Risk Of Healthcare-associated Infections Research Articles

Intersection of Race and Rurality With Health Care-Associated Infections and Subsequent Outcomes.

Health care-associated infections (HAIs) are a major cause of morbidity and mortality, but little is known about whether structural factors impacting race and rurality are associated with HAI and subsequent outcomes. To evaluate the association of race and rurality, which are proxies for structural disadvantage, with HAI and subsequent outcomes. This cohort study was conducted at 3 US urban and suburban hospitals. Participants were adults aged 18 years or older admitted for 48 hours or longer from January 1, 2017, to August 31, 2020. Statistical analysis was performed from November 2022 to April 2024. Patient race and rurality status were defined as the combination of race (Black or White) and residence (urban or rural per patient zip code). HAI was defined as a positive culture from a urine, blood, or respiratory specimen obtained 48 hours or longer after admission. To determine the association of race and rurality with HAIs, multivariable generalized estimating equations models were used to account for clustering of admissions by patient. Among patients with HAI admissions, similar models examined post-HAI intensive care unit admission and in-hospital death. Among 214 955 patients admitted to the hospital (median [IQR] age, 63 [51-73] years; 108 679 female patients [50.6%]; 72 490 Black patients [33.7%]; 142 465 White patients [66.3%]), recognized HAIs occurred during 6699 (3.1%). Compared with White urban patients, Black urban patients had a decreased risk of HAI (adjusted relative risk [aRR], 0.81; 95% CI, 0.75-0.87), White rural patients had an increased risk of HAI (aRR, 1.12; 95% CI, 1.05-1.20), and Black rural patients (aRR, 1.08; 95% CI, 0.81-1.44) had a similar risk of HAI. Among patients with HAI admissions, Black rural patients had an increased risk of intensive care unit admission (aRR, 1.92; 95% CI, 1.16-3.17) and in-hospital death (aRR, 1.78; 95% CI, 1.26-2.50). White rural and Black urban patients had outcomes similar to those of White urban patients. This cohort study of hospitalized adults identified inequities related to race and rurality in HAIs and adverse outcomes from HAIs. These findings suggest that factors such as structural racism and disinvestment in rural communities may be associated with individual HAI risk and post-HAI outcomes. Future work to further understand the reasons underpinning these disparities and methods to address structural factors through policy and process changes are critical to eliminate health inequities.

Implementation of Bundled Interventions to Reduce Surgical Site Infections in Pediatric Patients Undergoing Cardiothoracic Surgery: A Quality Improvement Project.

Pediatric patients undergoing cardiothoracic surgery are at increased risk for health care-associated infections, especially surgical site infections (SSIs). Delayed sternal closures are associated with prolonged lengths of stay and contribute to infection risks and morbidities. At a single-site academic pediatric center, we created an SSI-prevention bundle targeting the preoperative, intraoperative, and postoperative care periods. Using standard criteria, we determined the epidemiology of SSIs and measured SSI rates per 100 procedures from 2017 through 2023 before and after bundle implementation. Infections were predominantly caused by skin commensal bacteria. Despite an initial decrease in SSI rates for routine procedures and procedures with delayed sternal closures, there was no significant difference in SSI rates per 100 procedures during the preimplementation and postimplementation periods. However, compliance with bundle elements was preserved throughout the postimplementation period, including during the COVID-19 pandemic, which suggests that the use of the bundle is sustainable at our facility.

P-268. Root Cause Analysis of Healthcare-Associated Infections: A Case Study Methodology Using Pareto Charts, Ishikawa Diagrams, and Machine Learning

