Transmission Of Healthcare-associated Infections Research Articles

Evaluating a Continuously Active Disinfectant Wipe on High Touch Surfaces in Rooms of Patients with Multidrug-Resistant Organisms (MDROs)

<h3>Background</h3> Recontamination of the patient's environment occurs quickly after thorough disinfection and could contribute to the transmission of healthcare-associated infections. We aimed to determine whether a continuous active disinfectant wipe (CADW) could provide sustained disinfection for rooms of MDRO carriers. <h3>Methods</h3> We sampled a small number of rooms of MDRO carriers in an academic hospital and nursing home setting. Rooms underwent routine cleaning by environmental services immediately followed by additional high-touch cleaning by Infection Preventionists with 1) routine disinfecting wipes (RDW) and 2) CADW on separate days. Five pre-specified high-touch surfaces were cultured with pre-moistened spongesicles 23 hours post-cleaning in four hospital rooms, eight hours post-cleaning in two hospital rooms, and eight hours post-cleaning in three nursing home rooms. Spongesicles were processed at a CLIA-certified laboratory with 40cc of phosphate-buffered saline, stomaching for one minute, centrifuging the liquid, reconstituting in 5cc of fluid, and plating per CLSI standards. <h3>Results</h3> At 23 hours, three of four rooms had MDRO contamination after RDW (two MRSA and one C. auris), with same findings after CADW. Six RDW objects were positive for MRSA and two for C. auris. Five CADW objects were positive for MRSA and one for C. auris. At 8 hours, four of five hospital/nursing home rooms had MDRO contamination after RDW (two MRSA, one C. auris, one VRE) compared to three of five rooms after CADW (2 MRSA and 1 C. auris). Six RDW objects were positive for MRSA, two for C. auris, and one for VRE. Six CADW objects were positive for MRSA and one for C. auris. <h3>Conclusions</h3> In this exploratory analysis, CADW did not provide a clinically meaningful reduction in MDRO contamination of high-touch surfaces at either 8 or 23 hours compared to RDW. Ongoing efforts to demonstrate effective and sustained surface antimicrobial activity to reduce fomites is needed.

Longitudinal Assessment of Contamination Patterns on Workstations on Wheels (WOWs)

Background Representations of contamination on portable medical equipment inform strategies to prevent transmission and healthcare-associated infections (HAIs). While periodic disinfection of equipment is required in most hospitals, the complexity of demands on staff may limit their ability to adequately disinfect multiple surfaces and touch points on a piece of equipment. The purpose of this study was to determine if current disinfection practices were effectively managing bioburden on WOWs on our hospital wards. Methods Samples were collected using press plate for four weeks from 10 WOWs on three medical-surgical units in our hospital. The sampling scheme limited the ability of staff to anticipate sampling and ensured multiple surfaces on each WOW were consistently sampled. Aerobic bacterial colony counts were calculated after 24 hours of incubation. Bayesian multilevel models estimated the mean bioburden and compared bioburden from different locations on WOWs. Results Out of the 452 samples, the estimated mean colony count (95% credible interval) was 29.2 (16.1-51.1). The incident risk-ratio comparing the handle to the other surfaces on the WOWs were 0.43 (0.32-0.55) for the keyboard, 0.29 (0.22-0.38) for the tray, and 0.22 (0.16-0.29) for the mouse. Conclusions The handle used for moving the WOW around, had greater bioburden compared to the keyboard, tray, or the mouse. Difference in the bioburden may reflect number of touches and lack of hand hygiene when moving equipment. The lower bioburden on keyboards and mouses may conversely reflect greater attention to hand hygiene or may be an artifact of sampling (less contact with press plates). The correlation of bioburden to HAI transmission was not studied here so the significance of bioburden alone in the absence of HAI monitoring is uncertain. Representations of contamination on portable medical equipment inform strategies to prevent transmission and healthcare-associated infections (HAIs). While periodic disinfection of equipment is required in most hospitals, the complexity of demands on staff may limit their ability to adequately disinfect multiple surfaces and touch points on a piece of equipment. The purpose of this study was to determine if current disinfection practices were effectively managing bioburden on WOWs on our hospital wards. Samples were collected using press plate for four weeks from 10 WOWs on three medical-surgical units in our hospital. The sampling scheme limited the ability of staff to anticipate sampling and ensured multiple surfaces on each WOW were consistently sampled. Aerobic bacterial colony counts were calculated after 24 hours of incubation. Bayesian multilevel models estimated the mean bioburden and compared bioburden from different locations on WOWs. Out of the 452 samples, the estimated mean colony count (95% credible interval) was 29.2 (16.1-51.1). The incident risk-ratio comparing the handle to the other surfaces on the WOWs were 0.43 (0.32-0.55) for the keyboard, 0.29 (0.22-0.38) for the tray, and 0.22 (0.16-0.29) for the mouse. The handle used for moving the WOW around, had greater bioburden compared to the keyboard, tray, or the mouse. Difference in the bioburden may reflect number of touches and lack of hand hygiene when moving equipment. The lower bioburden on keyboards and mouses may conversely reflect greater attention to hand hygiene or may be an artifact of sampling (less contact with press plates). The correlation of bioburden to HAI transmission was not studied here so the significance of bioburden alone in the absence of HAI monitoring is uncertain.

