Infection Control Initiatives Research Articles

Effect of accreditation and certification on the quality management system: Analysis based on Turkish hospitals.

Effects of certification and accreditation on hospital quality management systems (QMS) are measured to better understand the value of external recognitions. This study identifies the QMS dimensions that show significant improvements with hospital certification and/or accreditation. Data were collected from 350 Turkish hospitals using a structured questionnaire. Mean scores of nine domains of QMS were used as outcome variables. Although quality policy documents, quality monitoring by board, and training of professionals are the focus of generic QMS, ISO certification did not affect these scores significantly. Formal protocols for infection control scores are affected by hospital size and certification status. Adoption of Ministry of Health's (MOH) infection control initiatives has improved this score for all hospital types. Formal protocols for medication and patient handling, analyzing performance of care processes, and evaluating results improved with accreditation and certification status. Larger hospitals were better able to implement application of protocols, analyzing care process and evaluating results. For improvements in the QMS scores, external assessments are valuable, but quality-focused governmental regulations appear important for improving QMS of small and medium-sized hospitals. Higher QMS scores, however, may not lead to improved quality. Future studies should explore the relationship between QMS scores and service quality.

Multidrug-resistant Gram-negative bacterial infections in solid organ transplant recipients-Guidelines from the American Society of Transplantation Infectious Diseases Community of Practice.

These updated guidelines from the Infectious Diseases Community of Practice of the American Society of Transplantation review the diagnosis, prevention, and management of infections due to multidrug-resistant (MDR) Gram-negative bacilli in the pre- and post-transplant period. MDR Gram-negative bacilli, including carbapenem-resistant Enterobacteriaceae, MDR Pseudomonas aeruginosa, and carbapenem-resistant Acinetobacter baumannii, remain a threat to successful organ transplantation. Clinicians now have access to at least five novel agents with activity against some of these organisms, with others in the advanced stages of clinical development. No agent, however, provides universal and predictable activity against any of these pathogens, and very little is available to treat infections with MDR nonfermenting Gram-negative bacilli including Abaumannii. Despite advances, empiric antibiotics should be tailored to local microbiology and targeted regimens should be tailored to susceptibilities. Source control remains an important part of the therapeutic armamentarium. Morbidity and mortality associated with infections due to MDR Gram-negative organisms remain unacceptably high. Heightened infection control and antimicrobial stewardship initiatives are needed to prevent these infections, curtail their transmission, and limit the evolution of MDR Gram-negative pathogens, especially in the setting of organ transplantation.

Changing Epidemiology of Invasive Candidiasis in Children during a 10-Year Period.

Candida species are a common cause of invasive infection in neonates and children. The aim of our study was to evaluate the epidemiology and microbiology of invasive candidiasis (IC) in the largest tertiary Greek pediatric hospital during a 10-year period. A retrospective cohort study was performed from January 2008 to December 2017. Identification of species and antifungal susceptibility testing was performed according to the Clinical and Laboratory Standards Institute (CLSI) methodology. During the study period, 178 cases of IC were recorded. The tissue distribution included blood (87.1%), cerebrospinal (7.9%), peritoneal (3.9%) and pleural fluids (1.1%). Candida albicans and Candida parapsilosis (sensu lato) were the most frequently isolated species (47.8% and 28.7% respectively). From period 2008–2012 to period 2013–2017, a significant decrease in IC rates was detected (0.21 cases/1000 hospitalization days VS 0.11 cases/1000 hospitalization days, P = 0.040), while median minimum inhibitory concentrations (MICs) of amphotericin B were significantly increased for both C. albicans and C. parapsilosis (sl) (P = 0.037 and P = 0.004 respectively). The decrease in IC rates may reflect the increased awareness as well as the effective infection control initiatives and antifungal interventions. However, the significant increase in the MICs for amphotericin B and echinocandins such as caspofungin, raises concerns about their common use as first-line treatment. Epidemiologic monitoring is, therefore, critically important in order to evaluate and optimize therapeutic protocols for IC in pediatric populations.

