Reduce Health Care-associated Infections Research Articles

ВИДОВИЙ ПРОФІЛЬ МІКРОБНИХ ЧИННИКІВ НОЗОКОМІАЛЬНИХ ІНФЕКЦІЙ

Nosocomial infections, also known as health care-associated infections (HAIs) are infections that appear in patients under medical care in hospitals or other health care facilities and were absent at the time of admission. From 5 to 7 thousand cases of HAIs are registered in Ukraine every year, but according to experts, the actual number is 900 thousand cases per year. Intensive care unit (ICU) represents a prominent tool in HAIs control and quality assurance in many developed countries. In this respect, the US Center for Disease Control and Prevention (CDC) recommends monitoring HAI as a leading tool for the reduction of HAIs. Therefore, the aim of this research was to investigate microbiological profile of nosocomial infections in ICU of public hospitals in Lviv, Ukraine. Material and methods. 105 clinical materials from 50 patients in two public hospitals in Lviv (Lviv Regional clinical hospital and Military Medical Clinical Center of the Western Region) were analyzed during July-December 2018. 114 strains of pathogens were isolated. HAIs was defined as an infection that appeared in patients later than 48 hours after admission to the hospital. Urinary tract infections (UTI), blood stream infection (BI), respiratory tract infection (RTI) and surgical site infections (SSI) were diagnosed using the criteria defined by the CDC and clinical protocols. Causative bacterial strains were isolated and identified using standard methods and chromogenic media CHROMID*S.aureusElite, CHROMID*VRE, CHROMID*MRSASMART, CHROMID*CARBASMART, CHROMID* ESBL, CHROMID*OXA-48, CHROMID*Candida (Biomerieux) and biochemical identification kitsMIKRO-LA-TESTNEFERMtest24, ENTEROtest24, CANDIDAtest21, STAPHYtest24, STREPTOtest24 (ErbaLacema, Czech Republic). Antibiotic sensitivity test was done using Kirby-Bauer disc diffusion technique. (Ethical Committee or Institutional Animal Care and Use Committee Approval Danylo Halytsky Lviv National Medical University: 25/06/2018 № 6). HAIs structure was as follows: Staphylococcus lentus (22%), Eschrichia coli (22%), Klebsiella pneumoniae subsp.ozaenae (9.8%), Pseudomonas aeruginosa (43.9%), Klebsiella pneumoniae subsp.pneumonia (8.8%), Srreptococcus spp. (7.0%), Burkholderia pseudomallei (5.3%), Staphylococcus haemolyticus (3.5), Staphylococcus aureus (3.5%). There were several types of HAIs which are rarely found, such as Staphylococcus lentus, Staphylococcus simulans, Staphylococcus lugdunensis, Aerococcus viridans, Pragia fontium, Aeromonasichthiosmia, Raoultella terrigena, Macrococcus caseolyticus. Conclusions. In the era of antibiotics, HAIs are still uncontrollable. It is assessed that over 90.0% of HAIs are not recognized as epidemics. It is important to remember this fact when attempting to design prevention or control strategy to reduce HAIs either at WHO level, or at the level of local health care unit.

Reduction of Healthcare-Associated Infections (HAIs) by 83% in a long-term acute care setting (LTAC)

