Hospital Infection Control Practices Research Articles

FRI0284 Preoperative Use of Biologic Agents is not an Independent Risk Factor for SSI and Delayed Wound Healing in Patients with Rheumatoid Arthritis

BackgroundThe perioperative use of biologic DMARDs in patients with rheumatoid arthritis (RA) has potential risks for delayed wound healing and infectious complications. Surgeons are recommended to discontinue biologic DMARDs to...

국내 의료기관의 의료관련감염 관리 실태

Abstract The purpose was to describe the state of healthcare-associated infection(HAI) control. Data were collected from 134 hospitals. The questionnaire developed by Kang[8] were modified. The mean of hospital beds was 556.4, 26.9% of hospitals were less than 300 beds. 99.3% of hospitals had infection control committee(ICC). ICC met 3.4 times a year. 54.5% of hospitals had one infection control practitioner(ICP). 95.5% of ICPs were nurse, 48.7% of ICPs had more than master's degree. Hospital experience of ICPs was 13.5 years. ICP experience was 3.2 years. 30.8% of ICPs worked for less than 1 year. All hospitals investigated HAI, 75.4% performed improvement activities. There are significant differences in existence of ICD, negative pressure room, computer program, numbers of ICPs according to hospital size. Manpower, organization, and facilities lacked in less than 300 beds. This conclusions will give baseline data to establish infection control system, manpower and practice in small-medium hospitals.

General influenza infection control policies and practices during the 2009 H1N1 influenza pandemic: A survey of women’s health, obstetric, and neonatal nurses

An evaluation of infection control practices was conducted following the release of the Centers for Disease Control and Prevention (CDC) guidance regarding the care of pregnant women during the 2009 H1N1 influenza pandemic. This paper describes 9 general hospital practices. A questionnaire was distributed electronically to 12,612 members of the Association of Women's Health, Obstetric, and Neonatal Nurses (AWHONN). Respondents (N = 2,304) who reported working in obstetric or neonatal settings during the pandemic completed the questionnaire. Most (73%) respondents considered the Centers for Disease Control and Prevention's guidance very useful. Significantly more reported a written hospital policy for each practice during versus before the pandemic. Six of the 9 practices were implemented most of the time by at least 70% of respondents; the practices least often implemented were mandatory vaccination of health care personnel involved (52%) and not involved (34%) in direct patient care and offering vaccination to close contacts of newborns prior to discharge (22%). The most consistent factor associated with implementation was the presence of a written policy supporting the practice at the respondent's hospital. We offer a descriptive account of general hospital infection control policies and practices during the 2009 H1N1 pandemic. Factors associated with reported implementation may be useful to inform planning to protect women and children for future public health emergencies.

Awareness, perceived relevance, and acceptance of large animal hospital surveillance and infection control practices by referring veterinarians and clients

To assess awareness, perceived relevance, and acceptance of surveillance and infection control practices at a large animal referral hospital among referring veterinarians and clients who sent horses to the facility for veterinary care. Survey. 57 referring veterinarians and 594 clients. A 15-question survey targeting Salmonella enterica as an important pathogen of interest in horses was sent to clients who sent ≥ 1 horse to the University of Florida Large Animal Hospital for veterinary care during July 1, 2007, through July 1, 2011, and to veterinarians who had referred horses to the same hospital prior to July 1, 2011. Responses were summarized with descriptive statistics. The χ(2) test and the Wilcoxon rank sum test were used to examine associations among variables of interest. Survey response rates were low (57/467 [12%] for veterinarians and 594/3,095 [19%] for clients). Significantly more (35/56 [63%]) veterinarians than clients (227/585 [39%]) were aware that the hospital operates a surveillance and infection control program. Most veterinarians (56/57 [98%]) and clients (554/574 [97%]) indicated that sampling and testing of horses to detect Salmonella shedding in feces at admission and during hospitalization was justified. In addition, on a scale of 1 (not important) to 10 (very important), veterinarians and clients indicated it was very important (median score, 10 [interquartile range, 8 to 10] for both groups) that a referral hospital operates a surveillance and infection control program. Survey results indicated that awareness of hospital surveillance and infection control practices was higher among veterinarians than clients, and these practices were considered relevant and well-accepted among participant veterinarians and clients.

Infection control knowledge, attitudes, and practices among healthcare workers in Addis Ababa, Ethiopia.

