Infection Control Practitioners Research Articles

What we learned from the infection control and what we need in the future: A quantitative and qualitative study on hospital infection prevention and control practitioners (HIPCPs) in Tianjin, China

BackgroundIn December 2022, the epidemic prevention and control policy was upgraded, and China entered a different stage of epidemic control. This study aims to identify implications for better infection control and health care supply during the epidemic. MethodsA longitudinal quantitative and qualitative study was performed based on 2 comprehensive questionnaire surveys among 497 hospital infection prevention and control practitioners (HIPCPs) before and during the epidemic peak in Tianjin, China. ResultsThe workload (8.2 hours vs 10.14 hours, P = 0) and self-reported mental health problems (23.5% vs 61.8%, P < .05) among the HIPCPs increased significantly in the peak period. Ward reconstruction and resource coordination were the most needed jobs in hospital infection control, and rapidly increased medical waste during the epidemic needs to be considered in advance. Community support for health care personnel and their families, maintaining full PPE to reduce simultaneous infection of medical staff, and clinical training of infectious diseases for medical staff, especially doctors, in advance are the most important things we learned. ConclusionAlthough it has been 4 years since the first outbreak of coronavirus disease 2019, more improvements should be made to prepare for the next epidemic of potential diseases.

Comparison of rectal swabs and fecal samples for the detection of Clostridioides difficile infections with a new in-house PCR assay.

Clostridioides difficile infection (CDI) is the leading cause of healthcare-associated diarrhea, resulting in high morbidity, mortality, and economic burden. In clinical laboratories, CDI testing is currently performed on stool samples collected from patients with diarrhea. However, the diagnosis of CDI can be delayed by the time required to collect stool samples. Barriers to sample collection could be overcome by using a rectal swab instead of a stool sample. Our study showed that CDI can be identified rapidly and reliably by a new PCR assay developed in our laboratory on both stool and rectal swab specimens. The use of PCR tests on rectal swabs could reduce the time for the detection of CDI and improve the management of this infection. It should also provide a useful alternative for infection-control practitioners to better control the spread of C. difficile.

Hand Hygiene Practices among Nurses in South Sulawesi Hospitals

Healthcare professionals’ adherence to hand hygiene protocols is paramount to prevent Healthcare-Associated Infections (HAIs) and ensure patient safety. This study evaluates compliance with the World Health Organization's (WHO) "Five-Moment Hand Hygiene" protocol among nurses in two Indonesian hospitals: Regional General Hospital X in Makassar City and Provincial General Hospital Y in South Sulawesi Province. A total of 60 nurses participated, with demographic analysis revealing significant differences between the hospitals. Utilizing a comprehensive observation tool provided by the WHO, data analysis indicated variations in hand hygiene practices, particularly after touching patient surroundings. Despite these differences, the data followed a normal distribution, enhancing the reliability of statistical analyses. Significant disparities in hand hygiene practices were found after touching patient surroundings (p-value = 0.008; α &lt; 0.05), underscoring the urgent need for targeted interventions among nurses to improve their compliance and enhance patient safety. This study recommends comprehensive training, resource provision, regular audits, fostering a supportive organizational culture, and integrating robust hand hygiene modules into nursing education. The study also suggests further research to identify barriers and improvement strategies. Addressing these recommendations collectively will bolster patient safety and reduce healthcare-associated infection burdens in Indonesian healthcare settings. The study's identification of specific deficiencies in hand hygiene practices provides actionable insights for healthcare administrators, infection control practitioners, and frontline healthcare workers, emphasizing the urgency of sustained efforts to promote proper hand hygiene practices.