Assessing the Risk of Spatial Spreading of Diseases in Hospitals

In recent years, the transmission of healthcare-associated infections (HAIs) has led to substantial economic loss, extensive damage, and many preventable deaths. With the increasing availability of data, mathematical models of pathogen spreading in healthcare settings are becoming more detailed and realistic. Here, we make use of spatial and temporal information that has been obtained from healthcare workers (HCWs) in three hospitals in Canada and generate data-driven networks that allow us to realistically simulate the spreading of an airborne respiratory pathogen in such settings. By exploring in depth the dynamics of HAIs on the generated networks, we quantify the infection risk associated with both the spatial units of the hospitals and HCWs categorized by their occupations. Our findings show that the “inpatient care” and “public area” are the riskiest categories of units and “nurse” is the occupation at a greater risk of getting infected. Our results provide valuable insights that can prove important for measuring risks associated with HAIs and for strengthening prevention and control measures with the potential to reduce transmission of infections in hospital settings.

Comparison of Survival of Healthcare Associated Bacteria on Materials used for Making White Coat

Healthcare-Associated Infections (HAIs) are of global concern in this present era and white coats play an important role in the transmission of HAIs. The most common healthcare-associated bacteria are Enterococcus species, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumanni, Pseudomonas aeruginosa and Enterobacter species (ESKAPE bugs). These healthcare-associated bacteria are capable of surviving on white coats which could act as fomites in the transmission of HAIs. The purpose of this study was to compare the duration of survival of healthcare-associated bacteria on different materials used for making white coats. Materials like pure cotton, artificial cotton, cotton silk, spun and crepe were cut into swatches of 1cm2 size and sterilized by autoclaving. Five different bacteria isolated from clinical specimens were grown on 5 % sheep blood agar and bacterial suspensions were made in sterile physiological saline. The swatches were immersed in bacterial suspension and kept in petri plates at 25°C. The viable counts of bacteria were determined at definite time intervals by surface plate method. The present study shows that among the healthcare-associated bacteria, S.aureus survived the maximum up to 52 days. The duration of survival of S.aureus was significantly longer than P.aeruginosa and A.baumannii (p &lt;0.05). A.baumannii survived only up to 20 days maximum. All the healthcare-associated bacteria significantly survived for the shortest duration of time on crepe. Therefore, crepe could be a better material used for making white coats.

Infection prevention and care bundles addressing health care-associated infections in neonatal care in low-middle income countries: a scoping review.