Abstract Background This paper introduces a method for analyzing the root causes of healthcare-associated infections (HAIs), stressing the importance of a holistic approach that merges clinical and epidemiological data.Figure 1Pareto Chart with the Main Specific Secondary Factors for HAIs Diagnosed in a General Hospital, January to September 2023. Pareto Chart with the Main Specific Secondary Factors for HAIs Diagnosed in a General Hospital, January to September 2023. Methods Risk and causal factors for HAI were identified and categorized into primary and secondary groups. A review of case studies and literature identified 63 factors, which were then organized into four primary categories: surgical factors, invasive procedures, care process failures, and intrinsic patient characteristics. Each category included specific secondary factors; for instance, intrinsic patient characteristics encompassed 18 factors such as neurogenic bladder, diabetes mellitus, and obesity. Active infection surveillance involved recording these factors for each patient and correlating them to specific infections. The analysis utilized Pareto charts, Ishikawa diagrams, and decision trees to summarize root causes in a case series study. From Pareto, construct Ishikawa, global (HAI), and for each topography.Figure 2Ishikawa Diagram for HAIs Diagnosed in a General Hospital, January to September 2023. Ishikawa Diagram for HAIs Diagnosed in a General Hospital, January to September 2023. Results During the active surveillance of 386 healthcare-associated infections (HAIs) diagnosed in a general hospital from January to September 2023: tracheobronchitis and pneumonia (178), surgical site infection (74), urinary tract infection (56), primary bloodstream infection (29), gastrointestinal infection (21), and other infections (28). A total of 2,323 potential risk and causal factors were recorded. The number of factors associated with each infection varied, ranging from zero (indicating no factors were identified with the infection) to 18 factors identified in a single case. The primary factor that predominated was intrinsic patient factors (44%), followed by failures in care processes (27%), surgical factors (21%), and invasive procedures (8%). With the risk factor data recorded during active infection surveillance, it's feasible to automate case-by-case critical analysis, for example, through mail merges, integrating data in spreadsheets with texts in Word.Figure 3Decision Tree Based on Secondary Factors to Stratify the Type of HAI. Decision Tree Based on Secondary Factors to Stratify the Type of HAI. Conclusion Our analysis illustrates how integrating clinical and epidemiological data can pinpoint critical factors contributing to HAIs. In addition to case series analysis, recording factors during active surveillance automates critical case-by-case analysis.Figure 4Example of an automated critical case-by-case analysis of a ventilator-associated pneumonia. Example of an automated critical case-by-case analysis of a ventilator-associated pneumonia. Disclosures All Authors: No reported disclosures

P-338. Impact of an Educational Program on Hand Hygiene Practice and Healthcare-Associated Infections in a Tertiary Care Hospital in Rural South India

Abstract Background Effective hand hygiene is pivotal in averting healthcare-associated infections (HAIs), especially in resource-limited settings. This study aimed to evaluate baseline hand hygiene practices among healthcare providers (HCPs) and the impact of an educational intervention on reducing HAIs in a rural South Indian tertiary care hospital. Methods Over a 12-week period, an observational study was conducted across internal medicine, neurology, pulmonology, urology, pediatrics, and general surgery departments. Hand hygiene compliance among HCPs was meticulously observed, while HAIs were monitored using CDC definitions. Subsequent to the baseline assessment, a targeted hand hygiene education program was initiated, focusing on enhancing compliance among 190 nurses. Results A total of 1817 inpatients were enrolled in the study, with 55% male and 45% female, and age ranging from 1 to 90 years (median age: 50 years). Among the 1817 inpatients, HAIs exhibited varying incidence rates across departments. Notably, pneumonia was the most prevalent HAI in the internal medicine department (incidence: 1.8%), while urinary tract infections were prominent in neurology and pulmonology (incidence: 0.9%), and surgical site infections in urology (incidence: 0.7%). Hand hygiene compliance varied across departments, with internal medicine demonstrating the highest compliance (24.5%). Post-implementation of the education program, compliance significantly improved to 65.2%. Consequently, there was a notable decrease in HAI rates, with pneumonia cases in internal medicine decreasing by 30%, and urinary tract infections in neurology and pulmonology decreasing by 25%. Conclusion This study underscores the pivotal role of hand hygiene practices among HCPs in preventing HAIs, particularly in resource-limited settings. The implementation of targeted educational interventions resulted in a substantial improvement in compliance and a subsequent reduction in HAI incidence rates. These findings emphasize the ongoing need for concerted efforts to enhance hand hygiene practices and mitigate the risk of HAIs in rural healthcare settings. Further research and interventions are warranted to sustain these improvements and ensure optimal patient safety outcomes. Disclosures All Authors: No reported disclosures

P-359. Healthcare Practitioners' Infection Prevention Strategies and Associated Factors in Primary Healthcare Facilities of Rohingya Refugee Camps in Bangladesh: A Qualitative Study