To better understand hospital infection control practices in Ethiopia. A cross-sectional evaluation of healthcare worker (HCW) knowledge, attitudes, and practices about hand hygiene and tuberculosis (TB) infection control measures. An anonymous 76-item questionnaire was administered to HCWs at 2 university hospitals in Addis Ababa, Ethiopia. Knowledge items were scored as correct/incorrect. Attitude and practice items were assessed using a Likert scale. In total, 261 surveys were completed by physicians (51%) and nurses (49%). Fifty-one percent of respondents were male; mean age was 30 years. While hand hygiene knowledge was fair, self-reported practice was suboptimal. Physicians reported performing hand hygiene 7% and 48% before and after patient contact, respectively. Barriers for performing hand hygiene included lack of hand hygiene agents (77%), sinks (30%), and proper training (50%) as well as irritation and dryness (67%) caused by hand sanitizer made in accordance with the World Health Organization formulation. TB infection control knowledge was excellent (more than 90% correct). Most HCWs felt that they were at high risk for occupational acquisition of TB (71%) and that proper TB infection control can prevent nosocomial transmission (92%). Only 12% of HCWs regularly wore a mask when caring for TB patients. Only 8% of HCWs reported that masks were regularly available, and 76% cited a lack of infrastructure to isolate suspected/known TB patients. Training HCWs about the importance and proper practice of hand hygiene along with improving hand sanitizer options may improve patient safety. Additionally, enhanced infrastructure is needed to improve TB infection control practices and allay HCW concerns about acquiring TB in the hospital.

Prevalence of HCV Antibodies and HBV Surface Antigen among Workers of Zagazig Faculty of Medicine and its Hospitals

Background and study aim:: Viral hepatitis is a serious global public health problem affecting billions of people globally, and both hepatitis B virus (HBV) and hepatitis C virus (HCV) infections are rapidly spreading in the developing countries including Egypt due to the lack of health education, poverty, and and illiteracy. So this study was conducted to determine the prevalence of HCV antibodies and HBsAg and possible risk factors of transmission of these infections among workers of Zagazig Faculty of medicine and its hospitals. Patients and methods: This study was conducted on two hundred workers (non medicals) All were randomly selected from all clinical and academic Departments of Zagazig Faculty of Medicine and its Hospitals. Their age was above 18 years and up to 60 years. Possible associated factors with infections by the viruses were collected from patient using questionnaire Rapid diagnostic test kits were used to screen for Hepatitis B surface antigen (HBsAg) and anti-Hepatitis C virus (HCV) antibodies. Results :Out of two hundred 39 (19.5%)of workers had Hepatitis C virus (HCV) antibodies and 7 (3.5%) of workers had Hepatitis B surface antigen and one worker 1 ((0.5%). had dual hepatitis B and C virus coinfection . The prevalence of chronic HCV and HBV is higher among males (20.2% and 4% respectively ) than females (17.3% and 1.92% ) and both HBsAg and HCV Abs was ( 0.7)% in males and negative in females. The prevelance of HCV Abs was high among workers with past history of barbering (69.23%) while prevalence of HBV was high in workers with a history of blood transfusion (28.57%).Multivariate regression was used to estimate independent effects of risk factors on seropositivity of both virsus . A highly significant association was found between workers with history barbering (OR 4.58 ) and those with seroposiotivity of HCV abs. While there was no significant association between workers with a history of dental procedure(OR 1.44), operation (OR 1.2) and blood transfusion(OR 1.5) and those with acquired seropositivity of HCVAbs. And a highly significant association was found between workers with history of blood transfusion and those with acquired seropositivity of HBV ( OR 8.18), while there was no significant association between workers with a history of dental procedure(OR 0.2), barbering(OR 0.59) and operation (OR 0.63) and those with acquired seropositivity of HBs. Conclusion : We can conclude that he prevalence of HBV and HCV infections among workers of Zagazig Faculty of Medicine and its hospitals in this study is high . Barbering has 4 times risk of HCV infection and blood transfusion has 8 times HBV infection. and working in operation units was associated with increase the risk of HBV and HCV infections, but working in other units like surgical and non surgical , administration and ICU was associated with increase HCV transmission. For prevention the spread of HBV and HCV, people must be educated about these infections and modes of transmission , better infection control practices in hospitals, healthcare and barbering facilities.

