Healthcare-associated Infections In Hospitals Research Articles

Infection Prevention and Control Among Paramedics: A Scoping Review

BackgroundParamedics are exposed to many infectious diseases in their daily professional activities, leading to a high risk of transmitting infectious diseases to patients in out-of-hospital settings, and possibly leading to healthcare associated infections in hospitals and the community. The coronavirus disease 2019 pandemic has highlighted the importance of infection prevention and control in healthcare more broadly and the role of paramedics in infection control is considered even more critical. Despite this, in many countries such as Australia, research into infection prevention and control research has mainly been focused on in-hospital health care professionals with limited out-of-hospital studies. MethodsThis scoping review was conducted based upon Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines to evaluate the literature relating to knowledge and awareness of infection prevention and control in paramedics in Australia and other countries. Results/DiscussionBased upon the selection criteria applied, six papers were identified for inclusion in this review. In many studies reviewed, infection prevention and control was identified by paramedics as being important, however compliance with hand hygiene practices was low and most studies highlighting the need for more education and training on infectious disease for paramedics. ConclusionThe current evidence suggests that paramedics have poor compliance with recommended IPC practices. The profession needs to improve IPC education, training, and culture.

Identification of Providencia spp. clinical isolates co-producing carbapenemases IMP-27, OXA-24, and OXA-58 in Mexico

Providencia rettgeri, belonging to the genus Providencia, had gained significant interest due to its increasing prevalence as a common pathogen responsible for healthcare-associated infections in hospitals. P. rettgeri isolates producing carbapenemases have been reported to reduce the efficiency of carbapenems in clinical antimicrobial therapy. However, coexistence with other resistance determinants is rarely reported. The goal of this study was the molecular characterization of carbapenemase-producing Providencia spp. clinical isolates. Among 23 Providencia spp. resistant to imipenem, 21 were positive to blaNDM-1; one positive to blaNDM-1 and blaOXA-58 like; and one isolate co-producing blaIMP-27, blaOXA-24/40 like, and blaOXA-58 like were identified. We observed a low clonal relationship, and the incompatibility groups Col3M and ColRNAI were identified in the plasmid harboring blaNDM-1. We report for the first time a P. rettgeri strain co-producing blaIMP-27, blaOXA-24-like, and blaOXA-58 like. The analysis of these resistance mechanisms in carbapenemase co-producing clinical isolates reflects the increased resistance.

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

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

After-action Review of Hospital Environments Exploring the ‘New Normal,’ Focusing on Structural Management Aspects and Bacterial Culture in Thai Hospitals Amid the COVID-19 Pandemic

OBJECTIVE This study aimed to explore the management of hospital environments during the COVID-19 pandemic, focusing on the structural aspects of ‘new normal’ health services delivery practices and bacterial culture in hospital rooms. METHODS This study employed a cross-sectional design that involved the evaluation of hospital environment management, the detection of indoor bacterial colonies in hospitals, and interviews with healthcare administrators on the ‘new normal’ measures. RESULTS The evaluation form was completed by 543 healthcare division heads from 30 hospitals. Respondents in each group reported that hospitals where they worked had effectively implemented new normal measures, making changes to the structure, processes, and personnel management components in line with the ‘new normal’ concept. The majority of the hospitals investigated, accounting for 71.7%, were found to have pathogenic bacterial counts lower than the permissible limits. The statistical analysis identified a significant association between ventilation, structural management under the ‘new normal’, and bacterial counts (p < 0.05). CONCLUSIONS The incorporation of the structural aspects of new normal practices for managing the workplace environment should be a routine and integral part of efforts to control healthcare-associated infections in hospitals. KEYWORDS hospital environment, the new normal, COVID-19, bacterial culture

The National Strategies for and Challenges in Infection Prevention and Control of the Healthcare System in the Kingdom of Saudi Arabia (Review Study).

