Improve Infection Prevention Practices Research Articles

Bacterial Resistance in Nephrology

Bacterial resistance to antibiotics (ABR) is a major threat to public health, particularly in nephrology, with far-reaching consequences, including longer hospital stays, higher healthcare costs and increased mortality. Indeed, patients with chronic kidney disease (CKD) are a population at risk of developing infections caused by antibiotic-resistant bacteria (ARBs), given their overexposure to healthcare facilities and the quality of their gut microbiota already damaged by CKD. It is a population with very high rates of colonization and ARB infection worldwide. The mechanisms deployed by these AROs to counteract the effect of antibiotics are multiple. This may include the production of antibiotic-inhibiting enzyme (ATB), waterproofing of the bacterial membrane, or modification of the antibiotic target. They include methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE) species, and several multidrug-resistant Gram-negative organisms. The emergence and global spread of these ARBs is facilitated by ATB selection pressure, inter-agency transmission of resistance determinants, suboptimal infection control practices, and frequency of international travel, among other factors. The spread of this veritable pandemic highlights the urgent need for new treatment options, the implementation of awareness campaigns to properly prescribe antibiotics and improve infection prevention practices, particularly at hemodialysis centers.

Evaluation of an infection control link nurse program: an analysis using the RE-AIM framework

BackgroundImportant elements of programs that train and support infection control link nurses (ICLN) are the engagement of stakeholders, support from hospital and ward management and a structure for iterative improvement. The effects of programs, that combine all these elements, are unknown. We evaluated such a comprehensive program to explore its impact on link nurses and infection prevention practices and routines.MethodsWe used the RE-AIM framework, a robust, evidence-based framework within the field of Implementation Science, to evaluate the impact of our ICLN training and support program. We used a mixed methods approach and organized the outcomes along its five dimensions: Reach, Effectiveness, Adoption, Implementation and Maintenance.ResultsBetween 2014 and 2018, on average 91% of the inpatient wards and 58% of the outpatient clinics participated in the program (Reach) and impacted guideline adherence in inpatient wards. Link nurses felt engaged and empowered, and perceived their contribution to these results as pivotal. Ward managers confirmed the value of ICLN to help with implementing IPC practices (Effectiveness). The program was adopted both at the hospital and at the ward level (Adoption). Based on ongoing evaluations, the program was adapted by refining education, training and support strategies with emphasis on ward specific aspects (Implementation). The ICLN program was described as a key component of the infection prevention policy to sustain its effects (Maintenance).ConclusionsOur infection control link nurse program helped ICLN to improve infection prevention practices, especially in inpatient wards. The key to these improvements lay within the adaptability of our link nurse program. The adjustments to the program led to a shift of focus from hospital goals to goals tailored to the ward level. It allowed us to tailor activities to align them with the needs specific to each ward.

Concerns and frustrations about the public reporting of device-related healthcare-associated infections: Perspectives of hospital leaders and staff

BackgroundPublic reporting of healthcare-associated infections (HAIs) aims to incentivize improvement in infection prevention. The motivation and mechanisms of public reporting have raised concerns about the reliability of this data, but little is known about the specific concerns of hospital leaders and staff. This study sought to better understand perspectives of individuals in these roles regarding the identification and public reporting of HAIs. MethodsWe conducted interviews with 471 participants including hospitals leaders (eg, administrative and clinical leaders) and hospital staff (eg, physicians and nurses) between 2017 and 2019 across 18 US hospitals. A semistructured interview guide was used to explore perspectives about the use of HAI data within the context of management strategies used to support infection prevention. ResultsInterviewees described concerns about public reporting of HAI data, including a lack of trust in the data and inadvertent consequences of its public reporting, as well as specific frustrations related to the identification and accountability for publicly-reported HAIs. ConclusionConcerns and frustrations related to public reporting of HAI data highlight the need for improved guidelines, transparency, and incentives. Efforts to build trust in publicly-reported HAI data can help ensure this information is used effectively to improve infection prevention practices.

