Healthcare-associated Infection Rates Research Articles

Healthcare workers’ perceptions about infection prevention and control in Latin America

Limited information exists regarding health care workers' (HCWs) perceptions about infection prevention and control (IPC) in Latin America. We conducted an electronic voluntary anonymous survey to assess HCWs' perceptions toward IPC in 30 hospitals in Latin America during August to September 2022. Nurses, physicians, and environmental cleaning (EVC) staff were prioritized for recruitment. Overall, 1,340 HCWs completed the survey. Of these, 28% were physicians, 49% nurses, 8% EVC staff, and 15% had "other" roles. Self-compliance with hand hygiene and prevention bundles was perceived to be high by 95% and 89% of respondents, respectively; however, ratings were lower when asked about compliance by their peers (reported as high by 81% and 75%, respectively). Regular training on IPC and access to health care-associated infections (HAI) rates were more limited among physicians than other HCWs (eg, 87% of EVC staff and 45% of physicians reported training upon hiring and thereafter, 60% of nurses and 51% of physicians reported regular access to HAI rate reports). We identified several opportunities to strengthen IPC practices in Latin American hospitals, including improving HCW education and training on IPC and their awareness of HAI rates and compliance with prevention measures.

P-344. Nursing Home Rates of Healthcare-associated infections Requiring Hospitalization by Facility Characteristics and Staffing Levels, October 2021 – September 2022

Abstract Background Healthcare-associated infections (HAIs) contribute to substantial morbidity among nursing home residents. The Centers for Medicare and Medicaid Services (CMS) tracks and reports a rate of HAIs requiring hospitalization per 100 resident stays (HAI rate) annually for nursing homes that is risk standardized by the health status and characteristics of the at-risk residents for each nursing home. We aimed to measure factors, including staffing, associated with nursing homes’ HAI rates.Figure 1.Description of nursing home characteristics among 11,431 nursing homes with a risk-standardized rate of healthcare-associated infections requiring hospitalization in fiscal year 2022. Estimated change in annual risk standardized rate of healthcare-associated infections requiring hospitalization per 100 residents (HAI rate) and p-values are calculated from parameter estimates in a multivariable linear regression model. Methods Nursing home characteristics and the annual HAI rate from October 2021 – September 2022 were extracted from Nursing Home Compare. We described the distribution of nursing home characteristics including type of ownership, number of beds, urbanicity, ventilator care capability, location within hospital, and the minority health-social vulnerability index (MH-SVI) of the surrounding county. We quantified nursing homes as meeting minimum staffing standards if they reported ≥0.55 registered nurse hours per resident per day (HPRD), ≥2.45 nurse aide HPRD, and ≥3.48 total nurse staffing HPRD to reflect newly finalized CMS rules. Multivariable linear regression models were used to identify characteristics associated with the HAI rate. Results The median annual HAI rate reported for 11,431 nursing homes was 6.79 hospitalizations per 100 residents (Q1-Q3: 5.93-7.87). In multivariable models, all characteristics were associated with the HAI rate (Figure 1). For-profit ownership was associated with 0.66 more infections per 100 residents (95% CI: 0.58, 0.73). Nursing homes located in counties in the highest MH-SVI quartile had 0.44 more HAIs per 100 residents per year (95% CI: 0.34, 0.54) than those in the lowest quartile. The 1,956 (17%) nursing homes that met minimum staffing standards had an estimated 0.44 fewer infections per 100 residents annually (95% CI: -0.52, -0.37) compared to nursing homes that did not, reflecting a 6% decrease in risk in an average facility. Conclusion Meeting minimum staffing standards may reduce the rate of HAIs requiring hospitalization in nursing homes. Interventions and outreach efforts focused on increasing support for nursing homes in communities with high levels of vulnerability may also reduce inequities in the rate of HAIs which require hospitalization. Disclosures All Authors: No reported disclosures

P-419. The Epidemiology of Healthcare-associated Infections in Jordanian Hospitals before and after the COVID-19 Pandemic

