Infection Control Measures For Prevention Research Articles

A longitudinal environmental surveillance study for SARS-CoV-2 from the emergency department of a teaching hospital in Hong Kong

Understanding factors associated with SARS-CoV-2 exposure risk in the hospital setting may help improve infection control measures for prevention. To monitor SARS-CoV-2 exposure risk among healthcare workers and to identify risk factors associated with SARS-CoV-2 detection. Surface and air samples were collected longitudinally over 14 months spanning 2020-2022 at the Emergency Department (ED) of a teaching hospital in Hong Kong. SARS-CoV-2 viral RNA was detected by real-time reverse-transcription polymerase chain reaction. Ecological factors associated with SARS-CoV-2 detection were analysed by logistic regression. A sero-epidemiological study was conducted in January to April 2021 to monitor SARS-CoV-2 seroprevalence. A questionnaire was used to collect information on job nature and use of personal protective equipment (PPE) of the participants. SARS-CoV-2 RNA was detected at low frequencies from surfaces (0.7%, n=2562) and air samples (1.6%, n=128). Crowding was identified as the main risk factor, as weekly ED attendance (OR=1.002, p=0.04) and sampling after peak-hours of ED attendance (OR=5.216, p=0.03) were associated with the detection of SARS-CoV-2 viral RNA from surfaces. The low exposure risk was corroborated by the zero seropositive rate among 281 participants by April 2021. Crowding may introduce SARS-CoV-2 into ED through increased attendances. Multiple factors may have contributed to the low contamination of SARS-CoV-2 at the ED, including hospital infection control measures for screening ED attendees, high PPE compliance among healthcare workers, and various public health and social measures implemented to reduce community transmission in Hong Kong where a dynamic zero COVID-19 policy was adopted.

Prediction of compliance with preventive measures among teachers in the context of the COVID-19 pandemic

The objective of this study is to examine, in primary and high schools, teachers' compliance with preventive infection control measures (in the context of the COVID-19 pandemic). Inspired by the technology acceptance model (TAM) and occupational health and safety (OHS) literature on personal protective equipment (PPE) use, we propose a model of compliance with preventive measures among teachers. Data were collected following an observational, cross-sectional design. The data for the study were collected via a questionnaire survey of teachers working in the province of Quebec, Canada. To study the impact of the explanatory variables on the dependent variable, we developed a multiple linear regression model. This model was estimated to assess the preventive measures as a whole (six items). Results show that having tested positive for a COVID test in the last year, judging that the situation does not require the use of the mask or the protective glasses, training received on preventive measures, factors related to comfort and use of protective eyewear, as well as age influence teacher compliance with COVID-19 preventive measures.

Anxiety Among Healthcare Workers During COVID-19 Pandemic in Lebanon: The Importance of the Work Environment and Personal Resilience.

BackgroundHealthcare workers (HCWs) have been severely impacted by the COVID-19 pandemic. In addition to their risk of direct exposure to the virus, they were subjected to long working hours, scarcity of PPE, and additional stressors that impacted their psychological wellbeing. The purpose of this study was to assess anxiety and its predictors among a sample of HCWs at the American University of Beirut Medical Center (AUBMC) and to evaluate the association between resilience and anxiety.MethodsThis cross-sectional study was conducted using an online survey between March and June 2021 among HCWs at AUBMC. The psychosocial scale section included the 7-item generalized anxiety disorder (GAD-7) scale and a 25-item resilience scale, validated tools used to assess anxiety and resilience respectively. Data were analyzed on SPSS version 27, and descriptive statistics were applied. Predictors were evaluated using bivariate and multivariate linear regression.ResultsFrom a total of 92 participants, 75% were involved in direct patient care, and of those, 95% worked directly with suspected or confirmed COVID-19 patients. The majority (83%) had minimal to mild anxiety, whereas the rest had moderate to high anxiety levels. Around 41% reported moderately high to high resilience, 47% were found to be between the low end and moderate resilience scale and only 12% had very low or low resilience. More than 80% of the participants received PPE training, reported always working with adequate preventive infection control measures, and were vaccinated. Further, more than 70% of participants reported trusting the management and agreed that the safety of the workers is considered a high priority. No significant association between sociodemographic and COVID-19 work exposure factors with anxiety was found. Multivariate analysis results showed that a lower anxiety score was associated with higher resilience (p = 0.011).ConclusionThis study has shown a strong association between low anxiety levels and high resilience scores in this group of mostly vaccinated HCWs caring for COVID-19 patients. The high percentage of vaccination along with PPE availability could explain the low anxiety levels reported among the participants.