The prevalence and diagnostic criteria of health-care associated infections in neonatal intensive care units in Turkey: A multicenter point- prevalence study

Healthcare-acquired infections (HAIs) in the neonatal period cause substantial morbidity, mortality, and healthcare costs. Our purpose was to determine the prevalence of HAIs, antimicrobial susceptibility of causative agents, and the adaptivity of the Centres for Disease Control and Prevention (CDC) criteria in neonatal HAI diagnosis. A HAI point prevalence survey was conducted in the neonatal intensive care units (NICUs) of 31 hospitals from different geographic regions in Turkey. The Point HAI prevalence was 7.6%. Ventilator-associated pneumonia (VAP) and central line-associated bloodstream infections (CLABSI) and late onset sepsis were predominant. The point prevalence of VAP was 2.1%, and the point prevalence of CLABSI was 1.2% in our study. The most common causative agents in HAIs were Gram-negative rods (43.0%), and the most common agent was Klebsiella spp (24.6%); 81.2% of these species were extended spectrum beta-lactamase (ESBL) (+). Blood culture positivity was seen in 33.3% of samples taken from the umbilical venous catheter, whereas 0.9% of samples of peripherally inserted central catheters (PICCs) were positive. In our study, 60% of patients who had culture positivity in endotracheal aspirate or who had purulent endotracheal secretions did not have any daily FiO2 change (p=0.67) and also 80% did not have any increase in positive end-expiratory pressure (PEEP) (p=0.7). On the other hand, 18.1% of patients who had clinical deterioration compatible with VAP did not have endotracheal culture positivity (p=0.005). Neonatal HAIs are frequent adverse events in district and regional hospitals. This at-risk population should be prioritized for HAI surveillance and prevention programs through improved infection prevention practices, and hand hygiene compliance should be conducted. CDC diagnostic criteria are not sufficient for NICUs. Future studies are warranted for the diagnosis of HAIs in NICUs.

Targeted Assessment for Prevention Facility Assessments: The Most Common CAUTI and CLABSI Infection Prevention Gaps

Background: The Targeted Assessment for Prevention (TAP) strategy is a quality improvement framework created by the Centers for Disease Control and Prevention (CDC) to facilitate the reduction of healthcare-associated infections (HAIs). TAP facility assessments are a component of the TAP strategy and are completed by staff across the facility to help identify perceptions of and target infection prevention gaps. We have described the gaps most commonly reported by facilities completing TAP facility assessments for catheter-associated urinary tract infections (CAUTIs) and central-line–associated bloodstream infections (CLABSIs). Methods: TAP CAUTI and CLABSI assessments were completed by acute-care facilities across the nation, with CDC technical assistance, from December 2014 to August 2019. Similar questions across 2 versions of CAUTI assessments and 3 versions of CLABSI assessments were combined. Analysis was limited to facilities with ≥10 assessments. Infection prevention gaps were defined as ≥33% respondents answering Unknown, ≥33% respondents answering “no,” or ≥50% of respondents answering “no” and “unknown” or “never” and “rarely” “sometimes” “unknown.” The analysis was completed at the facility level, and the gaps most commonly reported across facilities were identified. Results: In total, 1,942 CAUTI assessments from 42 facilities in 12 states and 1,623 CLABSI assessments from 29 facilities in 11 states were included for analysis. The mean numbers of assessments per facility were 46.2 for CAUTIs and 56.0 for CLABSIs. Across both CAUTIs and CLABSIs, commonly reported perceptions about infection prevention gaps included lack of physician and nurse champions for prevention activities, failure to conduct competency assessments, and inconsistency in select device insertion practices (Fig. 1). For CAUTIs, lack of practices to facilitate timely removal of urinary catheters were also commonly reported, with one-third of facilities reporting inconsistency in use of alerts for catheter removal, 78.6% reporting lack of physician response to these alerts, and 90.5% reporting deficiencies in removing unnecessary catheters in the postanesthesia care unit. For CLABSIs, 79.3% of facilities reported failure to replace central lines within 48 hours after emergent insertion, and 62.1% reported that feedback was not provided to staff on central-line device utilization ratios. Conclusion: For both assessments, absence of CAUTI and CLABSI prevention champions, failure to conduct competency assessments, and inconsistency in performing device insertion practices were commonly reported across facilities. These common gaps have and will continue to inform the development of tools and resources to improve infection prevention practices as well as help to better target the implementation of interventions.Funding: NoneDisclosures: None

Rapid Multidisciplinary Infection Control Approach After Identification of a Hospital Acquired Mucormycosis Infection