Abstract Background The pandemic of COVID-19 resulted in an exceptional stress on the healthcare system. On the other hand, infection control measures were strengthened within the hospital settings. However, the effect on healthcare associated infections (HAIs) is still not clear, and data are still lacking. This study examines the rates of three HAIs [bloodstream infections (BSIs), Urinary tract infections (UTIs), and pneumonia] before the COVID-19 pandemics and compare them with corresponding rates after the pandemic. Methods HAI data were extracted from the national surveillance of HAIs conducted by the Ministry of Health in Jordan. Data for 18 ICUs in 3 tertiary care hospitals were extracted and analyzed for this objective. An active prospective surveillance of HAIs was implemented using US CDC NHSN case definitions. Pooled incidence rates of three HAIs during the pre-pandemic (July 2018–March 2020) and post-pandemic periods (June 2021–December 2023) were calculated and compared. Results During the study period, a total of 1642 HAIs were identified in 1624 patients for 302983 patient days. Male gender constituted 59.8% (412/689) among pre-pandemic patients compared to 61.6% (576/935) among post-pandemic patients (p value =0.4). Mean age of pre-pandemic patients was 44.68±1.12 years compared to 49.51± 0.88 years in the post-pandemic patients (p value =0.15). Specific HAI rates were significantly reduced after the pandemic compared to pre-pandemic period. Pooled pneumonia rate was reduced from 2.5/1000 patient-days to 1.4/1000 patient days (RR: 0.56; 95% CI, 0.47–0.67), UTI rate was reduced from 2.0/1000 patient days to 1.2/1000 patient days (RR: 0.59; 95% CI 0.49–0.71) and BSI rate from 2.6/1000 patient days to 2.6/1000 patient days to 2.0/1000 patient days (RR: 0.77; 95% CI 0.66–0.91). On the other hand, in hospital mortality rate for HAI patients significantly increased from 42.0% to 46.2% (p value =0.03). Conclusion Post COVID-19 period was associated with a significant reduction in HAI rates. This could be due to increased compliance of the healthcare workers with the standards of infection control. Sustaining HAIs surveillance and auditing of infection control practices are needed to monitor HAIs rates and alert for waning compliance with infection control practices. Disclosures All Authors: No reported disclosures

P-378. Benchmarking Healthcare-Associated Infections in Developing Countries Post-COVID-19: From High-Resource Hospitals in Southwest Brazil to Remote Hospitals in Jungle Regions

Abstract Background Benchmarking is essential for evaluating healthcare quality. In Brazil, few studies on healthcare-associated infections (HAIs) exist, and most focus on internal benchmarking within specific populations, creating a gap in understanding broader regions. Applying benchmarks from high-resource countries to low-resource settings can produce misleading conclusions due to differing healthcare environments. Thus, it's crucial to refine external benchmarks tailored to developing countries.Figure 1Pooled mean and percentiles (10th, 25th, 50th, 75th, and 90th) for seven indicators related to overall and hemodialysis outcomes. Methods The majority of hospitals involved in this study use SACIH+, a hospital infection control software (www.biobytebrasil.com), which compiles data from various Brazilian hospitals. All hospitals followed prospective surveillance protocols for healthcare-associated infections (HAIs) in accordance with the NHSN/CDC guidelines. Benchmarks for HAIs were established for different categories: Medical/Surgical Intensive Care Unit (ICU) HAI rates, surgical site infections, and hospital-wide HAI rates. These benchmarks were defined as the 10th and 90th percentiles using data collected from 25 hospitals between 2021 and 2023. While not all benchmarks included data from every hospital, each benchmark represents data from at least three hospitals and a minimum denominator of 20.Figure 2Pooled mean and percentiles (10th, 25th, 50th, 75th, and 90th) for 21 indicators from Medical/Surgical Adult ICU, Pediatric ICU, and Neonatal ICU. Results Seven overall and hemodialysis rates were benchmarked (Fig. 1). We included lethality rate and global HAI risk (covering all infection sites) as they are required HAI indicators in Brazil. Figure 2 shows benchmarks for key indicators in Adult Medical/Surgical ICU, Pediatric ICU, and Neonatal ICU. Surgical site infection rates, overall and by surgical service, and for major surgical procedures, are detailed in Figures 3 and 4.Figure 3Pooled mean and percentiles (10th, 25th, 50th, 75th, and 90th) for 19 overall surgical site infection rates, stratified by service and wound classification (clean, clean-contaminated, contaminated, and infected). Conclusion This study provides a comprehensive summary of benchmarks for 95 key HAI rates applicable to Brazil in the post-COVID-19 era and other developing countries. By offering external benchmarks across diverse settings, including high-resource and remote hospitals, these findings can guide healthcare facilities in improving infection control practices and refining surveillance protocols. Ultimately, the established benchmarks offer a valuable resource for hospitals striving to enhance patient safety and optimize infection control measures globally.Figure 4Pooled mean and percentiles (10th, 25th, 50th, 75th, and 90th) for surgical site infections across 48 different surgical procedures. Disclosures All Authors: No reported disclosures

P-338. Impact of an Educational Program on Hand Hygiene Practice and Healthcare-Associated Infections in a Tertiary Care Hospital in Rural South India