Perceptions and digitalisation of outbreak management in UK health services: A cross-sectional survey

Background Global challenges arise from infectious diseases which represent significant challenges to the provision of healthcare, requiring efficient management procedures to limit transmission. Evaluating current outbreak management processes within UK healthcare services is essential for identifying strengths, weaknesses, and potential improvements. Objectives This study aimed to assess infection prevention and control (IPC) practitioners' access to outbreak management (OM) data. Secondary objectives involved determining IPC practitioners’ perceptions of outbreak management processes and the state of digitalisation of OM in the UK. Methods National cross-sectional survey data were collected to evaluate current outbreak management approaches. To supplement this, information requests were sent to the 10 largest teaching and research NHS hospital trusts in England. Findings The survey received 55 responses with 53 considered for analysis. Out of 10 NHS trusts, nine provided completed FOI responses, while one was unable to provide data. Discussion The study offers unique insights into prevailing outbreak management practices within UK health services. Although positive perceptions surround key outbreak management stages, concerns arise, including varying confidence levels in surveillance processes' robustness, efficacy of management interventions, and communication effectiveness. Conclusions The study highlights challenges with OM processes in the UK, including issues like poor surveillance and delayed outbreak detection. Positive practitioner perceptions contrast with concerns over data collection, follow-up, and limited digitalisation, relying on basic tools like Excel and Word, hindering retrospective learning.

Investigating expert and lay judgments of pathogen transmission risk in urban and architectural environments

ABSTRACT The threat of infection posed by the COVID-19 virus forced the general public to use the visible cues within urban and architectural environments as a ‘lens’ through which pathogen transmission risk could be inferred. This study presents a model that quantifies associations between (1) the visible cues of urban and architectural environments and lay ratings of pathogen transmission risk, (2) the same relationship for experts (i.e. Infection Control Practitioners), and (3) the association between the lay ratings and the expert ratings. A series of urban and architectural environments were rated on twenty visible architectural cues and for their perceived pathogen transmission risk by lay and expert raters. Correlational analyses between the two groups yielded considerable consensus between risk ratings, as well as between which cues were significantly associated with risk ratings, which included the space’s crowdedness, the potential for crowds, and cleanliness. Expert risk ratings were also significantly associated with corridor size, and marginally significantly associated with the number of touchable surfaces, the number of furniture/seating, and access to fresh air. In this way, expert cue utilization is more complex than lay assessments. Implications for public health policy makers and designers of the built environment are discussed.

Compliance with good practice guidelines for the prevention of vascular access infections: the multi-centre PHYDEL survey in French haemodialysis units

French guidelines for the prevention of vascular access infections in a haemodialysis setting were released in 2005. Compliance with these guidelines is currently unknown. The aim of this study was to assess compliance with the guidelines for vascular access infection prevention in French haemodialysis units, and to describe the difficulties reported. A cross-sectional survey was conducted between March and December 2019 in 200 haemodialysis units in France, selected at random. Data were collected via questionnaire, completed by telephone interview with an infection control practitioner. A practice was deemed compliant when >85% of units declared that they always complied with the guidelines. In total, 103 units (51.5%) agreed to participate. Most practices complied with the guidelines; however, some practices did not reach the 85% compliance threshold for working in pairs when connecting central venous catheter (CVC) lines, performing hand hygiene before disconnecting lines, rinsing antiseptic soap before painting CVC exit site or arteriovenous fistula (AVF) puncture site, allowing antiseptic paint to dry, handling CVC branches with antiseptic impregnated gauze, performing hand hygiene after AVF compression with gloves, wearing protective eyewear when connecting/disconnecting CVC or when puncturing AVF, and wearing a gown when puncturing AVF. The most frequently reported difficulties were understaffing, difficulties with skin preparation because of exit site skin damage, and lack of buttonhole technical expertise. Despite good overall compliance, this survey highlights some shortcomings in compliance with infection prevention guidelines, which could be associated with either higher risk of vascular access infection or increased blood-borne virus transmission.

Train-the-Trainers in hand hygiene facilitate the implementation of the WHO hand hygiene multimodal improvement strategy in Japan: evidence for the role of local trainers, adaptation, and sustainability