BACKGROUND HAIs impose significant patient safety consequences. LTACs provide extended medical and rehabilitative care to patients with clinically complex problems. LTAC patients have an average of three to six concurrent active diagnoses and multiple acute complexities with a 28?day average length of stay. Our objectives were to reduce HAI rates through process improvement. METHODS We focused on prevention bundles to reduce HAIs. Catheter?-associated urinary track infection (CAUTI) bundle included nurse-driven urinary catheter removal and hand hygiene protocols. Clostridium difficile infection (CDI) bundle included hand hygiene, personal protective equipment and transportation protocols, preemptive isolation and antibiotic stewardship. Central line-associated bloodstream infection (CLABSI) bundle included nurse-driven device removal and hand hygiene protocols. HAI champions served as role models for change through education and audits. RESULTS These implementations created change in our facility that decreased HAIs from 53 in 2013 to 9 in 2018. The CAUTI rate decreased from 5.4 per 1,000 line days (31 CAUTIs) to 1.8 (3 CAUTIs), SIR= 0.697. The incidence density rate (IDR) p-value was 0.0085. The urinary catheter line days decreased 61.6% from 5765 to 2213. The CDI rate decreased from 14.4 per 10,000 patient days (15 CDIs) to 4.1 (3 CDIs), SIR= 0.370. The IDR p-value was 0.0312. The CLABSI rate decreased from 1.04 per 1000 line days (7 CLABSIs) to 0.59 (2 CLABSIs), SIR= 0.296. The IDR p-value was 0.0312. The central line days decreased 49.8% from 6709 to 3367. Hand hygiene compliance increased 45% from 62% compliance to 90% compliance. CONCLUSIONS HAIs are a major concern in the LTAC setting. Focusing on prevention of HAIs was effective in reducing our rate by 83% with a significance level of p=0.0001. Although statistical significance was not reached, the reduction in HAIs was significant for our patients. HAIs impose significant patient safety consequences. LTACs provide extended medical and rehabilitative care to patients with clinically complex problems. LTAC patients have an average of three to six concurrent active diagnoses and multiple acute complexities with a 28?day average length of stay. Our objectives were to reduce HAI rates through process improvement. We focused on prevention bundles to reduce HAIs. Catheter?-associated urinary track infection (CAUTI) bundle included nurse-driven urinary catheter removal and hand hygiene protocols. Clostridium difficile infection (CDI) bundle included hand hygiene, personal protective equipment and transportation protocols, preemptive isolation and antibiotic stewardship. Central line-associated bloodstream infection (CLABSI) bundle included nurse-driven device removal and hand hygiene protocols. HAI champions served as role models for change through education and audits. These implementations created change in our facility that decreased HAIs from 53 in 2013 to 9 in 2018. The CAUTI rate decreased from 5.4 per 1,000 line days (31 CAUTIs) to 1.8 (3 CAUTIs), SIR= 0.697. The incidence density rate (IDR) p-value was 0.0085. The urinary catheter line days decreased 61.6% from 5765 to 2213. The CDI rate decreased from 14.4 per 10,000 patient days (15 CDIs) to 4.1 (3 CDIs), SIR= 0.370. The IDR p-value was 0.0312. The CLABSI rate decreased from 1.04 per 1000 line days (7 CLABSIs) to 0.59 (2 CLABSIs), SIR= 0.296. The IDR p-value was 0.0312. The central line days decreased 49.8% from 6709 to 3367. Hand hygiene compliance increased 45% from 62% compliance to 90% compliance. HAIs are a major concern in the LTAC setting. Focusing on prevention of HAIs was effective in reducing our rate by 83% with a significance level of p=0.0001. Although statistical significance was not reached, the reduction in HAIs was significant for our patients.

Methodology to Reduce Healthcare Associated Infections at a Large Multi-Hospital Health System

BACKGROUND In this changing landscape of healthcare, Infection Prevention (IP) programs need to demonstrate their value to their institutions. One way to do this is through the reduction of healthcare associated infections (HAI). This improves patient outcomes and can also provide value through the avoidance of hospital acquired condition (HAC) penalties. METHODS The reduction of HAIs at the system level of a 151-hospital health system became a top priority necessitating a structured approach. Beginning in January 2017, clear expectations of what is submitted to the National Healthcare Safety Network (NHSN) and reporting deadlines were defined. Next, HAI targets were established. Data is accessed from NHSN by the analytics department via Group Administrator rights. Analysis of standardized infection ratios (SIR), standardized utilization ratios (SUR) and Cumulative Attributable Differences (CADS) relative to system targets is conducted. Follow-up with hospitals having the highest CADS begins with a discussion with the IP team. Then, collaboration and feedback with the local team continues and efforts are escalated up to and including the C-suite and may culminate in a site visit if needed. The role and engagement of the Chief Quality Officer (CQO) is critical throughout the process. RESULTS Since establishing this methodology, the HAI outcomes have approved in six of the eight categories. In the past year (October?2017-September 2018) Clostridium difficile reduced 12%, central line associated bloodstream infection (CLABSI) 16%, catheter?associated urinary tract infection (CAUTI) 11%, abdominal hysterectomy surgical site infections (SSI) 46%, colon surgery SSI?19% and hip arthroplasty SSI 15%. In addition, HAC penalties were reduced. CONCLUSIONS This methodology has been very effective in reducing the HAIs across the health system. Also, the feedback from the stakeholders is positive because it results in collaboration and often brings needed attention to an area they have been struggling with.