Abstract Background Effective hand hygiene is pivotal in averting healthcare-associated infections (HAIs), especially in resource-limited settings. This study aimed to evaluate baseline hand hygiene practices among healthcare providers (HCPs) and the impact of an educational intervention on reducing HAIs in a rural South Indian tertiary care hospital. Methods Over a 12-week period, an observational study was conducted across internal medicine, neurology, pulmonology, urology, pediatrics, and general surgery departments. Hand hygiene compliance among HCPs was meticulously observed, while HAIs were monitored using CDC definitions. Subsequent to the baseline assessment, a targeted hand hygiene education program was initiated, focusing on enhancing compliance among 190 nurses. Results A total of 1817 inpatients were enrolled in the study, with 55% male and 45% female, and age ranging from 1 to 90 years (median age: 50 years). Among the 1817 inpatients, HAIs exhibited varying incidence rates across departments. Notably, pneumonia was the most prevalent HAI in the internal medicine department (incidence: 1.8%), while urinary tract infections were prominent in neurology and pulmonology (incidence: 0.9%), and surgical site infections in urology (incidence: 0.7%). Hand hygiene compliance varied across departments, with internal medicine demonstrating the highest compliance (24.5%). Post-implementation of the education program, compliance significantly improved to 65.2%. Consequently, there was a notable decrease in HAI rates, with pneumonia cases in internal medicine decreasing by 30%, and urinary tract infections in neurology and pulmonology decreasing by 25%. Conclusion This study underscores the pivotal role of hand hygiene practices among HCPs in preventing HAIs, particularly in resource-limited settings. The implementation of targeted educational interventions resulted in a substantial improvement in compliance and a subsequent reduction in HAI incidence rates. These findings emphasize the ongoing need for concerted efforts to enhance hand hygiene practices and mitigate the risk of HAIs in rural healthcare settings. Further research and interventions are warranted to sustain these improvements and ensure optimal patient safety outcomes. Disclosures All Authors: No reported disclosures

REVIEW OF PHARMACOLOGICAL INTERVENTIONS FOR THE PREVENTION OF HEALTHCARE-ASSOCIATED INFECTIONS 2025

Healthcare-associated infections (HAIs) are a significant threat to patient safety, contributing to increased morbidity, mortality, and healthcare costs globally. Pharmacological interventions are pivotal in preventing HAIs and addressing antimicrobial resistance. Objective: This narrative review explores key pharmacological strategies for preventing HAIs, including prophylactic antibiotics, antimicrobial stewardship programs (ASPs), infection prevention bundles, and innovative approaches like probiotic cleaning systems. Methods: The review synthesizes recent literature on established and emerging HAI prevention strategies, evaluating their efficacy, challenges, and applicability across diverse healthcare settings. Results: Prophylactic antibiotics are highly effective in reducing surgical site infections when used judiciously, while ASPs optimize antibiotic use and combat resistance. Infection prevention bundles, incorporating evidence-based practices like hand hygiene and catheter care, significantly lower bloodstream infection rates. Innovative approaches, such as probiotic cleaning systems, offer sustainable solutions to reduce environmental contamination. However, challenges remain, including variable adherence to protocols, resource constraints, and the need for scalable solutions in low-resource settings. Conclusion: Pharmacological interventions, when integrated with multidisciplinary approaches, are crucial for reducing HAI rates and improving patient outcomes. Future research should focus on scalable innovations and context-specific strategies to enhance infection prevention globally. Keywords: Healthcare-associated infections, Antimicrobial stewardship, Prophylactic antibiotics, Infection prevention bundles, Multidrug resistance, Patient safety.

Audit Report: Evaluating the Effectiveness of Infection Prevention and Control Programs in Healthcare Facilities

Infection prevention and control (IPC) programs are important for the prevention of infection among patient and health care workers in healthcare facilities to reduce healthcare associated infections (HAIs). Analyses showed that the rates of HAI have increased globally even with developments in medical practices, therefore, evaluation of the IPC implementation should continue. Aim: This paper assesses the IPC knowledge, practice, and compliance in selected healthcare facilities: how IPC is implemented, challenges faced and HCW’s perceptions to recognize gaps for improvement to the safety of patients. Methodology: A cross-sectional survey of HCWs used structured questionnaires administered to 200 HCWs from various posts in healthcare facilities. Exploratory and descriptive analysis of quantitative and qualitative data was done to evaluate IPC practice adherence, implementation challenges, and differences by department. Results: The findings were that adherence to hand washing was at 68%, use of PPE was at 75%, and sterilization practices of equipment and instruments at 82%. The emergency department exhibited the lowest compliance rates (hand hygiene: The overall infection rate is 62% while the PPE is 65%) and found to have the highest HAI rate of 7.1/1,000 patient days. General wards reported the highest compliance and lowest HAI rates (hand hygiene: (SS: 75%; PPE: 85%; HAI: 4.8/1,000 patient days). This study reveals that training effectiveness was high concerning practical demonstrations with a satisfaction of 82%, but low concerning the frequency of training sessions with only 65% satisfaction. Conclusion: Enhancing compliance needs interventions such as regularly scheduled training, increased surveillance, and IPC targeted approaches following risk areas such as emergency and ICU. Such measures have the potential to lower HAIs and enhance global healthcare provision.

