Healthcare-associated Infection Rates Research Articles

Assessment of Infection Prevention and Control Practices among Medical Students of a Medical College in Chengalpattu District, Tamil Nadu

Introduction: The incidence of healthcare-associated infections (HCAIs) and their complications has been known for several years. The only way to reduce HCAI rates, and to improve the knowledge of standard precautions and abidance among doctors is by incorporating infection prevention and control (IPC) measures in the curriculum of medical students. Objective: To determine the knowledge and practice of infection prevention and control measures among medical students. Materials and Method: This cross-sectional study was conducted among 146 medical students in the 2nd, 3rd, and 4th year of their MBBS in a private medical college, Chengalpattu, Tamil Nadu. Students were asked to fill a pretested semi-structured questionnaire comprising questions on socio-demographic details, knowledge and practice on hand hygiene and standard precautions, cough etiquette and respiratory hygiene, and personal protective equipment usage. The collected information was analysed using SPSS software version 21.0. Results: 134 students had adequate knowledge about the standard precautions and hand hygiene, 143 had adequate knowledge of cough etiquette and respiratory hygiene and 115 had adequate knowledge about the use of personal protective equipment. Only 21 students always followed all 8 steps of hand-washing, and 46 students followed proper donning and doffing instructions. Female students were found to have adequate knowledge of precautions and hand hygiene. Conclusion: It is clear from the study that students’ knowledge about IPC measures is adequate but their practice is not satisfactory which can be improved by conducting practical sessions and workshops on IPC and multilateral strategies approach.

Bir yoğun bakım ünitesinde sık görülen enfeksiyonların önlenmesi için bir bakım paketinin etkinlik ve maliyetinin analizi: Yarı deneysel bir öntest-sontest tasarım çalışması

Objective
 Healthcare-associated infections, threaten patient safety, cause prolonged hospitalization, morbidity, mortality and increased costs. This study was conducted to evaluate the effectiveness of interventions to prevent healthcare-associated infections and the effect of these interventions on cost.
 Methods
 A quasi-experimental pretest-posttest design study was completed between 1 January and 30 June 2018, and 1 October 2018 and 31 March 2019, in an intensive care unit, with a total of 54 patients, 27 pre-training and 27 post-training.
 Results
 In the study, infection rates were 20.34 in January to March 2018, 25.7 in April to June 2018, 20.97 in October to December 2018 and 17.77 in January to March 2019. When the infection rates of the four different periods were compared, it was found that there was a decrease compared to the pre-training period but that this decrease was not statistically significant (p>0.05). The average cost before the training was 11361.35₺ and the average cost after the training was 9149.87₺. Average bed costs, which are the most important of all costs, decreased by 25.7% compared to pre-training at the 95% confidence interval (5241.86₺-13251.50₺ and 3489.03₺-10257.41₺, respectively).
 Conclusion
 In conclusion, the study determined that training provided a significant increase in the intensive care nurses’ scores related to healthcare-associated infections and there were decreases in healthcare-associated infection rates, lengths of hospital stay and cost after the training although these were not statistically significant.

Impact of Coronavirus Disease 2019 (COVID-19) on Healthcare-Associated Infections in Arizona Acute Care Hospitals: 2016-2020 HAI Progress Report

