Hospital-associated Infections Research Articles

Eleven years impact of a stepwise educational program on healthcare associated infections and antibiotics consumption in an intensive care unit of a tertiary hospital in Brazil

BackgroundHospital acquired infections (HAI) and liberal use of broad-spectrum antibiotics are common in intensive care unit(ICU)s of low-middle income countries. We investigated the long-term association of a stepwise multifaceted educational program with the incidence of HAIs and antibiotics use in a Brazilian ICU. We also evaluated the program's cost impact. MethodsWe retrieved data from a prospective daily collected database of a twelve bedrooms ICU, all admitted patients within a period of eleven years were enrolled. FindingsFrom 03/15/2007 to 09/11/2019, we admitted 3059 patients where 2406 (79%) survived the ICU stay. Median age was 51 years-old, and median SAPS3 was 53. The initial density of catheter related blood infection (4.3 events / 1000 patients-day), urinary tract infection (9.2 event / 1000 patients-day) and ventilator associated pneumonia (54.9 events / 1000 patients-day) felt during the observed period to (0.35 events / 1000 patients-day), (0 events / 1000 patients-day), and (1.5 events / 1000 patients-day) respectively. The days of antibiotic therapy also decreased from 797.9 days of therapy / 1000 patients day to 292.3 days of therapy / 1000 patients day. The total cost per patient also decreased. The adjusted mortality rate was steady during the studied period from 23.2% to 22.9%. InterpretationA stepwise multifaceted educational program is an effective way to reduce hospital-associated infections, improve the rational use of antibiotics, and reduce costs. This impact occurred in a long term, and is probably consistent.

EFEKTIVITAS PEMBERIAN SIMULASI HAND HYGIENE TERHADAP KEPATUHAN HAND HYGIENE PETUGAS NON MEDIS DI RUMAH SAKIT PKU MUHAMMADIYAH YOGYAKARTA UNIT II

Hospital Associated Infection (HAIs) is the world’s problem and one of the causes is hand hygiene compliance in healthcare workers are still low. Data showed 80% of HAIs spread by hands. Non medical healthcare workers are at risk for spreading the phatogen by hands, because although they don’t give intervention directly to the patients, they still have big possibilities to be in one of 5 moments hand hygiene. Hand hygiene simulation is one of training methods for heakthcare workers to create higher compliance in hand hygiene. This research was an experimental design with one group pre-posttest design. The population were all non medical healthcare workers in security department, nutritional department, and cleaning service department, the total sample is 37 persons. Paired T-test is used for stastitical analysis.The results obtained, the implementation of hand hygiene with proper procedure is 0,55%. The compliance rate increase after intervention by hand hygiene simulation 13,83%. Statistical analysis showed significant result p<0,05; p=0,026 for security department, p=0,027 for nutritional department, and p=0,002 for cleaning service department, meaning there is a difference in hand hygiene compliance of non medical healthcare workers before and after intervention by hand hand hygiene simulation.Hand hygiene simulation is effecticve to improve hand hygiene compliance. Therefore it can be used to improve hand hygiene compliance in non medical healthcare workers.

Empowering hospital-associated infection prevention and control: A quasi-experimental study on the effect of scenario-based simulation training

AimThis study aimed to investigate the effect of scenario-based simulation training on infection control, specifically in terms of knowledge, self-efficacy and adherence to standard precautions. BackgroundHospital-associated infections can pose a threat to patient safety and are a critical public health issue that requires attention. DesignThis quasi-experimental study employed a pre-test/post-test design using a nonequivalent control group. MethodsInfection control nurses were randomly assigned to two groups using lottery methods. The experimental group received scenario-based simulation training, whereas both the experimental and control groups received conventional education. Data were collected from 27 August to 1 December 1 2022. The chi-square test and t-test were used for data analysis. ResultsThe mean scores for knowledge of infection prevention and control (t = 3.679, p < 0.001) and self-efficacy (t = 2.444, p = 0.018) were significantly higher in the experimental group than in the control group. Furthermore, the mean score for adherence to standard precautions was significantly higher in the experimental group than in the control group (t = 2.030, p = 0.048). ConclusionOur results suggest that scenario-based simulation training for infection control might be effective in improving knowledge, self-efficacy and adherence to standard precautions. Scenario-based simulation training for infection control may be an effective educational intervention to enhance knowledge, self-efficacy and adherence to standard precautions, thus empowering nurses in infection prevention and control.

