x0D; Conclusion: Most of the patients had acquired Hepatitis-C infection during in-center hemodialysis. This emphasizes the importance of stringent infection prevention and control practices

Identification of Methicillin-Resistant Staphylococcus Aureus From Methicillin-Sensitive Staphylococcus Aureus and Molecular Characterization in Quanzhou, China.

To distinguish Methicillin-Resistant Staphylococcus aureus (MRSA) from Methicillin-Sensitive Staphylococcus aureus (MSSA) in the protein sequences level, test the susceptibility to antibiotic of all Staphylococcus aureus isolates from Quanzhou hospitals, define the virulence factor and molecular characteristics of the MRSA isolates. MRSA and MSSA Pfam protein sequences were used to extract feature vectors of 188D, n-gram and 400D. Weka software was applied to classify the two Staphylococcus aureus and performance effect was evaluated. Antibiotic susceptibility testing of the 81 Staphylococcus aureus was performed by the Mérieux Microbial Analysis Instrument. The 65 MRSA isolates were characterized by Panton-Valentine leukocidin (PVL), X polymorphic region of Protein A (spa), multilocus sequence typing test (MLST), staphylococcus chromosomal cassette mec (SCCmec) typing. After comparing the results of Weka six classifiers, the highest correctly classified rates were 91.94, 70.16, and 62.90% from 188D, n-gram and 400D, respectively. Antimicrobial susceptibility test of the 81 Staphylococcus aureus: Penicillin-resistant rate was 100%. No resistance to teicoplanin, linezolid, and vancomycin. The resistance rate of the MRSA isolates to clindamycin, erythromycin and tetracycline was higher than that of the MSSAs. Among the 65 MRSA isolates, the positive rate of PVL gene was 47.7% (31/65). Seventeen sequence types (STs) were identified among the 65 isolates, and ST59 was the most prevalent. SCCmec type III and IV were observed at 24.6 and 72.3%, respectively. Two isolates did not be typed. Twenty-one spa types were identified, spa t437 (34/65, 52.3%) was the most predominant type. MRSA major clone type of molecular typing was CC59-ST59-spa t437-IV (28/65, 43.1%). Overall, 188D feature vectors can be applied to successfully distinguish MRSA from MSSA. In Quanzhou, the detection rate of PVL virulence factor was high, suggesting a high pathogenic risk of MRSA infection. The cross-infection of CA-MRSA and HA-MRSA was presented, the molecular characteristics were increasingly blurred, HA-MRSA with typical CA-MRSA molecular characteristics has become an important cause of healthcare-related infections. CC59-ST59-spa t437-IV was the main clone type in Quanzhou, which was rare in other parts of mainland China.

PROFILE OF NEONATAL INFECTIONS IN A MATERNITY OF REFERENCE IN THE STATE OF PIAUÍ

Health Care Related Infections (HAI) can be defined as those acquired through hospital procedures. In 2018, it was estimated that 5.3 million children worldwide died from preventable causes, most in the neonatal period. In Brazil, 60% of infant mortality occurs in the neonatal period, with neonatal infections being the main causes. The objective of this work, then, was to know the profile of neonatal infections in a reference maternity hospital in the state of Piauí. This is a retrospective, descriptive, exploratory, cross-sectional study with a quantitative approach on the profile of HAIs in Neonatal Intensive Care Units (NICU). It was observed that 54.79% of the registered HAI cases were Primary Bloodstream Infection and it was observed that the global density of infections was 55.6 infections/1,000 patients/day. The incidence density of IPCSL by central venous catheter/day in the unit was at an average of 24.32 per year, a number that is higher than that reported in the literature. In 463 cases of infection, the main isolated microorganism associated with episodes of infections was coagulase-negative Staphylococcus (SCoN) (229 cases). In view of these aspects, the study revealed high rates of incidence and prevalence of HAIs in the NICU, as well as the main microorganisms responsible for these infections. It reinforces the importance of implementing measures to be adopted for the treatment and/or prevention of HAIs in order to optimize the care provided to newborns.

Pre- and post-COVID-19 evaluation of antimicrobial susceptibility for healthcare-associated infections in the intensive care unit of a tertiary hospital.