BackgroundSince March 2020, coronavirus disease 2019 (COVID-19) has impacted clinical practices among Arizona acute care hospitals (ACHs), potentially affecting healthcare-associated infection (HAI) rates among these facilities. The Arizona Department of Health Services (ADHS) analyzed the impact of the COVID-19 pandemic on HAI occurrence among Arizona ACHs by utilizing data from the National Healthcare Safety Network (NHSN).MethodsStandardized infection ratios (SIRs) from NHSN's National and State HAI Progress Reports (2016-2020) along with 2015 national baselines and 2020 Health and Human Services (HHS) HAI target goals were compiled to evaluate trends for central line-associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), methicillin-resistant Staphylococcus aureus (MRSA) bloodstream events, and Clostridioides difficile infections (CDI). CLABSI and CAUTI SIRs among intensive care units (ICUs), ward locations, and neonatal critical care units (CLABSI only) were also analyzed. To calculate statistical significance, 95% confidence intervals were used.ResultsAmong reporting Arizona ACHs (n= 66-71, depending on year and HAI type) from 2016-2020, all four HAI SIRs decreased significantly from 2016 through 2019—CLABSI, 32% decrease; CAUTI, 25% decrease; MRSA, 41% decrease; and CDI, 36% decrease. However, CLABSI and MRSA SIRs increased significantly (60% and 45%, respectively) during 2020. Arizona CAUTI SIRs have been statistically significantly lower than the national SIRs from 2016-2020, remaining below the HHS target goal (SIR- 0.75) even during the onset of the pandemic (Arizona 2020 CAUTI SIR- 0.64). Among reporting ICUs during 2020, the CLABSI SIR increased 176% to 1.20 (significantly higher than the 2015 national baseline) and the ICU CAUTI SIR increased 49% to 0.69.ConclusionsArizona ACH HAI incidence significantly increased during the COVID-19 pandemic, especially for CLABSIs. Future recommendations for Arizona ACHs should focus on prevention activities and interventions specific to CLABSI and CAUTI occurrence among ICUs.

Cerebrospinal fluid shunt-associated surgical site infection with three-month versus twelve-month surveillance periods in Canadian hospitals.

Cerebrospinal fluid shunt-associated surgical site infection surveillance for 3 months compared to 12 months after surgery captures 83% of cases with no significant differences in patient characteristics, surgery types, or pathogens. A shorter 3-month follow-up can reduce resource use and allow for more timely reporting of healthcare-associated infection rates for hospitals.

Monitoring disparities in healthcare-associated infection surveillance: A SHEA Research Network (SRN) Survey

Background: Inequities are seen in many health-related outcomes, and systemic and structural factors result in inequitable care based on social determinants of health (SDOH). However, whether disparities exist specifically in healthcare-associated infections (HAIs) based on these factors has not been well described. Furthermore, there are no national standards on whether information related to equity and SDOH should be included in HAI surveillance and how such information could be used. Methods: We surveyed US members of the SHEA Research Network (SRN), a consortium of healthcare facilities with leaders interested in healthcare epidemiology and infection prevention, via an online REDCap survey from October to December 2021. Results: Of the 68 eligible US SRN facilities, 28 (41%) responded. Among them, 27 institutions provide direct patient care and were analyzed. Of these 27 facilities, 8 (30%) collected data regarding variables related to equity including language for care, race or ethnicity, insurance status, and other. Of these faclilities, 38% are collecting but not otherwise using this information; other facilities use this information for a variety of reporting and intervention purposes (Fig. 2). Only 3 facilities (11%) analyzed whether disparities exist in any HAI rates. The most common barrier to collecting SDOH information is that facilities have not considered doing this work (Fig. 3). Of the 15 facilities not yet undertaking such work, 10 (67%) were interested in doing so. Specific recommendations about how to operationalize such collection are needed (Table 1). Conclusions: Most institutions in this sample are not collecting data that would allow for assessment of disparities in the rates of HAIs; however, there is interest in doing so. A minority of early adopter facilities are assessing whether disparities exist and are designing interventions. National guidance can play a key role in standardizing the collection of this information and translating early findings to identify and subsequently improve disparities within HAIs.Funding: NoneDisclosures: None

Increased Rate of Hand Hygiene Compliance During COVID -19 Pandemic: Myths and Facts