Global diversity of enterococci and description of 18 previously unknown species

Enterococci are gut microbes of most land animals. Likely appearing first in the guts of arthropods as they moved onto land, they diversified over hundreds of millions of years adapting to evolving hosts and host diets. Over 60 enterococcal species are now known. Two species, Enterococcus faecalis and Enterococcus faecium, are common constituents of the human microbiome. They are also now leading causes of multidrug-resistant hospital-associated infection. The basis for host association of enterococcal species is unknown. To begin identifying traits that drive host association, we collected 886 enterococcal strains from widely diverse hosts, ecologies, and geographies. This identified 18 previously undescribed species expanding genus diversity by >25%. These species harbor diverse genes including toxins and systems for detoxification and resource acquisition. Enterococcus faecalis and E. faecium were isolated from diverse hosts highlighting their generalist properties. Most other species showed a more restricted distribution indicative of specialized host association. The expanded species diversity permitted the Enterococcus genus phylogeny to be viewed with unprecedented resolution, allowing features to be identified that distinguish its four deeply rooted clades, and the entry of genes associated with range expansion such as B-vitamin biosynthesis and flagellar motility to be mapped to the phylogeny. This work provides an unprecedentedly broad and deep view of the genus Enterococcus, including insights into its evolution, potential new threats to human health, and where substantial additional enterococcal diversity is likely to be found.

VirulenceFinder for Enterococcus faecium and Enterococcus lactis: an enhanced database for detection of putative virulence markers by using whole-genome sequencing data.

Enterococcus faecium (Efm) is a leading cause of hospital-associated (HA) infections, often enriched in putative virulence markers (PVMs). Recently, the Efm clade B was assigned as Enterococcus lactis (Elts), which usually lack HA-Efm infection markers. Available databases for extracting PVM are incomplete and/or present an intermix of genes from Efm and Enterococcus faecalis, with distinct virulence profiles. In this study, we constructed a new database containing 27 PVMs [acm, scm, sgrA, ecbA, fnm, sagA, hylEfm, ptsD, orf1481, fms15, fms21-fms20 (pili gene cluster 1, PGC-1), fms14-fms17-fms13 (PGC-2), empA-empB-empC (PGC-3), fms11-fms19-fms16 (PGC-4), ccpA, bepA, gls20-glsB1, and gls33-glsB] from nine reference genomes (seven Efm + two Elts). The database was validated against these reference genomes and further evaluated using a collection of well-characterized Efm (n = 43) and Elts (n = 7) control strains, by assessing PVM presence/absence and its variants together with a genomic phylogeny constructed as single-nucleotide polymorphisms. We found a high concordance between the phylogeny and in silico findings of the PVM, with Elts clustering separately and mostly carrying Elts-specific PVM gene variants. Based on our validation results, we recommend using the database with raw reads instead of assemblies to avoid missing gene variants. This newly constructed database of 27 PVMs will enable a more comprehensive characterization of Efm and Elts based on WGS data. The developed database exhibits scalability and boasts a range of applications in public health, including diagnostics, outbreak investigations, and epidemiological studies. It can be further used in risk assessment for distinguishing between safe and unsafe enterococci.IMPORTANCEThe newly constructed database, consisting of 27 putative virulence markers, is highly scalable and serves as a valuable resource for the comprehensive characterization of these closely related species using WGS data. It holds significant potential for various public health applications, including hospital outbreak investigations, surveillance, and risk assessment for probiotics and feed additives.

Rationality of antibiotic use in COVID-19 patients in the ICU of Dr. Hasan Sadikin General Hospital, Bandung; a cohort study