Background“Train-the-Trainers in hand hygiene” (TTT) is a standardized training to train infection prevention and control (IPC) practitioners with the aim to promote hand hygiene in health care according to the World Health Organization (WHO) multimodal improvement strategy. Little is known in the literature about the sustained impact of hand hygiene and IPC trainings adapted locally. The aim of this study is to describe the impact of three TTT courses conducted annually in Japan on the adoption of the WHO multimodal improvement strategy by local IPC practitioners who became a “trainer” after their first TTT participation as a “trainee”.MethodsThree TTT courses were conducted annually from 2020 to 2022 in Japan. A team “TTT-Japan” composed of more than 20 IPC practitioners who completed their first TTT participation adapted the original TTT program to reflect the local healthcare context in Japan, and subsequently convened the 2nd and 3rd TTTs. Pre- and post-course evaluations and post-course satisfaction surveys of the course participants were conducted to assess improvement in knowledge on hand hygiene and perception towards the course, respectively. Attitude and practice surveys of the TTT-Japan trainers were conducted to assess their perception and experience in hand hygiene promotion. The Hand Hygiene Self-Assessment Framework (HHSAF), a validated tool created by WHO to monitor the capacity of hand hygiene promotion at facility level, was applied at TTT-Japan trainers’ facilities to compare results before and after trainers’ engagement. We applied inductive thematic analysis for qualitative analyses of open-ended survey questions of the trainers’ attitude and practice surveys, and the Wilcoxon Sign Rank test for quantitive comparisons of pre- and post-data for the surveys and HHSAF.Results158 Japanese healthcare workers participated in three TTT courses, the majority of whom (131, 82.9%) were nurses. Twenty-seven local trainers were involved in 2nd and 3rd TTTs. The scores of pre- and post-course evaluations significantly improved after the course (P < 0.001) and the improvement was consistent across all three TTTs. Post-course satisfaction survey showed that over 90% of the participants reported that the course met their expectations and that what they learned in the courses would be useful for their practice. Trainers’ attitude and practice survey showed that more than three quarters (76.9%) of the trainers reported that their experience as a trainer had a positive impact on their practice at their own facilities. Qualitative analysis of the trainers’ attitude and practice survey revealed that trainers appreciated continuous learning as a trainer, and group effort to promote hand hygiene as the TTT-Japan team. The HHSAF institutional climate change element at the trainers’ facilities significantly improved after their engagement as a trainer (P = 0.012).ConclusionsTTTs were successfully adapted and implemented in Japan, leading to sustained hand hygiene promotion activities by local trainers over three years. Further research is warranted to assess the long-term impact on local hand hygiene promotion in different settings.

Customized molecular diagnostics of bacterial bloodstream infections for carbapenem resistance: A convenient and affordable approach

ABSTRACT The acute crisis of carbapenem resistance impedes the empirical use of carbapenems in medical emergencies, especially, bloodstream infections. Carbapenemase-producing carbapenem-resistant organisms (CP-CROs) attribute high case-fatality, necessitating rapid diagnostics to initiate early targeted antibiotics. Expensive diagnostics are the major driver of antibiotic misuse, neglecting evidence-based treatment in India. One in-house molecular diagnostics assay was customized for rapid detection of CP-CROs using positive blood-culture (BC) broths at a low-cost. The assay was validated using a known-set of isolates and evaluated on positive BC broths. DNA was extracted from positive BC broths using a modified alkali-wash/heat-lysis method. One end-point multiplex-PCR was customized targeting five carbapenemases (KPC, NDM, VIM, OXA-48-, and OXA-23-type) with 16S-rDNA as internal extraction control. Carbapenem resistance due to other carbapenemases, efflux-pump activity, and loss of porins was not under the scope of the assay. Promising analytical performances (sensitivity and specificity, >90%; kappa = 0.87), encouraged to assess diagnostic value, qualified the assay for the WHO minimal requirements (both≥95%) for a multiplex-PCR. Higher LR+ (>10) and lower LR− (<0.1) indicate a good diagnostic tool for ruling in or ruling out CRO bloodstream infections. Inclusion of OXA-23-type improved assay positivity. Multiple carbapenemases were detected in>30% of samples. Good concordance was found (kappa = 0.91) with twenty-six discrepant results. The results were available in 3 hours. The running cost of the assay was US$10 per sample. Fast and reliable detection of carbapenemase(s) allows clinicians and infection-control practitioners to execute early-directed therapy and containment measures. This convenient approach facilitates implementing the assay in resource-limited healthcare settings.