Epidemiology and Outcomes of Clostridium difficile Infection in Hospitalized Patients within the US Military Health Care System

Background Clostridium difficile infection (CDI) has become an emerging epidemic in the healthcare community. Our study aims to characterize the epidemiology and measure the attributable cost, length of stay, and in-hospital mortality of CDI among hospitalized patients in the US military health system (MHS).MethodsWe performed a retrospective cohort study of patients with CDI using MHS database billing records. Cases included all active duty patients, their dependents, or retirees admitted to a US military treatment facility for ≥2 days from October 2008 to September 2015 with a stool sample positive for Clostridium difficile via enzyme immunoassay, tissue cytotoxin assay, toxigenic culture, or polymerase chain reaction (PCR). Patient case-mix adjusted outcomes including in-hospital mortality, length of stay, and hospitalization cost were evaluated by high-dimensional propensity score adjusted logistic regression.ResultsAmong 1,156,672 admissions within the MHS from 2008–2015, we identified 1,640 (0.14%) patients with CDI and found a significant increase in the trend of CDI over the 7-year study period (P < 0.001). Median age (IQR) was 63 (41–76) in the CDI hospitalized group and 26 (6–46) in the non-CDI hospitalized group. Male gender was a risk factor for CDI (unadjusted odds ratio, 1.94; 95% confidence interval 1.76–2.14) and the majority of patients (84.5%) were associated with large-size medical centers. Patients hospitalized with CDI had significantly higher hospitalization cost (attributable difference [AD] $51,959, P < 0.001), prolonged hospital stay (AD 11.8 days, P < 0.001), and in-hospital mortality (case-mix adjusted odds ratio 3.28; 95% confidence interval 2.69–4.00).ConclusionCDI in hospitalized patients within the MHS is associated with advanced age, large medical centers, and an increased length of stay, hospital cost, and in-hospital mortality. We identified a significantly increased burden of hospitalization among patients admitted with CDI, highlighting the importance of infection control and antimicrobial stewardship initiatives aimed at decreasing the spread of this pathogen.Disclosures All authors: No reported disclosures.

Escherichia coli, cattle and the propagation of disease.

Several early models describing host–pathogen interaction have assumed that each individual host has approximately the same likelihood of becoming infected or of infecting others. More recently, a concept that has been increasingly emphasized in many studies is that for many infectious diseases, transmission is not homogeneous but highly skewed at the level of populations. In what became known as the ‘20/80 rule’, about 20% of the hosts in a population were found to contribute to about 80% of the transmission potential. These heterogeneities have been described for the interaction between many microorganisms and their human or animal hosts. Several epidemiological studies have reported transmission heterogeneities for Escherichia coli by cattle, a phenomenon with far-reaching agricultural, medical and public health implications. Focusing on E. coli as a case study, this paper will describe super-spreading and super-shedding by cattle, review the main factors that shape these transmission heterogeneities and examine the interface with human health. Escherichia coli super-shedding and super-spreading by cattle are shaped by microorganism-specific, cattle-specific and environmental factors. Understanding the factors that shape heterogeneities in E. coli dispersion by cattle and the implications for human health represent key components that are critical for targeted infection control initiatives.

Device-Associated Healthcare-Associated Infections (DA-HAI) and the caveat of multiresistance in a multidisciplinary intensive care unit

BackgroundDevice-Associated Healthcare-Associated Infections (DA-HAI), including Ventilator-Associated Pneumonia (VAP), Central-Line-Associated Blood Stream Infection (CLABSI), and Catheter-Related Urinary Tract Infection (CAUTI), are considered as principal contributors to healthcare hazard and threat to patient safety as they can cause prolonged hospital stay, sepsis, and mortality in the ICU. The study intends to characterize DA-HAI in a tertiary care multidisciplinary ICU of a teaching hospital in eastern India. MethodsThis prospective outcome-surveillance study was conducted among 2157 ICU patients of a 760-bedded teaching hospital in Eastern India. Clinical, laboratory and environmental surveillance, and screening of HCPs were conducted using the US Centers for Disease Control and Prevention (CDC)’s National Healthcare Safety Network (NHSN) definitions and methods. ResultsWith 8824 patient/bed/ICU days and 14,676 device days, pooled average device utilization ratio was 1.66, total episodes of DA-HAI were 114, and mean monthly rates of DA-HAI, VAP, CLABSI, and CAUTI were 4.75, 2, 1.4, and 1.25/1000 device days. Most common pathogens isolated from DA-HAI patients were Klebsiella pneumoniae (24.6%), Escherichia coli (21.9%), and Pseudomonas aeruginosa (20.2%). All Acinetobacter baumanii, >80% K. pneumoniae and E. coli, and >70% P. aeruginosa were susceptible only to colistin and tigecycline. One P. aeruginosa isolate was panresistant. ConclusionMean rates of VAP, CLABSI, and CAUTI were 14.4, 8.1, and 4.5 per 1000 device days, which are comparable with Indian and global ICUs. Patients and HCPs form important reservoirs of infection. Resolute conviction and sustained momentum in Infection Control Initiatives are an essential step toward patient safety.

