Implementation Of Infection Prevention Practices Research Articles

Infection prevention practice in home healthcare: a mixed-method study in two Swiss home healthcare organisations.

Infection prevention and control (IPC) research has long neglected the home healthcare sector with its unique challenges. This study aimed to gain an understanding of the barriers to the implementation of infection prevention practices relevant to this setting, the related attitudes, perceived relevance and priorities from the home healthcare worker perspective in Switzerland. The mixed-method study involved semi-structured interviews (n = 18) and an anonymous web-based survey (n = 144) among nursing assistants and nurses from two home healthcare organizations in northwest Switzerland. Questions in both sub-studies focused on perceived challenges to infection prevention practices, perceived relevance, and related attitudes and mitigation strategies. Using an exploratory-sequential design, survey questions were designed to quantify and complement the findings from the interview study. Healthcare workers in these two organisations felt adequately protected, trained and supported by their organisations regarding IPC (survey agreement rates > 90%). General challenges to IPC in the home environment most agreed on were lack of cleanliness, lack of space, and the priorities of the patient to be respected (survey agreement rates 85.4%, 77.1%, and 70.8%, respectively). Practices and perceived challenges in the case of colonisation with multi-drug resistant organisms (MDRO) and potentially infectious diarrheal or respiratory illnesses varied highly regarding information transfer, use of protective equipment, and use and disinfection practices of multi-use equipment. Challenges to hand hygiene, sharps safety, waste management and decontamination of equipment did not feature as a prominent concern. This study is the first to characterise the implementation of infection prevention practices and the related challenges in home healthcare in Switzerland. Home healthcare workers describe various challenges related to infection prevention practices as largely manageable in their work routine, and generally show satisfaction with the support provided by their organisations regarding IPC precautions. Key findings regarding challenges amenable to interventions include uncertainty and inconsistency regarding the management of MDRO colonisation and acute illnesses, and gaps in information transfer. Those challenges may benefit from both organisational interventions and further research into the level of precautions that are appropriate to the home healthcare setting.

Cesarean Surgical Site Bacterial Infection

Background: The high incidence rate of surgical site infections (SSIs) highlights the need for prioritizing patient demographics, procedures, and surgical factors to be controlled by programs to reduce the infection rate. Objectives: This study detects the prevalence, causative organisms, and explores the relation between the air contamination in the operative theater and the SSI. Methodology: Cross sectional one-year study from January 2019. One hundred and seventy-two women were involved underwent CD. Intraoperative air sampling was performed during 83 surgery and bacterial air contamination were identified. Follow up for the patients 30 days after surgery was done to detect hospital acquired and community acquired SSI. Two samples were taken from the patient wound with SSI. Microbiological identification and antibiotics susceptibility testing for the isolates were done. The clonal relationships between the same species of isolates from air and wound were studied by evaluating the genomic DNA with PFGE analysis. Results: 14.5 % was the total SSI rate; 6.4%, developed hospital acquired SSI and 8.1% developed community acquired SSI. Most SSI cases yielded growth of Staphylococcus spp. (39, 3%) followed by Pseudomonas spp. (32.1%) and finally Escherichia coli (28.6%). Six wound isolates belonged to two air isolates pulsotype and the rest of isolates showed unsimilar pulsotype of interest. Conclusions: air contamination one of the causes of SSI and measures are recommended to reduce its incidence, including the implementation of infection prevention practices and the administration of antibiotic prophylaxis with strict surgical techniques. Most common cause of community acquired SSI was bad hygiene.

Outbreaks in the adult ICUs.

Infectious disease outbreaks in the critical care setting are common and serious consequence. This article reviews and summarizes recent outbreaks in the adult ICUs. Outbreaks of multidrug-resistant bacteria, fungi, and emerging viruses in ICUs from different countries are common. Outbreak investigation relies on epidemiologic methods, microbiologic studies, and molecular typing methods. Overuse of antibiotics, gaps in implementing infection prevention measures, and contaminated environment are common causes of ICU outbreaks. ICU staff awareness of and preparedness for such outbreaks are crucial for outbreak prevention and control. Specific infection control measures vary according to outbreak transmission mode and cause. Outbreaks remain a significant threat to healthcare systems. Proper implementation of infection prevention practices and judicious use of antibiotics are needed for outbreak prevention in adult ICUs. Surveillance, proper outbreak investigation, adherence to infection prevention and control measures, and thorough disinfection of contaminated areas are required to successfully manage outbreaks.