INTRODUCTION: Antimicrobial resistance has worsened since the onset of COVID-19. METHODS: This study involved patients admitted to the adult intensive care unit (ICU) of a tertiary hospital. Pre- and post-COVID-19 data were analyzed. The healthcare-related infections (HCRIs) reported between January 2018 and January 2020 and during the pandemic between February and July 2020 were compared. RESULTS: Antimicrobial resistance increased during the pandemic, especially for Klebsiella pneumoniae isolates, with a rate increase from 5% to 50% for Polymyxin B. CONCLUSIONS: The susceptibilities of the main pathogens associated with HCRIs in the ICU changed and should be considered in managing severe COVID-19.

Antimicrobial Resistance in Enterococcus faecalis and Enterococcus faecium Bacteria Isolated from Bloodstream Infections: A Single-Center Evaluation

Objective: Enterococci are an important cause of healthcare-related bloodstream infections. The present study aimed to contribute to form empirical treatment models that can be used in the treatment of Enterococcus faecalis and Enterococcus faecium bacteria isolated from bloodstream infections in our hospital by reviewing their resistance status against antibiotics, requently used in the treatment of these bacteria. Methods: In our study, the resistance status of E. faecalis and E. faecium bacteria isolated from bloodstream infections in Sivas Cumhuriyet University, Health Services Practice and Research Hospital between January 2015 and June 2020 against ampicillin, amoxicillin, clavulanic acid, high-level gentamicin, linezolid, teicoplanin, and vancomycin was examined retrospectively. The diagnosis of healthcare-related bloodstream infections was made using the diagnostic criteria of “Centers for Diseases Control and Prevention (CDC).” Results: A total of 227 enterococcal isolates were evaluated within the scope of our study between the specified dates. The percentage of patients with Enterococcus bacteria isolated in their blood cultures were 44.5% male, and 55.5% female. Of the isolates, 60.8% were identified as E. faecalis and 39.2%as E. faecium. High-level gentamicin resistance was found to be 25.3% in E. faecalis isolates, and no resistance was found against vancomycin, teicoplanin, and linezolid. In E. faecium isolates, while the highest resistance was observed against amoxicillin-clavulanic acid and ampicillin with 87.6%, vancomycin resistance was determined to be 3.3%. No resistance to linezolid was identified. Conclusions: Enterococci cause life-threatening infections and there are some difficulties in the treatment. Especially since E. faecium has higher resistance against antibiotics, the agents to be chosen in the treatment of infections caused by these bacteria are limited. Therefore, the current local resistance data will be useful in developing rapid and appropriate treatment models, especially in cases when empirical treatment is required. We think that our study will contribute to the literature in this regard.

Investigation of catheter-related urinary tract infections in intensive care unit patients of anesthesiology and reanimation

