Healthcare-acquired Infections Research Articles

Infection Prevention and Control in Public Hospitals and COVID-19 Temporary Treatment and Monitoring Facilities in the Philippines: Results of a Baseline Survey

Infection prevention and control measures are effective at protecting patients and healthcare workers from healthcare-acquired infections, averting onward transmission of the disease and mitigating the impact of the outbreak on the healthcare system. This study assessed the compliance of public hospitals and isolation facilities with a set of standards for COVID-19 infection prevention and control. A 35-point questionnaire was developed and utilized to collect data from selected facilities in 38 local government units across the country. Descriptive statistics were used to analyze the data, and differences between island groups were tested using Pearson’s χ2 test for categorical variables. The results indicate that hospitals reported better infection prevention and control preparedness and compliance than temporary treatment and monitoring facilities in the domains of engineering and administrative controls. However, weak compliance was observed in a number of indicators for waste management in both types of facilities. These suggest that periodic monitoring and the augmentation of resources are necessary to sustain adherence to standards and to immediately address compliance gaps. In addition, systemic improvements through sufficient planning and long-term investments are required to sustain infection prevention and control practices over time.

Trends in Pseudomonas aeruginosa (P. aeruginosa) Bacteremia during the COVID-19 Pandemic: A Systematic Review.

Pseudomonas aeruginosa (P. aeruginosa) is among the most common pathogens associated with healthcare-acquired infections, and is often antibiotic resistant, causing significant morbidity and mortality in cases of P. aeruginosa bacteremia. It remains unclear how the incidence of P. aeruginosa bacteremia changed during the Coronavirus Disease 2019 (COVID-19) pandemic, with studies showing almost contradictory conclusions despite enhanced infection control practices during the pandemic. This systematic review sought to examine published reports with incidence rates for P. aeruginosa bacteremia during (defined as from March 2020 onwards) and prior to the COVID-19 pandemic. A systematic literature search was conducted in accordance with PRISMA guidelines and performed in Cochrane, Embase, and Medline with combinations of the key words (pseudomonas aeruginosa OR PAE) AND (incidence OR surveillance), from database inception until 1 December 2022. Based on the pre-defined inclusion criteria, a total of eight studies were eligible for review. Prior to the pandemic, the prevalence of P. aeruginosa was on an uptrend. Several international reports found a slight increase in the incidence of P. aeruginosa bacteremia during the COVID-19 pandemic. These findings collectively highlight the continued importance of good infection prevention and control and antimicrobial stewardship during both pandemic and non-pandemic periods. It is important to implement effective infection prevention and control measures, including ensuring hand hygiene, stepping up environmental cleaning and disinfection efforts, and developing timely guidelines on the appropriate prescription of antibiotics.

The Klebsiella pneumoniae ter Operon Enhances Stress Tolerance.

Healthcare-acquired infections are a leading cause of disease in patients that are hospitalized or in long-term-care facilities. Klebsiella pneumoniae (Kp) is a leading cause of bacteremia, pneumonia, and urinary tract infections in these settings. Previous studies have established that the ter operon, a genetic locus that confers tellurite oxide (K2TeO3) resistance, is associated with infection in colonized patients. Rather than enhancing fitness during infection, the ter operon increases Kp fitness during gut colonization; however, the biologically relevant function of this operon is unknown. First, using a murine model of urinary tract infection, we demonstrate a novel role for the ter operon protein TerC as a bladder fitness factor. To further characterize TerC, we explored a variety of functions, including resistance to metal-induced stress, resistance to radical oxygen species-induced stress, and growth on specific sugars, all of which were independent of TerC. Then, using well-defined experimental guidelines, we determined that TerC is necessary for tolerance to ofloxacin, polymyxin B, and cetylpyridinium chloride. We used an ordered transposon library constructed in a Kp strain lacking the ter operon to identify the genes that are required to resist K2TeO3-induced and polymyxin B-induced stress, which suggested that K2TeO3-induced stress is experienced at the bacterial cell envelope. Finally, we confirmed that K2TeO3 disrupts the Kp cell envelope, though these effects are independent of ter. Collectively, the results from these studies indicate a novel role for the ter operon as a stress tolerance factor, thereby explaining its role in enhancing fitness in the gut and bladder.