Health Care–Associated Infections in Children

HEALTH CARE–ASSOCIATED INFECTIONS (HAI) REsult in significant morbidity, prolong hospitalization, increase health care costs, and contribute to patient deaths. Among the aggressive national and local endeavors to address HAI, the subtle (and not so subtle) differences between pediatric and adult patients are often overlooked. Rates of central line–associated bloodstream infections (CLABSI), surgical site infections (SSI), and respiratory viral infections differ between children and adults, reflecting the unique susceptibilities of each population. Efforts to reduce the rates of HAI in children are often hampered by the lack of pediatric-specific research, lack of national pediatricspecific quality measures to guide prevention of SSI, and the implementation of infection prevention practices validated only in adult populations. The US Centers for Disease Control and Prevention/ National Healthcare Safety Network surveillance definitions for HAI in children and adults are in general the same, differing slightly for patients 1 year or younger. The commonality of definitions, however, belies the fact that children and adults differ in both susceptibility to infection and in the steps necessary to prevent these infections. Furthermore, identification of pediatric-specific risk factors for infection and the solutions needed to reduce pediatric HAI have not been well investigated. Central line–associated bloodstream infections, SSI, and viral infections in pediatric patients illustrate the important but overlooked differences between adult and pediatric HAI. Pediatric patients younger than 2 years and those requiring care in neonatal intensive care units (ICUs) and pediatric ICUs have especially high rates of HAI, and bloodstream infections are the most common HAI in all pediatric age groups. Pediatric patients have higher rates of bloodstream infections and viral lower respiratory tract infections than adult patients, whereas rates of catheter-related urinary tract infections, ventilator-associated pneumonia, and SSI are higher in adult patients, although rates for particular pediatric surgical procedures may be high. Data on CLABSI illustrate the difference between children and adults. Reported rates for CLABSI are frequently higher in pediatric ICUs than in adult ICUs. In adults, implementation of a multifaceted insertion bundle has been demonstrated to reduce the rates of CLABSI substantially. In contrast with adult data, maximizing insertion-bundle adherence is not sufficient to eliminate CLABSI in children. Data from the National Association of Children’s Hospitals and Related Institutions collaborative demonstrate that the main driver for reducing CLABSI in pediatric patients in the ICU involves optimizing the daily maintenance and care of central line catheters. Unique considerations are involved in the prevention of CLABSI in pediatric patients. Difficult intravenous access often requires placement of catheters in locations that have higher infection rates. In addition, catheters need to be maintained for longer periods of time because of difficult vascular access and the need to obtain blood. Maintenance practices must be tailored to the maturity of an infant’s skin. In very lowbirthweight infants, chlorhexadine may cause a chemical dermatitis or burn, and chlorhexadine-impregnated biopatches may cause pressure ulcers. However, individual neonatal ICUs and pediatric ICUs have been able to decrease their rates of CLABSI substantially, in some cases by incorporating novel technological approaches such as the use of closed intravenous systems to prevent maintenance-related intravascular catheter infections. The Surgical Care Improvement Project (SCIP) is a national quality improvement project to reduce surgical complications. Six of the 9 publicly reported SCIP measures focus on reducing SSI. Adherence rates to individual SCIP measures provide a benchmark to track infection prevention measures, and emerging data suggest that adherence with core SCIP measures may reduce SSI. Although several of the SCIP measures to reduce infection are appropriate for children, some measures such as postoperative glucose control for cardiac surgery and postoperative temperature control after colorectal surgery are intended for adults. It is perhaps not surprising that SCIP measures, and the requirement for hospitals to track and report SCIP adherence, do not apply to patients younger than 18 years. What is surprising is that similar measures are not in place for prevention of SSI in children. It is important that a national quality improvement program to reduce HAI does not apply to pediatric patients. The Surgical Care Improvement Project measures are tracked by the Joint Commission, the agency that accredits and certifies