Infection control strategies for healthcare workers during COVID-19 pandemic in German hospitals: A cross-sectional study in march–april 2021

BackgroundHealthcare workers (HCW) are at risk of getting infected with COVID-19 at work. To prevent such incidents and provide a safe environment in hospitals, comprehensive infection control strategies are necessary. We aimed to collect information on COVID-19 infection control strategies regarding personal protective equipment (PPE), regulations during breaks for HCW and dissemination of pandemic-related information. MethodsWe invited infection control practitioners from 987 randomly selected German hospitals in March–April 2021 to participate in our cross-sectional online survey. We categorized the hospital based on bed capacity (≤499 beds = small; ≥500 beds = large). Fisher's exact test was performed and p < 0.05 defined as statistically significant. Findings100 participants completed the questionnaire. Small hospitals were more directive about requiring FFP2 respirators (63%), whereas larger hospitals more often gave their HCW a choice between these and medical masks (67%). For the care of COVID-19 and suspected COVID-19 cases, >90% of the participants recommended the use of gloves. Notably, gloves were recommended beyond COVID-19 in 30% of the hospitals. During meal breaks various strategies were followed. ConclusionRecommendations for PPE varied across hospital sizes, which could be due to different assessments of necessity and safety. Regulations during breaks varied strongly which illustrates the need for clear official guidelines.

Plasmid DNA mediated vancomycin-resistant Staphylococcus aureus (VRSA) from cases of urinary tract infection

Vancomycin resistance commonly occurs with Staphylococcus aureus, a pathogen that exhibits intrinsic virulence. Sixty isolates of Staphylococcus aureus tested positive as vancomycin possessive isolates on Brain Heart Infusion Agar medium fortified with 6 μg/mL vancomycin from 100 clinical samples of urine from patients with cases of UTIs via agar diffusion method. Standard 30 μg vancomycin disc served as control. Increase in zones of growth inhibition in relation to vancomycin concentrations was noticed in some of the isolates while it was reversed in others, despite the increase in concentration. Typed strain was susceptible to six concentrations of vancomycin exposed and to the control. Thirty one of the sixty isolates were resistant to vancomycin control. Resistant isolates from standard vancomycin discs were then subjected to molecular investigation. Of the 31 isolates exposed to gel electrophoresis, 14 (47%)elicited plasmids of varied molecular weights ranging from 0.79-23.13 kb. The magnitudes of vancomycinresistant isolates from the clinical samples studied, coupled with some incoherent zones of inhibition and the plasmid DNA obtained from the resistant isolates, suggest the need for infection control practitioners and epidemiologist to devise strategies to curtail the spread of this pathogen both in hospital and community settings.

Development and Application of an Educational-Training Programme for Infection Control Practitioners in Long-Term Care Hospitals

Elderly persons are at risk of infection due to underlying diseases and weak immune systems. All elderly persons do not require hospitalization in LTCHs, even if have chronic illness or weakened immune systems, but they require care in long-term care hospitals (LTCHs) that have well-trained infection control practitioners (ICPs). This study aimed to develop an educational-training programme for ICPs working in LTCHs using the Developing A Curriculum (DACUM) method. Based on the results of the literature review and the DACUM committee workshop, 12 duties and 51 tasks of ICPs were identified. A total of 209 ICPs participated in the survey, rating 12 duties and 51 tasks on a 5-point scale in terms of frequency, importance, and difficulty. An educational-training programme consisting of five modules was developed, focusing on tasks higher than the mean for each of frequency (2.71 ± 0.64), importance (3.90 ± 0.05), and difficulty (3.67 ± 0.44). Twenty nine ICPs participated in a pilot educational-training programme. The mean programme satisfaction level was 93.23 (standard deviation: ±3.79 points) out of 100 points. The average total knowledge and skill scores were significantly higher after the programme (26.13 ± 1.09, 24.91 ± 2.46, respectively) than before the programme (18.89 ± 2.39, 13.98 ± 3.56, respectively) (p < 0.001, p < 0.001, respectively). This programme will improve the knowledge and skills of ICPs, and thereby contribute to the reduction in healthcare-associated infections in LTCHs.

The development and validation of screening tools for semi-automated surveillance of surgical site infection following various surgeries.