Implementation of A Year-Long Antimicrobial Stewardship Program in A 227-Bed Community Hospital in Southern Italy.

Healthcare-Acquired Infections (HAIs) are serious healthcare complications affecting hospital stay, in-hospital mortality, and costs. Root cause analysis has identified the inappropriate use of antibiotics as the main causative factor in the expansion of multi-drug-resistant organisms (MDRO) in our hospital. An Antimicrobial Stewardship (AMS) program was implemented to optimize antibiotic use, limit the development of resistance, improve therapeutic efficacy and clinical outcomes, and reduce costs. The stewardship strategies were: antimicrobial oversight on "critical" antibiotics; the development of hospital guidelines on antibiotic selection with the production of a consensus document; the implementation of clinical and management control algorithms with visual impact and Business Intelligence methods; training and updating; and the monitoring of outcome measures and process indicators. Clinical outcomes: length of stay reduced by 0.23 days, hospital readmission/first month rates decreased by 19%, and mortality for infections reduced by 8.8%. Microbiological Outcomes: Clostridium Difficile colitis incidence reduced by 9.1%.Economic Outcomes: Reduction in antimicrobial costs by 35% on average fee/discharged patient. The systematic application of the AMS program in a small hospital led to multiple improvements in clinical, microbiological, and economic outcome measures. The analysis of the core indicators for our hospital AMS program showed a significant adherence to the model and hospital recommendations.

Incidence, predictors, and 30-day outcomes of Clostridioides difficile infection in patients undergoing cystectomy: A national database analysis

Clostridioides difficile infection (CDI) is the second most common health care acquired infection (HAI) and the most common gastrointestinal HAI, with an estimated 365,200 cases reported by the center for disease control in 2017. CDI continues to remain a major cause of inpatient admission and utilization of health care resources. This study aimed to determine the true incidence, risk factors, and outcomes of CDI in patients undergoing cystectomy. We conducted an analysis of patients undergoing cystectomy between 2015 and 2017 using the American college of surgeon National Surgical Quality Improvement Program to study the incidence, risk factors, and 30 day postsurgical outcomes associated with CDI following cystectomy. Developed by the American College of Surgery, this is a nationally validated, risk adjusted, and outcomes based program designed to determine and improve the quality of surgical and postsurgical care. The incidence of CDI following cystectomy was 3.6% in our patient cohort. About 18.8% of patients developed CDI following hospital discharge. None elective surgeries and complete cystectomy procedures had a higher rate of CDI. About 48.4% of patients with CDI had a preceding postoperative infection. Postoperative organ space infections, postoperative renal failure, postoperative sepsis, and septic shock were independently associated with the development of CDI, (all P < 0.05). Patients who developed postoperative CDI during hospitalization had lengthier hospital admissions than those who did not develop a CDI and had a higher risk of deep venous thrombosis formation. A sizable number of patients experience CDIs after cystectomy procedures in the USA, and CDI development is associated with an increase in length of stay and unplanned readmissions. Interventions and initiatives are needed to reduce this burden of disease.

A feasibility study of the use of medical clowns as hand-hygiene promoters in hospitals.

Healthcare-acquired infections (HAI) pose vast health and economic burdens. Proper hand-hygiene is effective for reducing healthcare-acquired infections (HAI) incidence, yet staff compliance is generally low. This study assessed the feasibility, acceptability and preliminary effect of employing medical clowns to enhance hand-hygiene among physicians and nurses. Staff perception of the intervention and its impact on hand-hygiene was assessed via self-report questionnaires. Nearly 1,500 hand-hygiene compliance observations were conducted in accordance with WHO guidelines before, during and after the intervention. In each of three hospitals in Israel, two departments were selected-one in which medical clowns routinely operate and one clown-naive department. Professional medical clowns acted as hand-hygiene promoters employing humorous tactics to encourage hand-sanitizing based on the WHO "5 Moments" model. The clown appeared in each department seven times during the 2-week intervention phase. Pre-intervention hand-hygiene compliance ranged from just over 50% to 80% across hospitals and departments. Overall, about 70% of nurses (N = 132) and 80% of physicians (N = 49) felt the intervention improved personal and departmental hand-hygiene, with large inter-department variation. Pre- to post-intervention hand-hygiene compliance increased by 4% -25% (3.5-14.8 percentage points) in four departments, three of which had low baseline compliance levels. Results of this feasibility study suggest that employing medical clowns as hand-hygiene promoters as a novel approach toward HAI prevention is feasible and welcome by hospital staff.