Zero Health Worker Infection: Experiences From the China Ebola Treatment Unit During the Ebola Epidemic in Liberia.

In November 2014, a total of 164 health care workers were dispatched by the Chinese government as the first medical assistance team to Liberia. The tasks of this team were to establish a China Ebola treatment unit (ETU), to commence the initial admission and treatment of suspected and confirmed Ebola patients, and to provide public health and infection control training for relevant local personnel. Overall, during the 2-month stay of this first medical assistance team in Liberia, 112 Ebola-suspected patients presented to the ETU, 65 patients were admitted, including 5 confirmed cases, and 3 confirmed cases were cured. Furthermore, 1520 local people were trained, including health care workers, military health care workers, staff members employed by the ETU, and community residents. Most importantly, as the first Chinese medical assistance team deployed to Liberia fighting the Ebola virus on the frontline, not a single member of this team or the hired local staff were infected by Ebola virus. This highly successful outcome was due to the meticulous infection control initiatives developed by the team, thereby making a significant contribution to China's ETU "zero infection" of health workers in Liberia. The major infection control initiatives conducted in the China ETU that contributed to achieving "zero infection" of all health workers in the ETU are introduced in this report. (Disaster Med Public Health Preparedness. 2017;11:262-266).

Dos and don'ts for hospital cleaning.

More evidence is emerging on the role of cleaning and decontamination for reducing hospital-acquired infection. Timely and adequate removal of environmental pathogens leads to measurable clinical benefits for patients. This article considers studies published from 2013 examining hospital decontamination technologies and evidence for cost-effectiveness. Novel biocides and cleaning products, antimicrobial coatings, monitoring practices and automated equipment are widely accessible. They do not necessarily remove all environmental pathogens, however, and most have yet to be comprehensively assessed against patient outcome. Some studies are confounded by concurrent infection control and/or antimicrobial stewardship initiatives. Few contain data on costs. As automated dirt removal is assumed to be superior to human effort, there is a danger that traditional cleaning methods are devalued or ignored. Fear of infection encourages use of powerful disinfectants for eliminating real or imagined pathogens in hospitals without appreciating toxicity or cost benefit. Furthermore, efficacy of these agents is compromised without prior removal of organic soil. Microbiocidal activity should be compared and contrasted against physical removal of soil in standardized and controlled studies to understand how best to manage contaminated healthcare environments.

Impact of Infection Prevention and Control Initiatives on Acute Respiratory Infections in a Pediatric Long-Term Care Facility.

We evaluated the collective impact of several infection prevention and control initiatives aimed at reducing acute respiratory infections (ARIs) in a pediatric long-term care facility. ARIs did not decrease overall, though the proportion of infections associated with outbreaks and average number of cases per outbreak decreased. Influenza rates decreased significantly. Infect Control Hosp Epidemiol 2016;37:859-862.