VENTILATOR ASSOCIATED PNEUMONIA IN TRAUMA PATIENTS; ASSOCIATED RISK FACTORS, MICROBIAL ETIOLOGY AND OUTCOME

Objective: To assess the incidence, risk factors and outcome of ventilator associated pneumonia in trauma patients.
 Study Design: Prospective observational study.
 Place and Duration of Study: Shaheed Mohtarma Benazir Bhutto Institute of Trauma, Karachi, from Jul to Dec 2019.
 Methodology: All trauma patients, above 12 years, placed on mechanical ventilation in the emergency room or intensive care unit, were enrolled. Patients that developed a clinical pulmonary infection score of less than 6 were diagnosed with ventilator associated pneumonia.
 Results: A total of 113 patients were enrolled in this study. Mean age was 32.9 ± 14.4 years. Thirty eight (33.6%) developed ventilator associated pneumonia. Patients with ventilator associated pneumonia, compared to non-ventilator associated pneumonia, had a longer emergency room stay of 7.8 ± 10.1 vs. 4.7 ± 7.4 days (p-value=0.013), greater ventilator days of 18.5 ± 12.6 vs. 7.9 ± 5.5 (p-value=0.001), longer hospital stay of >14 days in 65.8% vs. 33.3% (p-value=0.001) and higher mortality of 65.8% vs. 56% (p-value=0.213). Nurse to patient ratio and infection control measures for prevention of ventilator associated pneumonia were significantly reduced in emergency room compared to intensive care unit (p-value=0.001). Out of 43 respiratory isolates in 38 ventilator associated pneumonia patients, 40 (93%) were gram negatives of which 23 (57.5%) were multidrug resistant with polymyxins as the only therapeutic option.
 Conclusion: There was a high incidence of ventilator associated pneumonia in patients with trauma. Prolonged retention in the emergency room is a significant risk factor for ventilator associated pneumonia, due to understaffing..................

Seroprevalence of Hepatitis B, Hepatitis C, and Human Immunodeficiency Viruses in End-Stage Renal Disease Patients, Southern Iran

Background: Hemodialysis [HD] patients are more prone to blood-borne viruses, such as hepatitis B virus [HBV], hepatitis C virus [HCV], and, to a lesser extent, Human Immunodeficiency Virus [HIV]. Chronic HBV and HCV infections are associated with liver cirrhosis, hepatocellular carcinoma, and early graft failure after kidney transplantation. As there was no recent information, this study aimed to evaluate the prevalence of HBV, HCV, and HIV infection in HD patients in Fars province, southern Iran. This could help health policymakers to run more effective infection control practices for reducing such blood-borne virus infections, if necessary. Methods: This cross-sectional study was performed on 906 HD patients in Fars province, southern Iran. A total of 906 blood samples were obtained from patients and diagnostic tests of HBV, HCV, and HIV were done. Demographic data and some other information, such as duration of dialysis, were extracted from the patients’ medical records. Data were analyzed in SPSS, version 18. Results: Out of the patients enrolled in the study, 547 [60.4%] were male and 359 [39.6%] female. The mean ± SD age of the patients was 58.0 ± 15.8 years. The prevalence of HBV, HCV, and HIV infection was 0.88%, 0.55% and 0.44%, respectively. HIV-infected subjects were significantly younger than the HIV-negative group [P <0.017]. Conclusion: It seems that Fars is among the provinces with low HBV and HCV prevalence in HD patients in comparison to other provinces of Iran. On the other hand, HIV prevalence here is higher than other provincial studies. Strict adherence to preventive infection control measures is recommended in HD centers.