Prevalence and correlates of knowledge and practices regarding infection prevention and control, and triage in primary healthcare settings: A cross-sectional study in Bangladesh

Despite the high prevalence of healthcare-acquired infection in resource-limited settings, healthcare workers' (HCWs') knowledge and practices of infection prevention and control (IPC) and triage are not well-researched. We examined thisin Bangladesh's primary healthcare facilities (HCFs) during the COVID-19 pandemic. We surveyed 312 HCWs in 94 community clinics (CCs) and 90 family welfare centres (FWCs) in six districts from February to April 2021. We assessed HCWs' self-reported knowledge and observed practices in four domains: personal hygiene, medical instrument processing, waste management, and triage. We constructed a weighted composite knowledge score and estimated the association between knowledge and background characteristics using a generalised linear mixed effects model. Practices were described through univariate analysis. On a scale of 100, the mean composite knowledge score was 38.3 (SD: 13.3) overall and 44.0 (SD: 13.1) and 33.8 (SD: 11.6) for FWCs and CCs, respectively. The HCWs of FWCs were more aged, experienced, and educated than those of CCs. Knowledge score was the highest in personal hygiene and the lowest in medical waste segregation. Knowledge was significantly associated with HCWs' designation and education. Concerning practices, not more than one-third of the HCWs or HCFs, on average, followed the recommended protocols, except for wearing face masks while on duty (87.1%) and referring potential COVID-19 patients to higher-level facilities (68.3%). HCWs' capacity in instrument processing, waste management, and triage needs to be improved through formal education and training initiatives. Our study can contribute to the under-researched IPC and triage domains in resource-limited settings.

Beyond checklists: Using clinic ethnography to assess the enabling environment for tuberculosis infection prevention control in South Africa.

Sub-optimal implementation of infection prevention and control (IPC) measures for airborne infections is associated with a rise in healthcare-acquired infections. Research examining contributing factors has tended to focus on poor infrastructure or lack of health care worker compliance with recommended guidelines, with limited consideration of the working environments within which IPC measures are implemented. Our analysis of compromised tuberculosis (TB)-related IPC in South Africa used clinic ethnography to elucidate the enabling environment for TB-IPC strategies. Using an ethnographic approach, we conducted observations, semi-structured interviews, and informal conversations with healthcare staff in six primary health clinics in KwaZulu-Natal, South Africa between November 2018 and April 2019. Qualitative data and fieldnotes were analysed deductively following a framework that examined the intersections between health systems 'hardware' and 'software' issues affecting the implementation of TB-IPC. Clinic managers and front-line staff negotiate and adapt TB-IPC practices within infrastructural, resource and organisational constraints. Staff were ambivalent about the usefulness of managerial oversight measures including IPC protocols, IPC committees and IPC champions. Challenges in implementing administrative measures including triaging and screening were related to the inefficient organisation of patient flow and information, as well as inconsistent policy directives. Integration of environmental controls was hindered by limitations in the material infrastructure and behavioural norms. Personal protective measures, though available, were not consistently applied due to limited perceived risk and the lack of a collective ethos around health worker and patient safety. In one clinic, positive organisational culture enhanced staff morale and adherence to IPC measures. 'Hardware' and 'software' constraints interact to impact negatively on the capacity of primary care staff to implement TB-IPC measures. Clinic ethnography allowed for multiple entry points to the 'problematic' of compromised TB-IPC, highlighting the importance of capturing dimensions of the 'enabling environment', currently not assessed in binary checklists.

Catheter-Associated Urinary Tract Infection (CAUTI).