Healthcare-associated infections (HAIs) lead to considerable morbidity. Prolonged hospital HAIs, also known as hospital infections or nosocomial infections, refer to infectious diseases that occur within 48 h of hospital admission, within three days of discharge or 30 days after having received healthcare. A total of 39 government-owned hospitals with a total of 10,822 beds providing the majority (59.9%) of Saudi Arabian healthcare were analyzed. Medicare and Medicaid use hospital data to track hospital performance on matters pertaining to IPC. In addition, many hospitals have limited capacity with which to develop the core components required to build an effective IPC programme. Hajj has been associated with the increased prevalence and spread of infectious diseases. These factors include changes in human demographics and behaviour, the effect of new technologies and industries, an increase in international travel and commerce, and breakdown resulting from public health measures. Overall public health service expenditure originates from the administration and services that are provided free of charge to all Saudi citizens.

Findings from healthcare-associated infections data validation attestation in California general acute-care hospitals

Background: Accurate and complete hospital healthcare-associated infection (HAI) data are essential to inform facility-level HAI prevention efforts and to ensure the validity and reliability of annual public reports. We implemented a validation attestation survey to assess and improve the HAI data reported by California hospitals via NHSN. Methods: The California Department of Public Health (CDPH) HAI Program invited all 401 general acute-care hospitals in California to participate in an annual HAI validation attestation survey in 2021. The survey was designed to be completed by the person with primary responsibility for HAI surveillance and reporting consistent with NHSN protocols and California laws. Survey questions addressed HAI reporting knowledge and practices and surgical procedures performed, and they included 3 hypothetical scenarios evaluating hospital application of HAI surveillance, decision making, and reporting methods. Results: We received responses from 345 hospitals (86%). For the 3 hypothetical scenarios, 171 hospitals (49.6%) correctly answered all 3 questions, 110 hospitals (31.9%) answered 2 questions correctly, 52 (15.1%) hospitals answered 1 question correctly, and 12 hospitals (3.5%) answered zero questions correctly. We did not detect a statistically significant association between facility type (ie, acute-care hospital, critical access hospital, long-term acute-care hospital, or rehabilitation hospital or unit) and the probability of getting all questions correct (Fisher exact P = .42). Of the 303 hospitals (88.0%) that perform at least 1 of the 28 surgical procedures reportable in California, 269 (88.8%) apply CDPH-recommended postoperative ICD-10 diagnosis flag codes to identify records that might indicate a possible surgical site infection (SSI). Moreover, ~289 (84.0%) hospitals confirmed that someone at their facility reviews CDPH quality assurance–quality control reports to verify the accuracy and completeness of their hospital’s reported HAI data. In 321 hospitals (93.0%) decisions about which infections are reported to NHSN are made solely by the infection preventionists or hospital epidemiologists, who are thoroughly familiar and follow NHSN protocol, definitions, and criteria. Conclusions: Most hospitals reported following best practices for evaluating records for SSIs; however, only half responded correctly to all 3 hypothetical scenarios. Our results highlight the need for ongoing education on HAI surveillance, decision making and reporting methods, and external HAI data validation in hospitals. This survey could serve as a model for other states that work with hospitals to improve HAI surveillance data and to ensure the integrity of public reports. Future research will link the results of this survey to NHSN validation audits.Funding: NoneDisclosures: None

Rare Actinomycetes from Undiscovered Sources as a Source of Novel Antimicrobial Agents to Control Multidrug-Resistant Bacteria

The major cause of death worldwide is infectious diseases and about 10 billion deaths, which represent 25% of all the major causes of death per year were recorded due to the rapidly increasing number of infections in hospitals among compromised and injured patients. Recently, the increasing prevalence of multi-drug resistant bacteria which cause serious healthcare-associated infections in hospitals were reported. The emergence of resistance to aminoglycosides, β lactam antibiotics, and meth

Effect of copper-coated surfaces on the bacterial burden in the intensive care unit