An environmental cleaning bundle and health-care-associated infections in hospitals (REACH): a multicentre, randomised trial

The hospital environment is a reservoir for the transmission of microorganisms. The effect of improved cleaning on patient-centred outcomes remains unclear. We aimed to evaluate the effectiveness of an environmental cleaning bundle to reduce health care-associated infections in hospitals. The REACH study was a pragmatic, multicentre, randomised trial done in 11 acute care hospitals in Australia. Eligible hospitals had an intensive care unit, were classified by the National Health Performance Authority as a major hospital (public hospitals) or having more than 200 inpatient beds (private hospitals), and had a health-care-associated infection surveillance programme. The stepped-wedge design meant intervention periods varied from 20 weeks to 50 weeks. We introduced the REACH cleaning bundle, a multimodal intervention, focusing on optimising product use, technique, staff training, auditing with feedback, and communication, for routine cleaning. The primary outcomes were incidences of health-care-associated Staphylococcus aureus bacteraemia, Clostridium difficile infection, and vancomycin-resistant enterococci infection. The secondary outcome was the thoroughness of cleaning of frequent touch points, assessed by a fluorescent marking gel. This study is registered with the Australian and New Zealand Clinical Trial Registry, number ACTRN12615000325505. Between May 9, 2016, and July 30, 2017, we implemented the cleaning bundle in 11 hospitals. In the pre-intervention phase, there were 230 cases of vancomycin-resistant enterococci infection, 362 of S aureus bacteraemia, and 968 C difficile infections, for 3 534 439 occupied bed-days. During intervention, there were 50 cases of vancomycin-resistant enterococci infection, 109 of S aureus bacteraemia, and 278 C difficile infections, for 1 267 134 occupied bed-days. After the intervention, vancomycin-resistant enterococci infections reduced from 0·35 to 0·22 per 10 000 occupied bed-days (relative risk 0·63, 95% CI 0·41-0·97, p=0·0340). The incidences of S aureus bacteraemia (0·97 to 0·80 per 10 000 occupied bed-days; 0·82, 0·60-1·12, p=0·2180) and C difficile infections (2·34 to 2·52 per 10 000 occupied bed-days; 1·07, 0·88-1·30, p=0·4655) did not change significantly. The intervention increased the percentage of frequent touch points cleaned in bathrooms from 55% to 76% (odds ratio 2·07, 1·83-2·34, p<0·0001) and bedrooms from 64% to 86% (1·87, 1·68-2·09, p<0·0001). The REACH cleaning bundle was successful at improving cleaning thoroughness and showed great promise in reducing vancomycin-resistant enterococci infections. Our work will inform hospital cleaning policy and practice, highlighting the value of investment in both routine and discharge cleaning practice. National Health and Medical Research Council (Australia).

Reducing Infections "Together": A Review of Socioadaptive Approaches.

Reducing healthcare-associated infections often requires the use of both technical and adaptive strategies. The experiences of Semmelweis and Nightingale teach us the importance of social adaptation of technical interventions. Because most infection prevention interventions require widespread participation by healthcare personnel, it is helpful for infectious diseases physicians to learn principles of diffusion of innovations theory and apply them to influence different groups. Comprehensive unit-based program has been successful in reducing device-associated infections. Positive deviance as a socioadaptive approach may be promising. These and other approaches such as social network analysis, relational coordination, link nurses, and stop the line policies need to be further evaluated in future studies. Future research on socioadaptive interventions needs to focus on developing tools and strategies for diagnosing local context and study how these interventions might influence culture of safety. Strategies to sustain momentum of improvement efforts in different healthcare settings need to be refined and further developed through additional research.