Surveillance of surgical site infections (SSIs) is essential for better prevention. We developed a screening method for SSIs in adults. The training dataset included data from patients who underwent orthopedic surgeries (N = 1,090), colorectal surgeries (N = 817), and abdominal hysterectomies (N = 523) during 2015-2018. The gold standard for the validation of the screening tool was the presence of SSI as determined by a trained infection control practitioner, via manual full medical record review, using the US Center for Disease Control and Prevention criteria. Using multivariable regression models, we identified the correlates of SSI. Patients who had at least one of these correlates were classified as likely to having SSI and those who did not have any of the correlates were classified as unlikely to have SSI. We calculated the sensitivity and specificity of this tool compared to the gold standard and applied the tool to a validation dataset (N = 1,310, years 2019-2020). SSI was diagnosed by an infection control specialist in 8.2, 5.2, and 31.2% of the patients in the training dataset who underwent hysterectomies, orthopedic surgeries and colorectal surgeries, respectively, vs. 6.2, 6.6, and 25.5%, respectively, in the validation dataset. The correlates of SSI after abdominal hysterectomy were prolonged hospitalization, ordering wound or blood culture, emergency room visit and reoperation; in orthopedic surgery, emergency room visit, wound culture, reoperation, and documentation of SSI, and in colorectal surgeries prolonged hospitalization, readmission, and ordering wound or blood cultures. Area under the curve was >90%. The sensitivity and specificity (95% CI) of the screening tool were 98% (88-100) and 58% (53-62), for abdominal hysterectomy, 91% (81-96) and 82% (80-84) in orthopedic surgeries and 96% (90-98) and 62% (58-66) in colorectal surgeries. The corresponding values for the validation dataset were 89% (67-97) and 75% (69-80) in abdominal hysterectomy; 85% (72-93) and 83% (80-86) in orthopedic surgeries and 98% (93-99) and 59% (53-64) in colorectal surgeries. The number of files needed to be fully reviewed declined by 61-66. The presented semi-automated simple screening tool for SSI surveillance had good sensitivity and specificity and it has great potential of reducing workload and improving SSI surveillance.

1218. Genotypic Investigation of a Rotavirus Cluster at a Pediatric Hospital in 2022

Abstract Background Rotavirus group A (RVA) was the most common cause of infectious gastroenteritis among young children before introduction of rotavirus vaccine in the United States in 2006. Following widespread vaccination, U.S. hospital acquired (HA) rotavirus cases are rare. We describe a cluster of rotavirus infections in a pediatric hospital with a genotype uncommon among U.S. children. Methods Patient cases of HA gastrointestinal (GI) illness were detected through hospital-wide microbiology surveillance, performed by Infection Prevention and Control (IPC) practitioners per state requirements. Cluster procedures were implemented on a unit when 3 cases were identified by symptoms and/or laboratory tests within 48 hours. Due to the current rarity of rotavirus clusters, the hospital partnered with Centers for Disease Control and Prevention (CDC) laboratories to sequence strains in addition to instituting local control measures. RVA strains were genotyped by using the genotype specific qRT-PCR assays for VP7 and VP4 genes. Next Generation Sequencing (NGS) was performed for RVA strain characterization on Illumina MiSeq. Genotypes for all 10 RVA were determined by NCBI’s BLASTN program. Results Epidemiologic surveillance identified a rotavirus cluster of 10 patients aged 10 months to 10 years old, of whom 50% had received rotavirus vaccine. Symptoms included emesis and diarrhea. Cases could not be attributed to vaccine related shedding. All patients had epidemiologic links by contiguous bed spaces or shared care teams. Sequencing was conclusive for 9 of the 10 stool samples to be a G9P[4] genotype, which is rarely detected amongst U.S. children. Local control measures of increased education and cleaning, isolation of positive patients in single rooms, use of soap and water instead of alcohol-based hand sanitizer on room exit, and furlough of symptomatic healthcare workers halted transmission. Conclusion Routine surveillance of HA GI illness identified a cluster; RVA strain genotyping and characterization identified unusual rotavirus genotype G9P[4] as the cause. Partnership between IPC practitioners and laboratorians with CDC demonstrated the need to enhance infection prevention measures to halt transmission and identified a rare rotavirus strain as the likely cause of the cluster. Disclosures Courtney E. Comar, PhD, Pfizer: Stocks/Bonds|Viatris: Stocks/Bonds.

Are emojis ready to promote the WHO 5 moments for hand hygiene in healthcare?