Background and Objectives: Nearly three-quarters of the patients with COVID-19 received antibiotic therapy despite the bacterial coinfection being only less than 10% in many studies and ranging from 8-22% in ICU patients. The use of broad-spectrum antibiotics in COVID-19 patients has not been proven effective. Overuse of antibiotics may be associated with side effects and antibiotic resistance. The purpose of this study was to determine the antibiotic rationality in COVID-19 patients in the ICU of Dr. Hasan Sadikin Hospital, Bandung, Indonesia.&#x0D; Methodology: This descriptive, retrospective cohort study was carried out by analyzing medical records of COVID-19 patients admitted in the ICU of Dr. Hasan Sadikin Hospital from January-June 2021.&#x0D; Results: There were 138 patients who met the inclusion criteria. A total of 126 (91.3%) patients received antibiotics. A total of 12 (8.7%) severe/critical patients did not receive antibiotics and 79 (62.70%) received inappropriate antibiotic duration. Inappropriate regimen was found in 59 patients (74.68%) with COVID-19 without HAP/VAP and 15 patients (31.92%) with HAP/VAP. The primary issue identified was the inappropriate regimen of antibiotics, Gyssens category 4a.&#x0D; Conclusion: This study concludes that 23.02% patients used rational empirical antibiotics and 45.98% used rational definitive antibiotics in COVID-19 patients in the ICU at RSUP Dr. Hasan Sadikin Bandung during January-June 2021.&#x0D; Abbreviations: ACE- Angiotensin Converting Enzyme; ICU- Intensive Care Unit; HAI- Hospital-Associated Infections; HAP- Hospital-Acquired Pneumonia; IDSA- Infectious Diseases Society of America VAP- Ventilator-Associated Pneumonia&#x0D; Key words: Antibiotics; Antimicrobial Resistance; COVID-19; Intensive Care Units; Prescribing Pattern&#x0D; Citation: Indriasari, Oktaliansah E, Munazat RI. Rationality of antibiotic use in COVID-19 patients in the ICU of Dr. Hasan Sadikin General Hospital Bandung; a cohort study. Anaesth. pain intensive care 2024;28(1):115−125.&#x0D; DOI: 10.35975/apic.v28i1.2384&#x0D; Received: November 20, 2023; Reviewed: December 03, 2023; Accepted: December 26, 2023

Phenotypic Detection of Extended Spectrum β-lactamase Producing Gram Negative Bacteria Isolated From Clinical Specimens

Background: Over the past decade, there has been a significant global rise in extended spectrum β-lactamase (ESBL) producing gram negative bacteria (GNB), posing a substantial concern. ESBLs, encoded by plasmids, are deemed threatening due to their ease of transmission between species. The Asia Pacific region has witnessed a surge in hospital-acquired infections attributed to ESBL-producing GNB, as highlighted by numerous studies. This study seeks to assess the prevalence of ESBL-producing GNB specifically within Nepal. Methods: This research, conducted at Grande International Hospital in Kathmandu, Nepal, adopted a descriptive cross-sectional approach. It spanned from July 2016 to February 2017 and encompassed patients receiving care at the hospital. The study involved the handling of samples directed to the Microbiology laboratory for Culture and sensitivity, as well as the identification of isolates and Antibiotic susceptibility testing, following established microbiological protocols. Screening for Multi-Drug resistance (MDR) and Extended Spectrum Beta-Lactamase (ESBL) was conducted for all Escherichia coli and Klebsiella pneumoniae isolates utilizing a combined Disk (CD) test method. Results: Out of 258 Escherichia coli and Klebsiella pneumoniae isolates, 42 isolates of E. coli and 21 isolates of K. pneumoniae were confirmed as ESBL producer. Conclusion: The regular surveillance of hospital-associated infections including monitoring of antimicrobial susceptibility pattern is needed for the formulation of a definite antimicrobial policy.

Investigation of the Antibacterial Effect of Taraxacum officinale Extracts Extracted in Different Solvents on Bacteroides fragilis ATCC 25285 Standard Strain by Broth Microdilution Method

Bacteria causing hospital-associated infections continue to become resistant due to antibiotic resistance, which has become a global problem worldwide and accordingly, the antibiotic options used in the treatment of infectious diseases caused by these bacteria are limited. In the light of the data obtained from experimental studies on plants, it is thought that plant extracts may be a promising option in the treatment of infectious diseases. In this study, it was aimed to determine the antibacterial activity of Taraxacum officinale extracts on Bacteroides fragilis ATCC 25285 standard strain by broth microdilution method and to pioneer different studies that will investigate the antibacterial effects of plant extracts on resistant B.fragilis strains that cause hospital-acquired opportunistic infections after invasive interventions and trauma. In this study, the T.officinale plant collected as a result of field work was divided into root, leaf and flower parts and dried at 70 °C for 24 hours and then turned into powder. Dried plant samples were extracted in ethanol and methanol for 24 hours. The obtained extracts were stored at -80 °C to be used in the broth microdilution method. B.fragilis ATCC 25285 standard strain was used as the bacterial strain. As a result of the experiments performed with broth microdilution method, the MIC (minimum inhibitory concentration) value of root, leaf and flower extracts with ethanol was determined as 200 μg/ mL, the methanolic root extract as 100 μg/mL and the methanolic leaf and flower extracts as 200 μg/mL. As a result, ethanol and methanol plant extracts were found to be effective on B.fragilis strain.