SummaryBackgroundHealth care-associated infections (HCAI) in neonatal units in low- and middle-income countries (LMIC) are a major cause of mortality. This scoping review aimed to synthesise published literature on infection prevention and care bundles addressing neonatal HCAI in LMICs and to construct a Classification Framework for their components (elements).MethodsFive electronic databases were searched between January 2001 and July 2020. A mixed-methods approach was applied: qualitative content analysis was used to build a classification framework to categorise bundle elements and the contents of the classification groups were then described quantitatively.Findings3619 records were screened, with 44 eligible studies identified. The bundle element Classification Framework created involved: (1) Primary prevention, (2) Detection, (3) Case management, and Implementation (3 + I). The 44 studies included 56 care bundles with 295 elements that were then classified. Primary prevention elements (128, 43%) predominated of which 71 (55%) focused on central line catheters and mechanical ventilators. Only 12 elements (4%) were related to detection. A further 75 (25%) elements addressed case management and 66 (88%) of these aimed at outbreak control.InterpretationThe 3 + I Classification Framework was a feasible approach to reporting and synthesising research for infection-relevant bundled interventions in neonatal units. A shift towards the use in infection prevention and care bundles of primary prevention elements focused on the neonate and on commonly used hospital devices in LMIC (e.g., self-inflating bags, suctioning equipment) would be valuable to reduce HCAI transmission. Detection elements were a major gap.FundingThis work was made possible in part by the John D. and Catherine T. MacArthur Foundation, the Bill & Melinda Gates Foundation, ELMA Philanthropies, The Children's Investment Fund Foundation UK, The Lemelson Foundation, and the Ting Tsung and Wei Fong Chao Foundation under agreements to William Marsh Rice University. The project leading to these results has also received the support of a fellowship from the “la Caixa” Foundation (ID 100010434). The fellowship code is LCF/BQ/EU19/11710040. EJAF is an Academic Clinical Fellow whose salary is funded by the UK National Institute for Health Research (NIHR). NES receives a Research Training Program Scholarship (Australian Commonwealth Government).

TINGKAT PENGETAHUAN PERAWAT DENGAN KEPATUHAN PELAKSANAAN HAND HYGIENE DI RUANGAN INTERNA RSUD TOTO KABILA

Hand hygiene is activities to clean hands with alcohol-based soap and water (hand wash) or (hand rub), washing hands also acts as a breaker of disease transmission chain. Nurse hand hygiene behaviour can affect the health of nurses and clients in preventing the transmission of HAIs (Health care associated infection) infection. The objective of research was to determine correlation of nurse knowledge level with the compliance implementation of hand hygiene. The design used quantitative analytic with cross sectional method. The samples were 34 respondents used total sampling technique. The variables researched include the dependent variable is compliance with the implementation of hand hygiene and the independent variable is nurses' knowledge. The method of collecting data used questionnaire with the observation and analysis used chi square test with significance value α=0,05. The result showed there are significance correlations with P value=0,003 which means small than α value=0,05. Concluded there is correlation of nurse knowledge level with the compliance implementation of hand hygiene in interna room of RSUD Toto Kabila.

820. Optimal Specimen Source(s) for Carbapenemase-Producing Acinetobacter Colonization Screening

Abstract Background Infection prevention (IP) strategies are implemented to limit the transmission of healthcare-associated infections (HAIs), which are estimated to occur in 1 out of 31 hospitalized patients per day in the United States. Carbapenem-resistant Acinetobacter (CRA) cause HAIs classified as an urgent threat by CDC. When carbapenemase-producing CRA (CP-CRA) are identified, containment strategies are implemented, including screening patients at high risk for colonization with CP-CRA. Point prevalence surveys (PPS) are conducted to assist with HAI outbreak investigations and identify colonized patients. Methods Herein, we describe results from culture-based CP-CRA colonization testing of multiple specimen sources (rectal, skin [axilla/groin or groin], respiratory, and/or wound). A total of 744 PPS specimens from 356 patients, across six states, were obtained from February 2019 to May 2021 for CP-CRA colonization screening including 30% (224/744) rectal, 52% (390/744) skin, 10% (73/744) respiratory, and 8% (57/744) wound sources. The specimens were plated onto both non-selective (blood agar) and selective media (MacConkey, ESBL CHROMagar, Acinetobacter CHROMagar), and RT-PCR was performed for detection of the Acinetobacter-specific carbapenemase genes blaOXA-23, blaOXA-24, and blaOXA-58. Results Twelve percent (90/744) of specimens, representing 17% (62/356) of patients, were positive for detection of blaOXA-23 and/or blaOXA-24 CP-CRA. The majority (96%) of CP-CRA harbored blaOXA-24. Of the 62 colonized patients, 52% (32/62) had more than one collection source and 47% (15/32) of those had more than one source positive for CP-CRA. There was no consensus regarding a single source type across positive specimens. However, rectal or skin swab collection alone would potentially miss 2% (4/163) or 8% (14/186) of positive specimens, respectively. Conclusion These data suggest that rectal or skin source collection alone could be sufficient for detection of CP-CRA. Overall, multiple factors should be considered to guide the source(s) for CP-CRA specimen collection, such as infection type, regional prevalence, patient factors, and/or IP gap(s) within a facility. Disclosures All Authors: No reported disclosures