<h3>Background</h3> Healthcare-acquired Mucormycosis is an uncommon disease associated with high morbidity and mortality, particularly in transplant recipients. Identification of a single case requires rapid investigation and multidisciplinary response to prevent additional cases. <h3>Methods</h3> In August 2018, Infection Prevention (IP) was notified of a positive Zygomycetes (the agent of Mucormycosis) in a wound culture of an Intensive Care Unit liver transplant patient. An immediate thorough chart review identified it met criteria for a Hospital-Acquired Surgical Site Infection. Within 24 hours, IP notified facility leadership and initiated an investigation with a focus on the following items: air handlers, water sources in patient care areas, linen cleaning processes and storage, supply and pharmacy recalls, dialysis machines, and medication compounding. Multiuse medications, all tape in ICU, and the patient care supplies were removed and secured for possible culturing. 12 months of facility mycology results were also reviewed. IP presented an action plan to leadership and a multidisciplinary team the following day, assigned tasks to appropriate staff, and asked leadership to reinforce expectations to ensure completion. Interventions were considered successful if no additional cases were seen in a 6-month timeframe. <h3>Results</h3> IP identified 17 unique actionable items including 2 high risk concerns: visibly compromised air filters and unstandardized in-room patient supply storage. Team members addressed all 17 items, including a more stringent air filter monitoring program and standardized in-room supply plan. Since the event, the facility has gone 16 months without a healthcare-acquired Mucor infection in the transplant population. <h3>Conclusions</h3> This unusual case provided an opportunity to drive stakeholder ownership of the environment and improve IP practices using a multidisciplinary approach. Future challenges include a continual emphasis on identified risks and managing practice change as new priorities and problems arise.

Healthcare-associated infections in paediatric and neonatal wards: A point prevalence survey at four South African hospitals.

Healthcare-associated infections (HAIs) cause substantial morbidity, mortality and healthcare costs. The prevalence of neonatal/paediatric HAI at South African (SA) district and regional hospitals is unknown. To document HAI rates, antimicrobial use for HAI, infection prevention staffing, hand hygiene (HH) provisions and HH compliance rates in neonatal and paediatric wards in two district and two regional hospitals in the Western Cape Province, SA. An HAI point prevalence survey (PPS) was conducted in neonatal and paediatric wards at two district and two regional hospitals in the Western Cape during December 2016, applying National Healthcare Safety Network HAI definitions. HAI events and antimicrobial therapy active at 08h00 on the PPS day and during the preceding 7 days (period prevalence) were documented. Provisions for HH and HH compliance rates were observed on each ward using the World Health Organization's HH surveillance tool. Pooled point and period HAI prevalence were 9.9% (15/151; 95% confidence interval (CI) 6 - 15.8) and 12.6% (19/151; 95% CI8 - 18.9), respectively. Hospital-acquired pneumonia (5/15, 33.3%), bloodstream infection (3/15, 20.0%) and urinary tract infection (3/15, 20.0%) were predominant HAI types. Risk factors for HAI were a history of recent hospitalisation (8/19, 42.1% v. 17/132, 12.9%; p&lt;0.001) and underlying comorbidity (17/19, 89.5% v. 72/132, 54.5%; p&lt;0.004). HH provisions (handwash basins/alcohol hand rub) were available and functional. HH compliance was higher in neonatal than in paediatric wards (125/243, 51.4% v. 25/250, 10.0%; p&lt;0.001). Overall HH compliance rates were higher among mothers (46/107, 43.0%) than nurses (73/265, 27.8%) and doctors (29/106, 27.4%). Neonatal and paediatric HAIs are common adverse events at district and regional hospitals. This at-risk population should be prioritised for HAI surveillance and prevention through improved infection prevention practices and HH compliance.

Aciertos bacteriológicos en las mesas y chasis radiológicos en el Departamento de Radiología del Instituto Nacional de Enfermedades Neoplásicas. Lima (Perú)

ObjectivesTo make a situational assessment of the Department of Radiology, National Institute of Neoplastic Diseases (INEN) in Lima–Peru, in order to identify different bacteria in the contact surfaces while taking X-rays, and to make the staff and patients aware of the contamination risk. Material and methodsA descriptive, observational, cross-sectional study, with Radiology sampling with 5 tables (simple procedures room, special, mammography, interventional, CT) was performed and 20 plate holders (conventional and digital). The microbes were counted and identified in the microbiology laboratory. ResultsThe bacteria found in the tables were: Staphylococcus saprophiticus (100%), S. epidermidis (60%), S. aureus (40%) and S. haemolyticus (20%), and in the plate holders: S. saprophiticus (50%), S. epidermidis (25%), S. aureus (20%), and S. haemolyticus (5%). ConclusionsThe tables and plate holders and their handling may be vehicles of transmission of germs may constitute a risk for patients and technologist staff operating the equipment. Awareness must be created on prevention by personnel operating radiology equipment, promoting good habits based on hygiene, and cleaning tables and plate holders every time they are used, to avoid cross infection between patients and radiological equipment. Promoting knowledge of the rules of cleaning and disinfection, will improve infection prevention practices.