One of the most prevalent health-related illnesses globally is catheter-associated urinary tract infection (CAUTI). CAUTIs account for almost half of all hospital-acquired diseases. Most of the healthcare-acquired urinary tract infections result from catheter tubes implantation. These tubes connect a collecting system and the urinary bladder via the urethra. These are known as indwelling urinary catheters. The length of catheterization has a key role in starting bacteriuria since biofilm eventually forms on all of these devices. Despite the low percentage of people with bacteriuria who start showing symptoms, there is nevertheless a significant burden associated with these contamination due to the repeated use of indwelling urinary devices. Minimizing indwelling device usage and stopping the catheter as soon as medically possible are the two most crucial preventative measures for bacteriuria and infection when device use is required. Efforts to avoid catheter-acquired urinary infections must be implemented and monitored by infection control guidelines in healthcare institutions. These approaches include monitoring device use, the suitability of device justifications, and problems. Ultimately, technological advancements in device substances that inhibit colony generation will be necessary to avoid these infestations. There is still some way by which we can bring down the increased phenomenon of catheter-associated urinary tract contamination by maintaining hygiene while handling the catheter and patients and keeping the infected patients away or isolated from unaffected patients as a precaution. This article mainly focuses on an overview that helps with discussing prevention, risk factors, diagnosis, control and management of CAUTI.

199. A novel and scalable antimicrobial surface modification technology to prevent and mitigate implant related surgical site infections: an in-vivo safety and efficacy study

<h3>BACKGROUND CONTEXT</h3> Despite significant technological advancements in material science, a high level of hand-hygiene and systematic use of antiseptics and antibiotics, surgical site infections (SSI) are still to date the number one complication seen after surgery in the United States. Methicillin-resistant Staphylococcus aureus (MRSA) is the largest purveyor of health care-acquired infections (HCAI) and is responsible for significant morbidity and mortality. <h3>PURPOSE</h3> This study aimed to demonstrate the in-vivo safety and antibacterial efficacy of non-eluting titanium implants covalently bound with a novel broad-spectrum biocidal quaternary ammonium compound (DBG21) against MRSA biofilm. <h3>STUDY DESIGN/SETTING</h3> Subcutaneous MRSA infection mouse model comparing the antimicrobial efficacy of untreatedversusDBG21-treated titanium alloy discs. A separate comparative safety study was performed in the absence of infection. <h3>PATIENT SAMPLE</h3> Sixty-five 11-week-old balb/c mice. <h3>OUTCOME MEASURES</h3> Efficacy study: Number of adherent bacteria on implants (CFU) and in the surrounding tissue (CFU/g) at days 7 and 14. Safety study: systemic and subacute toxicity (clinical tolerance, blood tests and histology). <h3>METHODS</h3> Efficacy Study: TiAl6V4 discs, 6mm ø, 0.5 mm thick, were activated, dip-coated in a polymer solution, and baked to produce covalently bound DBG21-treated discs. Untreated TiAl6V4 discs were used as controls. All discs underwent subsequent sterilization by 25kGy gamma-irradiation, were implanted either untreated for control mice or DBG21-treated for treated mice, and were challenged with a high-bacterial inoculum of MRSA (ATCC43300) in a well-established subcutaneous infection mouse model (11-week-old balb/c) in the absence of antibiotics. A veterinary ethics committee validated the protocol. Sixty-five mice (33 controls, 32 treated) were included in an antibacterial efficacy study. After implantation of one disc in a posterior subcutaneous pocket and closure of the skin for each mouse, 7 log10CFU (colony forming units) of MRSA were injected through a catheter into the operating site. Mice were sacrificed after either 7 days (18 treated, 18 controls) or 14 days (15 controls, 14 treated) to determine the number of adherent bacteria (biofilm) on implants and in the peri-implant surrounding tissues. Results were expressed respectively as median log10CFU reduction on implants and median log10CFU/g reduction in tissue compared with untreated control mice. The statistical significance (p) was determined using Mann-Whitney tests. Safety Study: Ten mice implanted with either control (5 mice) or DBG-21 treated (5 mice) discs were assessed in a safety study in the absence of infection (ISO 10993-11:2017 for systemic and subacute toxicity including clinical tolerance, blood tests and local histology). <h3>RESULTS</h3> Efficacy Study: At both 7 and 14 days, DBG21-treated implants yielded a significant decrease in MRSA biofilm (respectively 3.6 median log10CFU (99.97%) reduction (p < 0.001) and 1.9 median log10CFU (98.7%) reduction (p = 0.037)) and peri-implant surrounding tissues (respectively 2.7 median log10CFU/g (99.8%) reduction (p < 0.001) and 5.6 median log10CFU/g (99.9997%) reduction (p < 0.001)). At day 7, three treated mice (16.6%) were completely sterilized on both tissue and implant. At day 14, 10 treated mice (71.4%) had sterile peri-implant tissue. Safety Study: There were no significant differences between control and treated mice in terms of clinical scores, blood tests and local histology after up to 11 days from implantation. <h3>CONCLUSIONS</h3> Preventing biofilm formation has been recognized as a key element of SSI prevention. Yet, no biofilm-resistant titanium implants are available in clinical practice to prevent and mitigate the burden of SSIs. This small animal safety and efficacy trial suggests that DBG-21 is a promising candidate for antimicrobial surface modification of titanium implants. <h3>FDA DEVICE/DRUG STATUS</h3> DBG21 antimicrobial surface modification (Not approved for this indication).

