Healthcare Infection Prevention Research Articles

Impact of conducting hand hygiene audit in COVID-19 care locations of India—A large scale national multicentric study – HHAC study

PurposeHand hygiene (HH), the core element in infection prevention in healthcare, especially for multidrug resistant organism's transmission. The role of HH audits and HH adherence rates in the COVID-19 pandemic, especially in resource limited settings, are yet to be established. MethodsA nationwide multicenter study was conducted in India, involving public, private, teaching and non-teaching COVID healthcare facilities (COVID-HCFs) using the IBhar mobile application based on WHO's hand hygiene audit tool. The HH adherence rates (HHAR) such as complete HHAR (HHCAR), total HHAR (HHTAR), profession specific HHAR, WHO's 5 HH moment specific HHAR and associated variables were measured over 6 month duration (June–December 2021). ResultsA total of 2,01,829 HH opportunities were available and the HHCAR and HHTAR were 27.3% and 59.7%. The HHTAR was significantly higher in the west zone (72.2%), private institutes (65.6%), non-teaching institutes (67.7%), nurses (61.6%), HH moments 2 (71.8%) and 3 (72.1%), and morning shift (61.4%). The HHTAR was better in non-COVID HCFs (65.4%) than COVID-HCFs (57.8%) as well as non-COVID ICUs (68.1%) than COVID ICUs (58.7%). The HHTAR was increased from month 1 to month 6 except a small decrease in the month of December. ConclusionsThe hand hygiene adherence is comparable with adherence rate during COVID-19 pandemic in western countries as well as the resource limited settings. The use of gloves during the pandemic and simplified HH techniques and their influence over the HH adherence to be studied further. The sustainable adherence rate over long duration needs to be ensured by continuing the HH audit using multimodal interventions.

CDC COVID-19 healthcare infection prevention and control assistance to health departments, January 2020–December 2021

Background: Throughout the COVID-19 pandemic, CDC Division of Healthcare Quality Promotion (DHQP) has provided technical assistance in support of state, tribal, local, and territorial health departments for COVID-19 healthcare outbreak management and infection prevention and control (IPC). We characterized the volume and trends of technical assistance provided during the pandemic to inform the future needs of health departments for COVID-19 healthcare IPC and DHQP resources required to meet these needs. Methods: In January 2020, DHQP began receiving COVID-19 IPC TA requests directly from health departments for remote assistance or from CDC staff on field deployments providing onsite support. DHQP subject-matter experts provided responses via e-mail or, for more complex inquiries, outbreaks, or field deployments, via phone consultations. Records of e-mail communications and phone consultations were entered into an inquiry database for tracking. We calculated the number, mean, and range of technical-assistance responses by jurisdiction and by month from January 2020 through December 2021. We designated months as high-volume periods for technical assistance if inquiries surpassed the 75th percentile. Results: In total, 1,869 IPC technical-assistance responses were provided. Of all technical-assistance responses, 1,725 (92%) were to state or local health departments, 115 (6%) were tribal nations, and 28 (2%) were US territories. IPC technical assistance was provided to all 50 states and the District of Columbia, 16 tribal nations, and 5 US territories. The average total number of technical assistance responses per site during the 24-month period was 34 to state and local HDs (range, 2–111), 6 to tribal nations (when tribal nation was specified; range, 1–17), and 6 to US territories (range, 1–15). E-mail communications comprised 1,164 responses (62%); phone consultations made up the remaining 705 responses (38%). Of phone consultations, 350 (50%) were with CDC field deployers providing onsite support to health departments. The average number of technical-assistance responses provided each month across all jurisdictions was 78 (range, 0–334); months with high volumes included April–August 2020 and January 2021. Conclusions: These findings highlight the high-level collaboration between federal and state, tribal, local, and territorial health department partners in remote and onsite support of COVID-19 prevention and response efforts in healthcare settings. Variations in monthly volumes of health-department COVID-19 healthcare IPC technical assistance requests may reflect factors such as fluctuations in community infection rates and changes in CDC IPC guidance. The ability to provide effective technical assistance during pandemic response depends on the CDC maintaining sufficient healthcare IPC staffing and expertise.Funding: NoneDisclosures: None

A cross sectional study of organizational factors and their impact on job satisfaction and emotional burnout in a group of Australian nurses: infection control practitioners