Background: Pathogen-contaminated surfaces are known to transmit Healthcare-Associated Infections in hospitals and other healthcare facilities. Existing hospital-cleaning procedures alone are not enough to prevent the growth of microorganisms over time. Since copper alloy has inherent and continuous antibacterial properties, copper surfaces offer a solution to complement these procedures. Objectives: This study aimed to assess the antibacterial effects of copper-coated surfaces on the bacterial burden in the intensive care unit (ICU). Methods: This clinical controlled trial was conducted in a general ICU. The bacterial burden was measured on five surfaces that were coated with a copper alloy foil (purity 99.94%, 100-micron thickness) and five similar surfaces without the copper coating (n=60 each). The total bacterial burden and the colonization rate of Staphylococci, vancomycin-resistant enterococci, and gram-negative bacilli were measured on different surfaces. The collected data were analyzed using Chi-square or Fisher’s exact, Shapiro-Wilk, Mann-Whitney, and Kruskal-Wallis tests. Results: The cumulative bacterial burden was lower on copper-coated surfaces than on control surfaces. The copper-coated surfaces were found to have a significantly (95.96%) lower mean bacterial burden (145.20 colony-forming units [CFU]/100 cm2, n=60 surfaces) than the control surfaces (3,598.74 CFU/100 cm2, n=60 surfaces; P<0.001). Conclusion: The results of this study showed that placing a copper coating on the surface of five common, highly touched objects in ICU rooms reduced the bacterial burden by 96%, as compared with control surfaces.

Escherichia coli and Klebsiella pneumonia as the Most Common Bacteria Causing Catheter Associated Urinary Tract Infection

Background: Healthcare-Associated Infections (HAIs) are the result of a reaction between taint agents that infected the patient when the patient is hospitalized. A Study from The Center for Disease Control and Prevention shows that most HAIs in hospital are urinary tract infection, most of the infection incident in patient are caused by catheter. Catheter indwelling is notable in medical sphere. This study aimed to inquire case number of Catheter-Associated Urinary Tract Infection (CAUTI) in Dr. Soetomo General Hospital, the feature of CAUTI patients, the type of bacteria that cause CAUTI, and what is the relation among sex and bacteria colony.Materials and Methods: An analytic observational study with the population of pediatric hospitalized patients of Dr. Soetomo General Hospital was conducted in January-December 2017. Samples collected were positive urine culture from pediatric hospitalized patients. Information regarding the bacteria that cause CAUTI, gender, and length of catheter usage were collected.Results: There were total 140 samples of positive urine culture in pediatric patient, and 38.5% was diagnosed as CAUTI. Overall CAUTI was often found in male subjects (51.9 %), and similar with ≤1-year old patients which also often found in male subjects (60.8%). The highest length of catheter usage was 3-5 days (42.5%). All subjects had fever as a clinical sign and 83.3% had suprapubic pain. Escherichia coli and Klebsiella pneumoniae infections were highly discovered. There was an association between gender and urine culture colony count (p=0.02).Conclusion: CAUTI is commonnly found in Dr. Soetomo General Hospital, and two bacteria that cause the most infection were E. coli and K. pneumoniae.Keywords: catheter, urinary tract infection, healthcare associated infection

Leadership, Governance and Resources in the Prevention and Control of Healthcare Associated Infections (HAIs) At Hospital X Yogyakarta

Hospitals are required to provide quality, accountable and transparent health services, especially for patient safety assurance. Nosocomial infections (Hospital Acquired Infection) or HAIs are infections that occur in patients during hospitalization. The incidence of phlebitis in January 2019 was 13%, September 2019 was 6%. Meanwhile, the Minister of Health Decree No. 29/2008, the standard incidence of HAIs in the hospital should not be more than 1.5%. Leadership, governance and resources have a strong role to play in improving the patient safety system that has been established. The research objective was to analyze the implementation of prevention and control of HAIs on the aspects of leadership, governance, and hospital resources.
 This qualitative descriptive case study research with informants consisting of the leadership, the PPI team and hospital staff were taken by purposive sampling with the validity test technique through triangulation. Collecting data by interview, observation and documentation. Data analysis uses data reduction methods, data presentation and conclusion / verification.
 Leadership and governance as an effort to prevent and control HAIs in hospitals with the formation of the Infection Prevention and Control Committee (PPI), a Prevention Control Nurse (IPCN) officer was appointed with activities and reports on the results of supervision. However, reports on the results of supervision have not been optimally socialized only in the form of information conveyed through information boards / announcement boards. Resources can be fulfilled properly with the availability of a sufficient number of IPCLNs with their main duties, the availability of budget and supporting facilities while still taking into account the availability of isolation rooms for infectious cases in hospitals that do not yet exist.
 It is necessary to socialize the results of supervision and the PPI program through the assignments of the Head of the Inpatient Installation and through the IPCN Nurses in the room as well as the provision of information boards in each room for information media on the results of supervision and the PPI program.