Introduction: Hand Hygiene is the cheapest, easiest and the single most effective measure to reduce cross-transmission of infection from one patient to another and from the healthcare workers to patients and vice versa. Multiple studies have shown a decrease in healthcare-associated infections (HCAIs) rates after improvement in hand-hygiene compliance. Despite being the simplest procedure adherence to the hand hygiene recommendations remains well below 50% and healthcare workers repeatedly observed as being poor compliers. Objective: This study was planned to access the impact of covid-19 pandemic on the compliance of infection control practices at a tertiary health care centre in India. Methods: Institution-based cross-sectional study was used to assess the impact of covid-19 pandemic on attitude, knowledge and on the compliance of hand hygiene practices at a tertiary health care centre in India. Results: A marked difference was observed in the availability of resources for hand hygiene i.e., 48 (96%) locations and the display of instructions for hand hygiene 50 (100%). A significant difference was also observed among the knowledge of the steps of hand hygiene {2019: 16(32%; 2020: 33 (66%)} and of the moments of hand hygiene {2019: 27 (54%); 2020; 44 (88%)}. (ϰ2 = 79.2, df =1, p = 0). In 2020 (during COVID -19 pandemic) a significant increase in compliance was noted in most of the departments with highest compliance rate of ICUs (100%), followed by OTs (91.7%), paediatrics (95.8%) obstetrics and gynaecology (90.6%), surgery (86.5%), blood bank and laboratories (85.7%). However, unlike the other parameters, the compliance of hand hygiene during the previous year (2019) and during 2020 (COVID -19 pandemic, was poor with no significant difference in compliance of hand hygiene practices even during the pandemic. Of all the 5 moments suggested by WHO, maximum compliance (36% in 2019 and 60% in 2020 pandemic) was after body fluid exposure. Conclusions: Hand Hygiene should be made a national priority. Active involvement by healthcare administrators, national and local governments should be committed to make hand hygiene a mandate for patient safety. Accessibility to hand hygiene products like soap and water and/or alcohol-based hand rubs and written and verbal reminders to staff are essential to improve the compliance of hand hygiene. Thrust should also be given to hand hygiene as a research subject.

Increased Rate of Hand Hygiene Compliance During COVID -19 Pandemic: Myths and Facts

Introduction: Hand Hygiene is the cheapest, easiest and the single most effective measure to reduce cross-transmission of infection from one patient to another and from the healthcare workers to patients and vice versa. Multiple studies have shown a decrease in healthcare-associated infections (HCAIs) rates after improvement in hand-hygiene compliance. Despite being the simplest procedure adherence to the hand hygiene recommendations remains well below 50% and healthcare workers repeatedly observed as being poor compliers. Objective: This study was planned to access the impact of covid-19 pandemic on the compliance of infection control practices at a tertiary health care centre in India. Methods: Institution-based cross-sectional study was used to assess the impact of covid-19 pandemic on attitude, knowledge and on the compliance of hand hygiene practices at a tertiary health care centre in India. Results: A marked difference was observed in the availability of resources for hand hygiene i.e., 48 (96%) locations and the display of instructions for hand hygiene 50 (100%). A significant difference was also observed among the knowledge of the steps of hand hygiene {2019: 16(32%; 2020: 33 (66%)} and of the moments of hand hygiene {2019: 27 (54%); 2020; 44 (88%)}. (ϰ2 = 79.2, df =1, p = 0). In 2020 (during COVID -19 pandemic) a significant increase in compliance was noted in most of the departments with highest compliance rate of ICUs (100%), followed by OTs (91.7%), paediatrics (95.8%) obstetrics and gynaecology (90.6%), surgery (86.5%), blood bank and laboratories (85.7%). However, unlike the other parameters, the compliance of hand hygiene during the previous year (2019) and during 2020 (COVID -19 pandemic, was poor with no significant difference in compliance of hand hygiene practices even during the pandemic. Of all the 5 moments suggested by WHO, maximum compliance (36% in 2019 and 60% in 2020 pandemic) was after body fluid exposure. Conclusions: Hand Hygiene should be made a national priority. Active involvement by healthcare administrators, national and local governments should be committed to make hand hygiene a mandate for patient safety. Accessibility to hand hygiene products like soap and water and/or alcohol-based hand rubs and written and verbal reminders to staff are essential to improve the compliance of hand hygiene. Thrust should also be given to hand hygiene as a research subject.