BackgroundHand hygiene is universally recognized as a cornerstone measure for the prevention of healthcare-associated infections. Although the WHO “My five Moments for hand hygiene” poster has been used for more than a decade to delineate hand hygiene indications and promote action, adherence levels among healthcare workers are still notoriously low and disquieting. To compensate for the lack of effective hand hygiene communication, we aimed to evaluate emojis as possible surrogates for the non-verbal aspects of hand hygiene behaviour.MethodsFollowing a thorough review of the Unicode version 12.0, the most applicable emojis to the terms used in the WHO 5 Moments poster were extracted. We developed a self-administered questionnaire to assess the view of infection prevention and control (IPC) practitioners regarding the use of emojis to show the WHO 5 Moments. Completed questionnaires were collected and analysed to determine the suitability of the existing emojis to illustrate a unified emoji poster. Data were analysed using R (version 3.6.3).ResultsA total of 95 IPC practitioners completed the questionnaire from May to October 2019 from different countries. Of these, 69 (74%) were female, and the mean age of the participants was 44.6 ± 10.87 years. We found appropriate emojis for six of the words used in the poster, including for touching (72%), for patient (63%), for clean (53%), for procedure (56%), for body fluid (58%), and for exposure risk (71%). The existing emojis proposed for the words “hygiene”, “aseptic”, and “surrounding” seemed to be less satisfactory.ConclusionsIn summary, the findings of this study indicate that the existing emojis may not be able to substitute the words used in the WHO 5 Moments poster. Emojis might be helpful to address hand hygiene indications in healthcare that may eventually play a role in promoting this measure. However, emojis should be further studied to choose the most appropriate ones and avoid ambiguity and misinterpretation. More emojis to convey health related messages are needed. We recommend further research in this area to evaluate the effect of using emojis in healthcare-related behaviours.

COVID-19-Impfstrategien für Beschäftigte deutscher Kliniken: Ergebnisse einer Befragung von Leitungen der (Krankenhaus‑)Hygiene im Rahmen des B-FAST-Projektes

ZusammenfassungHintergrund und ZielZu Beginn der COVID-19-Impfkampagne in Deutschland wurden Beschäftigte in medizinischen Einrichtungen aufgrund des hohen Expositionsrisikos und des Kontakts mit vulnerablen Gruppen priorisiert gegen SARS-CoV‑2 geimpft. Die Krankenhäuser waren angehalten die Impfungen ihrer Beschäftigten möglichst schnell zu organisieren und durchzuführen. Ziel der vorliegenden Arbeit war es, die Impfstrategie für die Mitarbeitenden deutscher Kliniken zu erfassen.MethodenIn einer Querschnittstudie mit selbstentwickeltem Fragebogen wurden die Leitungen der (Krankenhaus‑)Hygiene aller deutschen Universitätskliniken sowie der Nicht-Universitätskliniken in Niedersachsen und Bayern im März 2021 befragt. Die Daten wurden nach den beiden Versorgungsstufen stratifiziert.Ergebnisse100 von 416 versendeten Fragebögen wurden vollständig ausgefüllt (Universitätsklinik: 33, Nicht-Universitätsklinik: 67). Universitätskliniken berichteten von einer größeren Impfkapazität als Nicht-Universitätskliniken, ein begrenzender Faktor waren die ungewissen Impfstofflieferungen. 89 % der Kliniken planten Informationskampagnen zum Thema Impfung oder hatten diese bereits durchgeführt. 70 % gaben an, keine Antikörpertests bei geimpften Beschäftigten durchführen zu wollen. Eine Nachverfolgung geimpfter Beschäftigter zur Detektion möglicher SARS-CoV-2-Infektionen mittels Erregernachweis durch PCR wurde von 41 % geplant. Im Falle des Nachweises einer SARS-CoV-2-Infektion bei geimpften Beschäftigten hatten 72 % weitere Diagnostik geplant.DiskussionAlle Krankenhäuser konnten eine schnelle Umsetzung der COVID-19-Vakzinierung ihrer Beschäftigten erreichen. Zum Zeitpunkt der Befragung gab es große Unsicherheit bezüglich des Umgangs mit Durchbruchsinfektionen und der Notwendigkeit von Auffrischimpfungen.