Abstract Background Healthcare-associated infections (HAIs) pose significant challenges to both patients and healthcare providers. Rohingya refugee camps in Bangladesh are the most densely populated in the world. In the primary healthcare facilities of Rohingya refugee camps, healthcare-associated infections pose major barriers to safe and high-quality healthcare delivery among Rohingya refugees. The study's goal was to evaluate infection prevention strategies and associated factors among primary healthcare practitioners in Rohingya refugee camps. Methods In 2023, we conducted a qualitative study among primary healthcare practitioners identified from 15 primary healthcare facilities in 15 Rohingya refugee camps. We conducted 60 in-depth interviews and six focus group discussions with community healthcare providers. We reviewed the collected data, developed a coding system, analyzed the data, and summarized findings according to the study objectives and themes. Results Respondents were 60 % men and 40 % women, with a median age of 30 years, and 85% had higher secondary education. All respondents were employed for a median of 3 months (range,1-36 months). Only 42.5% of primary healthcare practitioners were knowledgeable about infection prevention strategies, and 37.2% practiced good infection prevention. Primary healthcare providers who had higher education and formal training in IPC were significantly more likely to have good infection prevention practices. Effective infection prevention practices were linked to the availability and accessibility of hand washing facilities and soap, proper use of personal protective equipment, appropriate cleaning and disinfection protocols, adherence to infection prevention guidelines, surveillance of healthcare-associated infections, and adequate knowledge of infection prevention measures of primary healthcare providers. Conclusion Effective infection prevention and control practices are crucial for minimizing the risk of HAIs. This study assessed the infection prevention knowledge and practices, and their associated factors among primary healthcare practitioners in Rohingya refugee camps which would help develop and implement effective interventions to reduce HAIs within Rohingya refugee camps. Disclosures All Authors: No reported disclosures

P-1180. Nuanced NICUs: developing neonatal intensive care unit infection prevention and control training for health departments

Abstract Background Neonatal intensive care units (NICUs) provide life-sustaining care to premature neonates and infants with complex medical needs. NICU patients are at high risk for healthcare-associated infections (HAIs) and require nuanced infection prevention and control (IPC) strategies due to unique care requirements and medical equipment. Health departments are key in providing IPC technical assistance to NICUs for outbreak response and quality improvement initiatives; however, many health department personnel are unfamiliar with NICU settings. We created and delivered NICU-specific IPC training to help health departments improve their capacity to support NICUs. Methods CDC developed three NICU-specific IPC educational webinars for health department personnel covering NICU settings, care, neonatal physiology, IPC practices and their nuances, and select NICU outbreak case reports. Health department personnel submitted demographic information and registered for the course electronically. Participants voluntarily responded to polls during webinars; questions included level of comfort, job duties, and NICU IPC concerns. Results A total of 562 individuals enrolled in the course with 469 (84%) representing 59/64 (92%) of CDC-funded health department jurisdictions across the U.S.; most enrollees (59%) currently work in a non-IPC role (e.g., epidemiologist, program lead, data analyst). Most had five years or less time in their current role (84%), including 18% with less than a year of experience; 47% reported never providing technical assistance to a NICU in the past. Among poll participants (55%) reported being unaware of how many NICUs are in their jurisdiction. HAI risk associated with medical devices (46%), hand hygiene (20%), and environmental (19%) issues were perceived as the greatest IPC concerns in the NICU. After two of three training sessions, 94% of participants felt more confident providing IPC support to a NICU. Conclusion Educational and training courses like these are an efficient way to improve health department capacity in providing IPC technical assistance to NICUs, and can help to build partnerships with healthcare facilities by strengthening infection prevention and quality improvement initiatives. Disclosures All Authors: No reported disclosures

P-323. Evaluation of WHO Five Moments Compliance Among Nursing, Paramedical Staff, and Emergency Medicine Technicians in a Tertiary Care Hospital in India: Expected vs. Actual