BackgroundInfection control practitioners (ICPs) are a group of specialized nurses fundamental to effective healthcare infection prevention and control initiatives. Relative to other groups of nurses much less is known about their working conditions. Organizational factors may impact ICPs’ levels of job dissatisfaction and emotional job burnout and, subsequently, their quality of practice. We measure a range of organizational factors to document the working conditions of ICPs and show how these are linked to job satisfaction and emotional burnout in a sample of Australian ICPs.MethodsWe conducted a cross sectional study using an online survey. All employed ICPs in 50 of the largest public hospitals in Australia were invited to participate. One hundred and fifty three ICPs completed the survey.ResultsICPs are moderately to highly satisfied with their job but show high levels of emotional burnout, time pressure and cognitive demands. Low job satisfaction was associated with less job control, low perceived organizational support and poor communication. In contrast, emotional burnout was associated with high time pressure and cognitive demands coupled with poor communication.DiscussionThis study provides new evidence about the organizational context of ICPs in Australia, and about the factors that impact on job satisfaction and emotional burnout. These findings may be used to modify national infection prevention and control programs to suit local organizational contexts. Further research is needed to determine the precise nature of these relationships and the downstream impacts on hospital-wide infection control outcomes.ConclusionsOrganizational context and factors are important to consider when evaluating the impact and implementation of infection control programs.

Daily Disinfection of the Hospital Room and Non-critical Items: Barriers and Practical Approaches

Daily disinfection of the hospital room and non-critical items is an important component of healthcare infection prevention. Barriers exist for heightened and reliable daily disinfection in the healthcare setting, and definitions are lacking for clean or acceptable levels of microbial burden on hospital surfaces. Current methods for manual, daily cleaning of patient rooms are likely suboptimal for bioburden reduction. The use of UV-C and HP vapor light for decontamination of HTS may reduce bioburden yet requires investment in both resources and deployment. Applying the principles of HFE to daily disinfection processes may improve reliability and reduce microbial surface burden. All disinfectants must be EPA-approved for low-level disinfection (LLD).No single method exists for accuately monitoring the adequacy of the cleaning process; strategies include observation and feedback, the use of ATP bioluminescence assays and flourescent markers, ultraviolet UV light along with formal process audits and feedback. Safety programs must be aware that not all EPA hospital disinfectants approved for LLD will disinfect select organisms such as C. difficile. Further studies are needed to define optimal daily disinfection strategies and to demonstrate the impact of environmental hygiene on patient-centered healthcare infection outcomes.

Silica nanoparticles with encapsulated DNA (SPED) \u2013 a novel surrogate tracer for microbial transmission in healthcare

BackgroundThe increase in antimicrobial resistance is of worldwide concern. Surrogate tracers attempt to simulate microbial transmission by avoiding the infectious risks associated with live organisms. We evaluated silica nanoparticles with encapsulated DNA (SPED) as a new promising surrogate tracer in healthcare.MethodsSPED and Escherichia coli were used to implement three experiments in simulation rooms and a microbiology laboratory in 2017–2018. Experiment 1 investigated the transmission behaviour of SPED in a predefined simulated patient-care scenario. SPED marked with 3 different DNA sequences (SPED1-SPED3) were introduced at 3 different points of the consecutive 13 touch sites of a patient-care scenario that was repeated 3 times, resulting in a total of 288 values. Experiment 2 evaluated SPED behaviour following hand cleaning with water and soap and alcohol-based handrub. Experiment 3 compared transfer dynamics of SPED versus E. coli in a laboratory using a gloved finger touching two consecutive sites on a laminate surface after a first purposefully contaminated site.ResultsExperiment 1: SPED adhesiveness on bare skin after a hand-to-surface exposure was high, leading to a dissemination of SPED1–3 on all consecutive surface materials with a trend of decreasing recovery rates, also reflecting touching patterns in concordance with contaminated fingers versus palms. Experiment 2: Hand washing with soap and water resulted in a SPED reduction of 96%, whereas hand disinfection led to dispersal of SPED from the palm to the back of the hand. Experiment 3: SPED and E. coli concentration decreased in parallel with each transmission step – with SPED showing a trend for less reduction and variability.ConclusionsSPED represent a convenient and safe instrument to simulate pathogen spread by contact transmission simultaneously from an infinite number of sites. They can be further developed as a central asset for successful infection prevention in healthcare.

Evaluating patient attitudes to increased patient engagement with antimicrobial stewardship: a quantitative survey.