Healthcare-associated infections in Veterans Affairs acute-care and long-term healthcare facilities during the coronavirus disease 2019 (COVID-19) pandemic.

To assess the impact of the coronavirus disease 2019 (COVID-19) pandemic on healthcare-associated infections (HAIs) reported from 128 acute-care and 132 long-term care Veterans Affairs (VA) facilities. We compared central-line-associated bloodstream infections (CLABSIs), ventilator-associated events (VAEs), catheter-associated urinary tract infections (CAUTIs), methicillin-resistant Staphylococcus aureus (MRSA), and Clostridioides difficile infections and rates reported from each facility monthly to a centralized database before the pandemic (February 2019 through January 2020) and during the pandemic (July 2020 through June 2021). Nationwide VA COVID-19 admissions peaked in January 2021. Significant increases in the rates of CLABSIs, VAEs, and MRSA all-site HAIs (but not MRSA CLABSIs) were observed during the pandemic in acute-care facilities. There was no significant change in CAUTI rates, and C. difficile rates significantly decreased. There were no significant increases in HAIs in long-term care facilities. The COVID-19 pandemic had a differential impact on HAIs of various types in VA acute care, with many rates increasing. The decrease in CDI HAIs may be due, in part, to evolving diagnostic testing. The minimal impact of COVID-19 in VA long-term facilities may reflect differences in patient numbers and acuity and early recognition of the impact of the pandemic on nursing home residents leading to increased vigilance and optimization of infection prevention and control practices in that setting. These data support the need for building and sustaining conventional infection prevention and control strategies before and during a pandemic.

Effectiveness of the systematic use of antimicrobial filters in the water taps of critical care units for the prevention of healthcare-associated infections with Pseudomonas aeruginosa

Pseudomonas aeruginosa (PA) is the third leading aetiological agent in healthcare-associated infections (HAIs) and the one most frequently found in patients with pneumonia associated with mechanical ventilation. In intensive care units (ICU), its appearance is associated with higher mortality, an increase in the days spent on ventilation, and hospital stay length and costs. Thus, evaluating strategies for preventing these infections is essential for their control. Therefore, our objective was to evaluate the effectiveness of the systematic use of antimicrobial filters in preventing PA infections in critical care units. This was an open experimental crossover study. A total of 2,156 patients admitted for more than 24 hours in critical care units were included, 1,129 of them in units with filters, and 1,027 in units without filters. The study groups were followed-up for 24 months and HAIs were checked for the presence of PA. Chi-squared test were used to compare the rate of HAIs between groups and we calculated 95% confidence intervals adjusted by Poisson regression for the rate ratio (RR) of the association magnitude. Both groups were homogeneous in terms of intrinsic and extrinsic patient factors. The incidence of PA infections in the units with filters was 5.5 cases/1,000 hospitalized days and 5.4/1,000 hospitalized days for the units without water filters (RR=1.09 [0.67-1.79]). Routine placing antimicrobial filters in the water taps in critical care units was not an effective means of preventing the emergence of HAIs caused by PA.

Comparing the Occurrence of Healthcare-Associated Infections in Patients with and without COVID-19 Hospitalized during the Pandemic: A 16-Month Retrospective Cohort Study in a Hospital Intensive Care Unit

The COVID-19 pandemic has increased the healthcare-associated infection (HAI) risk in intensive care unit (ICU) patients. However, a comparison between patients with and without COVID-19 in terms of HAI incidence has been rarely explored. In this study, we characterized the occurrence of HAI among patients with and without COVID-19 admitted to the ICU of the Umberto I hospital of Rome during the first 16 months of the pandemic and also identified risk factors for HAI acquisition. Patients were divided into four groups according to their ICU admission date. A multivariable conditional risk set regression model for multiple events was constructed for each admission period. Adjusted hazard ratios and 95% confidence intervals were calculated. Overall, 352 COVID-19 and 130 non-COVID-19 patients were included, and a total of 361 HAIs were recorded. We found small differences between patients with and without COVID-19 in the occurrence and type of HAI, but the infections in the two cohorts mostly involved different microorganisms. The results indicate that patient management was likely an important factor influencing the HAI occurrence during the pandemic. Effective prevention and control strategies to reduce HAI rates should be implemented.