Abstract Background In tertiary care hospitals of a resource limited country like India, understanding hand hygiene (HH) compliance among nursing, paramedical staff, and emergency medical technicians according to the WHO Five Moments (5M) protocol is critical for improving infection control practices and patient outcomes. Methods Utilizing a pre-designed structured hand hygiene audit tool, this study conducted over 300 hours of direct HH observations between 2022 and 2022 at a tertiary care hospital in India. A total of 150 nursing staff, 60 paramedics, and 20 emergency medical technicians were included in the study cohort. Compliance with WHO 5M guidelines, including hand washing (50 seconds) and alcohol rub (25 seconds), was meticulously observed and recorded. Following the initial observation period, a targeted training program on the WHO Five Moments protocol was implemented for all healthcare professionals. Results A notable discrepancy between expected and actual compliance with HH protocols was evident among the observed healthcare professionals. Compliance varied across the groups: Among the 150 nursing staff, compliance rates were 55%; among the 60 paramedics, compliance rates were 40%; and among the 20 emergency medical technicians, compliance rates were 35%. Despite the established duration for HH procedures, all groups demonstrated suboptimal adherence to HH guidelines. Adherence to expected compliance increased the overall time per patient encounter by 5.5-11 minutes, highlighting the need for improved HH practices. Subsequent observations conducted six months after the training revealed a significant improvement in HH compliance rates across all groups: nursing staff demonstrated an increase to 81.3% paramedics to 68.3%, EMTs to 58.5%. Conclusion The study emphasizes the urgent need to address the gap between expected and actual HH compliance among healthcare professionals in Indian tertiary care hospitals. Enhanced educational interventions and reinforcement of HH practices are imperative to minimize the risk of healthcare-associated infections and improve patient safety outcomes. Disclosures All Authors: No reported disclosures

P-378. Benchmarking Healthcare-Associated Infections in Developing Countries Post-COVID-19: From High-Resource Hospitals in Southwest Brazil to Remote Hospitals in Jungle Regions

Abstract Background Benchmarking is essential for evaluating healthcare quality. In Brazil, few studies on healthcare-associated infections (HAIs) exist, and most focus on internal benchmarking within specific populations, creating a gap in understanding broader regions. Applying benchmarks from high-resource countries to low-resource settings can produce misleading conclusions due to differing healthcare environments. Thus, it's crucial to refine external benchmarks tailored to developing countries.Figure 1Pooled mean and percentiles (10th, 25th, 50th, 75th, and 90th) for seven indicators related to overall and hemodialysis outcomes. Methods The majority of hospitals involved in this study use SACIH+, a hospital infection control software (www.biobytebrasil.com), which compiles data from various Brazilian hospitals. All hospitals followed prospective surveillance protocols for healthcare-associated infections (HAIs) in accordance with the NHSN/CDC guidelines. Benchmarks for HAIs were established for different categories: Medical/Surgical Intensive Care Unit (ICU) HAI rates, surgical site infections, and hospital-wide HAI rates. These benchmarks were defined as the 10th and 90th percentiles using data collected from 25 hospitals between 2021 and 2023. While not all benchmarks included data from every hospital, each benchmark represents data from at least three hospitals and a minimum denominator of 20.Figure 2Pooled mean and percentiles (10th, 25th, 50th, 75th, and 90th) for 21 indicators from Medical/Surgical Adult ICU, Pediatric ICU, and Neonatal ICU. Results Seven overall and hemodialysis rates were benchmarked (Fig. 1). We included lethality rate and global HAI risk (covering all infection sites) as they are required HAI indicators in Brazil. Figure 2 shows benchmarks for key indicators in Adult Medical/Surgical ICU, Pediatric ICU, and Neonatal ICU. Surgical site infection rates, overall and by surgical service, and for major surgical procedures, are detailed in Figures 3 and 4.Figure 3Pooled mean and percentiles (10th, 25th, 50th, 75th, and 90th) for 19 overall surgical site infection rates, stratified by service and wound classification (clean, clean-contaminated, contaminated, and infected). Conclusion This study provides a comprehensive summary of benchmarks for 95 key HAI rates applicable to Brazil in the post-COVID-19 era and other developing countries. By offering external benchmarks across diverse settings, including high-resource and remote hospitals, these findings can guide healthcare facilities in improving infection control practices and refining surveillance protocols. Ultimately, the established benchmarks offer a valuable resource for hospitals striving to enhance patient safety and optimize infection control measures globally.Figure 4Pooled mean and percentiles (10th, 25th, 50th, 75th, and 90th) for surgical site infections across 48 different surgical procedures. Disclosures All Authors: No reported disclosures

Bacterial Contamination and Antimicrobial Resistance Patterns of Healthcare Workers' Mobile Phones in Hospitals at Khartoum City

