Infection Prevention Research Articles

Failure mode and effects analysis-based strategies for controlling multidrug-resistant organism infections in cancer patients.

In the context of advancing medical procedures, postoperative infections in cancer patients, particularly those involving multidrug-resistant organisms, have become a significant clinical concern. This study aims to comprehensively and systematically evaluate the effectiveness of infection prevention and control for multidrug-resistant organisms (MDROs) in postoperative cancer patients using Failure Mode and Effects Analysis (FMEA). This study was conducted in a tertiary A-level cancer specialty hospital in China, employing Failure Mode and Effects Analysis (FMEA) to assess the risks of hospital infections. Intervention measures were implemented for high-risk and medium-high-risk factors. Through the hospital's infection information system, data on patients who underwent surgical treatment from 2017 to 2022 were extracted. Data from 2017 to 2019 served as the control group, and data from 2020 to 2022 as the intervention group, to compare the changes in hospital infection incidence and MDRO infection incidence before and after the intervention. Categorical data were described in terms of frequency and percentage. The chi-square test was utilized for statistical inference to assess the differences in infection rates before and after the intervention. Prior to the intervention (2017-2019), the incidence rate of hospital infections was 1.66%, which decreased to 1.22% after the intervention (2020-2022), showing a statistically significant difference (χ2 = 48.83, P < 0.001). The incidence rate of MDRO infections also decreased from 1.808‰ before the intervention to 1.136‰ after the intervention, with a statistically significant difference (χ2 = 11.417, P = 0.001). This study confirms the effectiveness of the FMEA method in preventing and controlling MDRO infections in postoperative cancer patients. It highlights the practicality and value of widespread adoption of this method, particularly in the context of the COVID-19 pandemic.

Management of zoonoses in research institutions - lessons learned from a Coxiella burnetii outbreak case.

When biomedical research investigates the human surgical situation in the need of a chronic course, it is more often possible to do so using large animal models. The use of farm animals always poses special challenges for the institution conducting the research in terms of infection prevention and occupational safety. Especially for the zoonotic disease coxiellosis it is important to be aware of the constant risk of pathogen introduction by small ruminants and to take appropriate precautions. In this way, personal injury should be avoided or at least be kept to a minimum in the event of infection since then sustainable zoonosis control can be immediately initiated. Using the example of a Q fever outbreak at a research facility, we want to share with this extended case report the importance of central emergency structures, provisions and the inclusion of relevant experts and disciplines in a crisis team. Its primary purpose is to support the affected facility and coordinate the implementation of necessary cleaning, disinfection and decontamination measures in close contact with the responsible local authorities. The aim is to inactivate the pathogen in a systematic and controlled manner in few steps of action only and to keep the interruption of the facility's operations as short as possible.

Production of recombinant norovirus VP1 protein and its antigenic and immunogenic properties

Introduction. The importance of noroviruses in human infectious pathology and the danger of large epidemic outbreaks in organized groups determine the need to develop means of specific prevention of infection. The aim of the study was to obtain recombinant norovirus VP1 protein and analyze its immunogenic and antigenic properties . Materials and methods. Computer analysis of nucleotide and amino acid sequences, molecular cloning, polymerase chain reaction, electrophoresis of nucleic acids in agarose gel and proteins in polacrylamide gel, affinity chromatography, enzyme immunoassay. Results and discussion. A genetic construct encoding recombinant VP1 of the GII genotype norovirus with codons optimized for highly effective expression in Escherichia coli has been created. The strain of E. coli Rosetta 2 (DE3) has been transformed by genetic construct. VP1 expression was carried out in E. coli cells, conditions for its production, purification and renaturation were optimized. A purified soluble recombinant VP1 protein forms virus-like particles with a diameter of 30–50 nm. Immunization of BALB/c mice by protein lead to antibodies production with a titer greater than 1 : 1000. When evaluating antigenic properties, it was shown that human IgG, IgM, and IgA antibodies interact with recombinant VP1. The total antibody detection rate was 47,4%. The results indicate the possibility of using recombinant VP1 for development of domestic vaccine for the prevention of norovirus infection.