Food for thought. Malnutrition risk associated with increased risk of healthcare-associated infection

Infection and malnutrition are interconnected. UK and Irish guidelines recommend the Malnutrition Universal Screening Tool (MUST) for nutritional risk screening. Patients with a MUST score of ≥2 are considered at high risk of malnutrition and referral for nutritional assessment is recommended. To explore the association between healthcare-associated infection (HCAI) and the MUST score categories of patients. This was a cross-sectional study in May 2017 on ten representative wards in our institution. Patient demographics, MUST score, presence of medical devices, HCAI and antimicrobial use were collected. Of 240 patients, the HCAI prevalence was 10.4% (N=25) and 26% (N=63) were at high risk of malnutrition (MUST score ≥2). Patients with HCAI were more likely to have had surgery (odds ratio (OR): 5.5; confidence interval (CI): 2.1-14.3; P<0.001), a central vascular catheter (OR: 10.0; CI: 3.6-27.2; P<0.001), or a urinary catheter in situ (OR: 7.5; CI: 2.8-20.0; P<0.001), and to have a high risk of malnutrition (OR: 4.3; CI: 1.7-11.2; P<0.001). A higher MUST score remained a significant predictor of a patient having HCAI on multivariate regression analysis (CI: 0.2-0.6; P<0.001). Patients at risk of malnutrition when assessed with the MUST were more likely to have HCAI. However, prospective studies are required to investigate the temporal association between MUST and HCAI and which interventions best address malnutrition risk and HCAI reduction in different settings.

Healthcare-associated infection in the Grey’s Hospital paediatric intensive care unit: does an Infection Control Programme work?

Background: Healthcare-associated infections are an important cause of morbidity and mortality globally. Grey’s Hospital introduced an Infection Control Programme in August 2016, which included Best Care Always bundles for reducing the occurrence of central line-associated bloodstream infections, catheter-associated urinary tract infections and ventilatorassociated pneumonia. Methods: An observational before–after quasi-experiment was conducted retrospectively reviewing healthcare-associated infection rates in the Grey’s Hospital paediatric intensive care unit a year prior to (August 2015 to July 2016) and after (September 2016 to August 2017) implementation of an Infection Control Programme.Results: There was an absolute decrease in healthcare-associated infection from 102 to 81 and a statistically significant decrease in bloodstream infections per 1 000 central venous catheter days from 36/1 000–15/1 000 after intervention (RR 0.42, 95% CI 0.23–0.79, p = 0.004). The rate of healthcare-associated infection decreased from 23/100 admissions prior to the intervention to 20/100 admissions after the intervention (RR 0.87, 95% CI 0.51–1.48, p = 0.61) and from 40/1 000 patient days to 32/1 000 patient days (RR 0.80, 95% CI 0.51–1.26, p = 0.34). Reductions in healthcare-associated infection were also seen in bloodstream infections and urinary tract infections.Conclusion: The observed downward trend in overall healthcare-associated infections, bloodstream infections and urinary tract infections did not reach statistical significance except for bloodstream infections per 1 000 central venous catheter days. Further research or audit is needed to ascertain reasons for this less than expected decrease in healthcare-associated infections. In the meantime, meticulous adherence to bundles should be encouraged.

Hand hygiene in hospitals: an observational study in hospitals from two southern states of India