Background: Mobile phones used by healthcare workers (HCWs) have emerged as potential reservoirs for pathogens, posing a risk of healthcare-associated infections (HAIs). This study aimed to investigate the prevalence of bacterial contamination on HCWs' mobile phones, determine the antimicrobial susceptibility patterns, and compare findings with global data. Methods: We collected swabs from 94 mobile phones of HCWs across two hospitals in Khartoum. We identified bacterial isolates using standard microbiological techniques and evaluated antimicrobial resistance using the Kirby-Bauer disk diffusion method. Results: Bacterial contamination appeared in 93.6% of mobile phones. Gram-positive bacteria, such as Coagulase-negative staphylococci (36%) and S. aureus (31.8%) were prevalent. Gram-negative organisms were isolated. The predominant organisms were Klebsiella pneumoniae 15 (37%) isolates followed by Pseudomonas aeruginosa 12 (30%) isolates, Proteus mirabilis 5 (12%) isolates, Acintobacter baumannii 4 (10%), Enterobacter spp 3(8%) and Escherichia coli 1 (3%). Antimicrobial susceptibility tests revealed high resistance to penicillin among Gram-positive isolates. The tests revealed no multidrug-resistant (MDR) or extended-spectrum beta-lactamase (ESBL) production. Conclusion: HCWs' mobile phones represent a critical vector for bacterial transmission in hospitals. Stringent infection control measures and regular disinfection should mitigate the associated risks.

Knowledge, Attitudes, and Practices of Infection Prevention and Control Nurses in Public Hospitals in the Limpopo Province: A Qualitative Study.

A crucial aspect of delivering healthcare is infection prevention and control (IPC), especially in public hospitals where the high volume of patients and limited resources can heighten the risk of healthcare-associated infections. This qualitative study explores IPC nurses' knowledge, attitudes, and practices in public hospitals within the Limpopo province of South Africa. The study adopted a qualitative descriptive design. This qualitative study utilized self-developed validated semi-structured interviews with IPC nurses from 12 public hospitals (4 tertiary, 4 regional, and 4 district). The interviews were transcribed verbatim and analysed using thematic analysis to identify key themes related to knowledge, attitudes, and practices in IPC. Each interview lasted approximately 15 to 20 min. Themes and subthemes that emerged provided a structured overview of the key aspects discussed. Each theme captures a different facet of the experiences, perceptions, and challenges faced by IPC nurses in their role. The subthemes further break down these views into specific areas of focus, offering deeper insights into the nurses' experiences of their professional responsibilities. This study shows that, although IPC nurses have a good understanding of infection control and a positive attitude toward it, systemic problems and resource constraints make it difficult to consistently implement optimal practices. Affective mood, opportunity cost, coherence of the intervention, burden, perceived efficacy, self-efficacy, and ethics are among the major themes that were found. To improve IPC efforts, there is a clear need for more focused training, resources, and managerial support.

Ultraviolet-C-based sanitization is a cost-effective option for hospitals to manage health care-associated infection risks from high touch mobile phones.

Mobile phones have become essential tools for health care workers around the world, but as high touch surfaces, they can harbor microorganisms that pose infection risks to patients and staff. As their use in hospitals increases, hospital managers must introduce measures to sanitize mobile phones and reduce risks of health care-associated infections. But such measures can involve substantial costs. Our objective in this paper was to consider two mobile phone risk mitigation strategies that managers of a hypothetical hospital could implement and determine which involves the lowest cost. The first strategy required all staff to sanitize their hands after every contact with a mobile phone. The second involved the hospital investing in ultraviolet-C-based mobile phone sanitization devices that allowed staff to decontaminate their mobile phones after every use. We assessed each intervention on material and opportunity costs assuming both achieved an equivalent reduction in microbe transmission within the hospital. We found that ultraviolet-C devices were the most cost-effective intervention, with median costs of approximately AUD360 per bed per year compared to AUD965 using hand hygiene protocols. Our results imply that a 200-bed hospital could potentially save AUD1-1.4 million over 10 years by investing in germicidal ultraviolet-C phone sanitizers rather than relying solely on hand hygiene protocols.

Reusable Tourniquets as Potential Transmitters of Infection: A Microbiological Analysis.