Knowledge, Attitudes, and Practices Toward COVID-19 in a Saudi Arabian Population: A Cross-Sectional Study.

BackgroundPreventative measures are necessary to control a pandemic such as coronavirus disease 2019 (COVID-19), and different platforms to communicate guidelines have varying levels of effectiveness.ObjectiveAt the time of this study, there were no published studies investigating knowledge, attitudes, and practices related to COVID-19 within the Saudi population. Therefore, this study aims to address this gap in current knowledge and provide baseline data to the government and other health associations for preventive measurements for future outbreaks.MethodsThis study was conducted among the Saudi population using an online questionnaire. The questionnaire assessed the awareness of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) incubation period, the known symptoms of COVID-19, the mode of transmission of SARS-CoV-2, and infection control measures for prevention.ResultsThe study included 6000 participants. Most respondents (84.93%) of the population reported awareness of the virus, 78.78% reported a belief that the virus leads to death, 89.47% reported a belief that 14 days is the incubation period, and 93.73% were aware of the possibility of asymptomatic carriers.ConclusionsThe Saudi population is aware of the attitudes and practices of prevention as well as the mode of transmission. The efforts by the Ministry of Health were effective in increasing awareness among the Saudi population toward COVID-19.

Anorectal malformations: Early outcome analysis from a high-volume tertiary care institute

Context: Associated malformations in anorectal malformation (ARM) are of important implication with regard to final outcomes since the anorectal lesions that cause intestinal obstruction are correctable with operative intervention. Aims: To study the presentation, types of anomalies, associated malformations, and procedures performed in relation to the type of anomaly and early outcomes analysis of ARM patients in the neonatal period. Settings and Design: A retrospective study was performed from January 2016 to December 2016. Subjects and Methods: The study included all patients with ARM admitted in the Neonatal Intensive Care Unit. Results: There were 216 neonates having ARM with 173 males and 43 females (m:f = 4:1). High-type ARM was seen in 177 (81.94%) cases, while low type in 39 (18.06%) neonates. Associated malformations were documented in 67 (31.02%) neonates. Esophageal atresia (EA) was the most common (51) associated anomaly. Among the 200 procedures undertaken for ARM, left transverse loop colostomy was the most common (132). Only 83 (38.42%) neonates were diagnosed on the 1st day of life. There were 67 (31.02%) deaths, 145 (67.13%) survivors, and 4 (1.85%) cases left against medical advice. There were only 9 (17.65%) survivors among those associated with EA. Cardiovascular was the most common (39) cause of mortality followed by septicemia (30). Conclusions: An overall high mortality rate of 31.02% and an extremely high rate (74.51%) among those associated with EA were present. In spite of the progress made in the field of neonatal care, associated malformations compounded with a high volume of patients in our resource-limited institution negatively influence the outcome of ARM in the newborn period. Strict infection control measures for prevention of septicemia and investigations for other associated malformations are recommended to improve the outcomes.

Esophageal atresia: Early outcome analysis from a high-volume tertiary care institute in India