BackgroundHand hygiene is a simple and low-cost measure to reduce healthcare associated infection yet it has always been a concern in low as well as high resource settings across the globe. Poor hand hygiene during intra-partum and newborn care may result in sepsis, which is a major cause of death among newborns and puts a financial burden on already strained health systems.MethodsWe conducted non-participatory observations in newborn care units and labour rooms from secondary and tertiary level, public and private hospitals, as part of a baseline evaluation of a quality improvement collaborative across two southern states of India. We assessed hand hygiene compliance during examinations and common procedures, using tools adapted from internationally recommended checklists and World Health Organization’s concept of five moments of hand hygiene. We assessed differences in compliance by type (public/private), level (secondary/tertiary) and case load (low/intermediate/high). Analysis was adjusted for clustering and weighted as appropriate.ResultsWe included 49 newborn care units (19 private, 30 public) and 35 labour rooms (5 private, 30 public) that granted permission. We observed 3661 contacts with newborns and their environment, 242 per-vaginal examinations and 235 deliveries. For the newborns, a greater proportion of contacts in private newborn units than public complied with all steps of hand hygiene (44% vs 12%, p < 0.001), and similarly in tertiary than secondary units (33% vs 12%, p < 0.001) but there was no evidence of a difference by case load of the facility (low load-28%; intermediate load-14%; high load- 24%, p = 0.246). The component with lowest compliance was glove usage where indicated (20%). For deliveries, hand hygiene compliance before delivery was universal in private facilities but seen in only about one-quarter of observations in public facilities (100% vs 27%, p = 0.012). Average overall compliance for hand-hygiene during per-vaginal examinations was 35% and we found no evidence of differences by type of facility.ConclusionObserved compliance with hand hygiene was low overall, although better in private than public facilities in both newborn units and labour rooms. Glove usage was a particular problem in newborn care units.Trial registrationRetrospectively registered with Clinical Trials Registry- India (CTRI/2018/04/013014).

1146. Effectiveness of Ultraviolet Irradiation on Candida auris: A Laboratory Study

Background Candida auris is a multidrug-resistant yeast which persists on healthcare surfaces for prolonged periods of time and is an emerging pathogen in hospitals. It has been linked to healthcare-associated infection (HAI) through surface transmission. Mobile ultraviolet (UV) light emitting devices from mercury sources have been shown to be effective in reducing C. auris bioburden but require prolonged exposure. In this study, we demonstrate the efficacy of an UV emitting device used in our hospital for terminal disinfection on C. auris.MethodsTwo C. auris strains (AR-381-CAU-01 and CAU-02) isolates obtained from Centers for Disease Prevention and Control (CDC) were used along with a Candida albicans (C. albicans) strain. An organism load of 10 μL containing 106 colony forming unit (CFU) was spread on a 20-mm diameter stainless steel coupon and exposed to the UV source from a pulsed xenon device at 5 feet distance and 4 feet height for 5, 10, and 30 minutes. Killing efficacy in terms of log reduction was calculated in comparison to untreated control coupons.ResultsMean CFU log10 reduction for C. albicans, CAU-01, and CAU-02 was 0.547, 1.051, and 0.952 at 5 minutes; 1.412, 1.975, and 1.879 at 10 minutes; and 2.639, 3.971, and 4.145 at 30 minutes, respectively. Figure 1 describes the mean log10 reduction as well as the minimum and maximum log reduction by isolates.ConclusionOur study demonstrates the UV from a pulsed xenon device is effective in reducing the C. auris on stainless steel coupons. Similar to previously published data on reduction of C. auris by other UV sources, extended exposure is required to achieve a higher log reduction of C. auris. We did not have any C. auris clinical infections to assess efficacy of UV on HAI reduction. Disclosures C. Jinadatha, Xenex Healthcare Service: Grant Investigator, Research grant.

Vacuum-assisted closure (VAC\xae) systems and microbiological isolation of infected wounds

BackgroundNegative pressure wound therapy is now largely used to treat infected wounds. The prevention and reduction of healthcare-associated infections is a high priority for any Department of Health and great efforts are spent to improve infection control systems. It is assumed that vacuum-assisted closure (VAC®) dressings should be watertight and that all the secretions are gathered in a single container but there is no consistent data on air leakage and possible dispersion of bacteria from the machine.MethodsWe have conducted a prospective experimental study on 10 patients with diagnosis of wound infection to verify whether the filtration process is microbiologically efficient. We compared the bacteria population present in the wound to the one present in the air discharged by the VAC® machine.ResultsThis study shows that the contamination of the VAC® machine is considerably lower than the environment or wound contamination.ConclusionsNegative pressure wound therapy system does not represent a risk factor for healthcare-associated infections.