Compliance with “Five Moments For Hand Hygiene” in Reducing the Incidence of Healthcare Associates Infections (HAIs): A Systematic Review

Background: Hand hygiene is essential in breaking the transmission chain of infections. Scientifically, it has been proven to prevent and reduce the spread of harmful microorganisms, thereby decreasing the incidence of Healthcare-Associated Infections (HAIs). The purpose of this study is to find out if compliance with hand hygiene within five moments can reduce the number of healthcare associates' infections. Methods: This research method uses a literature review using the PRISMA technique. Data was obtained from journals, including PubMed, Clinical Key, Science Direct, and Google Scholar, from 2020-2024, based on the results of the identification based on inclusion criteria. A feasibility review was obtained, and twenty articles were received for review Results: Compliance with hand hygiene within five seconds can reduce the number of HAIs specifically. Conclusion: Compliance with the Five Moments for hand hygiene is a simple and effective way to reduce the rate of Healthcare-Associated Infections (HAIS) in hospitals

Competitive Electrochemical Apta-Assay Based on cDNA-Ferrocene and MXenes for Staphylococcus aureus Surface Protein A Detection.

Staphylococcus aureus (S. aureus) represents one of the most frequent worldwide causes of morbidity and mortality due to an infectious agent. It is a part of the infamous ESKAPE group, which is highly connected with increased rates of healthcare-associated infections and antimicrobial resistance. S. aureus can cause a large variety of diseases. Protein A (PrA) is a cell-wall-anchored protein of S. aureus with multiple key roles in colonization and pathogenesis and can be considered as a marker of S. aureus. The development of aptasensors, having an aptamer as a specific biorecognition element, increases selectivity, especially when working with complex matrices. The association with state-of-the-art materials, such as MXenes, can further improve the analytical performance. A competitive aptasensor configuration based on a ferrocene (Fc)-labeled cDNA hybridized (cDNA-Fc S13) on a specific aptamer (APT) for PrA in the presence of MXene nanosheets was designed for the indirect detection of S. aureus. The aptasensor displayed a linear range of 10-125 nM, an LOD of 3.33 nM, and a response time under 40 min. This configuration has been tested in real samples from volunteers diagnosed with S. aureus infections with satisfactory results, enabling the perspective to develop decentralized devices for the rapid detection of bacterial strains.

Assessment of IPCAF scores and incidence of healthcare-associated infections: a cross-sectional study in Eastern China.

A cross-sectional study was conducted to evaluate the relationship between Infection Prevention and Control Assessment Framework (IPCAF) scores and the incidence of healthcare-associated infections (HAIs) in tertiary hospitals in Eastern China. The results indicate that hospitals with IPCAF scores above 700 have a lower incidence rate of HAIs (1.31%; 95%CI, 1.15%-1.47%) compared to those with scores below 700 (1.90%; 95%CI, 1.60%-2.21%).

STRENGTHENING THE FOUNDATION - ESCALATES THE COMPLIANCE: ON PATH OF CONTINUAL IMPROVEMENT -AN OBSERVATIONAL STUDY AMONG HEALTH CARE WORKERS IN TERTIARY CARE HOSPITAL, CENTRAL INDIA