Evaluation of Hospital Mass Screening and Infection Control Practices in a Pandemic Influenza Full-Scale Exercise

Nonpharmacologic interventions such as limiting nosocomial spread have been suggested for mitigation of respiratory epidemics at health care facilities. This observational study tested the efficacy of a mass screening, isolation, and triage protocol in correctly identifying and placing in a cohort exercise subjects according to case status in the emergency departments at 3 acute care hospitals in Brooklyn, New York, during a simulated pandemic influenza outbreak. During a 1-day, full-scale exercise using 354 volunteer victims, variables assessing adherence to the mass screening protocol and infection control recommendations were evaluated using standardized forms. While all hospitals were able to apply the suggested mass screening protocol for separation based on case status, significant differences were observed in several infection control variables among participating hospitals and different hospital areas. Implementation of mass screening and other infection control interventions during a hospital full-scale exercise was feasible and resulted in measurable outcomes. Hospital drills may be an effective way of detecting and addressing variability in following infection control recommendations.

How big a challenge to initiate three basic infection control practices in hospitals of Bangladesh?

Not availableDOI: http://dx.doi.org/10.3329/bjmm.v4i2.10763

Persistance of HBsAg, liver enzyme changes and risk factors of hepatitis B infection among chronic carriers of hepatitis B

as high as 58.2% in multi-transfused children, 51.6% in children on hemodialysis and 87.5% in adult dialysis patients. Among populations at indirect risk, family contacts of HCV positive individuals had a prevalence of 5.7%, diabetic children a prevalence of 3.1%, select professions such as barbers 12.3%, and health care workers 15.7%, while Injection drug users and prisoners had a prevalence of 63% and 31.4%, respectively. Common risk factors appear to be increasing age, parenteral anti-schistosomal therapy, frequent transfusions, injections or surgical procedures. Conclusion: With the highest HCV prevalence in the world, Egypt appears to be experiencing an HCV epidemic. High HCV prevalence levels especially among select clinical populations, is indicative of ongoing iatrogenic transmission. Therefore, prevention programs need to be developed targeting HCV transmission routes suchasbetter infection control practices inhospitals, healthcare and dental care facilities.

Differences in the compliance with hospital infection control practices during the 2009 influenza H1N1 pandemic in three countries

In December 2009, the World Health Organization (WHO) issued updated guidelines on the prevention of H1N1 influenza virus in healthcare settings. In 2010, the WHO pandemic influenza alert level was still at phase 6. To study the practice of infection control measures during the 2009 influenza H1N1 pandemic among healthcare workers (HCWs) in three countries. A standardized, self-administered anonymous questionnaire survey was conducted in 2010 among doctors, nurses and allied HCWs in 120 hospital-based clinical departments in Hong Kong, Singapore and the UK. Questions were asked on demographics; previous experience and perceived severity of influenza; infection control practices; uptake of seasonal influenza vaccination and H1N1 vaccination. Multiple logistic regression was used to test the independent association with different factors. A total of 2100 HCWs in the three countries participated. They reported high compliance (>80%) with infection control procedures regarded as standard for droplet-transmitted infections including wearing and changing gloves, and washing hands before and after patient contact. However, the reported use of masks with indirect or direct patient contact (surgical or N95 as required by their hospital) varied considerably (96.4% and 70.4% for Hong Kong; 82.3% and 87.7% for Singapore; 25.3% and 62.0% for the UK). Reported compliance was associated with job title, number of patient contacts and perceived severity of pandemics. There was no association between the uptake for seasonal or 2009 H1N1 vaccines and compliance. Compliance with infection control measures for pandemic influenza appears to vary widely depending on the setting.

Crimean-Congo Hemorrhagic Fever, Kazakhstan, 2009–2010

We evaluated Crimean-Congo hemorrhagic fever (CCHF) surveillance data from southern Kazakhstan during 2009–2010 and found both spatial and temporal association between reported tick bites and CCHF cases. Public health measures should center on preventing tick bites, increasing awareness of CCHF signs and symptoms, and adopting hospital infection control practices.

Current Trends in Culture-Based and Molecular Detection of Extended-Spectrum-β-Lactamase-Harboring and Carbapenem-Resistant Enterobacteriaceae

The ever-expanding role of extended-spectrum-β-lactamase (ESBL)-harboring and carbapenem-resistant Enterobacteriaceae in causing serious infections poses a grave public health threat because these organisms also tend to be multidrug resistant, for which very few (if any) antibiotic options remain available. Rapid detection of such panresistant organisms offers one of the best solutions to improve patient screening and hospital infection control practices as well as curb inappropriate antibiotic use. This review discusses and compares primarily the current state-of-the-art culture-based and molecular methods that are commercially available for detection or screening of ESBL-harboring and carbapenem-resistant Enterobacteriaceae.