Context: Despite the progress made in the field of surgical techniques and neonatal care, conditions such as prematurity, very low birth weight, and associated anomalies compounded with delayed diagnosis may negatively influence the successful outcome of esophageal atresia (EA). Aims: The aim is to study the early outcome analysis of patients with EA and tracheoesophageal fistula (TEF) at a high-volume tertiary care institute. Settings and Design: A retrospective study performed from January 2016 to December 2016. Subjects and Methods: The study included all patients of EA and TEF admitted in the Neonatal Intensive Care Unit of our department. Results: There were 430 new cases of EA/TEF. Type C was the most common (90.23%), followed by Type A (8.37%), Type E (0.69%), and one case each of Type D, esophageal web, and esophageal stenosis. Two hundred and twenty-four (52.10%) remained undiagnosed on the 1st day of life. The average birth weight was 2200 g; 64.65% of patients were low birth weight. Associated major anomalies were present in 18.84% patients with gastrointestinal tract anomalies in 13.49% cases (anorectal malformation – 11.86%, duodenal atresia [DA] – 2.79%, and triple atresia – 0.93%) and VACTERL association in 11.63%. Surgical procedures were performed in 413 (96.05%) patients. Survival was seen in 29.77% cases, mortality in 68.84% and 1.39% patients left against the medical advice. The survival was better in Type C (29.89%) than Type A (27.78%) and also those without associated anomalies. VACTERL association had a very high (80%)-mortality rate. Septicemia (63.85%), severe pneumonia (53.71%), and congestive heart failure (24.32%) were main causes of mortality. Conclusions: Although there has been a marked improvement in the antenatal diagnosis of EA, most cases in our study remain undiagnosed in first 24 h of birth. Associated major anomalies were documented in approximately 1/5th patients. Survival was present in less than 1/3rd patients; survival outcomes were better in EA without associated anomalies. Early diagnosis with the help of red rubber catheter shortly after birth, measures to prevent pneumonia, strict infection control measures for prevention of septicemia, deployment of sufficient resources, and investigations for other associated anomalies are recommended to improve the outcomes of EA.

Middle East Respiratory Syndrome Coronavirus (MERS-CoV): a perpetual challenge.

Ann Saudi Med 2013 September-October www.annsaudimed.net 427 The emergence of a novel human coronavirus recently renamed the Middle East Respiratory Syndrome Coronavirus (MERS-CoV) from the Arabian Peninsula has created global alarm because it is the causative agent of a severe and frequently fatal acute respiratory illness (SARI) resembling the illness caused by severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV).1-4 The case fatality rate (CFR) in patients infected with MERS-CoV is high—estimated at 43% in 147 patients reported so far by World Health Organization (WHO).3 This rate is higher than that of SARS—estimated at 15%, and is strongly ageand sex-dependent.4 Although the source of virus in patients with sporadic infection remains unknown, it appears likely to be some species of animal.4,5 Clear evidence of limited human-to-human transmission of MERS-CoV has now been documented in several case clusters, including particularly family members and patients in health care facilities,6-8 but all such clusters have, at least thus far, been limited in extent. However, a real concern persists that the virus will adapt to interhuman transmission and switch from an aborted epidemic to a pandemic similar to the SARS-CoV epidemic in 2003–2004. MERS-CoV is transmitted through droplets and contact. In the case of invasive respiratory procedures, MERS-CoV is transmitted through airborne route.2 Early diagnosis and strict implementation of the core components for infection prevention and control programs are crucial for preventing epidemic amplification.2 In the absence of an effective vaccine and a specific antiviral treatment, there is an urgent need to rapidly identify potential therapeutics.

Refurbishment works in a hospital during normal operation.

Background: Construction and renovation work in hospitals pose risks of fungal airborne infections for immunosuppressed patients. If possible, reconstruction work will be postponed to periods without patient treatment. However, in many situations urgent damage demands immediate refurbishment works before the transferring of patients to other wards or closure of wards is possible. Reported here are infection control related measures and implemented procedures after two incidents of water damage which occurred on a surgical ward and an intensive care unit at the University hospital of Essen.Methods: Between January and April 2009 and between September and October 2009, respectively, concentration of air-borne particles and number of viable fungi were measured at two surgical wards and one ICU. Preventive Infection Control Measures included erection of protective walls and HEPA filtration of air from the renovation area.Results: During the renovation work on the surgical ward concentrations of moulds and particles ≥5 µm were significantly higher on the left side of the renovation area than on the right side (p=0.036 and p<0.001). Concentrations of particles ≥1 µm and particles ≥5 µm on both sides of the renovation area were significantly increased when compared with the control ward on the same floor but not when compared with the control ward on the other floor. Particles of all size were significantly elevated on the ICU during the renovation work. Aspergillus fumigatus could neither be cultured of the air of cardiac surgery intensive care unit nor of the intermediate care unit (control ward). During renovation works there was no nosocomial mould infection of patients treated on the two wards.Conclusion: Provided that the renovation area is tightly insulated from the areas of patient care on a ward, closure does not seem to be necessary during renovation works because variation of airborne fungi is similar to that of outdoor or control air. However a multidisciplinary team should be established. This team should perform risk assessment and determine necessary protective measures before starting any construction, renovation or maintenance work in health care settings.