Healthcare-associated infections (HAIs) pose a significant global challenge, resulting in prolonged hospital stays, higher healthcare costs, and increased morbidity and mortality rates. Reusable medical equipment, such as tourniquets, represents a potential vector for infection transmission. Despite frequent use and close contact with patients' skin, infection control protocols often overlook these devices. This study examines microbial contamination on the surface of reusable tourniquets in both emergency department and operating theatre settings. A cross-sectional study was conducted between March and September 2024 in Gdansk, Poland. Samples from tourniquets used in the emergency department and the operating theatre were collected after an indefinite period, 14 days, and 28 days. Bacterial contamination on the surfaces of the tourniquets was measured using Columbia agar blood medium and expressed as colony-forming units (CFUs) per cm2. Significant bacterial loads were detected on reusable tourniquets, with contamination levels varying by location and duration of use. The average number of CFU/cm2 across all stages of this study was 545 CFU/cm2 for the emergency department and 101 CFU/cm2 for the operating theatre. Tourniquets used in the emergency department exhibited higher bacterial counts compared to those from the operating theatre, which showed a greater diversity of bacterial species. These findings underscore the need to revise infection control protocols for reusable tourniquets. This study provides critical data that may influence future policy changes aimed at reducing the risk of HAIs through the improved management of reusable medical devices.

Enhancing Infection Control in ICUS Through AI: A Literature Review.

Infection control in intensive care units (ICUs) is crucial due to the high risk of healthcare-associated infections (HAIs), which can increase patient morbidity, mortality, and costs. Effective measures such as hand hygiene, use of personal protective equipment (PPE), patient isolation, and environmental cleaning are vital to minimize these risks. The integration of artificial intelligence (AI) offers new opportunities to enhance infection control, from predicting outbreaks to optimizing antimicrobial use, ultimately improving patient safety and care in ICUs. The primary objectives are to explore AI's impact on predicting HAIs, real-time monitoring, automated sterilization, resource optimization, and personalized infection control plans. A comprehensive search of PubMed and Scopus was conducted for relevant articles up to January 2024, including case series, reports, and cohort studies. Animal studies and irrelevant articles were excluded, with a focus on those considered to have significant clinical relevance. The review highlights AI's prowess in predicting HAIs, surpassing conventional methods. Existing evidence demonstrates AI's efficacy in accurately predicting and mitigating HAIs. Real-time patient monitoring and alert systems powered by AI are shown to enhance infection detection and patient outcomes. The paper also addresses AI's role in automating sterilization and disinfection, with studies affirming its effectiveness in reducing infections. AI's resource optimization capabilities are exemplified in ICU settings, showcasing its potential to improve resource allocation efficiency. Furthermore, the review emphasizes AI's personalized approach to infection control post-procedures, elucidating its ability to analyze patient data and create tailored control plans.

Safety of steroids in severe community-acquired pneumonia.

The systemic use of corticosteroids for patients with severe community-acquired pneumonia (sCAP) remains controversial in clinical practice, particularly in terms of the safety profile of these drugs. This narrative review aims to analyse the available literature data concerning the safety of short-term steroid use in the treatment of sCAP, while also highlighting potential future research directions. Several trials and meta-analyses have evaluated corticosteroid therapy as an adjuvant treatment for sCAP, yielding heterogeneous results regarding its efficacy and safety. Despite the wide variability in results, it is generally accepted that steroids are not associated with a significant risk of healthcare-associated infections, gastrointestinal bleeding or acute kidney injury in patients with sCAP in the short term. Nevertheless, such drugs are linked to hyperglycaemia, necessitating regular monitoring and appropriate management. The influence of steroids on long-term outcomes and their potential risks in viral sCAP still needs to be investigated.

Risk factors of healthcare-associated infection among healthcare workers in intensive care units: A multicenter cross-sectional study.

Healthcare-associated infections (HAIs) are a major global health threat, leading to higher morbidity and mortality, longer hospital stays, and increased healthcare expenses. Intensive care units (ICUs) present a particularly high risk of developing HAIs. This study aims to examine the risk factors of HAIs among healthcare workers (HCWs) in the ICUs of selected public hospitals. We employed a cross-sectional design using an online survey. Respondents were randomly selected from seven large public hospitals located in different areas of Riyadh, the capital city of Saudi Arabia. Data collection was conducted between November 1st to 15th, 2023. Logistic regression analysis was employed to examine previous exposure to HAIs as the response variable and selected predictors. A total of 600 HCWs participated in the study (response rate 88.2%). Among the study HCWs, 75.1% were female, with nurses making up 50% of the sample. Of the respondents, 78% had at least a year's experience, 71% had applied infection prevention and control (IPC) training from the infection control department, and 93% reported they had good knowledge about infection control. The level of knowledge of IPC (OR = 0.9, p < 0.05) and applied IPC training (0.1, p < 0.001) were significantly associated with a lower risk of HAIs. Additionally, a higher risk of HAIs was associated with HCWs years of clinical experience (p < 0.001). Overall, the findings indicated that HCWs who have poor knowledge of IPC, who reported no previous IPC applied training, and who have more years of clinical work experience have a greater risk of HAIs. Thus, legislators and Health officials should prioritize the prevention of infections linked to healthcare, paying particular attention to tailored and applied IPC initiatives.