The Relationship Between Total Parenteral Nutrition and Central Line‐Associated Blood Stream Infections

BackgroundCentral line‐associated blood stream infections (CLABSI) prevalencehas decreased significantly over the past years in part due to hospital‐level infection control initiatives. However, a large number still occur every year. Total parenteral nutrition (TPN) is a CLABSI risk factor; in a previous study, Ippolito et al. described the risk of CLBSI among patients receiving TPN in our hospital from 2007–2008 (OR=4.33, CI=2.50–7.48). In this study we aimed to describe the risk of CLABSI associated with TPN after the never event policy implementation in our hospital.MethodsWe used the Health Information Technology to Reduce Healthcare‐Associated Infection (HIT‐HAI) dataset in conjunction with electronic medical to identify patients who were discharged between January 1,2013 and December 31, 2014 and had a central venous catheter (CVC) during their stay. Patients from this dataset who also received TPN were identified using electronic medical records and ICD‐9 code. Student's t‐test and chi‐square were used to identify variables of interest and a multivariable logistic regression model was developed to assess the influence of TPN on CLABSI risk.ResultsAmong patients who received CVCs (n=12,868), 1253 received TPN, and 1106 patients developed CLABSI. Results from multivariable regression analysis show that TPN (OR, 2.20; 95% CI, 1.59–3.04) was a significant risk factor for CLABSI, controlling for Charlson index (score predicting risk of mortality based on comorbid conditions), diabetes, duration of catheterization, malignancy, HIV renal disease, surgical site infection, ICU stay, history of transplant and pneumonia.DiscussionAfter significant reductions in CLABSIs due to infection control program implementation, TPN remains a significant risk factor for CLABSI in our hospital. Although the odds ratio is smaller than found by Ippolito et al in 2007–2008, patients with CVCs receiving TPN in 2013–2014 were 2.2 times more likely to have a CLABSI than patients with CVCs who did not receive TPN. Because TPN still remains a risk factor for CLABSI, the way that TPN is currently prescribed at our hospital may need to be changed.Citation: Ippolito, P., Larson, E. L., Furuya, E. Y., Liu, J., &amp; Seres, D. S. (2014). Utility of Electronic Medical Records to Assess the Relationship Between Parenteral Nutrition and Central Line–Associated Bloodstream Infections in Adult Hospitalized Patients. JPEN J Parenter Enteral Nutr. 2015 Nov;39(8):929–34Support or Funding InformationThis study was funded by National Institutes of Health/National Institute of Nursing Research Grant #R01NR010822 and Training Grant #HL007343 Significant Risk Factors Associated with CLABSI Multivariable analysis Risk Factors p‐value OR 95% CI TPN &lt;.0001 2.199 1.589–3.044 Charlson index 0.8431 0.997 0.963–1.032 Duration of catheterization &lt;.0001 1.024 1.020–1.028 Diabetes 0.7679 1.023 0.880–1.188 Malignancy 0.0003 1.403 1.165–1.688 HIV 0.0005 2.266 1.431–3.589 Renal disease &lt;.0001 2.881 2.480–3.348 Surgical site infection 0.0039 1.743 1.195–2.541 History of transplant &lt;.0001 0.241 0.155–0.376 ICU stay &lt;.0001 1.427 1.240–1.641 Pneumonia 0.1369 1.186 0.947–1.484 CLABSI, central line‐associated blood stream infection; HIV, human immunodeficiency virus; ICU, intensive care unit; TPN, total parenteral nutrition

Prevention of meticillin-resistant Staphylococcus aureus bloodstream infections in European hospitals: moving beyond policies

There is evidence that meticillin-resistant Staphylococcus aureus (MRSA) bacteraemia can be reduced with improved infection control and antibiotic stewardship. To survey infection control and antibiotic stewardship practices within European hospitals and to identify initiatives that correlate with reduced MRSA prevalence. Online questionnaires were sent to European hospitals about their surveillance, hand hygiene, intravenous device management, admission screening, isolation, antibiotic prescribing, hospital demographics and MRSA blood culture isolates during 2010. In all, 269 replies were received from hospitals in 29 European countries. Lower MRSA prevalence showed significant association with presence of incidence surveillance, performance of root cause analysis, mandatory training requirements for hand hygiene, accountability measures for persistent non-compliance, and multi-stakeholder teamwork in antibiotic prescribing. Presence of policies on intravenous catheter insertion and management showed no variation between different MRSA prevalence groups. However, low-prevalence hospitals reported more competency assessment programmes in insertion and maintenance of peripheral and central venous catheters. Hospitals from the UK and Ireland reported the highest uptake of infection control and antibiotic stewardship practices that were significantly associated with low MRSA prevalence, whereas Southern European hospitals exhibited the lowest. In multiple regression analysis, isolation of high-risk patients, performance of root cause analysis, obligatory training for nurses in hand hygiene, and undertaking joint ward rounds including microbiologists and infectious disease physicians remained significantly associated with lower MRSA prevalence. Proactive infection control and antibiotic stewardship initiatives that instilled accountability, ownership, teamwork, and validated competence among healthcare workers were associated with improved MRSA outcomes.