Amaç: Bu çalışmanın amacı, Ankara Eğitim ve Araştırma Hastanesi, Anesteziyoloji ve Reanimasyon yoğun bakım ünitesinde yatan hastalarda gelişen kateter ilişkili üriner sistem infeksiyonlarının hızlarının ve infeksiyon etkenlerinin retrospektif değerlendirilmesidir.&#x0D; Gereç ve Yöntemler: Çalışmaya, 1 Ocak 2018-31 Aralık 2019 tarihleri arasında Anesteziyoloji ve Reanimasyon yoğun bakım ünitesi (ARYBÜ)’nde yatan ve kateter ilişkili üriner sistem infeksiyonu tanısı konulan hastalar dahil edildi. Hasta verileri enfeksiyon kontrol hemşirelerinin günlük vizitleri ve enfeksiyon hastalıklarının günlük konsültasyon kayıtlarından ve Ulusal Hastane Enfeksiyonları Sürveyans Ağı İNFLİNE programı verilerinden, laboratuvar verileri ise Mikrobiyoloji laboratuarından elde edildi. Hastaların demografik verileri, üriner kateterle ilişkili enfeksiyonları, enfeksiyon etkenleri, hastalardaki komorbid durumların varlığı kaydedildi.&#x0D; Bulgular: Anesteziyoloji ve Reanimasyon yoğun bakım ünitesinde iki yıllık sürede 17910 hasta gününde 1243 hasta takip edilmişti. Hastaların üriner kateter günü 17470 gün idi. Çalışmanın yapıldığı dönemde toplam 85 hastaya 116 Kİ-ÜSİ tanısı konuldu. Üriner kateter kullanım oranı 0.97, kateterle ilişkili üriner sistem infeksiyonu hızı (Kİ-ÜSİ) ise 6.63 olarak saptandı. 2019 yılı Sağlık Bakanlığı Eğitim ve Araştırma Hastaneleri ARYBÜ’lerinin sürveyans verileri ile karşılaştırıldığında; hastanemizin ARYBÜ üriner kateter kullanım oranının %25 persentil ile uyumlu olduğu, Kİ-ÜSE hızının ise %90 persentilin üzerinde olduğu saptandı.Hastaların 47 (% 55)’si kadın, 38 (%45)’i erkek, yaş median değeri 66 idi. Hastaların tümünde üriner kateter mevcuttu. Hastalarda görülen komorbid hastalıklar; 44 (%51.8) hastada nörolojik hastalık (serebrovasküler olay, demans vb.), 40 (%47.1) hastada hipertansiyon, 28 (%32.9) hastada diyabetes mellitus, 20 (%23.5) hastada KOAH ve iki (%2.4) hastada kronik böbrek hastalığı olarak belirlendi. Hastaların 72 (%84.7)’si entübe idi ve 19 (%22.4)’unda dekübit ülseri mevcuttu. Kİ-ÜSİ etkenlerinin dağılımı incelendiğinde 27 (%31.8) hastada birden fazla etkenin izole edildiği görüldü. Üriner sistem etkenleri 18 (%21.2) hastada Klebsiella türleri (spp.), 10 (%11.8) hastada Escherichia coli, dokuz (%10.6) hastada Enterococcus spp.,sekiz (%9.4) hastada Pseudomonas spp., yedi (%8.2) hastada Proteus spp., dört (%4.7) hastada Acinetobacter spp., bir (%1.2) hastada Staphylococcus aureus ve bir (%1.2) hastada Enterobacter spp. olarak belirlendi. Kİ-ÜSİ saptanan 85 hastanın 19’unda kan kültüründe de aynı etken izole edildi. Kan kültüründen en sık izole edilen etkenler sırasıyla; altı olguda birden fazla etken, yedi Klebsiella spp., iki E. coli ve iki Enterococcus spp., bir Acinetobacter spp., bir Proteus spp. olarak belirlendi. &#x0D; Sonuç: Yoğun bakım ünitelerinde kateter ilişkili üriner sistem infeksiyonu oranlarının azaltılması için üriner kateter takılması endikasyonlarının iyi belirlenmesi, gereklilik ortadan kalktığında kateterin çekilmesi ve enfeksiyon kontrol önlemlerine dikkat edilmesi uygun bir yaklaşım olacaktır. Yoğun bakım ünitesinde yatan hastalarda hastane infeksiyonu etkenlerinin belirlenmesi, ampirik tedavide yol gösterici olacağından mortalite ve morbidite oranlarının azaltılmasına da katkı sağlayacaktır.

Infectious complications related to medical tourism

Medical tourism has been increasing dramatically globally, with people travelling from developed countries to low-income or middle-income countries, often to avoid high costs or long delays associated with seeking healthcare in their countries of origin. The current review summarizes healthcare-related infections associated with medical tourism, focusing on cosmetic surgery and organ transplantation. A systematic MEDLINE and PubMed search from January 2010 to December 2019 yielded 80 relevant articles, including 49 articles on medical tourism-related infections focusing on cosmetic surgery and organ transplantation, which were included in this reviews. The literature reveals specific types of cross-border, healthcare-related infections depending on medical intervention. Destinations include low-income countries such as countries of Asia and the Indian subcontinent, middle-income countries including Central and South America, and high-income countries such as the United States and Europe. In terms of type of infections, in 36 (68%) and 15 (28.3%) studies, wound and blood-borne infections were documented, respectively, while in 21 studies (58.3%) non-tuberculous mycobacteria were isolated, including Mycobacterium abscessus, Mycobacterium chelonae, Mycobacterium senegalense and Mycobacterium fortuitum. The choices of medical tourists could have significant consequences for them and their home countries, including infectious complications and importation of pathogens, particularly antibiotic-resistant microorganisms, with public health implications. There is a need for public health strategies in order to prevent morbidity and mortality as well as future management and education of patients engaging in medical tourism.