Applying a multi-faceted infection control strategy to improve hospital environmental cleaning quality

BackgroundAlong with existing infection control policies, repeated education and training of environmental service workers (ESWs) improves their compliance and ultimately reduces hospital-associated infection (HAI) rates. However, only limited studies have explored the health behavioral determinants of ESWs regarding their cleaning performance after implementing an educational intervention with multi-faceted infection control strategy. ObjectiveTo determine whether an educational intervention with multi-faceted infection control strategy improves the health behavioral determinants associated with ESWs’ cleaning performance. MethodsTwenty-eight ESWs who received an educational intervention with multi-faceted hospital infection control strategy were included. ESWs’ knowledge, perceived benefits and barriers, self-efficacy, health literacy, and cleaning performance were evaluated at pre-intervention, post-intervention, and 3-month follow-up. ResultsHAI-related adenosine triphosphate (ATP) levels decreased significantly at post-intervention and 3-month follow-up compared with pre-intervention levels (all p < 0.05). All post-intervention ATP levels met the standard criterion after the 2nd environmental cleaning, with a median score of 267 (range, 71–386). High baseline ATP levels (odds ratio [OR] = 4.195, 95%CI 2.500–7.042, p < 0.05) were positively associated with qualified post-intervention ATP levels, while high education (OR = 0.480, 95%CI 0.276–0.833, p < 0.05) and high baseline knowledge scores (OR = 0.481, 95%CI 0.257–0.903, p = 0.023) were negatively associated with qualified post-intervention ATP levels. ConclusionEducational intervention using a multi-faceted infection control strategy improves health behavioral determinants (baseline education, knowledge scores and ATP levels) associated with ESWs’ hospital cleaning performance. Receiving an educational intervention may increase HAI knowledge of environmental cleaning among ESWs with high education or low baseline HAI knowledge.

Colony phase variation switch modulates antimicrobial tolerance and biofilm formation in Acinetobacter baumannii.

Carbapenem-resistant Acinetobacter baumannii causes one of the most difficult-to-treat nosocomial infections. Polycationic drugs like polymyxin B or colistin and tetracycline drugs such as doxycycline or minocycline are commonly used to treat infections caused by carbapenem-resistant A. baumannii. Here, we show that a subpopulation of cells associated with the opaque/translucent colony phase variation by A. baumannii AB5075 displays differential tolerance to subinhibitory concentrations of colistin and tetracycline. Using a variety of microscopic techniques, we demonstrate that extracellular polysaccharide moieties mediate colistin tolerance to opaque A. baumannii at single-cell level and that mushroom-shaped biofilm structures protect opaque bacteria at the community level. The colony switch phenotype is found to alter several traits of A. baumannii, including long-term survival under desiccation, tolerance to ethanol, competition with Escherichia coli, and intracellular survival in the environmental model host Acanthamoeba castellanii. Additionally, our findings suggest that extracellular DNA associated with membrane vesicles can promote colony switching in a DNA recombinase-dependent manner.IMPORTANCEAs a WHO top-priority drug-resistant microbe, Acinetobacter baumannii significantly contributes to hospital-associated infections worldwide. One particularly intriguing aspect is its ability to reversibly switch its colony morphotype on agar plates, which has been remarkably underexplored. In this study, we employed various microscopic techniques and phenotypic assays to investigate the colony phase variation switch under different clinically and environmentally relevant conditions. Our findings reveal that the presence of a poly N-acetylglucosamine-positive extracellular matrix layer contributes to the protection of bacteria from the bactericidal effects of colistin. Furthermore, we provide intriguing insights into the multicellular lifestyle of A. baumannii, specifically in the context of colony switch variation within its predatory host, Acanthamoeba castellanii.

Inter-Hospital Transfer Is an Independent Risk Factor for Hospital-Associated Infection.