Mupirocin resistance in clinical isolates of methicillin-resistant Staphylococcus aureus from a tertiary care rural hospital

Background and Aims: Mupirocin is a topical antibiotic that has been used extensively for treating methicillin-resistant Staphylococcus aureus (MRSA) associated infections. However, the prevalence of mupirocin-resistant MRSA has increased with the extensive and widespread use of this agent. The aim was to determine the rates of high-level and low-level mupirocin resistance in MRSA to study the antimicrobial resistance pattern and clindamycin resistance in mupirocin-resistant MRSA. Methods: A total of 267 non-duplicate clinical isolates of MRSA from various clinical specimens were tested for mupirocin resistance by the disk diffusion method using 5 and 200 μg mupirocin disks. MRSA isolates were tested for antibiotics by Kirby-Bauer disk diffusion method as per Clinical and Laboratory Standards Institute (CLSI) guidelines. Erythromycin-resistant isolates of MRSA were further studied for inducible clindamycin resistance by D test as per CLSI guidelines. Results: Of 267 MRSA isolates, high-level mupirocin resistance was observed in 5.99% and low-level resistance in 15.35%. Mupirocin-resistant MRSA isolates showed higher antibiotic resistance to fusidic acid (14.03% vs 7.14%), rifampicin (5.26% vs 2.38%), erythromycin (68.42% vs 58.57%), and clindamycin (52.63% vs 45.71%). No MRSA strains were found to be resistant to vancomycin and linezolid. Mupirocin-resistant MRSA isolates showed higher constitutive macrolide-lincosamide-streptogamin B (cMLS B ; 51.28% vs 42.98%) and inducible macrolide-lincosamide-streptogamin B (iMLS B ; 17.94% vs 13.15%) resistance, as compared to mupirocin-sensitive MRSA isolates. Conclusion: The emergence of mupirocin resistance could be limited by regular surveillance and effective infection control initiatives so to inform health care facilities to guide therapeutic and prophylactic use of mupirocin.

Mupirocin resistance in nasal carriage of Staphylococcus aureus among healthcare workers of a tertiary care rural hospital.

Introduction:Mupirocin (pseudomonic acid A) is a topical antimicrobial agent with excellent antistaphylococcal and antistreptococcal activity. A nasal formulation is approved by the United States Food and Drug Administration for eradicating nasal carriage in adult patients as well as in health care personnel. Resistance to mupirocin has already been reported worldwide. The increasing prevalence of mupirocin resistance among Staphylococcus aureus and coagulase-negative Staphylococcus (CoNS) species could be an important threat to the future use of mupirocin against methicillin-resistant S. aureus (MRSA). Thus, this study was carried out to find the prevalence of mupirocin resistance in S. aureus and CoNS by disc diffusion and to determine the rates of high-level and low-level mupirocin resistance in S. aureus and CoNS by disc diffusion.Materials and Methods:A total of 140 healthcare workers (HCWs) (doctor, nursing staff, housekeeping staff) were randomly selected. S. aureus and CoNS isolates were tested for mupirocin resistance by the disk diffusion method using 5 μg and 200 μg mupirocin discs. MRSA isolates were tested for antibiotics by Kirby-Bauer disc-diffusion method as per Clinical and Laboratory Standards Institute guidelines.Results:Out of 140 nasal swabs collected from HCWs, S. aureus was isolated in 38 (27.14%), and CoNS was isolated in 73 (52.14%). MRSA was isolated in 20 (14.28%) and methicillin-resistant coagulase-negative Staphylococci (MRCoNS) in 34 (24.29%. Methicillin-sensitive S. aureus (MSSA) and MSCoNS isolates were 100% sensitive to mupirocin, but two isolates from MRSA (1.43%) and five from MRCoNS (3.57%) were mupirocin resistant.Conclusion:The presence of mupirocin resistance in MRSA and MRCoNS is a cause for concern. It could be limited by regular surveillance and effective infection control initiatives so to inform health care facilities to guide therapeutic and prophylactic use of mupirocin.