Prevention of Central Venous Catheter Associated Infections Using Boron Carbon Nitride (BCN) Thin Films

Central line-associated blood stream infections (CLABSIs) are the infections caused due to use of central venous catheters in patients. Implanted catheters are susceptible to bacterial colonization, biofilm formation and consequently resulting in infection. CLABSIs continue being important and preventable health-care related infection. Of all the healthcare associated infections, CLABSIs make up to 250,000 cases per year in the US with mortality of up to 35% [1]. Additionally, these infections are associated with high hospital stay durations leading to extremely high cost burden accounting to ~$46,000 per case [2]. However, central venous catheters are imperative in delivery of fluids and medications and to monitor the patient health. Current approach to mitigate this problem heavily focusses on deposition of coatings, inhibiting bacterial adhesion and reducing biofilm formation.In this study, boron carbon nitride (BCN) coatings will be incorporated on central venous catheters for the first time. Boron carbon nitride (BCN) films have achieved attention owing to their crystal structure and unique properties. BCN compounds are expected to combine excellent properties of diamond, boron carbide and boron nitride with their properties adjustable depending on their composition and structure[3]. B-C-N ternary compounds have been reported previously for biological applications [4-7]. Influence of BCN coating on bacterial colonization of gram-positive and gram-negative bacteria will be investigated. BCN films will be deposited using RF sputtering technique.

Strategy for Increasing Alcohol Gel Consumption Based on Realistic Simulation, Opinion of Healthcare Workers, Structure Adequacy and Change in Alcohol Product

Background: Healthcare-related infections (HAIs) imply higher morbidity and mortality, length of hospitalization, and costs to institutions and the health system. An important practice for HAI control is hand hygiene. Due to the need for greater adherence to the practice of hand hygiene, as well as understanding about behavior and motivations related to actions associated with infection control, we conducted this study based on inquiry and intervention. Objectives: To describe the increase in adherence to hand hygiene through a multimodal strategy based on realistic simulation, inquiry, change of alcohol and training on actions related to infection control. Methods: In May 2018, a survey was administered to healthcare workers (HCW) regarding structure, process, and behavior related to hand hygiene. Training was also performed, which simulated a bed marked with GloGerm (later revealed with the application of black light), performing tasks by professionals, and completing a test. In November 2018, the structure of hand hygiene and points at which the alcoholic product was offered were redefined, and the alcohol-based product and its dispensers were exchanged. In December 2018, an educational campaign on hand hygiene and change disclosure was held. In February 2019, a new survey was applied to employees. Alcohol consumption was measured per patient day in the periods and compared with the historical average. Results: In the first application of the survey, 263 HCW reported dissatisfaction with hand hygiene structure (46% preferred water and soap). Most reported that training and structure would improve adherence. The training took place for 540 HCWs from many different professional positions. Alcohol gel consumption had a sustained increase from an average of 37 mL per patient day in the first semester to 49 mL per patient day in the second semester. After the product change and the new hand hygiene campaign, a second relevant and sustained increase has took place: the first 4-month average in 2019 was 67 mL per patient day. In the second survey, conducted with 187 HCWs, there was an increase in preference for alcohol-based product from a wall dispenser (from 38% to 62%).Funding: NoneDisclosures: None

Operating Room Nurses’ Knowledge of Surgical Site Infection Prevention Measures

Background: Surgical site infection (SSI) stands out among healthcare-related infections as one of the most important globally due to its associated morbidity and mortality. However, it is well known that the transoperative period is recognized as one of the most critical moments for the prevention of SSI. Objective: We evaluated the knowledge of the operating room (OR) nurse coordinators regarding SSI prevention measures. Methods: We conducted a cross-sectional study in 30 large hospitals in the state of Minas Gerais, Brazil, from February 2018 to April 2019. Data were collected through interviews with OR nurse coordinators. Results: Administration time of prophylactic antibiotic administered between 30 and 60 minutes prior to surgery was reported by 84% of the professionals and the suspension of this agent in the first 24 hours was reported by 47.8%. Preoperative hair removal within the operating room was mentioned by 60% of respondents and 36.7% mentioned using a razor. The Safe Surgery program of the WHO was unknown to 6.7% of nurses. Among those who knew about it, 20.8% stated that there was no surgical site demarcation. Presentation of the surgical team occurred before the beginning of the procedure in only 53.3% of the institutions. Patient surveillance for SSI was reported by 93.3% of respondents, but the criteria adopted for the diagnosis of SSI were unknown, even though SSI rates were given for 90% of services, predominantly via meetings (53.5%). Conclusions: The knowledge of nurses related to the prevention of SSI was not satisfactory, pointing to the need for immediate efforts in education and awareness programs. Such programs may facilitate changes in practice through the recognition of surgical patient risk by these professionals, thus leading to better planning and practice during the trans-operative period.Funding: NoneDisclosures: None