How long do bacteria, fungi, protozoa, and viruses retain their replication capacity on inanimate surfaces? A systematic review examining environmental resilience versus healthcare-associated infection risk by "fomite-borne risk assessment".

SUMMARYIn healthcare settings, contaminated surfaces play an important role in the transmission of nosocomial pathogens potentially resulting in healthcare-associated infections (HAI). Pathogens can be transmitted directly from frequent hand-touch surfaces close to patients or indirectly by staff and visitors. HAI risk depends on exposure, extent of contamination, infectious dose (ID), virulence, hygiene practices, and patient vulnerability. This review attempts to close a gap in previous reviews on persistence/tenacity by only including articles (n = 171) providing quantitative data on re-cultivable pathogens from fomites for a better translation into clinical settings. We have therefore introduced the new term "replication capacity" (RC). The RC is affected by the degree of contamination, surface material, temperature, relative humidity, protein load, organic soil, UV-light (sunlight) exposure, and pH value. In general, investigations into surface RC are mainly performed in vitro using reference strains with high inocula. In vitro data from studies on 14 Gram-positive, 26 Gram-negative bacteria, 18 fungi, 4 protozoa, and 37 viruses. It should be regarded as a worst-case scenario indicating the upper bounds of risks when using such data for clinical decision-making. Information on RC after surface contamination could be seen as an opportunity to choose the most appropriate infection prevention and control (IPC) strategies. To help with decision-making, pathogens characterized by an increased nosocomial risk for transmission from inanimate surfaces ("fomite-borne") are presented and discussed in this systematic review. Thus, the review offers a theoretical basis to support local risk assessments and IPC recommendations.

Optimizing Ultrasound Probe Disinfection for Healthcare-Associated Infection Control: A Comparative Analysis of Disinfectant Efficacy.

Background/Aims: Ultrasound is a key diagnostic tool in modern medicine due to its ability to provide real-time, high-resolution images of the internal structures of the human body. Despite its undeniable advantages, there are challenges related to the contamination of ultrasound probes, with the risk of healthcare-associated infections. The aim of this review was to identify the most effective disinfectants for disinfecting ultrasound probes to prevent the transmission of pathogens between patients. Methods: A narrative review was conducted using the PubMed, CINAHL, Embase, and Cochrane Library databases, resulting in the inclusion of 16 studies from an initial 1202 records. Results: Hydrogen peroxide (H2O2) was the most effective disinfectant, especially in automated systems, achieving a >5-log10 reduction in viral load, including that of resistant pathogens like Human Papillomavirus. Chlorhexidine gluconate (4%) demonstrated strong antibacterial efficacy, eliminating 84.62% of bacterial contamination, but was less effective against viral pathogens. Glutaraldehyde was effective in some cases, though its use carried a higher risk of probe damage. The use of sodium hypochlorite varied across guidelines; some endorsed it for COVID-19 prevention, while others cautioned against its application due to potential probe damage. Conclusions: This study highlights the importance of advanced disinfection technologies and strict adherence to protocols in improving infection control. Automated systems utilizing H2O2 strike an ideal balance between antimicrobial efficacy and equipment preservation. Future research should focus on developing disinfection methods that prioritize safety, cost-effectiveness, and environmental sustainability in various clinical environments.