Healthcare-associated infections in intensive care units in Taiwan, South Korea, and Japan: recent trends based on national surveillance reports

BackgroundSustainable systematic interventions are important for infection prevention and control (IPC). Data from surveillance of healthcare-associated infections (HAI) provides feedback for implementation of IPC programs. To address the paucity of such data in Asia, we searched for national HAI surveillance and IPC programs in this region.MethodsData were analysed from open access national surveillance reports of three Asian countries: Taiwan, South Korea and Japan from 2008 to 2015. National IPC programs were identified.ResultsThere were differences among the countries in surveillance protocols, hospital coverage rates, and national IPC policies and programs. Nevertheless, there was a 53.0% reduction in overall HAI over the 8-year period. This consisted of a decrease from 9.34 to 5.03 infections per 1000 patient-days in Taiwan, from 7.56 to 2.76 in Korea, and from 4.41 to 2.74 in Japan (Poisson regression, all p < 0.05). Across the three countries, Escherichia coli and Candida albicans were the major pathogens for urinary tract infection. Staphylococcus aureus, Acinetobacter baumannii and Enterococcus faecium were common bloodstream pathogens. For pneumonia, S. aureus, A. baumannii, Pseudomonas aeruginosa, and Klebsiella pneumoniae were the predominant pathogens, with considerable country differences. There was a 64.6% decrease in the number of isolates of methicillin-resistant S. aureus, 38.4% decrease in carbapenem-resistant P. aeruginosa and 49.2% decrease in carbapenem-resistant A. baumannii (CRAB) in Taiwan (all p < 0.05), and similarly in Korea with the exception of CRAB (30.5 and 50.4% reduction, respectively, both p < 0.05).ConclusionWe found a significant decrease in HAI across the three countries in association with sequential multifaceted interventions such as hand hygiene, care bundles, and antimicrobial stewardships. Further regional collaboration could be forged to develop joint strategies to prevent HAI.

Contemporary stethoscope cleaning practices: What we haven't learned in 150 years

Stethoscopes can be microorganism reservoirs. The US Centers for Disease Control and Prevention (CDC) has published medical equipment disinfection guidelines to minimize infection transmission risk, but studies of guideline adherence have been predominately survey based, with little direct observation of disinfection practices. We performed an observational, cross-sectional, anonymous study of patient-provider interactions, assessing practitioners' frequency and methods of stethoscope and hand disinfection practices. Stethoscopes were disinfected in 18% of 400 observed interactions, with less than 4% verified as conforming to CDC guidelines. None was disinfected before patient examinations involving open chest or abdominal wounds, as recommended by the CDC. Hands were cleaned before and after encounters 27 times (6.8%) but were not cleaned at all in 231 (58%) encounters, although gloves were worn in 197 (85.3%) of these cases. Stethoscope disinfection is grossly overlooked, possibly jeopardizing patient safety, particularly in acute care interactions. Periodic stethoscope disinfection, although inconvenient, helps reduce bacterial contamination and may reduce health care-associated infections. Stethoscopes were disinfected per CDC guidelines in less than 4% of encounters and were not disinfected at all in 82% of encounters. Although hands were rarely cleaned (6.8%) per CDC guidelines, gloves were usually worn, but no convenient stethoscope equivalent exists. Stethoscope cleanliness must be addressed.

Implementation of a national quality improvement program to enhance hand hygiene in nursing homes in Taiwan.

This study investigated the cause of hand hygiene deficit, and further implemented a quality improvement program using WHO's hand-hygiene strategy to enhance the compliance of hand hygiene in the nursing home in Taiwan. This prospective study was conducted in eleven nursing homes in Taiwan from January 2015 to December 2016. After intervention, we monitor the compliance, and accuracy of hand hygiene. In addition, we also calculated the number of episodes of infection per 1000 resident-days in each nursing home in the intervention period (July-December 2015) and post-intervention period (January-October 2016). Overall, the consumption of alcohol-based handrubs increased from 10.1ml per resident-day in intervention period to 12.2ml per resident-day in post intervention period. The compliance of hand hygiene increased from 74% in intervention period to 79% in post-intervention period and the rate of correct hand hygiene increased from 81% in intervention period to 87% in post-intervention period. Most importantly, the infection density decreased from 2.39 per 1000 resident-day in intervention period to 1.89 per 1000 resident-day. A national quality-improvement program using WHO's hand-hygiene strategy to enhance hand hygiene and reduce healthcare associated infection is effective in nursing homes in Taiwan.