HUBUNGAN PENGETAHUAN DAN SIKAP PETUGAS KESEHATAN TERHADAP KEPATUHAN MELAKUKAN HAND HYGIENE DI RSUD RAJA AHMAD TABIB TANJUNGPINANG

Hospitals, apart from medical referral centers, also have the potential to transmit infections which are often referred to as Healthcare Associated Infections (HAIs). HAIs are a major problem faced worldwide and their incidence is increasing. The incidence of HAIs in hospitals in Asian countries is around 3-21% with an average of 9%. In Indonesia, the average incidence of HAIs is around 9.1% higher than in Asian countries. The incidence of HAIs in government hospitals is 55.1%, private hospitals 35.7%, and ABRI hospitals 9.1%. Currently, the incidence of HAIs is used as a benchmark for the quality of hospital services. One of the steps in infection prevention and control is through hand hygiene. The purpose of this study was to determine whether there was a relationship between knowledge and attitudes of health workers on compliance with hand hygiene. This study used an analytical research design with a cross sectional approach and was carried out at the Raja Ahmad Tabib Hospital Tanjungpinang on July 16-30 2019. The sample in this study was 80 respondents with purposive sampling technique. From the results of the study, the majority of health workers have good knowledge (80%), the majority of health workers have good attitudes (77.5%), and most health workers comply with hand hygiene (65%). between knowledge and adherence to hand hygiene where p = 0.000 <0.05 and there is a relationship between attitudes towards compliance with hand hygiene where p = 0.000 <0.05. In conclusion, there is a relationship between knowledge and attitudes of health workers to compliance with hand hygiene. Suggestions that respondents can increase compliance to always do hand hygiene in order to reduce the incidence of HAIs in hospitals.

Using a multimodal strategy to improve patient hand hygiene

ObjectiveThe role of health care worker hand hygiene in preventing health care associated infections (HCAI) is well-established. There is less emphasis on the hand hygiene (HH) of hospitalized patients; in the context of COVID-19 mechanisms to support it are particularly important. The purpose of this study was to establish if providing patient hand wipes, and a defined protocol for encouraging their use, was effective in improving the frequency of patient HH (PHH).DesignBefore and after study.SettinGeneral Hospital, United Kingdom.ParticipantsAll adult patients admitted to 6 acute elderly care/rehabilitation hospital wards between July and October 2018.MethodsBaseline audit of PHH opportunities conducted over 6 weeks. Focus group with staff and survey of the public informed the development of a PHH bundle. Effect of bundle on PHH monitored by structured observation of HH opportunities over 12 weeks.ResultsDuring baseline 303 opportunities for PHH were observed; compliance with PHH was 13.2% (40/303; 95% confidence interval 9.9-7.5). In the evaluation of PHH bundle, 526 PHH opportunities were observed with HH occurring in 58.9% (310/526); an increase of 45.7% versus baseline (95% confidence interval 39.7%-51.0%; P < .001).ConclusionProviding patients with multiwipe packs of handwipes is a simple, cost-effective approach to increasing PHH and reducing the risk of HCAI in hospital. Health care workers play an essential role in encouraging PHH.

Distribution of Staphylococcal cassette chromosome mecA (SCCmec) types among coagulase-negative Staphylococci isolates from healthcare workers in the North-West of Iran.