306Switch from MRSA PCR to Agar for Nasal Screening Does Not Increase Transmission

 The VA has guidelines to screen inpatients on admission, transfer, and discharge. MRSA infection rates and transmissions have decreased dramatically nationally with a bundle for MRSA, which includes screening, improved infection prevention practices, environmental cleaning and culture change. Screening programs with PCR are expensive, but rapid.  Our facility implemented a new screening program with agar (Spectra by Thermo Scientific) with a lab processing time of 24 hours.  Our facility implemented a new screening program with agar (Spectra by Thermo Scientific) with a lab processing time of 24 hours.

Staphylococcal Enterocolitis: Forgotten but Not Gone?

Staphylococcus aureus may cause antibiotic-associated diarrhea and enterocolitis, with or without preceding antibiotic use, in immunocompromised adults or infants, or individuals with predisposing conditions, but there is little appreciation of this condition clinically. CLINICAL DISEASE: The main clinical feature that helps to differentiate staphylococcal enterocolitis (SEC) from Clostridium difficile-associated diarrhea is large-volume, cholera-like diarrhea in the former case. A predominance of gram-positive cocci in clusters on gram stain of stool or biopsy specimens and the isolation of S. aureus as the dominant or sole flora support the diagnosis. The pathogenesis of SEC requires the interaction of staphylococcal enterotoxins, which function as superantigens, with interstitial epithelial lymphocytes and intestinal epithelial cells (IECs). Most SEC represents recent S. aureus acquisition, so that improved infection prevention practices can reduce disease recurrence. Management should include aggressive fluid management and repletion and oral vancomycin.

Educational Interventions To Reduce Ventilator Associated Pneumonia Impact Behavior Change in a Community Intensive Care Unit

BACKGROUND/OBJECTIVES: Ventilated patients are at increased risk for the development of ventilator associated pneumonia (VAP). VAP is associated with increased mortality, increased length of stay and increased cost. A review of surveillance data in a 16 bed medical-surgical intensive care unit (ICU) revealed a 2003 VAP rate of 8.2/1000 ventilator days and a 2004 VAP rate of 7.0/1000 ventilator days. The objective was to educate ICU staff and respiratory therapists (RT) regarding VAP prevention techniques and improve infection prevention practices thereby reducing the risk of developing VAP. METHODS: An evidence based self study VAP educational module in booklet form with pre and post testing was distributed to ICU nurses, patient care technicians (PCT) and RTs. Head of bed (HOB) and covered Yankauer observations on ventilated patients were begun 1 month prior to distributing the module and continued for 6 months. Other educational interventions included fact sheets, inservices and feedback of rates and observational data to staff. Additionally, a unit based team was formed to develop weaning protocols. RESULTS: The completion rate for both the pre and post test of the module was 69% (25/36) for nursing and 86% (12/14) for RT. Nursing pre-test mean score was 82% and the post-test mean score was 93%, an increase of 11% (p < .01). The RT pre-test mean score was 83% and the post-test score was 90%, an increase of 7% (p < .01). Prior to the introduction of the module, HOB compliance was 100%. Covered Yankauer compliance was 50% although on the pretest 100% of staff correctly stated the Yankauer should be covered between uses. One month after completion of the module, HOB compliance was 100% and covered Yankauer compliance was 92% (p > .05). Six months after completion of module, HOB compliance mean was 98 % (p > .05); covered Yankauer compliance mean was 98 % (p < .05). Pre-intervention mean VAP rate was 7.0/1000 ventilator days (01/04-12/04) and post-intervention mean was 0/1000 ventilator days (06/05-12/05). CONCLUSIONS: Although staff understood the correct infection prevention practices, additional educational interventions were necessary to translate knowledge into clinical practice. Educational interventions, feedback of rates and observational data resulted in a significant increase in the compliance of covering the Yankauer and improved infection prevention practices.

Health Education for Peon to Improve Infection Prevention Practices in Government Health facilities of Morang

Not uploaded.Key words: Decontamination; Hand washing; Infection Prevention; Waste disposal.DOI: 10.3126/jnhrc.v6i1.2444Journal of Nepal Health Research Council Vol. 6, No. 1, Issue 12, April, 2008 Page: 49-52