NURSING'S ROLE IN THE PREVENTION AND CONTROL OF HEALTHCARE-ASSOCIATED INFECTIONS (HAIS)

Healthcare-Associated Infections (HAIs) represent an important public health problem worldwide. As it is a condition associated with increased morbidity and mortality, this type of infection requires control and prevention strategies to be adopted. In this sense, nursing care is an important element in the process of reducing the risks of HAIs, as they share routines that help minimize its causes, in addition to employing aseptic techniques to prevent a high potential for environmental contamination. professional and thus reduce possible infections by microorganisms. Given the importance of these professionals, the present study aimed to investigate the role of the nursing team in preventing and controlling infections related to healthcare, describing the main nursing actions in preventing and controlling these infections. The research was developed through a bibliographical review, with the selection of articles on the topic, whose publication occurred between the years 2019 and 2024. The application of the search criteria allowed the selection of 11 articles, which presented different approaches to the theme. According to these approaches, the group of selected articles can be classified by thematic areas: risk factors for the occurrence of HAIs; prevention measures for the nursing team; nursing practices to reduce risks; importance of the hospital infection control service. From carrying out this review, it was possible to observe that nursing acts directly in the prevention and control of this type of infection, whether through safe care practices, or through surveillance, the implementation of protocols and educational practices aimed at preventing these infections.

IoT-Based Hand Hygiene Compliance Monitoring System and Validation of Its Effectiveness in Hospital Environments.

Healthcare-associated infection (HAI) is the most common adverse medical event that affects patients. Internationally, healthcare workers (HCWs) are monitored for hand hygiene compliance to reduce HAI risk. While direct observation is considered the gold standard for monitoring, it has several disadvantages. To address this, the study focused on developing a comprehensive hand hygiene system that integrates the Internet of Things (IoT) hand hygiene with soap and water (HHW) and alcohol-based formulation (HHA) monitoring, incorporates real-time data visualization on a web interface to track HCWs' hand hygiene practices, and provides instant calculations of compliance and accuracy rates. This IoT system uses Bluetooth for HCW positioning and HHW detection, ultrasonic sensors for handwashing duration, and pressure sensors for HHA detection. Furthermore, a cloud server, database, and website are established to manage and display the data received by the IoT devices. To reduce HAI in Taiwan, hospitals must provide both HHW and HHA systems, and HCWs can choose either method when hand hygiene is necessary. The system achieved 72% accuracy in clinical practice within an adult intensive care unit (ICU).

Point Prevalence Survey of HAIs as a key component of Infection Prevention and Control programs

Abstract Healthcare-Associated Infections (HAIs) are a global concern, requiring surveillance strategies as Point Prevalence Surveys (PPS) to estimate their burden and investigate associated risk factors for targeted interventions in high-risk areas. This study aims to assess the prevalence of HAIs, identify determinants and evaluate antimicrobial use in a teaching hospital in Rome. A PPS was carried out from June 19th to 23rd, 2023, in accordance with the European Centre for Disease Prevention and Control (ECDC) protocol for HAIs and antimicrobial use in European acute care hospitals (version 6.1). Pearson’s chi-squared test was employed to investigate correlations between potential risk factors and HAIs. The survey included 829 patients with an average age of 56.3 years (SD: ±24.6). Of these, 48.4% were female and over half had visited the hospital’s Emergency Department (53.7%). The prevalence of active HAIs was 8.7%, with 72 patients diagnosed. Furthermore, 51.0% of all patients received at least one systemic antimicrobial agent, and 16.7% of those treated had an HAI. Penicillins (39.7%) and third-generation cephalosporins (37.8%) were the most frequently prescribed antimicrobials. The primary HAIs were bloodstream infections (34.1%), followed by urinary tract (27.3%), surgical site (23.9%), lower respiratory tract (6.8%), and gastrointestinal infections (7.9%). Escherichia coli (13.2%), Staphylococcus aureus (9.2%), and Clostridium difficile (6.6%) were the most frequently isolated pathogens. Intensive Care Unit admission, use of medical device, recent antibiotic therapy and prior hospitalization or surgery significantly correlated (p &amp;lt; 0.05) with increased HAIs risk. The detected prevalence of HAIs is lower than the national rates observed in 2022 (10.2%), which have increased since 2016. HAIs surveillance is essential for developing effective infection prevention and control programs and for optimizing resource allocation in hospital settings. Key messages • Surveillance of Healthcare-Associated Infections is crucial for developing targeted Infection Prevention and Control programs and optimizing hospital resource allocation. • Point Prevalence Surveys offer essential information for assessing the burden of Healthcare-Associated Infections and directing intervention strategies in hospitals.