Introduction: Healthcare-associated infections (HCAIs) are more likely to occur in healthcare settings, driven by factors involving host, pathogen and environmental elements, including healthcare personnel. Infection prevention and control (IPC) practices are crucial to mitigate pathogen transmission, with hand hygiene being especially effective. Despite knowledge of guidelines, adherence remains inconsistent, necessitating structured IPC education Aim: To evaluate the impact of a structured, multifaceted educational intervention on the knowledge and compliance of healthcare workers regarding IPC practices at a tertiary care centre. Methodology:A tertiary care facility in central India served as the site of this observational study for over eight months (Feb–Sept 2024), involved 394 participants, including nursing staff, interns, postgraduate students and hygiene warriors.The intervention includedinteractive CMEs, hands-on training, educational videos, and participatory activities like role plays and competitions. Pre-and post-intervention assessments measured knowledge improvement, while post-intervention door-to-door evaluations identified practical compliance. Results:The intervention significantly enhanced participants knowledge, with mean pre-test scores of 7.85 ± 1.47 increasing to 9.25 ± 1.19 post-intervention (p < 0.0001). Improvements were notable in hand hygiene practices, PPE use, and biomedical waste management. Interactive modules and multimedia tools effectively reinforced IPC measures. Conclusion: The educational intervention significantly improved IPC knowledge and compliance among healthcare workers, highlighting the need for ongoing training. Sustained education in IPC practices is essential to foster a safety culture, reduce HCAI rates, and improve patient outcomes.

Utility of syndromic surveillance for the surveillance of healthcare-associated infections in resource-limited settings: a narrative review.

Globally, Healthcare-associated infections (HCAIs) pose a significant threat to patient safety and healthcare systems. In low- and middle-income countries (LMICs), the lack of adequate resources to manage HCAIs, as well as the weak healthcare system, further exacerbate the burden of these infections. Traditional surveillance methods that rely on laboratory tests are cost-intensive and impractical in these settings, leading to ineffective monitoring and delayed management of HCAIs. The rates of HCAIs in resource-limited settings have not been well established for most LMICs, despite their negative consequences. This is partly due to costs associated with surveillance systems. Syndromic surveillance, a part of active surveillance, focuses on clinical observations and symptoms rather than laboratory confirmation for HCAI detection. Its cost-effectiveness and efficiency make it a beneficial approach for monitoring HCAIs in LMICs. It provides for early warning capabilities, enabling timely identification and response to potential HCAI outbreaks. Syndromic surveillance is highly sensitive and this helps balance the challenge of low sensitivity of laboratory-based surveillance systems. If syndromic surveillance is used hand-in-hand with laboratory-based surveillance systems, it will greatly contribute to establishing the true burden of HAIs in resource-limited settings. Additionally, its flexibility allows for adaptation to different healthcare settings and integration into existing health information systems, facilitating data-driven decision-making and resource allocation. Such a system would augment the event-based surveillance system that is based on alerts and rumours for early detection of events of outbreak potential. If well streamlined and targeted, to monitor priority HCAIs such as surgical site infections, hospital-acquired pneumonia, diarrheal illnesses, the cost and burden of the effects from these infections could be reduced. This approach would offer early detection capabilities and could be expanded into nationwide HCAI surveillance networks with standardised data collection, healthcare worker training, real-time reporting mechanisms, stakeholder collaboration, and continuous monitoring and evaluation. Syndromic surveillance offers a promising strategy for combating HCAIs in LMICs. It provides early warning capabilities, conserves resources, and enhances patient safety. Effective implementation depends on strategic interventions, stakeholder collaboration, and ongoing monitoring and evaluation to ensure sustained effectiveness in HCAI detection and response.

The burden of healthcare-associated infections in New Zealand public hospitals 2021.

There are no contemporary data on the burden of healthcare-associated infections (HAIs) in New Zealand. To estimate the economic burden of HAIs in adults in New Zealand public hospitals by number and monetary value of bed days lost; number of deaths, number of life years lost, and the monetary value (in NZ dollars); Accident Compensation Commission (ACC) HAI treatment injury payments; and disability-adjusted life years (DALYs). The annual incidence rate was calculated from the observed prevalence of HAIs in New Zealand, and length of patient stays. Total HAIs for 2021 were estimated by multiplying adult admissions by incidence rates. The excess length of stay and mortality risk attributed to those with HAI was calculated using a multistate model. Payments for treatment injuries were obtained from the ACC. DALYs for HAIs were estimated from the literature. The incidence rate of HAI was 4.74%, predicting 24,191 HAIs for 2021, resulting in 76,861 lost bed days, 699 deaths, with 9,371 years of life lost (YoLL). The annual economic burden was estimated to be $955m comprised of $121m for lost bed days, $792m for cost of YoLL, and $43m ACC claims. There were 24,165 DALY which is greater than many other measured injuries in New Zealand, eg motor vehicle traffic crashes with 20,328 DALY. HAIs are a significant burden for patients, their families, and the public health system. Preventive guidelines for many HAIs exist and a strategic plan is needed to reduce HAIs in New Zealand.