The impact of COVID-19 on health care–associated infections in intensive care units in low- and middle-income countries: International Nosocomial Infection Control Consortium (INICC) findings

BackgroundThis study examines the impact of the COVID-19 pandemic on health care–associated infection (HAI) incidence in low- and middle-income countries (LMICs).MethodsPatients from 7 LMICs were followed up during hospital intensive care unit (ICU) stays from January 2019 to May 2020. HAI rates were calculated using the International Nosocomial Infection Control Consortium (INICC) Surveillance Online System applying the Centers for Disease Control and Prevention's National Healthcare Safety Network (CDC-NHSN) criteria. Pre–COVID-19 rates for 2019 were compared with COVID-19 era rates for 2020 for central line–associated bloodstream infections (CLABSIs), catheter-associated urinary tract infections (CAUTIs), ventilator-associated events (VAEs), mortality, and length of stay (LOS).ResultsA total of 7,775 patients were followed up for 49,506 bed days. The 2019 to 2020 rate comparisons were 2.54 and 4.73 CLABSIs per 1,000 central line days (risk ratio [RR] = 1.85, p = .0006), 9.71 and 12.58 VAEs per 1,000 mechanical ventilator days (RR = 1.29, p = .10), and 1.64 and 1.43 CAUTIs per 1,000 urinary catheter days (RR = 1.14; p = .69). Mortality rates were 15.2% and 23.2% for 2019 and 2020 (RR = 1.42; p < .0001), respectively. Mean LOS for 2019 and 2020 were 6.02 and 7.54 days (RR = 1.21, p < .0001), respectively.DiscussionThis study documents an increase in HAI rates in 7 LMICs during the first 5 months of the COVID-19 pandemic and highlights the need to reprioritize and return to conventional infection prevention practices.

The Impact of COVID-19 Pandemic on Health Care-Associated Infections in Intensive Care Units: Results From the Egypt National Health Care-Associated Infections Surveillance, 2019-2020

Background The COVID-19 pandemic resulted in the unexpected influx of patients leading to high rates of hospitalization. Focusing resources to mitigate the pandemic unintentionally reduced attention to health care-associated infections (HAIs) prevention programs. Intensive care units (ICUs) have suffered the most burden due to requirement of ventilation. Objective In this paper, we aimed to estimate the national HAI rates at ICUs before and during the COVID-19 pandemic to better identify the pandemic’s impact on HAIs. Methods Egypt’s HAI Surveillance was established in 2016 in 177 governmental ICUs. CDC case definitions and questionnaire were used to collect patients’ data. The types of HAIs targeted included bloodstream infections, pneumonia, and urinary tract infections. Pathogen identification and antimicrobial resistance were performed at the central laboratory. Surveillance data 2019-2020 were obtained, and a descriptive data analysis was performed. HAI rates per 100 patient days and device-associated infections (DAIs) per 1000 device days were compared between 2019 and 2020. Results In 2020, 4028 HAIs were reported, including 777 (19.3%) ICU-acquired reports; however, in 2019, 6242 were reported, including 1084 (17.4%) ICU-acquired ones. Incidence significantly decreased in 2020 compared with 2019 (2.67 vs 2.72, P&lt;.001). The percentages of bloodstream infections, pneumonia, and urinary tract infection in 2020, compared with 2019, were 64.0% versus 61.6%, 10.9% versus 12.1%, and 25.1% versus 23.8%, respectively. DAIs decreased significantly, including CLABSI (2.6 vs 2.5, P&lt;.001), VAP (0.75 vs 0.87, P=.04), and CAUTI (1.5 vs 1.6, P=.02). Klebsiella spp. was the predominant pathogen in both years representing (35.6% and 38.1%), followed by S. aureus (11.2% and 15.4%). The rate of carbapenem-resistant K. pneumoniae insignificantly increased (25% vs 23%, P=0.3), and that of Methicillin-resistant S. aureus decreased (68% vs 70%, P=0.4). Conclusions Egypt’s HAI Surveillance successfully described the impact of COVID-19 pandemic on HAIs. It identified a significant decrease in ICU-acquired HAIs and DAIs at the first pandemic year, which could reflect better the infection control measures. The types of HAIs, causative pathogens, and antimicrobial resistance pattern did not change significantly. Surveillance should be maintained to guide HAIs’ preventive and control measures.