Assessment of cleaning methods on bacterial burden of hospital privacy curtains: a pilot randomized controlled trial

Healthcare-associated infections (HAIs) are an important global issue, leading to poor patient outcomes. A potential route of transmission of HAIs is through contact with hospital privacy curtains. The aim of this study is to evaluate cleaning on reduction of curtain bacterial burden. In this pilot cluster randomized controlled trial we compared the bacterial burden between three groups of 24 curtains on a regional burn/plastic surgery ward. A control group was not cleaned. Two groups were cleaned at 3–4 day intervals with either disinfectant spray or wipe. The primary outcome was the difference in mean CFU/cm2 between day 0 to day 21. The secondary outcome was the proportion of curtains contaminated with Methicillin-resistant Staphylococcus aureus (MRSA). By day 21, the control group was statistically higher (2.2 CFU/cm2) than spray (1.3 CFU/cm2) or wipe (1.5 CFU/cm2) (p < 0.05). After each cleaning at 3–4 day intervals, the bacterial burden on the curtains reduced to near day 0 levels; however, the level increased again over the intervening 3–4 days. By day 21, 64% of control curtains were contaminated with MRSA compared to 10% (spray) and 5% (wipe) (p < 0.05). This study show that curtains start clean and progressively become contaminated with bacteria. Regularly cleaning curtains with disinfectant spray or wipes reduces bacterial burden and MRSA contamination.

Probabilistic modelling of effects of antibiotics and calendar time on transmission of healthcare-associated infection

Healthcare-associated infection and antimicrobial resistance are major concerns. However, the extent to which antibiotic exposure affects transmission and detection of infections such as MRSA is unclear. Additionally, temporal trends are typically reported in terms of changes in incidence, rather than analysing underling transmission processes. We present a data-augmented Markov chain Monte Carlo approach for inferring changing transmission parameters over time, screening test sensitivity, and the effect of antibiotics on detection and transmission. We expand a basic model to allow use of typing information when inferring sources of infections. Using simulated data, we show that the algorithms are accurate, well-calibrated and able to identify antibiotic effects in sufficiently large datasets. We apply the models to study MRSA transmission in an intensive care unit in Oxford, UK with 7924 admissions over 10 years. We find that falls in MRSA incidence over time were associated with decreases in both the number of patients admitted to the ICU colonised with MRSA and in transmission rates. In our inference model, the data were not informative about the effect of antibiotics on risk of transmission or acquisition of MRSA, a consequence of the limited number of possible transmission events in the data. Our approach has potential to be applied to a range of healthcare-associated infections and settings and could be applied to study the impact of other potential risk factors for transmission. Evidence generated could be used to direct infection control interventions.