Effectiveness of comprehensive implementation of individualized bundling infection control measures for prevention of health care–associated infections in general medical wards

The prevalence of health care-associated infections (HAIs) in general medical wards at Siriraj Hospital in Bangkok, Thailand remains at 10% even after infection control measures were launched. The present study aimed to determine the effectiveness of comprehensive individualized bundling infection control measures in reducing HAIs and to identify the lowest possible rate of HAIs in general medical wards. This was a cluster randomized controlled study conducted in 8 general medical wards (4 control wards and 4 intervention wards) at Siriraj Hospital. The patients hospitalized in the control wards received regular health care, as well as regular measures for preventing HAIs. The patients hospitalized in the intervention wards received additional measures. Each patient in the intervention wards was visited by the infection control team once a day until he or she left the hospital. The infection control team identified risk factors for developing HAI in each patient, coordinated with the local health care team to eliminate or minimize such risk factors, and encouraged responsible personnel to comply with the appropriate infection control measures for each patient. Between January and April 2009, there were 954 patients (9,650 hospitalization-days) in the intervention wards and 920 patients (9,777 hospitalization-days) in the control wards. The patient characteristics were comparable in the 2 groups. The prevalence of HAI was significantly lower in the intervention wards compared with the control wards (5.6% vs. 9.2%; P = .003). Six episodes of HAI in patients in the intervention wards could have been avoided. Comprehensive individualized bundling infection control measures were effective in reducing the prevalence of HAIs in general medical wards. The target overall prevalence of HAIs in general medical wards should not exceed 4.9%.

Prevalence of hepatitis C, hepatitis B, and HIV infection among hemodialysis patients in Jenin District (Palestine)

Background and Aims: End-stage renal disease patients treated by hemodialysis (HD) are more susceptible for infection by viral hepatitis and human immunodeficiency virus (HIV) infections. Infection by these viruses is promoted by the characteristic immunological dysfunction that develops in renal failure and interferes with the patient's ability to eliminate these viruses. Prevalence of these viruses among hemodialysis patients in Jenin District (Palestine) was not studied until now, we aimed in this study to determine the prevalence of HCV, HBV and HIV among hemodialysis patients in Jenin District using serological methods, and to define the main risk factors for HCV infection. Materials and Methods: End-stage renal disease (ESRD) patients on maintenance hemodialysis from various demographic areas in Jenin District were included in the study. Data such as age, sex, drug abuse, history of transplantation were examined. Serological markers for HCV, HBV and HIV were determined using a microparticle enzyme immunoassay (MEIA). Pearson’ s correlation factor and independent samples t-test were used to analyze the significance of results. Results: The patients were 77 (42 males, 35 females, mean age 50.73 ± 16.78 years [age range: 14 – 80 years]), the mean duration of dialysis was 26.97 months with a standard deviation of 35.19 days. The prevalence of HCV was 24.68 % while the prevalence of HBsAg and HIV were 0% respectively. HCV seropositivity was associated with longer period of dialysis (P=0.000). There was no statistically significant correlation between age and HCV seropositivity (P=0.630), also there was no statistically significant relationship between sex and infection with HCV (P=0.849). Conclusion: The prevalence of HCV among hemodialysis patients in Jenin District is high compared to many Arab and other countries. None of the patients were a former drug abuser or had a history of tattooing. None of the patients was with a former transplant was HCV positive, so it seemed that the infection was mainly nosocomial during dialysis process. Duration of dialysis was an important risk factor (P=0.000). Dialysis staff, incomplete disinfection of dialysis machines (monitors), non-isolation of HCV positive patients on special dialysis units or special monitors may be important risk factors. So, careful attention of the preventive infection control measures is essential to limit the transmission of HCV in the dialysis unit in Jenin District.