Surveillance for surgical site infections in orthopedic trauma surgeries at an Indian hospital

PurposeSurgical site infections (SSIs) are one of the most common, causing substantial morbidity, mortality and are highly cost-effective means of reducing healthcare associated infections rates in health care set-ups. In India, there is no existing system for systematic surveillance of SSIs, encompassing post-discharge period. MethodsAn indigenous SSI e-surveillance software was developed. Patients developing SSI as per standard definitions were included in the study. A denominator form and a case report form were filled for each case of SSI detected. The microbiological diagnosis was done as per standard methods. Logistic regression analysis was used to test for association of SSI and risk factors and determining the prevalence odds ratios. ResultsOf the total of 850 patients enrolled in the SSI surveillance, 47 (5.5%) developed SSI. Most patients (490/850, 58%) underwent the open reduction internal fixation (ORIF) and also developed an SSI (33/490, 6.7%). Clean contaminated wound class and Dressing were found to be associated with increased risk of SSI significantly, Also increase in the length of stay was found to be associated with increased risk of SSI significantly. High antimicrobial resistance was observed in the microbial isolates recovered from SSIs. Patients who developed SSI had longer hospital stays. ConclusionsOur study has been the first systematic surveillance effort in India, where patients were followed up till six months post surgeries. This pilot study was later expanded to other Indian hospitals. This network of SSI-Surveillance will lay the foundation for initiation of SSI-surveillance across the country.

Health care-associated infections, including device-associated infections, and antimicrobial resistance in Iran: The national update for 2018

SummaryIntroductionSurveillance of health care-associated infections (HAIs) is an essential part of an efficient healthcare system. This study is an update on incidence and mortality rates of HAIs in Iran in 2018.MethodsAlmost all hospitals across the country (940 hospitals) entered the data of HAIs and denominators to the Iranian Nosocomial Infections Surveillance (INIS) software. Statistics were derived from INIS.ResultsFrom 9,607,213 hospitalized patients, 127,953 suffered from HAI, 15.65% of whom died. The incidence rate of HAI was calculated as 4.2 per 1000 patient-days. Considering relative frequencies among HAIs, Pneumonia (29.1%) and UTIs (25.6%) were the most common types of infection. Ventilator-associated pneumonia (VAP) was the most frequent device-associated infection (DAI) 25.66 per 1000 ventilator-days, and had the highest mortality rate (43.08%). Incidence density of other DAIs was 5.43 for catheter-associated UTI and 2.86 for catheter-associated BSI per 1000 device-days. Medical ICUs had the highest incidence and percentage of deaths (15.35% and 37.63%, respectively). The most causative organisms were Escherichia coli, Acinetobacter baumannii, and Klebsiella pneumonia. The rate of methicillin-resistance Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus (VRE), and Klebsiella pneumoniae carbapenemase (KPC)-producing bacteria was about 49%, 57%, and 58% respectively.ConclusionThis study provided an overview of HAIs in Iran and indicated that HAIs required special attention both in detection/reporting and in infection control measures. Future studies could be done on adherence rate of DAIs’ preventive bundles, interventions via multimodal strategies, evaluating the effect of training, and effect of antibiotic stewardship programs.

The Effect of Long Public Holidays on Healthcare-associated Infection Rate

The Effect of Long Public Holidays on Healthcare-associated Infection Rate

Infection preventionist staffing levels and rates of 10 types of healthcare-associated infections: A 9-year ambidirectional observation.