Experiences and Resilience of Hygiene Team Members During the SARS-CoV-2 Pandemic

In compliance with German data protections regulations, we conducted an anonymous survey among participants of the annual infectious disease and control meeting in Freiburg, Germany in October 2021. We report the results of nurse and physician members of infection control teams on their perceptions and emotions during the pandemic. Descriptive statistics and Chi Square Test with P<0.05 (SPSS Statistics Standard Version) were used when applicable. Of the 391 of 750 distributed surveys, 391 were returned; 48% were infection control practitioners (IP), 12% Link Nurses (LN), 12% Board Certified Hospital Epidemiologists (HE), 17% infection control-trained physicians (ITP), 1% Occupational Health or Public Health specialists and 10% others. 72% were female, 25.3% male, 0.2% divers and 2.5% gave no answers. The 349 members of infection control teams (IP, LN, HE, ITP) reported a high level of competency, importance and appreciation and a low rate of anxiety or hopelessness. A quarter reported anger and frustration which nevertheless did not result in reduced motivation. Information provided by the German national health agency Robert Koch-Institute (RKI) was utilized most by participants. Social media, on the other hand, were criticized frequently. Cooperation within the institution and local public health authorities was good. Free text answers regarding lessons learned showed wide potential for improvement. Our survey results indicate a high level of resilience among members of infection control teams in German medical institutions despite obvious shortcomings in supplies during the first wave of the pandemic. The high level of self-perceived competency and appreciation possibly helped deal with the situation and prevented the feeling of loss of control implied in the question items "feeling overwhelmed" and "hopeless". However, the lessons learned from the pandemic need to be implemented to maintain this high level of resilience not only for infection control teams but the medical system in general.

The Related Factors of Adherence to Infection Prevention and Control Practices in Dental Clinics during the Coronavirus Disease 2019 Epidemic

Objectives: The objective of this study was to determine the related factors of adherence to infection prevention and control practices (IPCPs) in dental clinics during the Coronavirus disease 2019 (COVID-19) epidemic. Methods: We surveyed 137 dental hygienists working in dental clinics in November 2021. We considered demographic characteristics, workplace characteristics, COVID-19 experiences, and motivation to IPCPs as independent variables. We performed multivariable regression modeling for adherence to IPCPs using the stepwise-selection method. Results: Dental hygienists properly adhered to recommended IPCPs if they were 30 years old or above (B = 0.31, p = 0.014), if their clinic employed infection control practitioners (B = 0.79, p = 0.001), and if they gained a will to adhere IPCPs after treating patients who were very conscious about hygiene (B = 0.26, p = 0.020). The interaction between dental hygienists’ age and the employment status of infection control practitioners was significant (p = 0.047). Conclusions: During the COVID-19 epidemic, dental hygienists’ age, the employment status of infection control practitioners in clinics, and their motivation to adhere IPCPs after treating patients who were very conscious about hygiene were significantly associated with their adherence to recommended IPCPs.

Strategies to improve the implementation of infection control link nurse programmes in acute-care hospitals

Infection control practitioners face several challenges when implementing infection control link nurse (ICLN) programmes. Identification of strategies to address these can improve the impact of current ICLN programmes and guide their future implementation. We aimed to identify implementation strategies for ICLN programmes in acute-care hospitals with the Consolidated Framework for Implementation Research (CFIR)-Expert Recommendations for Implementing Change (ERIC) Implementation Strategy Matching tool. An expert panel matched 19 implementation and sustainment barriers, identified in our previous studies, to the most fitting CFIR constructs. Subsequently, we applied the CFIR-ERIC Matching Tool and generated a list of implementation strategies to address these barriers. Barriers were predominantly found within the CFIR domains 'inner setting' (characteristics of the implementing organization) and 'process' (stages of implementation). With the ERIC Matching Tool, we identified the 10 most important strategies to address barriers of implementation of ICLN programmes: identify and prepare champions, conduct local consensus discussions, assess for readiness and identify barriers and facilitators, inform local opinion leaders, use facilitation, create a learning collaborative, conduct local needs assessments, develop a formal implementation blueprint, build a coalition, and identify early adopters. The CFIR domains 'inner setting' and 'process' appeared to be the most important to impede implementation of ICLN programmes in acute-care hospitals. Application of the CFIR-ERIC tool highlighted the identification and preparation of champions as the leading strategy for the successful implementation of these programmes. With this tool, strategies can be specifically tailored towards local implementation and sustainment barriers.