The effect of disinfectants on the microbial community on environmental healthcare surfaces using next generation sequencing

BackgroundHealthcare-associated infections are a significant economic burden and cause of avoidable morbidity and mortality within healthcare systems. The contribution of environmental contamination to healthcare-associated infection transmission has been recognized, but the mechanisms by which transmission occurs are still being investigated. The objective of this study was to characterize the microbial communities of disinfected, non-critical healthcare surfaces using next generation sequencing technology. MethodsComposite environmental surface samples were from high-touch surfaces in rooms of patients isolated for infections with multidrug-resistant organisms during their hospitalization. Information on the disinfectant product used and cleaning type (routine or terminal) was collected. 16S rRNA gene amplicon sequencing and analysis were performed. Community analysis was conducted to determine the bacterial composition and compare the detection of target pathogens by culture from 94 Contact Precaution rooms. ResultsOverall percent agreement between culture and sequence methods ranged from 52%-88%. A significant difference was observed in bacterial composition between rooms cleaned with bleach and those cleaned with a quaternary ammonium compound for composite 2 (overbed table, intravenous pole, and inner room door handle) (ANOSIM R = 0.66, P = .005) but not composite 1 (bed rails, television remote control unit, call buttons, and telephone). ConclusionsSurfaces in bleach-cleaned rooms contained a higher proportion of gram-positive microbiota, whereas rooms cleaned with quaternary ammonium compound contained a higher proportion of gram-negative microbiota, suggesting disinfectant products may impact the healthcare environment microbiome.

Compliance with hygiene practices among healthcare workers at an academic hospital emergency department.

IntroductionHealthcare-associated infections (HCAIs) are an important contributor to patient morbidity and mortality. Healthcare workers (HCWs) hands are the chief mode of transmission of HCAIs. The emergency centre (EC) is frequently the first point of contact for patients within the health care system. The aim of this study is to determine compliance with hygiene practices among healthcare workers at a tertiary hospital EC.MethodsHygiene practices of staff were observed over a six-week period. Data pertaining to compliance rates with hand cleansing and other hygiene practices was collected. Consent was obtained retrospectively to avoid influencing participant behaviour.ResultsFrom a total of 477 potential hygiene opportunities, compliance with hand hygiene was only 34.4% (n = 164). Hand cleansing with an alcohol-based hand rub was observed in 87 (26.7%) of the 326 (68.3%) opportunities where it was indicated, while handwashing with soap and water was observed in 35 (23.2%) of the 151 opportunities where this was indicated. Compliance to each of the six steps of handwashing ranged between 62.2% and 83.5%, with there being a gradual deterioration in compliance from step one through to step six. Compliance with ‘bare below the elbows’ was observed in 242 (50.7%) opportunities while disposable surgical gloves were worn on 85 (44.7%) of the 190 opportunities where this was indicated.ConclusionCompliance with hygiene practices among EC HCWs is suboptimal. Various strategies including ongoing systematic training and regular audits may improve overall hygiene practices among EC staff.

Practice of Standard Safety Measures among Nursing Personnel at Tertiary Mental Health Institute, North-East, India

Background: Health care-associated infection (HAI) is a serious problem that deeply impacts patient safety and is a major cause of patient morbidity and mortality. Adherence to standard safety measures while performing procedures and related infection control measures is a part of nurses responsibility as it protects patients and health care workers from transmission of health-care associated infections. Assessing practice of standard safety measures while performing nursing procedures is immensely important so that necessary changes can be brought to enhanced quality nursing care. Methodology: The study adopted an observational descriptive research design. The setting of the study was the Tertiary Mental Health Institute, North-East, India. The sample of the study consisted of the thirty eight (38) nursing personnel who performed the total 150 procedures i.e. 30 times of each five domains (waste disposal, intramuscular injection, intravenous injection, hand-washing, aseptic wound dressing). Convenience sampling technique was used. Result: Finding showed that all the nursing personnel followed proper waste disposal practice but partially adhere to standard safety measures while administering intramuscular and intravenous injections. Whereas practice on standard safety measures while performing hand washing and aseptic wound dressing were less than average. Conclusion: The present study highlights the importance of in-service education on standard safety measures by incorporating new guidelines of nursing procedures based on evidence based practices. In-service education brought changes in the performance level as it is showed that the nursing personnel who had earlier received in-service education on Bio-medical waste management from the institute followed satisfactory waste disposal practice. Keywords: Standard safety measures, nursing personnel.

Prevention of nosocomial transmission and biofilm formation on novel biocompatible antimicrobial gloves impregnated with biosynthesized silver nanoparticles synthesized using Eucalyptus citriodora leaf extract.