Objective(s):Methicillin-resistant coagulase-negative Staphylococci (MR-CoNS) are recognized as one of the major causes of healthcare-associated infections in hospitals. The present investigation aimed to study the prevalence of Staphylococcal cassette chromosome mec (SCCmec) types, along with aminoglycoside modifying enzymes (AMEs) genes in the nasal carriage of MR-CoNS in the north-west of Iran.Materials and Methods:To assess the potential of coagulase-negative Staphylococci as hidden reservoirs for antibiotic resistance, we analyzed the antimicrobial susceptibility of MR-CoNS using the disk diffusion method. In addition, PCR and multiplex PCR assays were performed to determine the prevalence of AME encoding genes and SCCmec types in methicillin-resistant coagulase-negative Staphylococci isolates.Results:A total of 51 MR-CoNS isolates were recovered from the anterior nares of healthcare workers. The observed resistance rates to tobramycin, gentamicin, cotrimoxazole, kanamycin, erythromycin, tetracycline, and ciprofloxacin were 74.5%, 68.5%, 57%, 53%, 51%, 49%, and 8%, respectively. Of the 51 tested MR-CoNS isolates, 2(4%) were harboring SCCmec type I, four (8%) were type II, six (12%) type III, eleven (21.6%) type IVa, two (4%) type IVb, two (4%) type IVc, six (12%) type IVd, and two (4%) type V. The rates of prevalence of the aminoglycoside modifying enzyme genes were as follows: aac (6′)/aph (2′′) (28 cases, 55 %), ant (4′)-Ia (20 cases, 39%), and the aph (3´)-IIIa gene (9 cases, 17.6 %).Conclusion:Subtypes IVa and IVd were the most prevalent SCC elements, and aac (6′)/aph (2′′) was the most common AME gene detected among the MR-CoNS isolates.

Strong Antimicrobial Activity of Hydroxamic Acids and Newly Synthesized Derivatives

Antibiotic resistant pathogenic bacteria are a growing worldwide health concern according to the Centers for Disease Control and Prevention. These bacteria are responsible for most of the infectious diseases and healthcare‐associated infections in hospitals (HAIs). The need for new therapeutic approaches using novel antimicrobial compounds is becoming vital as the number of infections caused by antibiotic resistant strains of bacteria such as Staphylococcus aureus and Staphylococcus epidermis has drastically increased. The focus of this study is to test newly designed and synthesized therapeutic agents for antimicrobial properties. Several hydroxamic acids and analogs synthesized by the Chemistry Department at New Jersey City University were tested for antibacterial activity against eight ATCC strains of human and plant pathogenic microorganisms. The antimicrobial activity of each compound was evaluated using the disk‐diffusion assay and the liquid broth assay. All compounds displayed a various spectrum of antibacterial activity. Compounds with the strongest antimicrobial effect were selected for further characterization to determine the minimal inhibitory concentration using serial dilution and absorbance reading. A subset of compounds with antimicrobial effects against plant pathogens were further tested for cytotoxicity and the ability to prevent fruit and vegetable bacterial infections. Future work will focus on using a cell‐culture‐based assay to test the remaining compounds for animal cell cytotoxicity.Support or Funding InformationThis research was done under the support of the U.S. Education Department Title III Part F HSI Grant # P031C160155, the NSF IUSE (Improving Undergraduate STEM Education) Award #1611843, and the New Jersey City University Separately Budgeted Research Fund.

Infection as a predictor of mortality in decompensated liver cirrhosis: exploring the relationship to severity of liver failure.

Infections are common in patients with liver cirrhosis and increase mortality. We explored the relationship between infection and liver dysfunction in their effects on mortality. Single-center data on decompensated liver cirrhosis patients hospitalized between March 2014 and December 2017 (index period) were reviewed until death, liver transplantation or 31 December 2018. Infections were classified as community-acquired infection (CAi) or hospital/healthcare associated infection (HCAi). Child-Pugh, model for the end-stage liver disease (MELD) and chronic liver failure-organ failure (CLiF-OF) scores indicated liver (dys)function. We enrolled 155 patients (85% alcoholic liver disease), 65 without infection at first hospitalization, 48 with CAi and 42 with HCAi. Multidrug resistant agents were confirmed in 2/48 (4.2%) CAi and 10/42 (23.8%) HCAi patients. At first hospitalization, infection was independently associated with worse liver dysfunction and vice versa, and with higher 30-day mortality [odds ratio (OR) = 2.73, 95% confidence interval (CI) 1.07-6.94]. The association was reduced with adjustment for MELD/CLiF-OF scores, but mediation analysis detected an indirect (via liver dysfunction) association. Twenty-eight patients were repeatedly hospitalized, 11 with new HCAi. HCAi was independently associated with twice higher risk of medium-term mortality and added an additional risk to any level of liver dysfunction, considering all or patients who survived the first 30 days. In those repeatedly hospitalized, HCAi appeared independently associated with a higher probability of infection and higher MELD scores at subsequent hospitalizations. Infection (particularly HCAi) adds mortality risk to any level of liver dysfunction in decompensated liver cirrhosis patients. Mechanisms of long(er)-term effects (in acute episode survivors) seemingly include enhanced deterioration of liver function.