Multiplex real-time PCR for detection of &lt;i&gt;qac A/B&lt;/i&gt; and &lt;i&gt;smr&lt;/i&gt; genes in Gram-positive bacteria

Background. Disinfectants are effective means of non-specific prevention of infections associated with the provision of medical care. Violation of disinfectant use regimes leads to the formation of microorganism resistance to them. To monitor the spread of clinically significant microorganisms resistant to disinfectants, the development of methods for their detection, including molecular genetic methods, remains relevant. The aim of the study was to develop a multiplex real-time PCR for the identification of qacA/B and smr genes, the determinants of resistance to cationic biocides, in Gram-positive bacteria. Materials and methods. Conserved regions of qacA, qacB and smr genes were searched, and primers and probes were designed using BLASTN, GeneRunner, and Multiple Primer Analyzer programs. To evaluate the analytical sensitivity of the multiplex PCR, plasmids pTZ57-qacA/B, pTZ57-smr, and pTZ57-16S containing qacA/B, smr and 16S rRNA gene fragments of 197 bp, 127 bp, and 287 bp, respectively, were constructed. The method was tested on clinical isolates of Gram-positive bacteria (n = 30). Results. A multiplex real-time PCR using TaqMan probes was developed for the detection of qacA/B and smr genes in Gram-positive bacteria. The 16S rRNA gene was used as an internal amplification control. The sensitivity of the multiplex PCR was 103 copies for all genes. Multiplex PCR validation showed that qacA/B genes were present in 30%, smr genes were present in 10% of the isolates tested. The reproducibility of the results was 100%. Conclusion. The developed multiplex PCR differs from existing assays by high specificity and short turnaround time, as well as by the presence of an internal amplification control. It can be used for the detection of Gram-positive bacteria potentially resistant to cationic biocides.

Development of COVID-19 Infection Prevention and Control Training Program Based on ADDIE Model for Clinical Nurses: A Pretest-Posttest Study.

Scientific and effective training is important to enhance the theoretical knowledge and practical skills of clinical nurses in coronavirus disease 2019 (COVID-19) prevention and control (IPC), so as to improve the IPC capacity. The study aimed to design and implement a COVID-19 IPC training program for clinical nurses based on the ADDIE model, and to evaluate its clinical application effects. This was a pretest-posttest study in which 389 clinical nurses were recruited through convenience sampling. The IPC training program for clinical nurses was developed based on the five stages of ADDIE model. Data were analyzed using pared-sample t test, McNemar's test, and Wilcoxon test. After training, nurses' theoretical scores and operational scores except for hand hygiene were improved significantly (p < 0.001). Compared to pre-training assessment, their job performances were also significantly improved (p < 0.001). And they had higher satisfaction with the program post-training. Under the situation of COVID-19, training based on the ADDIE model can effectively improve the IPC ability of clinical nurses. Besides, it provides new ideas, methods, and approaches for future clinical IPC training.

Crimean-Congo haemorrhagic fever among healthcare workers in Iran 2000-2023, a report of National Reference Laboratory.

Crimean-Congo haemorrhagic fever (CCHF) is a lethal acute viral zoonosis with a case fatality rate of 5-50%. Due to the potential of human-to human transmission of the disease, healthcare workers (HCWs) are at risk of occupational exposure to CCHF virus. Little is known about CCHF virus route of transmission and risks in Iranian HCWs. Therefore this study was designed to identify the routes of exposure to the CCHF virus among Iranian HCWs. From Oct 2000 to Feb 2023, 96 CCHF suspected healthcare workers referred to national reference laboratory were tested for CCHF virus infection by the use of RT-PCR and IgM Capture Enzyme-Linked Immunosorbent Assay (MAC-ELISA) and exposure history of cases were investigated to determine the CCHF virus routes of transmission in nosocomial settings. Twelve CCHF confirmed cases were identified including seven nurses and five physicians, with the median age of 32.5 years (range 23-53 years) and the median incubation period of 6.8 days (range from 1 to 22 days). None of the cases reported a history of tick bite or close contact with tissues or animal blood. The cases were from Razavi Khorasan (seven cases), Sistan and Baluchistan (two cases), Isfahan (one case), South Khorasan (one case) and Fars (one case). Percutaneous exposure (needle stick) (three cases), mucosal exposure (blood splash in to face) (three cases) and skin contact with blood (three cases) constituted the most prevalent routes of transmission. Since 2013, no CCHF cases have been identified among Iranian HCWs. In healthcare settings, physicians and nurses are at risk of nosocomial CCHF virus infection. The routes of transmission mainly include direct exposures via needle-stick, mucosal or direct contact with the skin to infected blood. Continuous education and implementation of infection prevention and control measures are key factors to minimize the incidence of healthcare related CCHF.