Proton Motive Force Inhibitors Are Detrimental to Methicillin-Resistant Staphylococcus aureus Strains.

ABSTRACTMethicillin-resistant Staphylococcus aureus (MRSA) strains are tolerant of conventional antibiotics, making them extremely dangerous. Previous studies have shown the effectiveness of proton motive force (PMF) inhibitors at killing bacterial cells; however, whether these agents can launch a new treatment strategy to eliminate antibiotic-tolerant cells mandates further investigation. Here, using known PMF inhibitors and two different MRSA isolates, we showed that the bactericidal potency of PMF inhibitors seemed to correlate with their ability to disrupt PMF and permeabilize cell membranes. By screening a small chemical library to verify this correlation, we identified a subset of chemicals (including nordihydroguaiaretic acid, gossypol, trifluoperazine, and amitriptyline) that strongly disrupted PMF in MRSA cells by dissipating either the transmembrane electric potential (ΔΨ) or the proton gradient (ΔpH). These drugs robustly permeabilized cell membranes and reduced MRSA cell levels below the limit of detection. Overall, our study further highlights the importance of cellular PMF as a target for designing new bactericidal therapeutics for pathogens.IMPORTANCE Methicillin-resistant Staphylococcus aureus (MRSA) emerged as a major hypervirulent pathogen that causes severe health care-acquired infections. These pathogens can be multidrug-tolerant cells, which can facilitate the recurrence of chronic infections and the emergence of diverse antibiotic-resistant mutants. In this study, we aimed to investigate whether proton motive force (PMF) inhibitors can launch a new treatment strategy to eliminate MRSA cells. Our in-depth analysis showed that PMF inhibitors that strongly dissipate either the transmembrane electric potential or the proton gradient can robustly permeabilize cell membranes and reduce MRSA cell levels below the limit of detection.

Microbiological profile and anti-microbial susceptibility pattern of isolates from endo tracheal aspirate and endo tracheal tube tips in ICU patients

Background: There has been a surge of sufferers contracting healthcare-acquired infections (HAIs) in recent times. This has been further exacerbated by the SARS-CoV-2 pandemic which, beginning in 2020, has severely affected the majority of the world's nations, and one of the biggest problems caused by this infection was the high number of patients who required critical care. Aim: We sought to identify the microbiological profile and antimicrobial susceptibility pattern of bacteria isolated from tracheal aspirate and endotracheal tube (ETT) tips of patients who had to undergo ICU admittance. Methodology: We isolated a total of 150 microbial samples from 131 patients, of which 97 came from endo tracheal aspirates and the remaining 53 samples were obtained from ETT tips, following which the isolation and identification of bacteria was then done according to requisite microbiological assays. The Kirby-Bauer Technique with Mueller-Hinton agar was used to conduct the antimicrobial susceptibility testing in accordance with Clinical and Laboratory Standards Institute (CLSI) 2016 standards. Results: 53 (35%) of the 150 total specimens were from ETT tips, whereas 97 (65%) came from tracheal aspirates. 101 (67%) of the organisms were gram-negative, and 49 (33%) were gram-positive.