Colonization of Resistant Microorganisms in Renal Transplants

Background: Kidney transplant recipients are a group of patients at risk for healthcare-related infections. The results of this study make an important clinical contribution and contribute to findings options to decrease the infection-related morbidity and mortality that affects this patient population. Objectives: We evaluated the prevalence of colonization by multidrug-resistant bacteria, Klebsiella pneumoniae carbapenemase (KPC)–producing bacteria, vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA) in renal transplant patients; we identified the infection rate, morbidity, and mortality in this population. Methods: Prospective cohort study was conducted at the Kidney and Hypertension Hospital from 2012 to 2015. This project was approved by the Unifesp Research Ethics Committee (no. 1630/11) and an informed consent form was obtained from patients included in the study. Study protocol: Data collection was performed in 2 phases: within the first 24 hours after transplantation and 7 days after transplantation. For all included patients, the following data were collected: identification data, clinical data, and laboratory tests of the first day in the study. All included patients (colonized or not) were followed prospectively for 6 months or until treatment change or death. Results: The study included 200 renal transplant patients in accordance with the inclusion and exclusion criteria. We observed that 76 (38%) patients included in our sample were colonized; 8% S. aureus, 11% Enterococcus, and 19% K. pneumoniae. We verified the presence of concomitant colonization of 1 or more of these pathogens. The most prevalent concomitance identified in our population was E. coli and K. pneumoniae. We identified the presence of diabetes and diabetes associated with hypertension as risk factor for colonization. Thus, patients with more systemic complications may be at risk for colonization by multidrug-resistant bacteria. Another risk factor for colonization was antibiotic use in the 6 months prior to transplantation. Transplant-related outcomes were length of stay after transplantation, delayed graft function (ie, dialysis after the transplantation) and postoperative care in an intensive care unit. At the 6-month follow-up, we identified urinary infection and surgical site infection as risk factors. One death occurred due to stroke in the group of colonized patients, unrelated to infectious causes. Conclusions: These results show fundamental aspects for health professionals for bacterial characterization, transmission, and resistance mechanisms and, mainly, tools for prevention and control of multidrug-resistant bacteria from patients colonized under conservative treatment before the complexity of high-risk procedures begins, such as dialysis and transplantation to reduce morbidity and mortality.Funding: FAPESP São Paulo Research Support FoundationDisclosures: None

Coexistence of the Oxazolidinone Resistance-Associated Genes cfr and optrA in Enterococcus faecalis From a Healthy Piglet in Brazil.

Oxazolidinones are one of the most important antimicrobials potentially active against glycopeptide- and β-lactam-resistant Gram-positive pathogens. Linezolid—the first oxazolidinone to be approved for clinical use in 2000 by the US Food and Drug Administration—and the newer molecule in the class, tedizolid, inhibit protein synthesis by suppressing the formation of the 70S ribosomal complex in bacteria. Over the past two decades, transferable oxazolidinone resistance genes, in particular cfr and optrA, have been identified in Firmicutes isolated from healthcare-related infections, livestock, and the environment. Our goals in this study were to investigate the genetic contexts and the transferability of the cfr and optrA genes and examine genomic features, such as antimicrobial resistance genes, plasmid incompatibility types, and CRISPR-Cas defenses of a linezolid-resistant Enterococcus faecalis isolated in feces from a healthy pig during an antimicrobial surveillance program for animal production in Brazil. The cfr gene was found to be integrated into a transposon-like structure of 7,759 nt flanked by IS1216E and capable of excising and circularizing, distinguishing it from known genetic contexts for cfr in Enterococcus spp., while optrA was inserted into an Inc18 broad host-range plasmid of >58 kb. Conjugal transfer of cfr and optrA was shown by filter mating. The coexistence of cfr and optrA in an E. faecalis isolated from a healthy nursery pig highlights the need for monitoring the use of antibiotics in the Brazilian swine production system for controlling spread and proliferation of antibiotic resistance.