A multicentric survey and single-centre observational study of usage behaviour of sinks in intensive care: training is needed to minimize risk

IntroductionSinks have been introduced near patients to improve hand hygiene as part of infection prevention and control measures. However, sinks are a known reservoir for gram-negative bacterial pathogens in particular and their removal to prevent bacterial infections in intensive care patients is currently recommended by several international guidelines.MethodsHealthcare workers (HCWs) in 15 intensive care units (ICUs) in Germany were given the opportunity to complete an anonymous survey on the use of sinks between August 2022 and January 2023. Observations were then made in three participating ICUs to determine the frequency and reason for contact with the sink.Results258 questionnaires were returned (nurses 87%). 90% found it useful to very useful to have a sink in the patient room, and 56% reported using it daily for hand hygiene. We observed 33 contacts between nurses and sinks over 17 h. In 20/33 (60%) cases, the sink was used for waste disposal. In 3/33 (10%) it was used for hand washing.DiscussionSinks are still used for daily care in intensive care units. Educational Interventions in existing buildings to minimise risk through “sink hygiene” (i.e. separation of sinks for water disposal and uptake) can make an important contribution to infection prevention.

Nursing Interventions for Preventing Hospital-Acquired Infections

Hospital-acquired infections (HAIs) are a significant contributor to patient morbidity, mortality, and healthcare costs. With an increasing emphasis on patient safety and infection control, nursing interventions play a vital role in reducing the incidence of HAIs. This systematic review and meta-analysis evaluated the effectiveness of nursing-led interventions in preventing HAIs, focusing on four primary strategies: hand hygiene, aseptic technique, environmental cleaning, and patient education. A total of 52 peer-reviewed studies, including over 50,000 patient cases across various healthcare settings, were analyzed. The meta-analysis revealed that hand hygiene adherence led to a 35% reduction in HAIs, with an odds ratio (OR) of 0.65 (95% CI: 0.54–0.79). Structured training in aseptic techniques for invasive procedures correlated with a 40% reduction in catheter-associated infections (OR: 0.60, 95% CI: 0.50–0.75), while enhanced environmental cleaning protocols decreased HAI rates by 30% (OR: 0.70, 95% CI: 0.55–0.89). Patient education showed a 15% reduction in HAIs, although results were less statistically significant. These findings highlight the essential role of nursing interventions in infection control and underscore the need for continuous training, compliance monitoring, and institutional support. Future research should explore integrated infection prevention programs and technological innovations to improve adherence and expand patient education initiatives. Overall, nursing interventions remain crucial to achieving lower HAI rates and enhancing patient safety.

Plant resources for immunonutrients and immunomodulators to combat infectious respiratory viral diseases: a review.

Boosting the immune system has become a crucial aspect in the global battle against the COVID-19 pandemic and other similar infections to protect oneself against symptoms, especially in the prevention of viral infections of the lower respiratory tract. The importance of conducting more studies to create successful herbal formulations as infection prevention measures is emphasized in this review, which looks at the function of immune-boosting nutrients, medicinal plants, and herbal treatments. We reviewed and analyzed 207 studies published from 1946 to the present using reputable databases like Google Scholar, PubMed, and NCBI. The review examined 115 plant species in total and identified 12 key nutrients, including vitamins A, D, C, omega-3 fatty acids, iron, and zinc, while noting that four plant families, Rosaceae, Asteraceae, Amaryllidaceae, and Acanthaceae, show potential against respiratory infections like influenza, RSV, and SARS-CoV. To lower the risk of infection, it is recommended to consume nutritious meals that have immune-modulating qualities. Information on the bioactive components of medicinal herbs, spices, and plants that have been effective in treating respiratory viral infections and related conditions is compiled in this review, which highlights phytoactive substances with antibacterial and antiviral activity as effective modulators to lower the risk of infections. Furthermore, it is highlighted that ancient knowledge systems, like Ayurveda and Naturopathy, should be integrated to help develop new herbal formulations. To improve immunity and lessen vulnerability to serious respiratory infections, the results highlight the need for including immune-modulating foods and plant-based medicines into everyday routines.