Hybrid Work: Doctor &amp; Nurse Participation in the Reduction of Healthcare-acquired Infections

Hybrid Work: Doctor &amp; Nurse Participation in the Reduction of Healthcare-acquired Infections

Fuhrman and Zimmerman’s Pediatric Critical Care, 6th Edition

Fuhrman and Zimmerman’s Pediatric Critical Care, 6th Edition

Raman Microscopic Analysis of Dry-Surface Biofilms on Clinically Relevant Materials.

Moist/hydrated biofilms have been well-studied in the medical area, and their association with infections is widely recognized. In contrast, dry-surface biofilms (DSBs) on environmental surfaces in healthcare settings have received less attention. DSBs have been shown to be widespread on commonly used items in hospitals and to harbor bacterial pathogens that are known to cause healthcare-acquired infections (HAI). DSBs cannot be detected by routine surface swabbing or contact plates, and studies have shown DSBs to be less susceptible to cleaning/disinfection products. As DSBs are increasingly reported in the medical field, and there is a likelihood they also occur in food production and manufacturing areas, there is a growing demand for the rapid in situ detection of DSBs and the identification of pathogens within DSBs. Raman microspectroscopy allows users to obtain spatially resolved information about the chemical composition of biofilms, and to identify microbial species. In this study, we investigated Staphylococcus aureus mono-species DSB on polyvinylchloride blanks and stainless steel coupons, and dual-species (S. aureus/Bacillus licheniformis) DSB on steel coupons. We demonstrated that Raman microspectroscopy is not only suitable for identifying specific species, but it also enables the differentiation of vegetative cells from their sporulated form. Our findings provide the first step towards the rapid identification and characterization of the distribution and composition of DSBs on different surface areas.

Healthcare-acquired Infections (HAI) Rates in Oncology Patients Undergoing Hematopoietic Stem Cell Transplant (HSCT) in Tertiary Hospital in Brazil

<h3>Background</h3> Healthcare-acquired infections (HAI) in oncology patients undergoing hematopoietic stem cell transplant (HSCT) are associated with an increased risk of morbidity and mortality. Increased risks are attributed, in part, to immunosuppression caused by chemotherapy, prolonged neutropenia and mucosal damage. The increased risk is knowing, but data are lacking. The objective of this study is to know the HAI rate in patients undergoing hematopoietic stem cell transplant and the most prevalence HAI. <h3>Methods</h3> This prospective study included all patients that were between 0–360 days after received autologous or allogeneic HSCT when were hospitalized in a HSCT unity in a tertiary hospital in Brazil. The surveillance occurred between July 1, 2020, and July 31 2021. The United States National Healthcare Safety Network guideline were used to define HAI. The HAI were stratified by bloodstream, respiratory, and urinary tract infections. <h3>Results</h3> The oncology patients undergoing HSCT surveillance has found twelve HAI episodes among two thousand and four hundred seventy patient days, resulting in a HAI rate of 4.8 per 1,000 patient-days. Bloodstream infection was the most common healthcare-acquired infection (n=9) followed by urinary tract infection (n=2) and respiratory infection (n=1). The most common organism isolate was Stenotrophomonas maltophilia (n = 4) followed by Klebsiella pneumoniae (n = 3) and Staphylococcus epidermidis (N=3). 5 episodes of HAI was detected in the first 3 months following transplant. Of the 12 patients who presented HAI, 4 died with noninfection-related causes. <h3>Conclusions</h3> HAI rate in the oncology patient undergoing HSCT found our study is similar to international rates and the bloodstream infection is the most common healthcare-acquired infection. A surveillance program is recommended to monitor outcomes, adherence prevention strategies and identify quality improvement opportunities and strategically targeting interventions especially to oncology patient undergoing hematopoietic stem cell transplant.