Failure in the prevention of cross-transmission from contaminated gloves has been recognized as an important factor that contributes to the spread of several healthcare-associated infections. Ex situ coating process with silver nanoparticles (AgNPs) using Eucalyptus citriodora ethanolic leaf extract as reducing and capping agents to coat glove surfaces has been developed to prevent this mode of transmission. Elemental analysis of coated gloves showed 24.8 Wt% silver densely adhere on the surface. The coated gloves fully eradicated important hospital-acquired pathogens including Gram-positive bacteria, Gram-negative bacteria, and yeasts within 1 h. The coated gloves showed significant reduction, an average of five logs when tested against all standard strains and most clinical isolates (p<0.01). Following prolonged exposure, the coating significantly reduced the numbers of most adhered pathogenic species, compared with uncoated gloves (p<0.0001). AgNPs-coated gloves reduced microbial adhesion of mixed-species biofilms. A series of contamination and transmission assays demonstrated no transmission of viable organisms. Biocompatibility analysis confirmed high viability of HaCaT and L929 cells at all concentrations of AgNPs tested. The coated gloves were non-toxic with direct contact with L929 cells. The highly efficacious AgNPs-coated gloves potentially provide additional protection against transmission of healthcare-associated infections.

Healthcare workers\u2019 compliance and its potential determinants to prevent COVID-19 in public hospitals in Western Ethiopia

BackgroundGlobally, Coronavirus disease-19 has created unprecedented challenges to public health. Healthcare workers (HCWs) are at risk of COVID-19 because of their profession. There are limited studies conducted in Ethiopia among HCWs regarding their compliance with COVID-19 preventive measures. Therefore, this study intended to assess HCWs’ compliance with measures to prevent COVID-19, and its potential determinants in public hospitals in Western Ethiopia.MethodsA self-administered, multicenter hospital-based cross-sectional survey was proposed to 422 randomly selected HCWs working in seven public hospitals in Western Ethiopia identified as COVID-19 referral centers. Data were entered into Epi Data version 3.1 and analyzed using SPSS version 24. Binary logistic regression was used to identify potential determinants of outcome variables at p-value < 0.05.ResultsOut of 422 completed questionnaires, the overall HCWs’ compliance with COVID-19 prevention is 22% (n = 404). In multivariate regression analysis, factors such as spending most of caring time at bedside (AOR = 1.94, 95%CI, 1.06–3.55), receiving training on infection prevention/COVID-19 (AOR = 1.86, 95%CI, 1.04–3.33), reading materials on COVID-19 (AOR = 2.04, 95%CI, 1.14–3.63) and having support from hospital management (AOR = 2.09, 95%CI, 1.20–3.64) were found to be significantly associated with COVID-19 preventive measures. Furthermore, inadequate supplies of appropriate personal protective equipment (83.2%), insufficient supportive medications (78.5%), and lack of provision of adequate ventilation (77.7%) were the barriers to COVID-19 prevention most frequently mentioned by participants.ConclusionOur findings highlight HCWs’ poor compliance with COVID-19 preventive measures. Providing information and refreshing training to improve the level of healthcare workers’ adherence with COVID-19 prevention is as imperative as increasing staff commitment to supply resources necessary to protect HCWs and to reduce healthcare-associated infections transmission of SARS-COV-2.

Information technology on hand hygiene compliance among health care professionals: A systematic review and meta-analysis.

To determine the effectiveness of information technology interventions on hand hygiene compliance among health care professionals. Performing hand hygiene is the optimal approach to prevent the transmission of health care-associated infections. However, results regarding the effectiveness of information technology interventions on hand hygiene compliance were inconsistent to date. A search for studies published up to May 2020 was undertaken. A meta-analysis was conducted using RevMan 5.3 software. The most commonly used information technology systems were as follows: automated training, electronic counting devices and remote monitoring, real-time hand hygiene reminders and feedback, and automated monitoring. These four types of technology systems can significantly improve hand hygiene compliance among health care professionals (odds ratio=3.06, p<.001). The four types of information technology can be effectively used to change the hand hygiene behaviour. Because the information systems can monitor personnel and conduct statistical analyses automatically, they save labour costs of human monitors, are more time efficient and eliminate accompanying human error. The use of the four types of information technology is convenient and could reduce health care-associated infections; thus, they could be widely used in the future as the key to increase hand hygiene compliance rate.