Background: Regionalization of surgical care shifts higher acuity patients to larger centers. Hospital-associated infections (HAIs) are important quality measures with financial implications. In our ongoing efforts to eliminate HAIs, we examined the potential role for inter-hospital transfer in our cases of HAI across a multihospital system. Hypothesis: Surgical patients transferred to a regional multihospital system have a higher risk of National Healthcare Safety Network (NHSN)-labeled HAIs. Patients and Methods: The analysis cohort of adult surgical inpatients was filtered from a five-hospital health system administration registry containing encounters from 2014 to 2021. The dataset contained demographics, health characteristics, and acuity variables, along with the NHSN defined HAIs of central line-associated blood stream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and Clostridioides difficile infection (CDI). Univariable and multivariable statistics were performed. Results: The surgical cohort identified 92,832 patients of whom 3,232 (3.5%) were transfers. The overall HAI rate was 0.6% (528): 86 (0.09%) CLABSI, 133 (0.14%) CAUTI, and 325 (0.35%) CDI. Across the three HAIs, the rate was higher in transfer patients compared with non-transfer patients (CLABSI: n = 18 (1.3%); odds ratio [OR], 4.79; CAUTI: n = 25 (1.8%); OR, 4.20; CDI: n = 37 (1.1%); OR, 3.59); p < 0.001 for all. Multivariable analysis found transfer patients had an increased rate of HAIs (OR, 1.56; p < 0.001). Conclusions: There is an increased risk-adjusted rate of HAIs in transferred surgical patients as reflected in the NHSN metrics. This phenomenon places a burden on regional centers that accept high-risk surgical transfers, in part because of the downstream effects of healthcare reimbursement programs.

Antibiotic and antifungal use in paediatric departments at three academic hospitals in South Africa

ObjectivesSouth Africa implemented a National Strategic Framework to optimise antimicrobial stewardship in 2014; however, there is limited data on how this has affected prescribing, especially to children treated in academic centres. MethodsWe conducted a point prevalence survey using the World Health Organization (WHO) methodology to evaluate antibiotic and antifungal prescribing practices in paediatric departments at three academic hospitals in South Africa. ResultsWe recorded 1946 antimicrobial prescriptions in 1191 children, with 55.2% and 39.2% of the antibiotics classified as WHO AWaRe Access and Watch drugs, respectively. There were significant differences in prescription of Reserve antibiotics and antifungals between institutions. Receipt of WHO Watch and Reserve antibiotics was independently associated with infancy (<12 months) and adolescents (13-17 years) (adjusted relative risk [aRR]: 2.09-9.95); prolonged hospitalisation (aRR: 3.29-30.08); rapidly or ultimately fatal illness (aRR: 1.94 to 5.52); and blood transfusion (aRR: 3.28-5.70). Antifungal prescribing was associated with treatment of hospital-associated infection (aRR: 2.90), medical prophylaxis (aRR: 3.30), and treatment in intensive care units (aRR: 2.15-2.27). ConclusionsGuidance on optimisation of infection prevention and control practice and strengthening of antimicrobial stewardship would impact positively on the care of sick children in our setting.

Incidence and outcomes of hospital-associated respiratory virus infections by viral species.

Although the incidence of hospital-associated respiratory virus infection (HARVI) is well recognized, the risk factors for infection and impact on patient outcomes are not well characterized. We identified a cohort of all inpatient admissions ≥24 hours duration at a single academic medical center from 2017 to 2020. HARVI were defined as respiratory virus detected in a test ordered after the 95th percentile of the virus-specific incubation period. Risk factors for HARVI were assessed using Cox proportional hazards models of the competing outcomes of HARVI and discharge. The associations between time-varying HARVI status and the rates of ICU admission, discharge, and in-hospital death were estimated using Cox-proportional hazards models in a competing risk framework. HARVI incidences were 8.8 and 3.0 per 10,000 admission days for pediatric and adult patients, respectively. For adults, congestive heart failure, renal disease, and cancer increased HARVI risk independent of their associations with length of stay. HARVI risk was also elevated for patients admitted in September-June relative to July admissions. For pediatric patients, cardiovascular and respiratory conditions, cancer, medical device dependence, and admission in December increased HARVI risk. Lengths of stay were longer for adults with HARVI compared to those without, and hospital-associated influenza A was associated with increased risk of death. Rates of ICU admission were increased in the 5 days after HARVI identification for adult and pediatric patients. HARVI was not associated with length of stay or death among pediatric patients. HARVI is associated chronic health conditions and increases morbidity and mortality.