It's Time to Focus! Maximizing the Effectiveness and Outcomes of Your Infection Prevention Committee

Background One out of every 25 patients is impacted by a healthcare-acquired infection (HAI). Mitigation and prevention efforts require both a skilled infection preventionist (IP) and a high functioning infection prevention committee (IPC) by which the diffusion of information related to HAI risks is reviewed. In addition, there exist numerous regulatory requirements for infection prevention programs (IPP). This breadth of IPP elements led to deferred discussions of critical items, information overload, and limited time for detailed case reviews. Member attendance was sporadic therefore, situational awareness of practice gaps was missing. IPP action planning was ineffective due to this continual cycle of inefficiencies, thus putting patients and the organization at risk. Methods Within this healthcare system, the formation of IPP quality assurance, process improvement (QAPI) was implemented using standardized tools and a meeting consent agenda format. The IPC was educated on the consent agenda method and member responsibilities. Regulatory program requirements are all listed on a one-page checklist, providing clarity with all IPP components. These items and accompanying performance metrics are sent to committee members one week before the meeting. Most of the items are placed on the consent agenda which leaves time for focused discussions on critical items. Results Observed benefits across this network of hospitals include focused discussion on critical items and improved performance metrics. Other benefits include clarity for attendee expectations regarding meeting preparedness and readiness to discuss items of pertinence, meeting flexibility for the IPC by maneuvering consent agenda items based on need and shortened meeting time. Improved meeting attendance and meeting satisfaction was reported. Conclusions The IPP effectiveness and outcomes are based on an organized QAPI process and engaged committee members. Effective meeting facilitation and tools assist the IP in managing the broad scope of IPP elements ensuring patient harm is mitigated and regulatory requirements are met. One out of every 25 patients is impacted by a healthcare-acquired infection (HAI). Mitigation and prevention efforts require both a skilled infection preventionist (IP) and a high functioning infection prevention committee (IPC) by which the diffusion of information related to HAI risks is reviewed. In addition, there exist numerous regulatory requirements for infection prevention programs (IPP). This breadth of IPP elements led to deferred discussions of critical items, information overload, and limited time for detailed case reviews. Member attendance was sporadic therefore, situational awareness of practice gaps was missing. IPP action planning was ineffective due to this continual cycle of inefficiencies, thus putting patients and the organization at risk. Within this healthcare system, the formation of IPP quality assurance, process improvement (QAPI) was implemented using standardized tools and a meeting consent agenda format. The IPC was educated on the consent agenda method and member responsibilities. Regulatory program requirements are all listed on a one-page checklist, providing clarity with all IPP components. These items and accompanying performance metrics are sent to committee members one week before the meeting. Most of the items are placed on the consent agenda which leaves time for focused discussions on critical items. Observed benefits across this network of hospitals include focused discussion on critical items and improved performance metrics. Other benefits include clarity for attendee expectations regarding meeting preparedness and readiness to discuss items of pertinence, meeting flexibility for the IPC by maneuvering consent agenda items based on need and shortened meeting time. Improved meeting attendance and meeting satisfaction was reported. The IPP effectiveness and outcomes are based on an organized QAPI process and engaged committee members. Effective meeting facilitation and tools assist the IP in managing the broad scope of IPP elements ensuring patient harm is mitigated and regulatory requirements are met.

Healthcare-Acquired Infection Surveillance in Neurosurgery Patients, Incidence and Microbiology, Five Years of Experience in Two Polish Units.