Effectiveness of a hospital-wide infection control programme on the incidence of healthcare-associated infections and associated severe sepsis and septic shock: a prospective interventional study

ObjectivesTo evaluate whether a hospital-wide infection control programme (ICP) is effective at reducing the burden of healthcare-associated infections (HAIs) and associated severe sepsis/septic shock or death (severe HAIs). MethodsProspective, quasi-experimental study with two surveillance periods (September 2011 to August 2012; May 2013 to August 2014). Starting October 2012, the ICP included hand hygiene promotion and bundle implementation for common HAIs. We applied segmented mixed-effects Poisson regression and multi-state models. We reported adjusted incidence rate ratios (aIRR) and adjusted hazard ratios (aHR) with 95% confidence intervals (CI). ResultsOverall, 62 154 patients were under surveillance, with 1568 HAIs identified in 1170 patients (4.3 per 100 admissions) in the first and 2336 HAIs identified in 1711 patients (4.9 per 100 admissions) in the second surveillance period. No differences were found in the overall HAI incidence rates between the periods in the general wards (aIRR 1.29, 95% CI 0.78–2.15) and intensive care units (ICUs) (aIRR 0.59, 95% CI 0.27–1.31). However, the HAI incidence rate was declining in the ICUs after starting the ICP (aIRR 0.98, 95% CI 0.97–1.00 per 1-week increment), in contrast to general wards (aIRR 1.01, 95% CI 1.00–1.02). A reduction in severe HAIs (aIRR 0.13, 95% CI 0.05–0.32) and a lower probability of HAI-associated in-hospital deaths (aHR 0.56, 95% CI 0.31–0.99) were observed in the second period in the ICUs. ConclusionsThere was no overall reduction in HAIs after implementation of the ICP. However, there was a significant reduction in severe HAIs in ICUs. Whether this difference was a consequence of the ICP or improvement in HAI case management is not clear.

An automated hand hygiene compliance system is associated with decreased rates of health care-associated infections

Health care-associated infections (HAIs) are avoidable through good hand hygiene (HH) practices. Hand hygiene compliance systems (HHCSs) have been shown to reliably measure HH adherence, but data on their effectiveness at reducing HAI rates are limited. This nonrandomized, pre-post intervention study was conducted at a community hospital in the United States. HAI rates were examined before and after implementation of a HHCS. Preintervention began in January 2014 and intervention began in March 2015; data were collected through September 2017. Additional infection-specific interventions were carried out. HAIs were calculated as incidence rate ratios. The preintervention and intervention periods included 14,297 and 36,890 patients, respectively. The HHCS recorded an average of 696,928 HH opportunities/month. A significant reduction in the rate of catheter-associated urinary tract infections was observed during the intervention: IRR, 0.55; 95% CI, 0.35-0.87. Similarly, a significant reduction in the rate of central line-associated bloodstream infections was observed: IRR, 0.45; 95% CI, 0.23-0.89. These findings suggest that monitoring HH practices with an automated system, in addition to other infection control measures, may be an effective means of reducing HAIs. Further studies are needed to isolate the potential role of HHCSs in the reduction of HAIs.

Effect of copper-impregnated composite bed linens and patient gowns on healthcare-associated infection rates in six hospitals

Hospital linens and patient gowns are frequently touched and contaminated, and may contribute to endogenous, indirect-contact, and aerosol transmission of nosocomial-related pathogens. Recently Sentara Healthcare adopted biocidal copper oxide-impregnated linens across its hospitals. To assess whether the replacement of the linens resulted in the reduction of healthcare-associated infection (HCAI). Rates of HCAI caused by Clostridium difficile and multidrug-resistant organisms (MDROs) were compared in six Sentara Healthcare hospitals with similar patient demo-graphics (total of 1019 beds) in three parallel periods (90, 180 and 240 days) before and after (periods A1, A2 and A3, and periods B1, B2, and B3, respectively), replacing all the regular non-biocidal linens with the copper oxide-impregnated biocidal linens. During periods B1, B2, and B3, compared with periods A1, A2 and A3, there were 61.2% (P<0.05), 41.1% (P<0.05) and 42.9% (P<0.01) reductions in HCAI per 10,000 patient-days in hospital caused by C.difficile, respectively; 48.3% (P>0.05), 36.4% (P>0.05), and 19.2% (P>0.05) reductions in HCAI per 1000 patient-days caused by MDROs; and 59.8% (P<0.01), 39.9% (P<0.05), and 37.2% (P<0.05) in the reduction of HCAI per 1000 patient-days caused by C.difficile and MDROs combined. The use of biocidal copper oxide-impregnated linens in the six analysed Sentara Healthcare hospitals resulted in significant reduction in both HCAI caused by C.difficile, and the combined metric of C.difficile or MDRO infection. Similar reductions in HCAI caused by MDROs were observed, although these reductions did not reach statistical significance, probably due to very low HCAI rates caused by these pathogens in the study facilities.