Infection control practices among doctors and nurses in a tertiary care hospital

Background: Basic infection control measures in any healthcare setup can reduce the rates of healthcare-associated infections. A study to assess the knowledge and practice of 400 healthcare personnel regarding hospital infection control practices was performed. Materials and Methods: A structured questionnaire was distributed to the study group and collected the same day. Knowledge and practices of 329 […]

Correlations between genotyping and antibiograms of clinical isolates of Pseudomonas aeruginosa from three different south Indian hospitals

Purpose: To compare the molecular relationships and antibiograms of nosocomial isolates of Pseudomonas aeruginosa obtained from three different genres of hospitals located in Southern India, two located at Hyderabad (one private hospital and an ophthalmic hospital) and one in Puducherry (tertiary care teaching hospital). Each of these hospitals, which follow different infection control strategies and various problems associated with it, were investigated. Materials and Methods: Antibiograms generated by disk diffusion susceptibility testing for clinically relevant antibiotics and genotyping through fluorescent amplified fragment length polymorphism analysis (fAFLP) were the tools used in the study. Results: Molecular genotyping revealed a heterogeneous group of unrelated molecular clusters of P. aeruginosa strains having higher resistance that are apparently being endemic throughout the tertiary care teaching hospital. In eye care hospital, only a few distinct strains of P. aeruginosa predominating the study period were shown to be responsible for outbreaks. The third private hospital witnessed a group of resistant and persistent strains that might have clonally originated from a diverse collection of strains. Conclusions: The divergent kind of strains in our study suggests that there may be a direct link between the infection control practices followed in each hospital and kind of strains isolated in that particular setup. The study also emphasizes the need for maintaining infection control practices in hospitals with superior standards, failure of which might result in thriving of persistent P. aeruginosa clones in the hospitals.

Vancomycin use in a brazilian teaching hospital: comparison with the Hospital Infection Controlpractices Advisory Committee Guidelines (HICPAC)

This study describes vancomycin prescribing patterns in an average complexity hospital and compare the guidelines proposed by the Hospital Infection Control Practices Advisory Committee (HICPAC). The study was conducted in a 256-bed secondary-care hospital. Data were collected of all patients given vancomycin from March 2003 to February 2004, using a standardized chart-extraction form designed. Appropriate and inappropriate use was reviewed according to the Hospital Infection Control Practices Advisory Committee (HICPAC) guidelines on prudent vancomycin use. Out of 118 prescriptions, 95 (80.5%) were considered appropriate. Out of these 95 orders, 77 (81.1%) were administered for empiric treatment of suspected Gram-positive infections, 17 (17.9%) were administered for treatment of proven Gram-positive infections (76.5% identified as Staphyloccocus aureus-like agents) and 1 (1.0%) for beta-lactam allergy. The majority of the patients (96.6%) had recently used an antimicrobial medication (3 months). The mean pre-treatment hospitalization period was 11+/-10 days. Out of the 118 treatments, 67 (56.8%) were for nosocomial infections. The more frequent indications for vancomycin use were pneumonia (48.3%) and primary sepsis (18.6%), accounting for more than 66% of all treatments. No restriction policy was suggested because vancomycin use was considered adequate in the majority of the treatment cases. The broad empiric use of this antimicrobial was greater than expected in the institution and its use should be revised.

Indicadores de desempenho sobre uso de antibioticoprofilaxia cirúrgica: construção e validação

O estudo pretende contribuir com práticas de controle de infecção hospitalar, pela elaboração e validação de indicadores de avaliação de desempenho do uso de antibioticoprofilaxia cirúrgica. Por meio de metodologia de elaboração de medidas de avaliação em saúde, foram construídos um indicador básico e cinco secundários, submetidos à validação de construto operacional, representatividade e aplicabilidade, por meio de técnica de consenso de especialistas. Todos os indicadores obtiveram consenso nos atributos dos construtos operacionais e de representatividade. Quanto à aplicabilidade, o indicador básico não obteve consenso somente para o atributo de acessibilidade, e os secundários para o de contextualização. As sugestões dos especialistas, contudo, permitiram ajustes e, portanto, validação. Tendo em vista que diversos tipos de avaliação de práticas assistenciais têm sido construídos, embora nem sempre sejam fundamentados e validados, acreditase que os modos de construção e validação utilizados neste estudo constituem a sua maior contribuição.