Introduction: Patients in neurosurgical units are particularly susceptible to healthcare-associated infections (HAI) due to invasive interventions in the central nervous system. Materials and methods: The study was conducted between 2014 and 2019 in neurosurgery units in Poland. The aim of the study was to investigate the epidemiology and microbiology of HAIs and to assess the effectiveness of surveillance conducted in two hospital units. Both hospitals ran (since 2012) the unified prospective system, based on continuous surveillance of HAIs designed and recommended by the European Centre for Disease Prevention and Control (protocol version 4.3) in the Healthcare-Associated Infections Surveillance Network (HAI-Net). In study hospitals, HAIs were detected by the Infection Prevention Control Nurse (IPCN). The surveillance of healthcare infections in hospital A was based mainly on analysis of microbiological reports and telephone communication between the epidemiological nurse and the neurosurgery unit. HAI monitoring in hospital B was an outcome of daily personal communication between the infection prevention and control nurse and patients in the neurosurgery unit (HAI detection at the bedside) and assessment of their health status based on clinical symptoms presented by the patient, epidemiological definitions, microbiological and other diagnostic tests (e.g., imaging studies). In hospital A, HAI monitoring did not involve personal communication with the unit but was rather based on remote analysis of medical documentation found in the hospital database. Results: A total of 12,117 patients were hospitalized. There were 373 HAIs diagnosed, the general incidence rate was 3.1%. In hospital A, the incidence rate was 2.3%, and in hospital B: 4.8%. HAI types detected: pneumonia (PN) (n = 112, 0.9%), (urinary tract infection (UTI) (n = 108, 0.9%), surgical site infection (SSI) (n = 96, 0.8%), bloodstream infection (BSI) (n = 57, 0.5%), gastrointestinal system infection (GI) (n = 13, 0.1%), skin and soft tissue (SST) (n = 9, 0.1%). HAI with invasive devices: 44 ventilator-associated pneumonia (VAP) cases (45.9/1000 pds with ventilator); catheter-associated urinary tract infection (CA-UTI): 105 cases (2.7/1000 pds with catheter); central venous catheter (CVC-BSI): 18 cases (1.9/1000 pds with CVC). The greatest differences between studied units were in the incidence rate of PN (p < 0.001), UTI (p < 0.001), and SSI (p < 0.05). Conclusions: The way HAIs are diagnosed and qualified and the style of work of the infection control team may have a direct impact on the unit epidemiology with the application of epidemiological coefficients. Prospective surveillance run by the infection prevention and control nurse in hospital B could have been associated with better detection of infections expressed in morbidity, especially PN and UTI, and a lower risk of VAP. In hospital A, the lower incidence might have resulted from an inability to detect a UTI or BSI and less supervision of VAP. The present results require further profound research in this respect.

Implementation of surgical site infection surveillance in 16 health facilities in Sierra Leone

Background: Surgical site infections (SSIs) are associated with increased healthcare costs, antibiotic resistance, morbidity, and mortality. In low- and middle-income countries (LMICs), SSIs account for most healthcare-acquired infections (HAIs). In Africa, up to 20% of women who undergo a caesarean section develop a wound infection. Surveillance has been shown to be an essential component in the overall strategy to reduce SSIs. Methods: Surgical site infection surveillance is being implemented in 16 health facilities in Sierra Leone, with at least 1 from each of the 5 US Census regions: Eastern, Western, Northern, Northwestern, and Southern. These health facilities were selected based on the availability of a dedicated infection prevention and control (IPC) focal person. Women were observed for 30 days after caesarean section. A standardized surgical safety and surveillance checklist including case definitions and observable criteria (eg, purulent drainage, wound abscess, or intentional reopening) was used. Clinical staff were trained to collect data and to conduct in-person and phone interviews with patients on days 3, 7, and 30 after caesarean section. Results: From March 2021 to July 2021, a total of 2,529 women had caesarean sections in 15 health facilities; most occurred in the Northern region (785 of 2,529). Among these 2,529 women, 1,522 (60%) had an SSI surveillance checklist started, and of those 1,522, 632 (42%) had a completed checklist. Health facilities in most of the rural regions, (Eastern, Northwestern, and Southern) had no completed checklists. The overall SSI rate for the 15 health facilities was 3% (70 of 2,529). The Southern region had the highest SSI rate at 50% (35 of 70), but the Western region did not report any SSIs. Of the 70 cases, 49 (70%) were identified through active inpatient surveillance and 21 (30%) were identified through postdischarge surveillance. Conclusions: One of the priorities of Sierra Leone’s National IPC Action Plan is to establish HAI surveillance. Surgical site surveillance is an essential component of HAI surveillance and leads to timely identification so infections can be treated quickly. This study was limited by inadequate data collection and patients lost to follow-up after discharge. However, this study illustrates that surveillance leads to the diagnosis of most SSI cases after caesarean section while patients are still hospitalized. Simple yet effective SSI surveillance can be conducted in LMICs to identify and ultimately treat SSI after caesarean section. More support is needed in rural and smaller facilities for better implementation of SSI surveillance in Sierra Leone.Funding: NoneDisclosures: None

Healthcare Disparities Are Patient Safety Hazards

Clinicians and policymakers should view disparities as significant safety hazards on a par with healthcare-acquired infections, falls, or wrong-site surgery. In particular, healthcare providers and physician leaders should consider how structural racism and implicit bias (or overt racism) may play a role in disparities by race, ethnicity, and gender.