COVID-19 vaccination strategy for hospital staff in Germany: a cross-sectional study in March–April 2021

BackgroundSARS-CoV-2 vaccination for healthcare workers (HCWs) started in Germany in December 2020. Hospitals had little time to prepare a vaccination strategy.AimTo gather information on the initial vaccination strategy for HCWs from the infection control practitioners in Germany.MethodsA cross-sectional, ethically approved questionnaire was developed, formatted as an online survey and pre-tested. Infection control practitioners responsible for hygiene/infection prevention in 987 randomly selected German hospitals were invited to participate in the survey in March and April 2021. For statistical analysis, the hospitals were categorized into two groups based on bed capacity (<500 beds: small; ≥500 beds: large).FindingsOne hundred out of 987 (10%) infection control practitioners completed the survey. In 80% of the participating hospitals, HCW vaccination prioritization was based on recommendations of the German standing committee on vaccination (STIKO). Even so, only 54% prioritized the vaccination of HCWs with contact to vulnerable patients, thus deviating from STIKO recommendations. HCWs with a high personal health risk were prioritized for vaccination in 24% of the hospitals. Transferring unvaccinated HCWs to an area with less infection risk was considered by 2% of large and 12% of small hospitals.ConclusionVaccination prioritization differed across hospitals and deviated from STIKO recommendations. A pandemic preparedness concept should address the potential impact of divergent strategies compared to a common approach. In addition, further studies analysing the reasons why HCWs remain unvaccinated are needed to adopt effective strategies. This is especially important against the background of facility-based compulsory vaccination.

Perceptions and emotions of infection control team member during the COVID-19 pandemic in Germany

Background: We conducted an anonymous survey in compliance with German data protections regulations among participants of the annual infectious disease and control meeting in Freiburg, Germany, in October 2021. Methods: In total, 391 surveys were returned: 188 from nurse infection control practitioners (ICPs) and 66 from specially infection control trained physicians (STPs). We report the results of these 2 subgroups regarding their perceptions and emotions during the pandemic. Descriptive statistics and χ2 test with P &lt; .05 were used when applicable. Results: Shortages of medical masks or FFP2 masks during the first pandemic wave in 2020 were reported by 48.5% STPs and 57.4% ICPs. STPs and ICPs relied equally on information provided by the Robert Koch Institute, the WHO, the ECDC and the CDC. Occupational health information was sought significantly more often by ICPs; only 17% of ICPs never used this source versus 51.5% of STPs (P &lt; .001). Most ICPs (58%) and STPs (51%) described their relationship to local authorities as good as well as communication with institutional leaders (69.7%). Fewer ICPs (36.1%) felt frequently appreciated during the pandemic compared to 45.5% of STPs and more ICPs (25%) reported frustration than STPs (18.2%). However, the differences were not statistically significant. Rarely, ICPs (2.1%) or STPs (1.5%) felt unsafe at work and only 1.6% of ICPs and no STPs reported loss of motivation. In addition, 13.8% of ICPs and 12.1% of STPs often felt overwhelmed, but only 3.2% of ICPs and no STPs felt hopeless. Their self-reported competency was rated as high by 75% of ICPs and 69.7% of STPs. The 5 most frequent free-text comments regarding “lessons learned” pertained to better crisis communication, better supply chain management, precise regulations, “less talking more doing,” and mandatory vaccination. The most frequent free-text general comments pertained to maintain basic hygiene measures in private and public life because of the pandemic. Conclusions: Our survey results indicate a high level of resilience among members of infections control teams in German medical institutions despite obvious shortcomings in supplies during the first wave of the pandemic. There were no significant differences between physician and nurse members of infection control teams regarding their perceptions and emotions, indicating a homogenous situation within the teams. The high level of self-perceived competency has likely helped deal with the pandemic and prevented the feeling of loss of control implied in the question items “feeling overwhelmed” and “hopeless.”Funding: NoneDisclosures: None