Clinical Effectiveness of a 3-Step Versus a 6-Step Hand Hygiene Technique: A Randomized Controlled Cross-over Study

Abstract Background The aim of this study is to assess the clinical effectiveness of the 3-step hand hygiene (HH) technique (3-HT) compared with the 6-step HH technique (6-HT; World Health Organization 6-step technique) using an alcohol-based hand rub. Methods A randomized controlled crossover trial was conducted from November to December 2023 in 10 wards of a tertiary A-level hospital according to CONSORT guidelines. The 240 healthcare workers (HCWs) were randomly divided into the 3-HT intervention group or the 6-HT control group. The trial was conducted in 2 stages, and the effectiveness of each indicator in the 2 groups was compared after a washout period of 2 weeks. Results Compared with the 6-HT, the 3-HT has demonstrated significant superiority in all indicators of HH compliance as well as the accuracy rate of HH practices. The total HH median times for the 3-HT and 6-HT were 16.00 (interquartile range, 15.00–20.00) and 32.50 (30.00–40.00) seconds, respectively (P < .05). The reduction factors for bacterial colony-forming unit counts did not differ and the colony-forming unit counts were not significantly different. Bacillus, Staphylococcus, and Micrococcus were detected before and after the use of hand rubs. HCWs preferred the 3-HT over the 6-HT. There were no significant difference in healthcare-associated infections rate between the 2 techniques. Conclusions The 3-HT was significantly superior to the 6-HT in terms of the HH eligibility rate, compliance, and HH time. The safety and feasibility of the 3-HT were verified by assessing microorganism count.

Prevalence of Healthcare-Associated Infections in a Tertiary Hospital in Casablanca, Morocco, 2021.

During the COVID-19 pandemic, healthcare professionals experienced an increased workload, which may have affected infection prevention and control (IPC) programs and consequently healthcare-associated infection (HAI) rates. The objective of this study was to estimate the prevalence of HAI in Ibn Rochd University Hospital Center (IRUHC) and identify associated factors. A survey was conducted on November 30, 2021 at IRUHC, including all patients hospitalized for at least 48 hours. Data was collected using a questionnaire, and analyzed using SPSS IBM software version 16. The significance level was set at 0.05. Among 887 patients, the prevalence of HAI was 9.7% (7.7%; 11.6%). The highest prevalence was observed in intensive care units (ICUs) (44.2%). Nosocomial pneumonia was the most common site (26.8%). The main isolated microorganisms were Acinetobacter baumannii (18.0%) and Escherichia coli (16.0%). All Acinetobacter baumannii isolated strains were imipenem-resistant. The presence of HAI was significantly associated with the presence of an invasive medical device (p<0.001), a higher physical status score of American Society of Anesthesiologists (ASA) (p<0.001), and a longer hospital stay (p<0.001). Conclusion: The emergence of imipenem-resistant Acinetobacter baumannii(IRAB) represents a serious therapeutic and epidemiological problem requiring the establishment of a system for monitoring the microbial environment and the application of strict hygiene measures.

Quality control efforts of medical institutions: the impacts of a value-based payment system on medical staff and healthcare-associated infections

In South Korea, various quality assessments have been introduced to improve the quality of care; as such, the overall level of quality of medical institutions has improved. However, gaps still exist between institutions. To evaluate the impact of quality management efforts of medical institutions on securing medical staff and healthcare-associated infections in intensive care units (ICUs). This study used data from the second and third ICU quality assessments conducted by the Health Insurance Review and Assessment Service, which included 265 hospitals and 39,096 inpatients. The continuous quality improvement efforts of medical institutions were measured according to changes in their grade based on quality assessment results. In addition, healthcare-associated infection rates were measured, including rates for ventilator-associated pneumonia and catheter-associated infections. The incidence rate ratio (IRR) was calculated using generalized estimating equation Poisson regression models that included hospital and patient characteristics. Healthcare-associated infections occurred in approximately 2% of patients using ventilators or catheters. Ventilator-associated pneumonia increased significantly in institutions with a decline in grade [IRR 2.038, 95% confidence interval (CI) 1.426-2.915]. In institutions with an improvement in grade, infections associated with central venous catheters (IRR 0.484, 95% CI 0.330-0.711) and urinary catheters (IRR 0.587, 95% CI 0.398-0.866) decreased. Although quality assessment has been introduced in ICUs in South Korea, some gaps remain between medical institutions. Differences in securing medical resources through the quality management efforts of medical institutions were observed, and the infection rate was low in hospitals with high-quality management and high in hospitals with low-quality management.