Effect of an Add-On Multi-Strain Probiotic Formulation in the Prevention of Recurrent Urinary Tract Infections: A Double-Blind Randomized Placebo-Controlled Trial

Urinary tract infections (UTIs) present a significant health challenge for women globally, particularly due to high recurrence rates. This randomized, double-blinded, placebo-controlled study conducted at AIIMS Bhubaneswar, India, evaluated the effectiveness of a multi-strain lactobacilli probiotic formulation as an adjunct to standard antibiotic therapy in preventing recurrent UTIs. Fifty-one adult women (18–50 years) with recurrent UTIs received either the probiotic or a placebo for 24 weeks. The primary outcome was UTI recurrence, while secondary outcomes included the number of UTI episodes and changes in urinary nerve growth factor (NGF) and serum macrophage colony-stimulating factor (M-CSF) levels. The results showed a significant reduction in UTI recurrence in the probiotic group, with 75% remaining recurrence-free, compared to 33% in the placebo group (p = 0.007). The relative risk for recurrence absence was 2.67 (95% CI: 1.19–5.99). Although the mean number of UTI episodes decreased in the probiotic group, the difference was not statistically significant (p = 0.379). The urinary NGF and serum M-CSF levels significantly decreased from baseline in both groups, but there were no significant differences between them. This study suggests probiotics may be a valuable adjunct therapy for preventing recurrent UTIs.

Effectiveness of training on health care workers’ knowledge, attitude and practice regarding COVID-19 infection prevention and control, Yemen, 2021

BackgroundAlthough several training courses for Health Care Workers (HCWs) on COVID-19 were conducted in Yemen, no evaluation has been done to assess the effectiveness of such training on the Knowledge, Attitude and Practice (KAP) of HCWs. Therefore, this study aimed to assess the effectiveness of training on the KAP of HCWs toward infection prevention and control (IPC) for COVID-19, determine the relationship between the change in the KAP of HCWs, and identify the associated factors with the change in KAP.MethodologyA cross-sectional study was conducted from April to December 2021. It was conducted among 186 HCWs working at COVID-19 isolation centers and caring for COVID-19 patients, in all Yemen’s governorates. The data were collected one week before and immediately after the training session. SPSS version 26 was used for data entry and analysis. The median, interquartile range (IQR) and median difference were calculated. The Wilcoxon Signed Ranks Test was used to estimate the significant difference between KAP pre- and post-training scores. Kurskal-Wallis and Mann-Whitney U tests were used to assess the associated factors. Spearman’s correlation coefficient test was used to assess the statistical relationship between the change in KAP. A P value < 0.05 was considered statistically significant.ResultsOut of 186 HCWs, 181 HCWs filled the pre- and post-assessment, with a response rate of 97.3%. The median difference (IQR) in the KAP scores were 3.0 (1.0 and 6.0), 1.0 (-1.0 and 4.0) and 2.0 (-1.0 and 5.0), respectively. However, there are statistical difference in the KAP scores between the pre- and post-training (p value = 0.000, 0.004 and 0.000, respectively). There are significant positive correlations between the change in knowledge, attitude and practice (all p values < 0.01). A significantly change in knowledge was found among those working in epidemiological surveillance (p value = 0.031).ConclusionsThis evaluation concludes that the training program is effective in improving the KAP of HCWs toward IPC for COVID-19. It provides scientific evidence about the importance of training courses for HCWs during the COVID-19 pandemic. Further study is recommended to evaluate the retention of the KAP after a period of training.