Methicillin-Resistant Staphylococcus aureus: An Evolving Pathogen

The horizontal transmission of methicillin resistance to Staphylococcus aureus (MRSA) in hospital and community settings, and growing prevalence of these strains, presents a significant clinical challenge to the management of serious infections worldwide. While infection control initiatives have stemmed the rising prevalence, MRSA remains a significant pathogen. More recently, evidence that MRSA is becoming resistant to glycopeptides and newer therapies raises concern about the use of these therapies in clinical practice. Vancomycin resistance has become evident in select clinical settings through rising MICs, growing awareness of heteroresistance, and emergence of intermediate-resistant and fully resistant strains. While resistance to linezolid and daptomycin remains low overall, point mutations leading to resistance have been described for linezolid, and horizontal transmission of cfr-mediated resistance to linezolid has been reported in clinical isolates. These resistance trends for newer therapies highlight the ongoing need for new and more potent antimicrobial therapies.

Central Line-Associated Blood Stream Infection Rates in Emergency Medicine: A Multi-Center Cohort Study

Approximately 41,000 central line-associated blood stream infections (CLABSI) occur in U.S. hospitals each year. These infections typically cause prolongation of hospital stay, increased cost, risk of mortality and are a National Patient Safety Imperative. CLABSI can be minimized by implementation of published quality improvement, infection control initiatives and has been driven as low as 1.17 infections per 1000 patient days in the 350 hospital On the CUSP: Stop BSI AHRQ funded project. Central venous catheters (CVCs) are commonly placed in the emergency department (ED) setting and represent a core procedure for the emergency physician.

Impact of cleaning and other interventions on the reduction of hospital-acquired Clostridium difficile infections in two hospitals in England assessed using a breakpoint model

Clostridium difficile infection remains a major challenge for hospitals. Although targeted infection control initiatives have been shown to be effective in reducing the incidence of hospital-acquired C.difficile infection, there is little evidence available to assess the effectiveness of specific interventions. To use statistical modelling to detect substantial reductions in the incidence of C.difficile from time series data from two hospitals in England, and relate these time points to infection control interventions. A statistical breakpoints model was fitted to likely hospital-acquired C.difficile infection incidence data from a teaching hospital (2002-2009) and a district general hospital (2005-2009) in England. Models with increasing complexity (i.e. increasing the number of breakpoints) were tested for an improved fit to the data. Partitions estimated from breakpoint models were tested for individual stability using statistical process control charts. Major infection control interventions from both hospitals during this time were grouped according to their primary target (antibiotics, cleaning, isolation, other) and mapped to the model-suggested breakpoints. For both hospitals, breakpoints coincided with enhancements to cleaning protocols. Statistical models enabled formal assessment of the impact of different interventions, and showed that enhancements to deep cleaning programmes are the interventions that have most likely led to substantial reductions in hospital-acquired C.difficile infections at the two hospitals studied.

High prevalence of colonization with Staphylococcus aureus clone USA300 at multiple body sites among sexually transmitted disease clinic patients: an unrecognized reservoir

Extranasal colonization is increasingly recognized as an important reservoir for Staphylococcus aureus among high-risk populations. We conducted a cross-sectional study of multiple body site colonization among 173 randomly selected STD clinic patients in Baltimore, Maryland. Staphylococcal carriage at extranasal sites, including the oropharynx, groin, rectum, and genitals, was common among study subjects. The USA300 clone was particularly associated with multiple sites of colonization compared with non-USA300 strains (p = .01). Given their high burden of multi-site colonization and confluence of established staphylococcal risk factors, STD clinic patients may represent a community-based reservoir for S. aureus and be well suited for innovative infection control initiatives.