739. Impact of Alcohol-based Nasal Decolonization’s Method of Documentation in Reducing Methicillin-resistant Staphylococcus aureus Hospital-associated Infections

Abstract Background Infections related to multi-drug resistant organisms (MDRO) are increasingly difficult to treat and contribute to elevated mortality, prolonged length of stay and financial burden. At a 382-bed academic medical center, universal decolonization using an alcohol-based nasal decolonizing agent is performed twice daily on all inpatients, as well as chlorhexidine gluconate (CHG) bathing on select populations. Numerous studies cite decolonization as an effective reduction method for MDRO such as methicillin-resistant Staphylococcus aureus (MRSA). Unfortunately, documentation method is a seldomly considered variable. The purpose of this review was to evaluate the impact of documentation method for an alcohol-based nasal decolonization agent in reducing MRSA hospital-associated infections. Methods The study included all National Healthcare Safety Network (NHSN) defined hospital associated laboratory identified (Lab ID) MRSA blood infections from July 2019 through March 2023. Data was divided into descriptive categories with number of infections noted. The baseline period included population specific decolonization (n=35), followed by universal decolonization documentation via nursing task list (n=13), and concluded with electronic medication administration record (EMAR) implementation (n=7). The Kruskal Wallace Test was utilized for evaluation due to non-normative distribution. Results A Kruskal Wallace H Test indicated a statistical significance in medians between the task list and EMAR H(1) =5.10, p=0.024. There was no significance noted between the baseline and task list H(1 =0.04), p=0.841. Medians between baseline and EMAR approached significance but did not meet for this study H(1) =3.24, p=0.072. Clinically, there was a reduction in MRSA Lab ID of 48% between baseline and task list, followed by a 46% reduction between task list and EMAR. Overall reduction from baseline to EMAR was 80%. Conclusion Reduction of infection is crucial for patient safety and quality outcomes. Documentation is not typically highlighted as a risk reduction method. This study noted a significant decrease in hospital-associated MRSA Lab ID events after transition of documentation from the nursing task list to the EMAR. Disclosures All Authors: No reported disclosures

Prevalence of hospital-associated infections and its association with discharge destinations and hospital readmissions in Brussels, Belgium, from 2008 to 2020: A hospital-based, cross-sectional study.

To examine time trends of hospital-associated infections (HAIs) in people living in the Brussels-Capital Region, and to evaluate the consequences for hospitals and long-term care facilities (LTCFs). Cross-sectional analyses of yearly hospital administrative data. All Belgian hospitals and discharge destinations, focusing on LTCFs. All individuals from the Brussels-Capital Region hospitalized for >1 day throughout Belgium between 2008 and 2020 (N = 1,915,572). We calculated HAI prevalences and then, adjusting for confounders, the odds of being discharged to a LTCF or being readmitted within 30 days postdischarge after an HAI. HAIs included hospital-associated bloodstream infections, hospital-associated urinary tract infections, hospital-associated pneumonia, ventilator-associated pneumonia, and surgical-site infections. Between 2008 and 2020, we identified 77,004 HAIs. Changes in time trends occurred. We observed a decrease of all HAIs from 2012 to 2014 from 5.17% to 2.19% (P < .001) and an increase from 2019 to 2020 from 3.38% to 4.06% (P < .001). Among patients with HAIs, 24.36% were discharged to LTCFs and 13.51% underwent early readmission. For stays ≥4 days, HAIs were associated with higher odds of LTCF discharge (adjusted odds ratio [aOR], 1.25; 95% confidence interval [CI], 1.22-1.28), but with lesser odds of early readmission (aOR, 0.88; 95% CI, 0.85-0.90). Administrative data can be useful to detect HAIs trends, but they seem to underestimate the burden compared to surveillance systems. Risk factors of readmission should be identified during hospital stays to ensure continuity of care. Considering the results from 2020 coinciding with the COVID-19 pandemic, monitoring the impact of HAIs should continue.