Perceptions of distinctions between patient and healthcare zones among intensive care unit nurses at a Korean tertiary hospital: A cross-sectional study.

Intensive care unit (ICU) patients face higher infection risks from invasive procedures, highlighting the critical role of ICU nurses in infection prevention. Clear differentiation between the patient and healthcare zones is essential for effective hand hygiene and disinfection, yet research on this topic is limited. To assess ICU nurses' perception of the concept of patient and healthcare zones and evaluate their similarity and accuracy in identifying the zones. A descriptive survey was conducted at a 2,732-bed tertiary hospital in Korea from 28 July to 27 August 2022. Participants were recruited from various ICUs through flyers. 225 questionnaires-with illustrations 27 item locations for three ICU scenarios-were made available at nursing stations for voluntary completion. Participants were asked to classify items into the patient zone or the healthcare zone. Similarity scores reflected participant agreement, while accuracy scores measured the proportion of correct answers. Participants' free-text opinions regarding zone classification were analysed thematically. 104 nurses participated voluntarily. Average similarity and accuracy were 84.7% and 82.7%, respectively. The top 8 items, with over 97% similarity and accuracy, were all frequently in contact with ICU patients (e.g., pulse oximeter, Levin tube, central line, urine bag, and patient bed). The bottom 7 items, with less than 80%, included the glucometer, flashlight, trolley, and sink. Participants with higher education levels had significantly higher similarity (p = .044) and accuracy (p = .033), whereas those already familiar with the patient-zone concept had significantly higher accuracy (p = .009). From the free-text analysis, participants considered factors beyond proximity to the patient, such as patient contact, room type, and distance. To address zone classification challenges, clear criteria for patient and healthcare zones, space redesign, and educational programs are recommended. Further research is necessary to improve greater clarity and consensus regarding patient and healthcare zones to enhance infection control practices.

Protective threshold of a potent neutralizing Zika virus monoclonal antibody in rhesus macaques.

Zika virus (ZIKV) is a mosquito-borne flavivirus that caused a global pandemic in 2016-2017 with continued ongoing transmission at low levels in several countries. In the absence of an approved ZIKV vaccine, neutralizing monoclonal antibodies (mAbs) provide an option for the prevention and treatment of ZIKV infection. Previous studies identified a potent neutralizing human mAb ZIKV-117 that reduced fetal infection and death in mice following ZIKV challenge. In this study, we report exquisite potency of ZIKV-117-LALA-YTE, which has been engineered to reduce Fc receptor binding and to extend half-life, in a titration study in rhesus macaques to protect against ZIKV challenge. We show complete protection at a dose of 0.016 mg/kg ZIKV-117-LALA-YTE, which resulted in median serum concentrations of 0.13 µg/mL. The high potency of this mAb supports its potential clinical development as a novel biotherapeutic intervention for ZIKV.IMPORTANCEIn this study, we report the potency of the Zika virus (ZIKV)-specific neutralizing antibody ZIKV-117-LALA-YTE against ZIKV challenge in a titration study rhesus macaques. This high potency supports the further development of this monoclonal antibody for ZIKV.

Laboratory detection of carbapenemases among Gram-negative organisms.

SUMMARYThe carbapenems remain some of the most effective options available for treating patients with serious infections due to Gram-negative bacteria. Carbapenemases are enzymes that hydrolyze carbapenems and are the primary method driving carbapenem resistance globally. Detection of carbapenemases is required for patient management, the rapid implementation of infection prevention and control (IP&C) protocols, and for epidemiologic purposes. Therefore, clinical and public health microbiology laboratories must be able to detect and report carbapenemases among predominant Gram-negative organisms from both cultured isolates and direct from clinical specimens for treatment and surveillance purposes. There is not a "one size fits all" laboratory approach for the detection of bacteria with carbapenemases, and institutions need to determine what fits best with the goals of their antimicrobial stewardship and IP&C programs. Luckily, there are several options and approaches available for clinical laboratories to choose methods that best suits their individual needs. A laboratory approach to detect carbapenemases among bacterial isolates consists of two steps, namely a screening process (e.g., not susceptible to ertapenem, meropenem, and/or imipenem), followed by a confirmation test (i.e., phenotypic, genotypic or proteomic methods) for the presence of a carbapenemase. Direct from specimen testing for the most common carbapenemases generally involves detection via rapid, molecular approaches. The aim of this article is to provide brief overviews on Gram-negative bacteria carbapenem-resistant definitions, types of carbapenemases, global epidemiology, and then describe in detail the laboratory methods for the detection of carbapenemases among Gram-negative bacteria. We will specifically focus on the Enterobacterales, Pseudomonas aeruginosa, and Acinetobacter baumannii complex.