To quantitatively evaluate relationships between infection preventionists (IPs) staffing levels, nursing hours, and rates of 10 types of healthcare-associated infections (HAIs). An ambidirectional observation in a 528-bed teaching hospital. All inpatients from July 1, 2012, to February 1, 2021. Standardized US National Health Safety Network (NHSN) definitions were used for HAIs. Staffing levels were measured in full-time equivalents (FTE) for IPs and total monthly hours worked for nurses. A time-trend analysis using control charts, t tests, Poisson tests, and regression analysis was performed using Minitab and R computing programs on rates and standardized infection ratios (SIRs) of 10 types of HAIs. An additional analysis was performed on 3 stratifications: critically low (2-3 FTE), below recommended IP levels (4-6 FTE), and at recommended IP levels (7-8 FTE). The observation covered 1.6 million patient days of surveillance. IP staffing levels fluctuated from ≤2 IP FTE (critically low) to 7-8 IP FTE (recommended levels). Periods of highest catheter-associated urinary tract infection SIRs, hospital-onset Clostridioides difficile and carbapenem-resistant Enterobacteriaceae infection rates, along with 4 of 5 types of surgical site SIRs coincided with the periods of lowest IP staffing levels and the absence of certified IPs and a healthcare epidemiologist. Central-line-associated bloodstream infections increased amid lower nursing levels despite the increased presence of an IP and a hospital epidemiologist. Of 10 HAIs, 8 had highest incidences during periods of lowest IP staffing and experience. Some HAI rates varied inversely with levels of IP staffing and experience and others appeared to be more influenced by nursing levels or other confounders.

Impact of COVID-19 on an infection prevention and control program, Iowa 2020-2021

BackgroundThe COVID-19 pandemic has affected infection prevention and control (IPC) programs worldwide. We evaluated the impact of COVID-19 on the University of Iowa Hospitals & Clinics IPC program by measuring the volume of calls to the program, changes in healthcare-associated infection rates, and team member perceptions. MethodsWe retrieved the IPC call log and healthcare-associated infection trends for 2018-2020. We defined 2 periods: pre-COVID-19 (2018-2019) and COVID-19 (January-December 2020). We also conducted one-on-one interviews and focus group interviews with members of the IPC program and describe changes in their working conditions during the COVID-19 period. ResultsA total of 6,564 calls were recorded during 2018-2020. The pre-COVID-19 period had a median of 71 calls and/or month (range: 50-119). During the COVID-19 period, the median call volume increased to 368/month (range: 149-829), and most calls were related to isolation precautions (50%). During the COVID-19 period, the central line-associated bloodstream infection incidence increased significantly. Infection preventionists reported that the ambiguity and conflicting guidance during the pandemic were major challenges. ConclusionsOur IPC program experienced a 500% increase in consultation requests. Planning for future bio-emergencies should include creative strategies to increase response capacity within IPC programs.

Implementation of the Comprehensive Unit-Based Safety Program to Improve Infection Prevention and Control Practices in Four Neonatal Intensive Care Units in Pune, India.

Objective: To implement the Comprehensive Unit-based Safety Program (CUSP) in four neonatal intensive care units (NICUs) in Pune, India, to improve infection prevention and control (IPC) practices.Design: In this quasi-experimental study, we implemented CUSP in four NICUs in Pune, India, to improve IPC practices in three focus areas: hand hygiene, aseptic technique for invasive procedures, and medication and intravenous fluid preparation and administration. Sites received training in CUSP methodology, formed multidisciplinary teams, and selected interventions for each focus area. Process measures included fidelity to CUSP, hand hygiene compliance, and central line insertion checklist completion. Outcome measures included the rate of healthcare-associated bloodstream infection (HA-BSI), all-cause mortality, patient safety culture, and workload.Results: A total of 144 healthcare workers and administrators completed CUSP training. All sites conducted at least 75% of monthly meetings. Hand hygiene compliance odds increased 6% per month [odds ratio (OR) 1.06 (95% CI 1.03–1.10)]. Providers completed insertion checklists for 68% of neonates with a central line; 83% of checklists were fully completed. All-cause mortality and HA-BSI rate did not change significantly after CUSP implementation. Patient safety culture domains with greatest improvement were management support for patient safety (+7.6%), teamwork within units (+5.3%), and organizational learning—continuous improvement (+4.7%). Overall workload increased from a mean score of 46.28 ± 16.97 at baseline to 65.07 ± 19.05 at follow-up (p < 0.0001).Conclusion: CUSP implementation increased hand hygiene compliance, successful implementation of a central line insertion checklist, and improvements in safety culture in four Indian NICUs. This multimodal strategy is a promising framework for low- and middle-income country healthcare facilities to reduce HAI risk in neonates.