Prevalence and risk factors of hepatitis B and C viruses among haemodialysis patients in Gaza strip, Palestine

BackgroundThe prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) and its associated risk factors among haemodialysis (HD) patients in Gaza strip was investigated using serological and molecular techniques.ResultsThe overall prevalence of HBV among the four HD centers was 8.1%. The main risk factors were HD center (p = 0.05), history of blood transfusion (p < 0.01), and treatment abroad (p = 0.01). The overall prevalence of HCV among the four HD centers was 22%. The main risk factors were HD center (p < 0.01), time duration on HD (p < 0.01), history of blood transfusion (p < 0.01), treatment abroad (p < 0.01), and history of blood transfusion abroad (p < 0.01). Serum aminotransferases levels decreased in HD patients compared with normal population but still there was a direct association between the activity of liver enzymes and both HBV (p < 0.01) and HCV (p < 0.01) infection.ConclusionThe much higher prevalence of Hepatitis viruses among HD patients compared to the normal population of Gaza strip indicates a causative relation between HD and hepatitis viruses transmission. Therefore extremely careful observation of preventive infection control measures is essential to limit Hepatitis viruses' transmission in HD centers.

Transmission of Helicobacter pylori and the role of water and biofilms

Documented evidence relating to the survival of Helicobacter pylori outside the gastric niche is extremely limited. To date the primary transmission routes of H. pylori have yet to be confirmed and when this is achieved preventive infection control measures can be implemented to reduce and ultimately prevent human infection from this pathogen. There is mounting evidence which suggests that the prevalence of H. pylori infection has a strong correlation with access to clean water, suggesting a transmission route to the host. However, there are no established culture methods for the detection of viable H. pylori in the environment, in particular drinking water supplies, preventing the development of true epidemiological and risk assessments. The aim of this review is to highlight the available data to date that suggests drinking water and possible survival in biofilms as a probable transmission mode for H. pylori.

Riesgo de transmisión de enfermedades infecciosas en la clínica dental

In this paper, we present a review of the risk of transmission of infectious diseases and its implications for dentistry. Hepatitis, specially hepatitis B and C, HIV infection, tuberculosis and other infectious diseases can be potencially transmitted in dental-care settings affecting both patients and the dental staff. Knowing the transmission probability and its features is the basis for the development of preventive infection control measures, in order to try to avoid or at least minimize the probability of acquiring these diseases in the working environment.

EPIDEMIOLOGY OF SEPSIS, CAUSED BY STAPHYLOCOCCUS AUREUS (STAPHYLOCOCCAL SEPSIS) AT MARIBOR TEACHING HOSPITAL IN THE YEARS 2001–2002

Background. Staphylococcal sepsis represents a serious disease carrying high mortality rates. Risk factors, complications and preventive measures are known. At Maribor Teaching Hospital, patients with staphylococcal sepsis are treated at the same department at which the sepsis was diagnosed. Therefore some differences in treatment are observed at our hospital. Methods. Retrospective analysis of data of all patients with staphylococcal sepsis treated at Maribor Teaching Hospital. Results. Comparing our patients and the data published, no significant differences in epidemiology of staphylococcal sepsis were recognized. The factors predisposing to infection remain the same, the patients are mostly from higher age groups. Half of the patients had hospital-acquired staphylococcal sepsis. Primary localized infection was recognized in only 50% of patients. Susceptibility of Staphylococcus aureus to antibiotics is high, the percentage of MRSA is under 10%. Despite the existing recommendations for treatment with antistaphylococcal penicillins, our patients were treated with various antibiotics, decreasing the mortality rate to 23%. Conclusions. In view of the collected results, infectologists should be engaged in the diagnostic and treatment process in septic patients at all departments of Maribor Teaching Hospital. Moreover, a further decrease in morbidity, complications and mortality of staphylococcal sepsis could be achieved by correct antibiotic treatment and preventive infection-control measures.

Infection control for SARS in a tertiary neonatal centre

The Severe Acute Respiratory Syndrome (SARS) is a newly discovered infectious disease caused by a novel coronavirus, which can readily spread in the healthcare setting. A recent community outbreak in...