Exploring the why and how questions associated with adoption of evidence-based practices to reduce health care-associated infections

Exploring the why and how questions associated with adoption of evidence-based practices to reduce health care-associated infections

Reducing health care-associated infections by implementing separated environmental cleaning management measures by using disposable wipes of four colors

BackgroundEnvironmental cleaning is a fundamental principle of infection control in health care settings. We determined whether implementing separated environmental cleaning management measures in MICU reduced the density of HAI.MethodsWe performed a 4-month prospective cohort intervention study between August and December 2013, at the MICU of Cathay General hospital. We arranged a training program for all the cleaning staff regarding separated environmental cleaning management measures by using disposable wipes of four colors to clean the patients’ bedside areas, areas at a high risk of contamination, paperwork areas, and public areas. Fifteen high-touch surfaces were selected for cleanliness evaluation by using the adenosine triphosphate (ATP) bioluminescence test. Then data regarding HAI densities in the MICU were collected during the baseline, intervention, and late periods.ResultsA total of 120 ATP readings were obtained. The total number of clean high-touch surfaces increased from 13% to 53%, whereas that of unclean high-touch surface decreased from 47% to 20%. The densities of HAI were 14.32‰ and 14.90‰ during the baseline and intervention periods, respectively. The HAI density did not decrease after the intervention period, but it decreased to 9.07‰ during the late period.ConclusionImplementing separated environmental cleaning management measures by using disposable wipes of four colors effectively improves cleanliness in MICU environments. However, no decrease in HAI density was observed within the study period. Considering that achieving high levels of hand-hygiene adherence is difficult, improving environmental cleaning is a crucial adjunctive measure for reducing the incidence of HAIs.

Innovative Methods of Hospital Disinfection in Prevention of Healthcare-Associated Infections

The purpose of this review is to give the reader an update on recent studies and developments regarding the hospital environment role in transmission of healthcare-associated infections (HAIs), and novel strategies to obtain a cleaner, safer patient environment. Hospital patient rooms are increasingly recognized as a reservoir of multi-drug-resistant organisms that contribute to HAIs. In simulated environments, surfaces can easily be adequately disinfected of pathogenic bacteria. However, translation into real healthcare settings has been less reliable and efficacious, with barriers to implementation of best practices. In this review, we describe and compare new and evolving technologies for enhancing room disinfection, such as UV-C, hydrogen peroxide vapor, ozone, and chlorine. We also review recent studies examining antimicrobial surfaces such as copper and silver and introduce a novel transdisciplinary human factors, systems engineering, and infection prevention approach to improve manual room cleaning. We highlight outstanding questions, including additional benefit of no touch technology in a human factors-optimized manual cleaning setting, and cost-effectiveness of optimized manual cleaning vs additional of no touch technology. There are evolving technologies and strategies to enhance patient room cleaning and decrease risk of HAI transmission. It is important for the infection prevention community to keep up to date with, and understand the implications of, these developments so as to best inform hospital HAI reduction strategy.

Healthcare-associated infections: potential for prevention through vaccination.

The challenge of healthcare-associated infections is compounded by the higher incidence of resistant organisms and the decreasing utility of antimicrobial agents. Historic and current vaccines have already contributed to reductions in healthcare-associated infections, and future vaccines have the potential to reduce these infections further. Through examples of bacterial and viral vaccines, this review will attempt to chart the way forward.