Artificial Intelligence-based tools to control healthcare associated infections: where do we stand

Abstract Background Control of Healthcare associated infections (HAI) is a key public health concern in Europe. Current HAI surveillance systems are based on manual medical records review, vulnerable to misclassification &amp; expensive. Artificial intelligence (AI), as a digital tool, offers great potential to HAI control. Still, scant evidence is available on both its practice and impact. Methods As part of a broader multidisciplinary project, we conducted a systematic review to retrieve, pool and critically apprize all the available evidence on practice, performance and impact of AI-based HAI control programmes. We followed PRISMA and searched the Medline and Embase databases for relevant studies. Included studies were stratified by HAI type and outcomes of interest, including all possible performance measures, clinical, organizational and economic outcomes. Results We screened 2873 records, resulting in 27 papers included in the review. Studies were carried out in 9 countries, the majority in the US (56%), 18.5% in EU countries, 25.9% published in 2018. Two thirds of studies focused on selected types of infections. Study designs were very diverse and performance observed for HAI detection were very heterogeneous, precluding pooled calculation of summary diagnostic accuracy estimates in most instances, but generally higher than non AI-based models. Overall performance measures of AI algorithms were: sensitivity range 19%-92%, accuracy 70.2%-96.1%. Conclusions Use of AI for HAI surveillance of HAI has increased reliability compared to traditional surveillance or to automated surveillance models. With ongoing improvements in information technology, implementation of AI models will improve the quality and capacity of surveillance will support hospital HAI surveillance. Main messages AI offer great potential to healthcare associated infections control. Preliminary evidence show AI-based models have perform better than manual or automated models for HAIs detection.

Artificial Intelligence-based tools to control healthcare associated infections: where do we stand

Abstract Background Control of Healthcare associated infections (HAI) is a key public health concern in Europe. Current HAI surveillance systems are based on manual medical records review, vulnerable to misclassification and expensive. Artificial intelligence (AI) offers great potential to public health action and, specifically, to HAI control. Still, scant evidence is available on both its practice and impact. Methods As part of a broader multidisciplinary project, we conducted a systematic review to retrieve, pool and critically apprize all the available evidence on practice, performance and impact of AI-based HAI control programmes. We followed PRISMA guidelines and searched the Medline and Embase databases for relevant studies. Included studies were stratified by HAI type and outcomes of interest, including all possible performance measures, clinical, organizational and economic outcomes. Results We screened 2873 records, resulting in 27 papers included in the review. Studies were carried out in 9 countries, the majority in the US (56%), 18.5% in EU countries, 25.9% published in 2018. Two thirds of studies focused on selected types of infections. Study designs were very diverse and performance observed for HAI detection were very heterogeneous, precluding pooled calculation of summary diagnostic accuracy estimates in most instances, but generally higher than non AI-based models. The highest performance outcomes were Specificity and Negative Predictive Value. Overall performance measures of AI algorithms were: sensitivity range 19%-92%, specificity range 64%-96%, accuracy 70.2%-96.1%. Conclusions Use of AI algorithms for HAI surveillance of HAI has increased reliability compared to traditional surveillance or to automated surveillance models. With ongoing improvements in information technology, implementation of AI models will improve the quality and capacity of surveillance will support hospital HAI surveillance. Key messages Artificial Intelligence (AI) offer great potential to healthcare associated infections (HAI) control. Preliminary evidence show AI-based models have perform better than manual or automated models for HAIs detection.