Multidrug-Resistant Acinetobacter baumannii in New York City—10 Years Into the Epidemic

Multidrug-Resistant <i>Acinetobacter baumannii</i> in New York City—10 Years Into the Epidemic

Evaluation of ChromID MRSA for the Detection of Methicillin-resistantStaphylococcus aureus

Background: Methicillin-resistant Staphylococcus aureus (MRSA) is a significant pathogen in both nosocomial and community settings, and screening for a carrier is an important infection control practice in many hospitals. We evaluated the sensitivity and specificity of the ChromID MRSA assay (bioMerieux, Marcy I’Etoile, France). Methods: A total of 190 clinical samples were collected from the anterior nares of premature infants in a newborn intensive care unit (N-ICU). Equal volumes (100μL) of the samples were inoculated on mannitol salt agar with oxacillin 6 mg/L (MSAO) and ChromID MRSA after emulsifying the screening swab in brain-heart Infusion broth with oxacillin 6 mg/L (BE). The specimens in BE were subcultured on ChromID MRSA after an overnight incubation. Results: Twenty-one of 190 samples (11%) was positive for MRSA by BE. After a 24 h incubation, the sensitivity/specificity of MSAO was 52%/98% and that of ChromID MRSA was 62%/100%, and at 48 h, the sensitivity/specificity of MSAO was 62%/92% and that of ChromID MRSA was 81%/99%. Conclusion: ChromID MRSA is a useful selective medium for the rapid isolation and identification of MRSA. (Korean J Clin Microbiol 2009;12:169-173)

Single room isolation to prevent the transmission of infection: development of a patient journey tool to support safe practice

A variety of infection prevention and control precautions are used to minimise the risk of infection spread from person to person, both patients and staff. Standard Precautions (SPs), including hand hygiene and use of personal protective equipment (PPE), are applied routinely to all patients, whereas transmission-based precautions (TBPs) are used when a patient is known or suspected to have an epidemiologically important infectious disease or condition, in order to further reduce the risk of spread of infection. The use of single room isolation is part of TBPs and is a cornerstone of hospital infection prevention and control practice. However, successfully implementing TBPs, including single room isolation, continues to be a challenge in the UK for a number of reasons. Effective approaches to increasing the quality and safety of patient care are increasingly based on utilising simple tools that increase the likelihood that care will be provided in a reliable way. The tool presented is intended to facilitate both learning and practice in relation to TBPs and to promote the delivery of safe patient care in relation to single room isolation. It is designed for use in those situations when a single room is available for patient isolation. It also highlights the other important TBPs to be taken to prevent the spread of infection, whether or not a single room is available. It can be adapted for use with any organism or disease for which TBPs are recommended. At a time when healthcare associated infections (HCAI) such as Clostridium difficile and meticillin resistant Staphylococcus aureus (MRSA) continue to have an impact on both acute and community care settings, and their reduction is embedded within national targets for NHS healthcare providers, tools that make it easy for healthcare workers to apply safe practices within their daily routines are essential. Initial testing suggests that this tool is acceptable to healthcare workers and further study will identify its potential contribution to healthcare workers' knowledge and practice in this area.

Infection control and antibiotic stewardship practices reported by south-eastern Mediterranean hospitals collaborating in the ARMed project

The prevalence of multiply resistant organisms (MROs) reported from south-eastern Mediterranean hospitals highlights the need to identify possible contributory factors to help design control interventions. This was investigated through a structured questionnaire, which examined infection control and antibiotic stewardship practices in hospitals participating or collaborating with the Antibiotic Resistance SurveilLance & Control in the Mediterranean Region (ARMed) project. A total of 45 hospitals (78.9% of invited institutions) responded to the questionnaire; 60% indicated that they faced periods of overcrowding when available bed complement was insufficient to cope with hospital admissions and 62% reported difficulties in isolating patients with MROs due to lack of available beds. Most hospitals relied mainly on washing to achieve hand hygiene, whether by non-medicated or disinfectant soaps. Dependence on solid bars of soap (28.9%) and cloth towels (37.8%) were among the problems identified as well as inconvenient distances of sinks from patient beds (66.6%). Alcohol hand rub was the predominant hand hygiene product in only 7% of hospitals. Programmes for better antibiotic use were mostly limited in scope; 33.3% reported having antibiotic prescribing guidelines and 53.3% of hospitals fed back resistance rates to prescribers. Auditing of antibiotic consumption, whether institution- or unit-based, was carried out in 37.8% of responding hospitals. Multi-faceted approaches aimed at improving isolation of patients with MROs, increasing the emphasis on hand hygiene by encouraging greater use of alcohol hand rubs and introducing effective antibiotic stewardship programmes should be encouraged in south-eastern Mediterranean hospitals.