Assessment of the Knowledge and Practice of Handwashing among Healthcare Workers in a Tertiary Hospital in Ekiti, Southwestern Nigeria

Background: The most common means of transmission of Healthcare-Associated Infections (HAIs) is the contaminated hand of Healthcare Workers (HCWs), proper handwashing by HCWs is the best method of halting this transmission, however, there is poor adherence to the practice of the simple handwashing procedure in many health facilities.&#x0D; Aims: To assess the knowledge and practice of proper handwashing, to identify the factors impeding adherence to its good practice among HCWs and to identify the handwashing and hand drying facilities available to these HCWs.&#x0D; Study Design: This is a descriptive cross-sectional study.&#x0D; Place and Duration of Study: The study was carried out at Federal Teaching Hospital, Ido-Ekiti (FETHI), Southwestern Nigeria between July 2020 and December 2020.&#x0D; Methods: The study involved 328 randomly selected HCWs. Data was collected using pretested self administered questionnaires, entered into Microsoft Excel 2016 and analyzed by SPSS version 23.&#x0D; Results: Only 31.10% of respondents had good knowledge of handwashing while 80.18% had good practice of handwashing. Longer stay in service and being a doctor or nurse were associated with good knowledge and good practice of handwashing. Only 16.46% of respondents had previous training on handwashing within 3 years prior to this study. Previous training on handwashing was associated with good knowledge of handwashing (P=.001). Up to 68.60% of respondents used stored water and soap for handwashing. The most common hand drying facility reported in the study was common towel, no respondent ever used paper towel. The most common reason given for poor adherence to handwashing practices was the busy schedule.&#x0D; Conclusion: Hospital managers must prioritize the regular provision of handwashing and hand drying facilities for their centre, in addition to organizing regular hand hygiene training for HCWs, to improve their knowledge and practice of handwashing and thus reduce the rate of HAIs

PRE AND POST EXPOSURE ANALYSIS OF CHLORHEXIDINE GLUCONATE’S EFFECTIVENESS AGAINST BACTERIAL CONTAMINATION OF STETHOSCOPES

Objective: The present study is to assess the effectiveness of chlorhexidinegluconate as a disinfectant for the stethoscope diaphragm, to survey the routine practices followed by health care professionals (HCPs) towards stethoscope disinfection and to ascertain their general awareness on the matter.&#x0D; Methods: Questionnaire-based study conducted to assess the degree of awareness and attitude of HCPs towards stethoscope disinfection procedures. 200 responses were obtained and analyzed. Randomized, blind trial comparing bacterial load of stethoscope post-exposure to chlorhexidinegluconate vs. ethyl alcohol. The swabs collected from stethoscope diaphragm before and after exposure to disinfectant, were cultured using spread plate technique on nutrient agar. CFU count was compared.&#x0D; Results: Out of 200, nearly all HCPs part of this study were aware that stethoscopes could be linked to transmission of healthcare-associated infections (HCAIs) but only 78.5% (157) were accustomed to stethoscope disinfection practices. Although only 13.5% (27/200) of participants believed that chlorhexidinegluconate was effective, this study found it to be highly efficacious against bacterial recontamination.&#x0D; Conclusion: We stress upon the importance of regular disinfection of the stethoscope after each use and encourage frequent cleaning of the device with chlorhexidinegluconate, which may reduce bacterial recontamination for a longer period.

Probabilistic transmission models incorporating sequencing data for healthcare-associated Clostridioides difficile outperform heuristic rules and identify strain-specific differences in transmission.