Factors Determining Adherence to Hand Antisepsis by Healthcare Workers during Pandemic Infection Spread (as exemplified by COVID­-19)

Relevance. The healthcare personnel’s adherence to hand antisepsis is а pressing problem during any epidemic outbreak. In the context of high biological hazards, the possibility of performing proper antiseptic procedures is reduced while nosocomial pathogen transmission and healthcare-associated infection (HAI) rate growth are promoted. Aims. Studying the factors determining the healthcare workers’ adherence to hand antisepsis during a pandemic infection spread (as exemplified by COVID-19). Materials and methods. The study was conducted during the entire COVID-19 pandemic. To estimate the rate of adherence rate by the healthcare personnel to hand hygiene, we conducted an anonymous questionnaire survey of the staff in infectious disease hospitals (2021–2022) as well as assessed the viral and bacterial contamination rates of the personnel’s hands and the hospital environment items (2021–2023). Epidemiological (descriptive-evaluation), bacteriological (conventional culture, AMR determination using a VITEK2 analyzer), molecular biological (RT-PCR, Sanger sequencing) and statistical (a questionnaire survey, building machine learning models) methods were used in the study. Results. Based on the results of the survey, the main factors influencing the formation of attitudes towards antiseptics among the staff of medical organizations with medical and non-medical education were identified. It was found that the pandemic spread of infections negatively affects the level of contamination of the hands of infectious diseases hospital staff, which amounted to 35.3% of doctors, 28.8% of nurses, and 25% of hospital cleaners. The spectrum of isolated pathogens included viruses (SARS-CoV-2) and opportunistic microorganisms (Enterococcus faecalis, Enterococcus faecium, Pantoea agglomerans, Acinetobacter baumannii, Klebsiella pneumoniae, Staphylococcus aureus, Escherichia coli), including those with a wide profile of antimicrobial resistance. Conclusion. During the COVID-19 epidemic, the rate of adherence to hand antisepsis in the infectious disease hospital was 82.3% in the staff with a medical background and 71.2% in the staff without one. The results confirm the significant role of staff hands in the in-hospital transmission of dangerous pathogens and indicate the need for systematic monitoring of the level of knowledge on antiseptics among all employees of a medical organization, regardless of specialization and level of education.

Impact of Discontinuing Contact Precautions for Multidrug-resistant Gram-negative Enterobacteriaceae in a Large Health System

Background: Contact precautions (CP) to prevent transmission of multidrug-resistant gram-negative (MDRGN) Enterobacteriaceae are recommended, although studies of discontinuation of CP (DcCP) have found no change in healthcare associated infections (HAI) due to extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae. Limited data exists on DcCP for MDRGN in a large health system. Methods: We performed a retrospective observational study analyzing the relationship between use of CP and HAI due to two definitions of MDRGN Enterobacteriaceae: ESBL, and non-susceptibility to ≥3 drug classes (3DC-GNR), with carbapenem resistant Enterobacteriaceae (CRE) serving as control. The study included all inpatient admissions from 2/2017 through 9/2022 at 21 acute care hospitals. Hospitals had latitude to determine CP practices based on local risk assessment, but in 2/2018, system-wide transmission-based precautions guidance was updated to recommend DcCP for MDRGN Enterobacteriaceae and in 12/2019 was updated to clarify DcCP specifically for ESBL and 3DC-GNR while continuing CP for carbapenem-resistant organism carriage. We interviewed infection preventionists to define when CP were used for CRE, ESBL, and 3DC-GNR Enterobacteriaceae. HAI were defined using National Healthcare Safety Network criteria including all HAI categories. We compared the incidence rate of HAI attributable to the two MDRGN types in hospital months with and without use of CP, with HAI due to CRE as a comparison group since all hospitals used CP for CRE throughout the study period. Results: The periods of CP use, by hospital, are shown in Figure 1. Throughout the study period, there were 987 HAI attributed to ESBL Enterobacteriaceae, 579 due to 3DC-GNR Enterobacteriaceae, and 329 due to CRE. Figure 2 shows the unadjusted aggregate rate of HAI for each of the three MRGN types, including among hospitals with and without CP in each month, for ESBL and 3DC-GNR. In months with and without CP, the rate of HAI was 1.482/10,000 and 1.093/10,000 patient days (incidence rate ratio [IRR], 1.356 [95% confidence interval, 1.195-1.540]) for ESBL Enterobacteriaceae. In months with and without CP, the rate of HAI was 1.071/10,000 and 0.493/10,000 patient days (IRR,2.173[95% confidence interval, 1.838-2.569]) for 3DC-GNR Enterobacteriaceae. Conclusion: DcCP was not associated with an increase in HAI due to ESBL and 3DC-GNR Enterobacteriaceae in aggregated facilities that self-selected for DcCP. Facilities that used CP were associated with significantly higher rates of ESBL and 3DC-GNR Enterobacteriaceae, a relationship that did not change as hospitals DcCP for these MDRGN. Further analyses are necessary to assess for a causal relationship.