Strengthening the role of hospital leadership in infection control (LEAD-IC) – a multimodal educational intervention in German acute care hospitals

BackgroundThe effect of leadership support for adherence to infection control and prevention (IPC) measures has been demonstrated. To expand this support, a target group-specific educational study for chief medical officers (CMO) was implemented and its influence on IPC indicators was investigated.MethodsA controlled cohort study was conducted between 2018 and 2019. The intervention based on an initial workshop, an e-learning course, and a final meeting. Participants’ activities involving IPC management were surveyed. Consumption of alcohol hand rub (AHR) and incidence density of hospital-associated (HA) Clostridioides difficile-associated infections (CDI) were analyzed.ResultsEight percent of 360 CMOs invited participated in the initial workshop; 70% of those participants registered for the online course. Overall, 43% completed the post-intervention questionnaire, in which 85% of respondents reported increased collaboration with relevant stakeholders. The pre-intervention median AHR consumption was higher in the intervention group than in the control group. Both groups showed an increase (38.6 (interquartile range (IQR) 33.6; 45.0) to 41.9 ml/patient day (PD) (IQR 35.0; 56.6) and 33.4 (IQR 28.3; 40.8) to 35.8 ml/ PD (IQR 31.6; 43.2), respectively). Pre-intervention median HA CDI cases were lower in the intervention group than in the control group. Both groups reported a decrease (0.22 (IQR 0.17; 0.33) to 0.19 cases/1000 PD (IQR 0.15; 0.26) and 0.32 (IQR 0.2; 0.48) to 0.22 cases/1000 PD (IQR 0.11; 0.33), respectively).ConclusionMultimodal IPC training of CMOs is worthwhile and can lead to changes in IPC-relevant cooperation in hospitals. IPC training of hospital management should be further intensified.

The impact of the COVID-19 pandemic on hospital-acquired infections at a comprehensive cancer center

Robust infection prevention and control (IPC) measures were deployed across health care institutions at the start of the COVID-19 pandemic, resulting in increased use of personal protective equipment, enhanced contact precautions, and an emphasis on hand hygiene. Here, we evaluate the effect of enhanced IPC practices on the occurrence of various hospital-associated infections (HAIs) in a comprehensive cancer center. From September 2016 through March 2022, we calculated the incidence rates (IRs) of HAIs for C. difficile infection, multidrug-resistant organisms, respiratory viral infections (RVIs), and device-related infections. We analyzed the incidence rate ratios for all HAIs during the periods before the pandemic, during the pandemic, atthe time of the surges, and in COVID-19-designated wards. When comparing the prepandemic to the pandemic period, the IR across all MRDOs was similar. We observed a decrease in the IR of central line-associated bloodstream infections and a stable IR of catheter-associated urinary tract infections. A significant decrease was observed in the IR of C. difficile infection. The total IR of nosocomial RVIs decreased, as did for each respiratory virus. A similar IR of nosocomial RVIs between COVID-19 community surge versus nonsurge periods was observed except for SARS-CoV-2, RSV, and influenza. multidrug resistant organisms were 5 times more likely to occur on the COVID-19 wards compared with the non-COVID-19 wards. Implementing strict IPC measures during the COVID-19 pandemic in a cancer hospital led to a significant decrease in many HAIs and a reduction in nosocomial RVIs.

NDM-1- and OXA-23-producing Acinetobacter baumannii in wastewater of a Nigerian hospital.

Carbapenem-resistant Acinetobacter baumannii spp. are increasingly important pathogens with limited treatment options, and there is limited knowledge on the environmental factors contributing to their spread. We determined the occurrence of carbapenem-resistant A. baumannii in hospital wastewater and their phylogenetic relationships with clinical A. baumannii isolates. Grab samples of raw and treated hospital wastewater were collected monthly at the University College Hospital, Ibadan, Nigeria, between March 2021 and February 2022. Acinetobacter baumannii strains were selectively isolated and identified using VITEK2, and their whole genomes were sequenced on an Illumina platform. We performed antimicrobial susceptibility testing and in silico genomic characterization of the strains and determined their phylogenetic relationships to previously characterized clinical A. baumannii strains from Nigeria. A. baumannii complex isolates were recovered from wastewater throughout the study. Of the 82 isolates identified based on whole-genome sequences, 77 were A. baumannii. A. baumannii isolates had high resistance rates (≥48.1%) to 10 of 12 antimicrobials tested, and majority (42/77, 54.5%) were resistant to carbapenems, with bla NDM-1 being the most common (24/77, 31.2%) carbapenem resistance gene detected, followed by bla OXA-23 (n = 22, 28.6%). There was no statistically significant difference in carbapenem resistance rates or carbapenem gene carriage between the raw and treated wastewater isolates. Most of the isolates belonged to novel or sparsely described lineages, some of which were closely related to clinical isolates. The release of inadequately treated hospital wastewater into the environment may contribute to the increased spread of carbapenem-resistant and clinically important A. baumannii lineages in Ibadan, Nigeria. IMPORTANCE Acinetobacter baumannii is a leading cause of hospital-associated infections globally. A. baumannii reservoirs outside hospital settings are still unknown, and their occurrence in the environment is linked to clinical and anthropogenic activities. Although the risk of transmission of A. baumannii from environmental sources to humans is not fully understood, these sources pose significant risks for the continued dissemination of A. baumannii and their resistance traits. This study provides evidence that diverse and clinically relevant A. baumannii strains, many of which are resistant to carbapenems, are constantly being discharged into the environment through inadequately treated hospital wastewater. We further elucidate potential transmission routes between the environment and clinical infections and demonstrate the high prevalence of carbapenem resistance genes on highly mobile transposons among these strains. Our findings highlight the pressing need to address hospital wastewater as a crucial factor in curtailing the spread of carbapenem-resistant A. baumannii.