An environmental cleaning bundle and health-care-associated infections in hospitals (REACH): a multicentre, randomised trial

The hospital environment is a reservoir for the transmission of microorganisms. The effect of improved cleaning on patient-centred outcomes remains unclear. We aimed to evaluate the effectiveness of an environmental cleaning bundle to reduce health care-associated infections in hospitals. The REACH study was a pragmatic, multicentre, randomised trial done in 11 acute care hospitals in Australia. Eligible hospitals had an intensive care unit, were classified by the National Health Performance Authority as a major hospital (public hospitals) or having more than 200 inpatient beds (private hospitals), and had a health-care-associated infection surveillance programme. The stepped-wedge design meant intervention periods varied from 20 weeks to 50 weeks. We introduced the REACH cleaning bundle, a multimodal intervention, focusing on optimising product use, technique, staff training, auditing with feedback, and communication, for routine cleaning. The primary outcomes were incidences of health-care-associated Staphylococcus aureus bacteraemia, Clostridium difficile infection, and vancomycin-resistant enterococci infection. The secondary outcome was the thoroughness of cleaning of frequent touch points, assessed by a fluorescent marking gel. This study is registered with the Australian and New Zealand Clinical Trial Registry, number ACTRN12615000325505. Between May 9, 2016, and July 30, 2017, we implemented the cleaning bundle in 11 hospitals. In the pre-intervention phase, there were 230 cases of vancomycin-resistant enterococci infection, 362 of S aureus bacteraemia, and 968 C difficile infections, for 3 534 439 occupied bed-days. During intervention, there were 50 cases of vancomycin-resistant enterococci infection, 109 of S aureus bacteraemia, and 278 C difficile infections, for 1 267 134 occupied bed-days. After the intervention, vancomycin-resistant enterococci infections reduced from 0·35 to 0·22 per 10 000 occupied bed-days (relative risk 0·63, 95% CI 0·41-0·97, p=0·0340). The incidences of S aureus bacteraemia (0·97 to 0·80 per 10 000 occupied bed-days; 0·82, 0·60-1·12, p=0·2180) and C difficile infections (2·34 to 2·52 per 10 000 occupied bed-days; 1·07, 0·88-1·30, p=0·4655) did not change significantly. The intervention increased the percentage of frequent touch points cleaned in bathrooms from 55% to 76% (odds ratio 2·07, 1·83-2·34, p<0·0001) and bedrooms from 64% to 86% (1·87, 1·68-2·09, p<0·0001). The REACH cleaning bundle was successful at improving cleaning thoroughness and showed great promise in reducing vancomycin-resistant enterococci infections. Our work will inform hospital cleaning policy and practice, highlighting the value of investment in both routine and discharge cleaning practice. National Health and Medical Research Council (Australia).

Implementation of patient safety centers and the healthcare-associated infections.

To verify the implementation of the Patient Safety Center and its relation to the control of Healthcare-associated Infections in hospitals of Natal. Quantitative, cross-sectional study. The sample consisted of 28 infection control professionals from 12 hospitals. Data were collected between February and August 2017, through a semi-structured questionnaire. The Patient Safety Center was implemented in nine hospitals. Among the protocols implemented, the patient identification (66.70%), hand hygiene (50%) and fall prevention (50%) were the most important ones. Hospitals with the Center affirmed they develop patient safety training activities together with the professionals. 44.5% reported effective communication. Although the actions implemented do not fully comply with the recommendations of the National Health Surveillance Agency, most of these actions are directly related to the control of infections in services.

Innovative Methods of Hospital Disinfection in Prevention of Healthcare-Associated Infections

The purpose of this review is to give the reader an update on recent studies and developments regarding the hospital environment role in transmission of healthcare-associated infections (HAIs), and novel strategies to obtain a cleaner, safer patient environment. Hospital patient rooms are increasingly recognized as a reservoir of multi-drug-resistant organisms that contribute to HAIs. In simulated environments, surfaces can easily be adequately disinfected of pathogenic bacteria. However, translation into real healthcare settings has been less reliable and efficacious, with barriers to implementation of best practices. In this review, we describe and compare new and evolving technologies for enhancing room disinfection, such as UV-C, hydrogen peroxide vapor, ozone, and chlorine. We also review recent studies examining antimicrobial surfaces such as copper and silver and introduce a novel transdisciplinary human factors, systems engineering, and infection prevention approach to improve manual room cleaning. We highlight outstanding questions, including additional benefit of no touch technology in a human factors-optimized manual cleaning setting, and cost-effectiveness of optimized manual cleaning vs additional of no touch technology. There are evolving technologies and strategies to enhance patient room cleaning and decrease risk of HAI transmission. It is important for the infection prevention community to keep up to date with, and understand the implications of, these developments so as to best inform hospital HAI reduction strategy.