BackgroundAntimicrobial stewardship (AMS) describes interventions designed to optimize antimicrobial therapy, minimize adverse treatment consequences and reduce the spread of antimicrobial resistance (AMR). Previous research has investigated the patient’s role in healthcare infection prevention but the patient’s role in AMS has not been extensively explored.ObjectivesTo investigate the willingness of hospital inpatients to question staff about prudent antimicrobial use in an Irish hospital and evaluate the impact of patient and public involvement in research (PPI) on this study.MethodsA survey was co-designed with the hospital Patient Representative Group (PRG) to evaluate patient willingness to engage with prudent antimicrobial treatment. A random sample of 200 inpatients was selected to self-complete the survey using pen and paper. PRG members provided feedback on their involvement.ResultsOf the 200 inpatients randomly selected to participate, 120 did not fulfil the inclusion criteria. Of the remaining 80, 67 participated (response 84%). Median respondent age was 58 years, 30% were employed and 30% had a third-level education degree. Over 90% had not heard of AMS while just over 50% had not heard of AMR. Patients preferred asking factual questions rather than challenging ones but did not have a preference in asking questions of doctors compared with nurses. Older patients were less likely to ask questions. PRG members reported an overall positive experience as research collaborators.ConclusionsFuture patient-centred AMS interventions should empower patients to ask about antimicrobial treatment, in particular the older patient cohort. PPI is a valuable component of patient-centred research.

Risk Factors Associated with External Ventricular Drain Associated Infections

<h3>Background</h3> The reduction of intracranial pressure using external ventricular drains (EVDs) is a life saving measure, but infection is a major complication of this procedure. Therefore, reducing procedural meningitis/ventriculitis is an important goal for healthcare infection prevention teams. This study determines the effectiveness of a newly implemented infection prevention bundle (IPB) and identifies possible risk factors increasing incidence of EVD-AIs. <h3>Methods</h3> This is a pre- and post-study performed at a single 440-bed academic medical center reviewing all EVD-AIs between January 2014 and October 2018 comparing the rates of EVD-AI before and after application of the IPB. Measured variables included procedure time, EVD placement location & duration, cerebrospinal fluid (CSF) specimen source, surgeon, and the presence of EVD-AI. Confirmed infection was defined as positive CSF culture, and possible infection was defined as high white blood cell count (>100 cells/ml) and/or low glucose levels (<40 mg/dL). Odds ratios (OR) of measured variables as related to EVD-AI presence were determined with a significance threshold of p-value <0.05. <h3>Results</h3> Out of 313 procedures, there were 105 unique patients eligible for analysis. Seventy patients had CSF analysis performed; 37 had possible EVD-AIs (31 pre-IPB and 6 post-IPB) and 7 were confirmed EVD-AIs (5 pre-IPB and 2 post-IPB) with no statistically significant difference pre- and post-IPB. The EVD duration (OR 1.20), EVD placement procedure (OR 2.38), and CSF specimen source (OR 7.00) were associated with increased risk of infection. <h3>Conclusions</h3> Multiple risk factors are associated with EVD-AIs, including longer EVD duration, EVDs placed at bedsides, and CSF drawn from EVD collection bags. The decrease in EVD-AIs is not conclusively linked to the implementation of the IPB due to the small number of procedures and short duration of follow up. The application of effective evidence-based infection prevention measures for EVD-related procedural meningitis/ventriculitis is an essential intervention to reduce morbidity and mortality.

Microbiological profile of catheter associated urinary tract infection in ICUs of a tertiary care hospital Bhubaneswar, Odisha, India

Among nosocomial infections catheter associated urinary infection (CA-UTI) is one of the most common infection. Uro- pathogens isolated from CAUTI were more multi-drug resistant than from community acquired urinary tract infection (UTI).To isolate micro-organisms responsible for CA-UTI in ICUs, to find out antibiotic sensitivity pattern of the isolates and to know the Impact of CAUTI care bundle on reducing CAUTI rate.A retrospective study was conducted from September 2017 to August 2018, urine samples were collected from 300 catheerised patients which were processed microbiologically and antimicrobial sensitivity test was performed. Out of 300 catheterised paients , 76 patients developed CAUTI. So the incidence rate of CAUTI is 21.7%. A sum total of 38,067 catheter days were obtained in the study period from the month of September 2017 to August 2018. CAUTI rate was found to be 1.9 per 1000 catheter days over a period of 1 yearOut of 76 total isolates 56 were Gram negative and 20 were Gram positive bacteria. Gram negative bacteria included Escherichia coli 19(25%), followed by Klebsiella 14(19%), Proteus8 (11%) Pseudomomas 6(8%), Acinetobacter 4(8%). Among gram positive Enterococcus species is 17(22%) followed by staphylococcus spp.03 (4%). Enterobacteriaceae showed high resistant to commonly used antimicrobials like Gentamycin, Ceftriaxone, Ofloxacin, Ciprofloxacin but were highly sensitive to Amikacin, ceftazidime, pipercillin Tazobactum, Imepenem, Meropenem. Enterococcus and staphylococcus were sensitive to Tigecyclin , Vancomycin, Teicoplanin and linezolid.The most common organism responsible for CAUTI is Escherichia coli followed by Klebsiella spp. and Enerococcus spp. Members of enterobacteriaceae are highly sensitive to Amikacin, ceftazidime, pipercillin Tazobactum, Imepenem, Meropenem. Enterococcus and staphylococcus are sensitive to Tigecyclin, Vancomycin, Teicoplanin and linezolid. Strict insertion and maintainance CAUTI care bundle reduces CAUTI rate. Prevention of infections attributable to these devices should be an important goal of health-care infection prevention