Fitting stochastic transmission models to electronic patient data can offer detailed insights into the transmission of healthcare-associated infections and improve infection control. Pathogen whole-genome sequencing may improve the precision of model inferences, but computational constraints have limited modelling applications predominantly to small datasets and specific outbreaks, whereas large-scale sequencing studies have mostly relied on simple rules for identifying/excluding plausible transmission. We present a novel approach for integrating detailed epidemiological data on patient contact networks in hospitals with large-scale pathogen sequencing data. We apply our approach to study Clostridioides difficile transmission using a dataset of 1223 infections in Oxfordshire, UK, 2007–2011. 262 (21% [95% credibility interval 20–22%]) infections were estimated to have been acquired from another known case. There was heterogeneity by sequence type (ST) in the proportion of cases acquired from another case with the highest rates in ST1 (ribotype-027), ST42 (ribotype-106) and ST3 (ribotype-001). These same STs also had higher rates of transmission mediated via environmental contamination/spores persisting after patient discharge/recovery; for ST1 these persisted longer than for most other STs except ST3 and ST42. We also identified variation in transmission between hospitals, medical specialties and over time; by 2011 nearly all transmission from known cases had ceased in our hospitals. Our findings support previous work suggesting only a minority of C. difficile infections are acquired from known cases but highlight a greater role for environmental contamination than previously thought. Our approach is applicable to other healthcare-associated infections. Our findings have important implications for effective control of C. difficile.

Knowledge, attitude and self-reported practice of healthcare workers on infection control in a health facility in Akure, Nigeria

Background: Infection control is pivotal in reducing healthcare-associated infections (HAIs), one of the leading causes of morbidity with growing prevalence in sub-Saharan Africa. Objectives: We investigated the knowledge, attitude and self-reported hygiene practices towards hospital infection control among healthcare workers (HCWs) at the State Specialist Hospital, Akure, Nigeria. Methods: This descriptive cross-sectional study involving self-administered, structured questionnaires administered to 137 randomly selected HCWs (19 doctors, 66 nurses and 52 health assistants) was conducted in 2015. Descriptive and inferential statistics were used for data analysis at 5% level of significance. Results: Mean age of HCWs was 39.81 ± 8.69 years. Majority (84.7%) was trained on hand hygiene and was knowledgeable about HAIs (86.9%), modes of transmission (57.7%) and effectiveness of hand hygiene (94.9%). However, about half (48.9%) of the HCWs reported did not adhere to hand hygiene often, because of the distance between a water source and the wards. This study also showed that there are relationships between categories of respondents and their knowledge of routes of HAI transmission (P &lt; 0.01) and practice of hand hygiene after contacts with hospital surfaces (P &lt; 0.01). Conclusions: Hospital and hand hygiene can be improved by ensuring water supply located close to the wards. There is need for the provision of clear guidance on procedures for hospital hygiene and sanitation.

Recontamination of Healthcare Surfaces by Repeated Wiping with Biocide-Loaded Wipes: "One Wipe, One Surface, One Direction, Dispose" as Best Practice in the Clinical Environment.

The wiping of high-touch healthcare surfaces made of metals, ceramics and plastics to remove bacteria is an accepted tool in combatting the transmission of healthcare-associated infections (HCAIs). In practice, surfaces may be repeatedly wiped using a single wipe, and the potential for recontamination may be affected by various factors. Accordingly, we studied how the surface to be wiped, the type of fibre in the wipe and how the presence of liquid biocide affected the degree of recontamination. Experiments were conducted using metal, ceramic and plastic healthcare surfaces, and two different wipe compositions (hygroscopic and hydrophilic), with and without liquid biocide. Despite initially high removal efficiencies of >70% during initial wiping, all healthcare surfaces were recontaminated with E. coli, S. aureus and E. faecalis when wiped more than once using the same wipe. Recontamination occurred regardless of the fibre composition of the wipe or the presence of a liquid biocide. The extent of recontamination by E. coli, S. aureus and E. faecalis bacteria also increased when metal healthcare surfaces possessed a higher microscale roughness (<1 μm), as determined by Atomic Force Microscopy (AFM). The high propensity for healthcare surfaces to be re-contaminated following initial wiping suggests that a “One wipe, One surface, One direction, Dispose” policy should be implemented and rigorously enforced.