Burden of Healthcare-Associated Infections in a Pediatric Intensive Care Setting Before, During, and After the Pandemic

Background: Adult rates of non-COVID-19-related healthcare-associated infection (HAI) initially decreased and subsequently increased during the COVID-19 pandemic. Little is known about pediatric HAI rates during this period. Methods: A retrospective review of HAIs was conducted for patients admitted to the intensive care unit (PICU) at a pediatric tertiary care hospital between January 1, 2019 and November 30, 2023. Patients who spent ≥48 hours in the PICU were included. Surgical site infections were excluded. Data were obtained from infection surveillance reports; each HAI was reviewed for validity and attribution based on National Healthcare Safety Network definitions. HAIs were grouped into 3 time periods: pre-pandemic (January 2019-February 2020), pandemic (March 2020- February 2022), and post-pandemic (March 2022-November 2023). Infection rate ratios were calculated for pre-pandemic and post-pandemic periods. Results: Among 2,959 PICU patients admitted during the study period, there were 60 HAI events (4.78 per 1,000 patient days). Rates generally remained steady throughout with slight increases and decreases between time periods (Table 1). There was no significant difference in CAUTI, CLABSI, or HAVRI rates noted in the PICU between pre-pandemic and post-pandemic periods despite a significantly higher device utilization ratio in the post-pandemic period for both urinary catheters and central lines (IRR, 0.89; p &lt; 0 .05; 95% CI, 0.82-0.97). The most frequent HAI in all time periods was CAUTI. Conclusion: Unlike reports from adult centers, no significant variation between time periods was noted for HAIs in our pediatric center. Despite numerous COVID-19-related changes in infection prevention and control measures and contexts throughout the study period, HAI rates remained stable. This may be due in part to the lower burden of critically ill COVID-19 pediatric patients compared to adult populations. Additionally, this could indicate resiliency and consistency in practice among pediatric providers throughout the pandemic. Further evaluation of pediatric HAIs in the context of the COVID-19 pandemic may reveal practices that could be replicated elsewhere to control HAI rates.

Back to Basics: Blood Culture Contamination Reduction Across a Multicenter Academic Health System

Background: Blood culture contamination is common in healthcare and contributes to diagnostic uncertainty, unnecessary treatments and follow-up testing, increased length of stay, higher rates of reportable healthcare-associated infections and events, over utilization of resources and staff including consultative care, and undue emotional stress to patients. The national benchmark for institutional blood culture contamination rates as recommended by The American Society for Microbiology (ASM) and the Clinical Laboratory Standards Institute (CLSI) is &lt; 3 %. Our institution’s overall rate was 8.9% with the highest burden being from our Emergency Department (ED) locations. We formed a multidisciplinary team aimed to reduce these rates through efforts centered around education and simplification of the collection process. Method: Working closely with and gathering feedback from nursing staff, nurse educators, and supply chain, we developed a blood culture collection kit that included all items necessary for blood culture collection thus eliminating the need for nurses to gather these items individually prior to collection. Additionally, simple step-by-step educational materials (Fig. 1) detailing the collection technique were provided. Education was presented at nursing huddles and skills fairs prior to kit roll-out. Blood culture kits were then stocked in place of individual blood culture collection bottles in all ED stock rooms in August 2022. Result: The 12-week pre-intervention period found 249 contamination events from 4265 total collections deriving a contamination rate of 5.8% across our health system’s four ED locations. During a 12-week post-intervention period following kit roll-out, 116 contamination events occurred from 3629 total collections deriving a contamination rate of 3.2% across our four ED locations. Given our results, we ultimately rolled this out to all units in all locations of our health system. When including all time from kit rollout to present (August 2022 to November 2023, 16 months), there were 1077 contamination events from 43379 total collections deriving an overall contamination rate of 2.5%. When compared to the 16 months prior to the kit rollout (April 2021 to July 2022) there were 1803 contamination events in 49335 total collections (3.7% contamination rate) deriving an overall percent reduction of 32.1%. Conclusion: We were able to decrease our health system’s blood culture contamination rate through simple interventions aimed at reducing the mental burden on nursing staff by developing a blood culture collection kit and educational materials. Since implementation of the kits, we have continued to maintain lower contamination rates as evident by our 16 month follow up period.