Aerosol generating procedures, dysphagia assessment and COVID-19: A rapid review.

Aerosol generating procedures, dysphagia assessment and COVID-19: A rapid review.

Identifying and Interrupting Superspreading Events-Implications for Control of Severe Acute Respiratory Syndrome Coronavirus 2.

It appears inevitable that severe acute respiratory syndrome coronavirus 2 will continue to spread. Although we still have limited information on the epidemiology of this virus, there have been multiple reports of superspreading events (SSEs), which are associated with both explosive growth early in an outbreak and sustained transmission in later stages. Although SSEs appear to be difficult to predict and therefore difficult to prevent, core public health actions can prevent and reduce the number and impact of SSEs. To prevent and control of SSEs, speed is essential. Prevention and mitigation of SSEs depends, first and foremost, on quickly recognizing and understanding these events, particularly within healthcare settings. Better understanding transmission dynamics associated with SSEs, identifying and mitigating high-risk settings, strict adherence to healthcare infection prevention and control measures, and timely implementation of nonpharmaceutical interventions can help prevent and control severe acute respiratory syndrome coronavirus 2, as well as future infectious disease outbreaks.

Averting a betrayal of trust: System and individual accountability in healthcare infection prevention

Averting a betrayal of trust: System and individual accountability in healthcare infection prevention

‘Data speaks’: Exploring the requirements for infection prevention data management systems at local, regional and national levels

Introduction: Effective healthcare infection prevention strategies rely upon the collection, analysis and reporting of valid and robust data. To appropriately engage stakeholders, data must also be interpretable and available in a timely manner. The objective of this presentation is to highlight the requirements for successful data management systems for infection prevention programs. Methods: Existing national and international surveillance programs will be used to demonstrate the range of data management systems that are employed, the required resources, and the range of objectives and deliverables for small- and large-scale datasets. Results: The scope of an infection prevention program must be defined to enable objectives of data handling to be specified. Hospital, regional and national contexts are contrasted to illustrate the range of objectives for data management systems: informing quality improvement processes, bench-marking, research, public reporting, and performance monitoring/funding. Key elements of a national data reporting system are defined: governance, standardised surveillance methodology, peer-grouping, risk-adjustment, and reporting functionality. Methods for improving the efficiency of data handling include adoption of accepted surveillance methods and automated data feeds. Human resources and IT maintenance are acknowledged as ongoing requirements for data handling, especially when surveillance methods are refined over time. Conclusions: For surveillance to be effectual, data handling/management must be appropriate. When planning a surveillance strategy the scope and specifications of data handling and warehousing need to be considered a priori for timely, robust and reliable data to adequately inform quality improvement process and research agenda.

Active surveillance of hospital-acquired infections in South Africa: Implementation, impact and challenges.

Hospital-acquired infections (HAIs) are a significant although unquantified burden in South Africa. Lack of adequate surveillance compounds this problem. To report on the establishment and outcomes of a unit-specific surveillance system for hospital-acquired infections, based on international standards, in a private academic hospital. Active unit-specific surveillance of device-associated infections (DAIs) was introduced over a 2-year period. The surveillance system was based on the US National Healthcare Safety Network (NHSN) utilising standardised definitions. Analysis of DAI rates and device utilisation was done according to Centers for Disease Control and Prevention methods. Comparative analysis using study-derived annualised data and existing NHSN data was done. Surveillance results of DAI rates showed significant reductions in intensive care unit-related ventilator-associated pneumonia (42%) and central line-associated bloodstream infections (100%) over a 3-year period. Substantial variations in DAI rates and utilisation ratios between wards highlight the importance of unit-specific surveillance. Active surveillance requires a significant investment in resources and is a sustained operational challenge, although equally significant benefits are derived from a better understanding of HAIs with more targeted interventions and efficient use of resources. A robust surveillance system is an essential component of any healthcare infection prevention and control programme and is a prerequisite to contextualising the HAI burden of hospitals.