Incidence of Drug-Resistant Hospital-Associated Gram-Negative Bacterial Infections, the Accompanying Risk Factors, and Clinical Outcomes with Treatment.

Extensive drug resistance to bacterial infections in hospitalised patients is accompanied by high morbidity and mortality rates due to limited treatment options. This study investigated the clinical outcomes of single and combined antibiotic therapies in extensive (XDR), multidrug-resistant (MDR) and susceptible strains (SS) of hospital-acquired infections (HAIs). Cases of hospital-associated drug-resistant infections (HADRIs) and a few susceptible strains from hospital wards were selected for this study. Bacteria identifications (IDs) and antimicrobial susceptibility tests (ASTs) were performed with a Vitek 2 Compact Automated System. Patients' treatment types and clinical outcomes were classified as alive improved (AI), alive not improved (ANI), or died. The length of hospital stay (LOHS) was acquired from hospital records. The HAI pathogens were Acinetobacter baumannii (28%), Escherichia coli (26%), Klebsiella pneumoniae (22%), Klebsiella (2%) species, Pseudomonas aeruginosa (12%), Proteus mirabilis (4%), and other Enterobacteriaceae. They were MDR (40.59%), XDR (24.75%), carbapenem-resistant Enterobacteriaceae (CRE, 21.78%) and susceptible (12%) strains. The treatments were either monotherapy or combined therapy with different outcomes. Monotherapy produced positive significant outcomes with E. coli infections, while for P. aeruginosa, there were no differences between the number of infections treated with either mono/combined therapies (50% each). Nonetheless, combined therapy had significant effects (p < 0.05) as a treatment for A. baumannii and K. pneumoniae infections. Clinical outcomes and LOHS varied with infecting bacteria. The prevalence of XDR and MDR HAIs was found to be significantly high, with no association with treatment type, LOHS, or outcome.

A Multilayered Imaging and Microfluidics Approach for Evaluating the Effect of Fibrinolysis in Staphylococcus aureus Biofilm Formation.

The recognition of microbe and extracellular matrix (ECM) is a recurring theme in the humoral innate immune system. Fluid-phase molecules of innate immunity share regulatory roles in ECM. On the other hand, ECM elements have immunological functions. Innate immunity is evolutionary and functionally connected to hemostasis. Staphylococcus aureus (S. aureus) is a major cause of hospital-associated bloodstream infections and the most common cause of several life-threatening conditions such as endocarditis and sepsis through its ability to manipulate hemostasis. Biofilm-related infection and sepsis represent a medical need due to the lack of treatments and the high resistance to antibiotics. We designed a method combining imaging and microfluidics to dissect the role of elements of the ECM and hemostasis in triggering S. aureus biofilm by highlighting an essential role of fibrinogen (FG) in adhesion and formation. Furthermore, we ascertained an important role of the fluid-phase activation of fibrinolysis in inhibiting biofilm of S. aureus and facilitating an antibody-mediated response aimed at pathogen killing. The results define FG as an essential element of hemostasis in the S. aureus biofilm formation and a role of fibrinolysis in its inhibition, while promoting an antibody-mediated response. Understanding host molecular mechanisms influencing biofilm formation and degradation is instrumental for the development of new combined therapeutic approaches to prevent the risk of S. aureus biofilm-associated diseases.