Evaluation of healthcare-associated infection rates in patients with hematologic malignancies and stem cell transplantation during the coronavirus disease 2019 (COVID-19) pandemic.

To evaluate whether rates of healthcare-associated infections (HAIs) changed during the coronavirus disease 2019 (COVID-19) pandemic in malignant hematology and stem cell transplant patients. A retrospective, cohort study. The study included malignant hematology and stem cell transplant patients admitted between March 1, 2019, through July 31, 2019, and March 1, 2020, through July 31, 2020. Rates of catheter-associated urinary tract infections (CAUTIs), central-line-associated bloodstream infections (CLABSIs), central-line-associated mucosal barrier injury infections (CLAMBIs), and Clostridioides difficile infections (CDIs) during the pandemic were compared to those in a control cohort. Secondary outcomes included the rate of non-COVID-19 respiratory viruses. The rate of CAUTIs per 1,000 hospital days was 0.435 before the pandemic and 0.532 during the pandemic (incidence rate ratio [IRR], 1.224; 95% confidence interval [CI], 0.0314-47.72; P = .899). The rate of CLABSIs was 0.435 before the pandemic and 1.064 during the pandemic (IRR, 2.447; 95% CI, 0.186-72.18; P = .516). The rate of CLAMBIs was 2.61 before the pandemic and 1.064 during the pandemic (IRR 0.408, 95% CI 0.057-1.927; P = .284). The rate of CDIs was 2.61 before the pandemic and 1.579 during the pandemic (IRR, 0.612; 95% CI, 0.125-2.457; P = .512). Non-COVID-19 respiratory virus cases decreased significantly from 12 (30.8%) to 2 cases (8.3%) (P = 0.014). There was no significant difference in HAIs among inpatient malignant hematology and stem cell transplant patients during the COVID-19 pandemic compared to those of a control cohort. Rates of infection were low among both cohorts. Rates of community-acquired respiratory viruses decreased significantly during the pandemic among this population.

The management of healthcare-related infections through lean methodology: systematic review and meta-analysis of observational studies.

Lean is largely applied to the health sector and on the healthcare-associated infections (HAI). However, a few results on the improvement of the outcome have been reported in literature. The purpose of this study is to analyze if the lean application can reduce the HAI rate. A comprehensive search was performed on PubMed/Medline, Scopus, CINAHL, Cochrane, Embase, and Google Scholar databases using various combinations of the following keywords: "lean" and "infection". Inclusion criteria were: 1) research articles with quantitative data and relevant information on lean methodology and its impact on healthcare infections; 2) prospective studies. The risk of bias and the study quality was independently assessed by two researchers using the "The National Institutes of Health (NIH) quality assessment tool for before-after (Pre-Post) study with no control group". The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines has been used. 22 studies were included in the present meta-analysis. Lean application demonstrated a significant protective role on healthcare-associated infections rate (RR 0.50; 95% C.I.: 0.38-0.66) with significant impact on central line-associated bloodstream infections (CLABSIs) (RR 0.47; 95% C.I.: 0.28-0.82). Lean has a positive impact on the decreasing of HAIs and on the improvement of compliance and satisfaction of the staff.