Healthcare infection prevention and control really is everyone’s business

Lyn Gilbert , Jon Iredell and John Merlino Marie Bashir Institute for Emerging Infections and Biosecurity, Centre for Values, Ethics and the Law in Medicine, University of Sydney, and Level 3, Institute of Clinical Pathology & Medical Research, Westmead Hospital, PO Box 533, Wentworthville, NSW 2145, Australia. Tel: +61 2 9845 6252, Email: lyn.gilbert@sydney.edu.au WestmeadMillennium Institute forMedical Research, C24 –WestmeadHospital, TheUniversity of Sydney, NSW2006, Australia. Tel: +61 2 9845 6255, Email: jonathan.iredell@sydney.edu.au Department of Microbiology and Infectious Diseases, Concord Hospital, and Department of Infectious Diseases and Immunology, Sydney Medical School, University of Sydney, Hospital Road, Concord, NSW 2139, Australia. Tel: +61 2 9767 6658, Email: JMerlino@med.usyd.edu.au

Breaking through the Status Quo: Improving Influenza Vaccination Coverage among Health-Care Personnel

Address correspondence to: Jennifer L. Gordon, PhD, Department of Health and Human Services, Office of the Assistant Secretary for Health, National Vaccine Program Office, 200 Independence Ave. SW, 733G, Washington, DC 20201-0004; tel. 202-260-6619; fax 202-260-1165; e-mail . No one wants to be admitted to a health-care facility, but when it is necessary, every patient expects to receive the highest quality care possible. Too often, however, admission leads to harm, not health. At any given time, one out of every 20 patients has an infection related to their hospital stay.1 Such has been the case for far too long. The passage of the Patient Protection and Affordable Care Act of 2010 has brought not only a heightened commitment to better systems of health-care infection prevention, but also new tools and resources to improve quality of care and protect patients.2 Preventing the spread of seasonal influenza in health-care settings is an important element of any effort to improve patient safety. While influenza infections in patients and health-care personnel (HCP) often go undiagnosed or underreported,3 we know that influenza can spread from HCP to patients, from patients to HCP, and from HCP to HCP.4–7 In fact, evidence shows that HCP are at a greater risk of influenza infection than other healthy adults.8 For vulnerable patients, these transmissions can result in severe complications and sometimes even death. Fortunately, improving policies for HCP influenza vaccination can substantially increase coverage and help reduce the likelihood that providers become infected or serve as vectors for infection.9–11 Although HCP influenza vaccination coverage rates have risen to nearly 67% in recent seasons,12 they remain well below the 90% Healthy People 2020 goal.13,14 Notably, coverage rates differ by health-care setting. HCP influenza vaccination rates (for the 2011–2012 influenza season) reached 76.9% within hospital settings but only 52.4% within long-term care facilities,12 where patients are at the highest risk of complications and death from influenza.15,16

Knowledge sharing among healthcare infection preventionists: the impact of public health professionals in a rural state

BackgroundHealthcare-associated infections are a major source of morbidity and mortality in the United States. Infection Preventionists (IPs) are healthcare workers tasked at overseeing the prevention and control of these infections, but they may have difficulties obtaining up-to-date information, primarily in rural states. The objective of this study was to evaluate the importance of public health involvement on the knowledge-sharing network of IPs in a rural state.FindingsA total of 95 attendees completed our survey. The addition of public health professionals increased the density of the network, reduced the number of separate components of the network, and reduced the number of key players needed to contact nearly all of the other network members. All network metrics were higher for public health professionals than for IPs without public health involvement.ConclusionsThe addition of public health professionals involved in healthcare infection prevention activities augmented the knowledge sharing potential of the IPs in Iowa. Rural states without public health involvement in healthcare-associated infection (HAI) prevention efforts should consider the potential benefits of adding these personnel to the public health workforce to help facilitate communication of HAI-related information.

A Model of a Longstanding State Infection Prevention Collaborative

In an era of limited resources, it is a significant advantage to have collaboration among state organizations involved in healthcare infection prevention and control. Such collaboration may be difficult due to obstacles such as organizational territoriality and lack of a vehicle for shared planning.

Dutch Society of Infection Prevention in Healthcare (VHIG)

The Dutch Society of Infection Prevention in Healthcare society was founded in 1973 and is since 1987 member of the International Federation of Infection Control (IFIC). VHIG has currently 350 members entitled: Consultant Infection Prevention (CIP).