Integrating an Ethics Advisory Committee Into Public Health Response: A Case Study of COVID-19, Infection Prevention and Control, and Essential Work in the United States.

A lack of infection prevention and control protections for essential industries in the United States led to increased risk and incidence of COVID-19 among essential workers during the COVID-19 pandemic. When the nation deems an industry essential during a disease outbreak, an ethical obligation exists to safeguard the health of workers who are at increased risk of being exposed to disease. The Global Center for Health Security at the University of Nebraska Medical Center began work to rapidly develop and disseminate infection prevention and control guidance for essential industries, such as meat processing. The Global Center for Health Security established an ethics advisory committee to support COVID-19 response efforts. The ethics advisory committee supported the development of guidance on infection prevention and control to promote justice, reciprocity, health, safety, and equity for workers in the meat processing industry. Our experience highlighted the fundamental role of ethical analysis in public health response efforts, but ethical analysis in this case required an interdisciplinary approach, including the need for effective community-relevant solutions. The integration of an ethics committee into public health emergency response efforts can address ethical concerns for workers in industries that must remain operational during public health emergencies.

SHEA practice update: infection prevention and control (IPC) in residential facilities for pediatric patients and their families.

In 2011, the Society for Healthcare Epidemiology of America (SHEA) and Ronald McDonald House Charities® (RMHC®) established a formal collaboration to develop the first IPC guideline. Both organizations agreed that RMH programs staff and other organizations operating similar programs would benefit from a standardized approach. In 2023, the collaboration was re-established to revise and update the original IPC guideline. This SHEA Practice Update on "Infection Prevention and Control (IPC) in Residential Facilities for Pediatric Patients and Their Families" addresses preventing transmission of infectious agents in "home away from home" residential settings, of which the Ronald McDonald Houses (RMHs) serve as a prototype.

Reevaluating antibiotic prophylaxis: insights from a network meta-analysis on dry socket and surgical site infections.

Three databases (MEDLINE, Cochrane Library, and Scopus) were searched in December 2021 for 16 Randomised Clinical Trials (RCTs). Three reviewers reviewed the articles on oral antibiotic prophylaxis (ABP) for the prevention of surgical site infection (SSI) and dry socket (DS) after lower third molar (L3M) extraction using the PICO framework. From 1999 to 2021, RCTs involving healthy patients undergoing L3M extraction with ABP, placebo, or no therapy were included. Adverse effects (AEs) associated with antibiotic usage, along with the main outcomes (DS and SSI), were also documented. Three independent investigators selected articles based on pre-established inclusion criteria, with any disagreements resolved by consensus or additional researchers. PRISMA guidelines were followed, involving initial title and abstract screening, followed by full-text evaluation. Exclusion reasons were documented, and the most recent report was included when multiple reports on the same patients were found, with no language restrictions applied. Two investigators evaluated studies quality and quality of evidence respectively using the Cochrane Collaboration tool and GRADEpro GDT. They independently extracted data, focusing on the type of extraction and the number of extracted L3M. They also detailed the use of antibiotics, including dosage, dosage regimen, timing, and duration. Among 16 articles, 15 used a parallel arm design, while one used a crossover design. The antibiotics studied included Amoxicillin+Clavulanic acid (7 articles), Amoxicillin (6), Metronidazole (2), Azithromycin (1), and Clindamycin (2), all compared with no treatment or placebo. A pairwise meta-analysis was used to combine studies with equivalent treatment (direct estimation), and a network meta-analysis compared outcome variables across different treatments (indirect comparison). Two included articles had a low risk of bias and the level of evidence was low according to GRADE. Pooled results supported the use of antibiotics to reduce DS and SSI following L3M extraction with a number needed to treat 25 and 18, respectively. Despite the fact that ABP reduces the risk of DS and SSI, it is recommended to consider systemic conditions and individual patient risk factors before prescribing antibiotics, due to global health threat.