A Ticket To Ride: A Colloborative Approach To Infection Control Initiatives For a Hospital Relocation

Issue: In Canada more than 8,000 patients die from health care associated infections a year. Hands of health care workers are the most common mode of transmission. The number one way to prevent infection is to perform hand hygiene by using alcohol based hand rub or soap and water. In 2009/2010 our hospital hand hygiene rates were at an overall rate of 42% compliance. In 2010/ 2011, hand hygiene was picked as a quality indicator with a goal to increase our rate to 80% compliance. Project: Our aim was to increase compliance rates but also implement a sustainable hand hygiene program. In planning our initiatives we spoke with other hospitals with successful hand hygiene programs prior to developing our plan. Results: Successful hand hygiene programs encourage involvement and ownership from frontline staff. Unit auditors or Germinators' were implemented. Staffs from inpatient units were trained to observe and collect hand hygiene data. Binders were created and left on each unit with reference material and this was a place that Germinators' could drop off completed observation sheets for IPAC to pick up. During IPAC week a matching game was put together where staff had tomatch a various leaders of our hospital with their hand hygiene message. Our goal was to engage staff and show that that hand hygiene impacts all departments. In addition, using case studies that had actual outcomes of morbidity andmortality helped staff to understand that infections do kill and that infections can be prevented by hand hygiene. On Global Hand Hygiene day we offered staff a chance to win 6 hours of free house cleaning if they allowed IPAC to observe them for a fewminutes and provide on the spot feedback. This was well received by staff, creating an environment where feedback was acceptable. New pamphlets were implemented encouraging patients to ask if their health care worker had performed hand hygiene. Finally, our program tried to use positive deviance principals. During audits, we highlighted staff that were caught with excellent practice and were given a coffee/ muffin voucher. In addition, IPAC recognized one staff member per quarter as an IPAC star. An article was written for the hospital newsletter recognizing their contributions to positive outcomes for our program. Lesson Learned: Our rates have shown that staff involvement and ownership of hand hygiene rates does in fact impact practice. Although our work is not done and hand hygiene is a continuous battle, through our various initiatives, by being visibly present, using positive reinforcement and education we were able to see an increase in our hand hygiene compliance, from 42% to 75%.

Prevalence and molecular epidemiology of meticillin-resistant Staphylococcus aureus in nursing home residents in northern Germany

Nursing home residents are a population at risk for carrying meticillin-resistant Staphylococcus aureus (MRSA). To better guide infection control and healthcare network initiatives, we investigated the point prevalence and molecular epidemiology of MRSA colonisation among nursing home residents in Brunswick, northern Germany. Among the 32 participating nursing homes of the available 34 in the region, 68% of residents (1827 of 2688) were screened for nasal and/or wound colonisation. A total of 139 residents (7.6%; 95% confidence interval: 6.4-8.8%) were identified as MRSA positive, almost six-fold more than the 24 MRSA carriers (0.9%) expected according to the nursing homes' pre-test information. Although known risk factors including urinary tract catheters, wounds, preceding hospital admission, and high grade resident care were confirmed, none was sensitive enough to be considered as the sole determinant of MRSA carriage. spa typing revealed that more than 70% of isolates belonged to the Barnim strain (ST-22, EMRSA-15, CC22) typical for hospital-acquired MRSA in northern Germany. There was no evidence for the presence of community-acquired or livestock-associated S.aureus strains. These data show that in northern Germany MRSA has spread from the hospital environment to other healthcare institutions, which must now be regarded as important reservoirs for MRSA transmission.

Organisation of hospital infection control in Mongolia

As with other areas of the public sector in Mongolia, the healthcare system has undergone significant structural and policy reforms since the early 1990s. The previous infection control system, characterised as a sanitary-epidemiological network, was dismantled with no replacement. A new infection control management system was established in 1997 with the adoption of infection control policies and guidelines, establishment of hospital infection control programmes in all major hospitals, training of health professionals and the commencement of passive surveillance of hospital-acquired infections (HAIs). Recent health statistics claim that HAIs occur in 0.01-0.02% of all hospital admissions with the highest percentage (0.05%) in tertiary hospitals in the capital city Ulaanbaatar, but this is very likely to be an underestimate. In 2002 the Government approved a national programme to establish a sentinel surveillance system for HAIs with improved laboratory-based monitoring. However, implementation has been delayed due to insufficient support from stakeholders and a shortage of resources and trained infection control professionals. Non-governmental infection control initiatives are limited by time and coverage.