Perspective on WHO implementation guidance on TB infection prevention and control.

Perspective on WHO implementation guidance on TB infection prevention and control.

Effects of establishing infection control program with core components of World Health Organization on reducing the risk of residents’ infections and improving staff infection control competency in a nursing home

BackgroundNursing homes (NHs) are high-risk facilities with limited infection control resources and residents susceptible to infectious diseases. The evidence regarding World Health Organization (WHO) core components in NHs is lacking. This study evaluates the effectiveness of establishing an infection prevention and control (IPC) program with WHO’s core components in an NH.MethodsThe IPC program, encompassing evidence-based guidelines, education and training, surveillance, multimodal strategies, monitoring and feedback, workload and staffing considerations, and the built environment, was implemented in a 130-bed NH for one year. The effects were assessed based on the number of infections among residents, the level of knowledge, and the performance of infection control among staff. The risk of infection was analyzed across three phases: pre-implementation phase, implementation phase (6 and 12 months after intervention initiation), and sustainability phase (3, 6, and 12 months after intervention was finished). Staff data were analyzed before and after the intervention.ResultsAnalysis of 18,124 resident-days revealed that during the sustainability phase, the risk of respiratory tract infection was significantly lower than before intervention implementation (odds ratio [OR] 0.51, 95% CI 0.30–0.86, p = 0.012). Moreover, a significant improvement was observed in staff knowledge (p = 0.002) and performance (p < 0.001) after the intervention compared to before.ConclusionsWHO’s core components may have a potential effect on reducing healthcare-associated infections among residents and enhancing the infection control competency of staff in the NH with limited IPC resources.

EDI&amp;S SO05 Barriers to delivering a net zero NHS: An evaluation of Sustainability in Surgery across the Midlands

Abstract Background The healthcare sector is under increasing scrutiny for contributing approximately 4.6% of the UK’s total carbon footprint and 25% of the public sector’s carbon footprint. With support from the UK Health Alliance on Climate Change, the NHS aims to reach a net zero carbon target by 2045 through its Greener NHS campaign. This study aimed to identify key barriers to implementing sustainable practices in the surgical environment. It involved reviewing Green Plans published by Integrated Care Systems (ICSs) in the Midlands, conducting a thematic analysis of relevant literature, and surveying key stakeholders within NHS Trusts in the Midlands. Method Between June and September 2023, Green Plans from 11 ICSs across the Midlands were evaluated by two reviewers for the inclusion of the "key areas of focus" outlined by the NHS Green Plan Guidance. Additionally, three computerised searches were conducted using Ovid MEDLINE and Embase to retrieve abstracts published before May 2023 on reusable surgical gowns, re-sterilisation of surgical energy devices, and operating theatre waste management. Three reviewers screened the abstracts to identify barriers to implementing change. Based on these findings, a framework was developed for the “Supporting a Greener NHS Survey” and disseminated to key stakeholders in the Midlands. Results A heat map was created to assess compliance of each Green Plan with NHS England guidance (Figure 1). The literature search yielded 82 abstracts and key barriers to sustainability were identified as infection control, cost implications, instrument damage, and waste management practices. The survey received 89 responses; 45% did not use reusable drapes at their Trust, 35% did not use reusable gowns, 46% did not use reusable laparoscopic ports, and 59% didn’t know whether their energy devices were recyclable. Key barriers to implementing sustainable change included surgeon preference, financial constraints, and infection control concerns. Conclusion The literature analysis and survey of stakeholders in the Midlands identified several barriers to implementing sustainable changes. With national, regional and local organisational impetus coupled with clinical leadership commitment to sustainability, these barriers can be overcome with multi-disciplinary involvement. By investing in comprehensive training programmes and implementing rigorous quality control measures with input from infection prevention and control teams, clinical leaders and clinicians are best placed to help overcome these barriers and promote sustainability in the surgical environment.