Risk Of Healthcare-associated Infections Research Articles

Bacterial Contamination and Antimicrobial Resistance Patterns of Healthcare Workers' Mobile Phones in Hospitals at Khartoum City

Background: Mobile phones used by healthcare workers (HCWs) have emerged as potential reservoirs for pathogens, posing a risk of healthcare-associated infections (HAIs). This study aimed to investigate the prevalence of bacterial contamination on HCWs' mobile phones, determine the antimicrobial susceptibility patterns, and compare findings with global data. Methods: We collected swabs from 94 mobile phones of HCWs across two hospitals in Khartoum. We identified bacterial isolates using standard microbiological techniques and evaluated antimicrobial resistance using the Kirby-Bauer disk diffusion method. Results: Bacterial contamination appeared in 93.6% of mobile phones. Gram-positive bacteria, such as Coagulase-negative staphylococci (36%) and S. aureus (31.8%) were prevalent. Gram-negative organisms were isolated. The predominant organisms were Klebsiella pneumoniae 15 (37%) isolates followed by Pseudomonas aeruginosa 12 (30%) isolates, Proteus mirabilis 5 (12%) isolates, Acintobacter baumannii 4 (10%), Enterobacter spp 3(8%) and Escherichia coli 1 (3%). Antimicrobial susceptibility tests revealed high resistance to penicillin among Gram-positive isolates. The tests revealed no multidrug-resistant (MDR) or extended-spectrum beta-lactamase (ESBL) production. Conclusion: HCWs' mobile phones represent a critical vector for bacterial transmission in hospitals. Stringent infection control measures and regular disinfection should mitigate the associated risks.

Knowledge, Attitudes, and Practices of Infection Prevention and Control Nurses in Public Hospitals in the Limpopo Province: A Qualitative Study.

A crucial aspect of delivering healthcare is infection prevention and control (IPC), especially in public hospitals where the high volume of patients and limited resources can heighten the risk of healthcare-associated infections. This qualitative study explores IPC nurses' knowledge, attitudes, and practices in public hospitals within the Limpopo province of South Africa. The study adopted a qualitative descriptive design. This qualitative study utilized self-developed validated semi-structured interviews with IPC nurses from 12 public hospitals (4 tertiary, 4 regional, and 4 district). The interviews were transcribed verbatim and analysed using thematic analysis to identify key themes related to knowledge, attitudes, and practices in IPC. Each interview lasted approximately 15 to 20 min. Themes and subthemes that emerged provided a structured overview of the key aspects discussed. Each theme captures a different facet of the experiences, perceptions, and challenges faced by IPC nurses in their role. The subthemes further break down these views into specific areas of focus, offering deeper insights into the nurses' experiences of their professional responsibilities. This study shows that, although IPC nurses have a good understanding of infection control and a positive attitude toward it, systemic problems and resource constraints make it difficult to consistently implement optimal practices. Affective mood, opportunity cost, coherence of the intervention, burden, perceived efficacy, self-efficacy, and ethics are among the major themes that were found. To improve IPC efforts, there is a clear need for more focused training, resources, and managerial support.

Ultraviolet-C-based sanitization is a cost-effective option for hospitals to manage health care-associated infection risks from high touch mobile phones.

Mobile phones have become essential tools for health care workers around the world, but as high touch surfaces, they can harbor microorganisms that pose infection risks to patients and staff. As their use in hospitals increases, hospital managers must introduce measures to sanitize mobile phones and reduce risks of health care-associated infections. But such measures can involve substantial costs. Our objective in this paper was to consider two mobile phone risk mitigation strategies that managers of a hypothetical hospital could implement and determine which involves the lowest cost. The first strategy required all staff to sanitize their hands after every contact with a mobile phone. The second involved the hospital investing in ultraviolet-C-based mobile phone sanitization devices that allowed staff to decontaminate their mobile phones after every use. We assessed each intervention on material and opportunity costs assuming both achieved an equivalent reduction in microbe transmission within the hospital. We found that ultraviolet-C devices were the most cost-effective intervention, with median costs of approximately AUD360 per bed per year compared to AUD965 using hand hygiene protocols. Our results imply that a 200-bed hospital could potentially save AUD1-1.4 million over 10 years by investing in germicidal ultraviolet-C phone sanitizers rather than relying solely on hand hygiene protocols.

Reusable Tourniquets as Potential Transmitters of Infection: A Microbiological Analysis.

Healthcare-associated infections (HAIs) pose a significant global challenge, resulting in prolonged hospital stays, higher healthcare costs, and increased morbidity and mortality rates. Reusable medical equipment, such as tourniquets, represents a potential vector for infection transmission. Despite frequent use and close contact with patients' skin, infection control protocols often overlook these devices. This study examines microbial contamination on the surface of reusable tourniquets in both emergency department and operating theatre settings. A cross-sectional study was conducted between March and September 2024 in Gdansk, Poland. Samples from tourniquets used in the emergency department and the operating theatre were collected after an indefinite period, 14 days, and 28 days. Bacterial contamination on the surfaces of the tourniquets was measured using Columbia agar blood medium and expressed as colony-forming units (CFUs) per cm2. Significant bacterial loads were detected on reusable tourniquets, with contamination levels varying by location and duration of use. The average number of CFU/cm2 across all stages of this study was 545 CFU/cm2 for the emergency department and 101 CFU/cm2 for the operating theatre. Tourniquets used in the emergency department exhibited higher bacterial counts compared to those from the operating theatre, which showed a greater diversity of bacterial species. These findings underscore the need to revise infection control protocols for reusable tourniquets. This study provides critical data that may influence future policy changes aimed at reducing the risk of HAIs through the improved management of reusable medical devices.

Enhancing Infection Control in ICUS Through AI: A Literature Review.

Infection control in intensive care units (ICUs) is crucial due to the high risk of healthcare-associated infections (HAIs), which can increase patient morbidity, mortality, and costs. Effective measures such as hand hygiene, use of personal protective equipment (PPE), patient isolation, and environmental cleaning are vital to minimize these risks. The integration of artificial intelligence (AI) offers new opportunities to enhance infection control, from predicting outbreaks to optimizing antimicrobial use, ultimately improving patient safety and care in ICUs. The primary objectives are to explore AI's impact on predicting HAIs, real-time monitoring, automated sterilization, resource optimization, and personalized infection control plans. A comprehensive search of PubMed and Scopus was conducted for relevant articles up to January 2024, including case series, reports, and cohort studies. Animal studies and irrelevant articles were excluded, with a focus on those considered to have significant clinical relevance. The review highlights AI's prowess in predicting HAIs, surpassing conventional methods. Existing evidence demonstrates AI's efficacy in accurately predicting and mitigating HAIs. Real-time patient monitoring and alert systems powered by AI are shown to enhance infection detection and patient outcomes. The paper also addresses AI's role in automating sterilization and disinfection, with studies affirming its effectiveness in reducing infections. AI's resource optimization capabilities are exemplified in ICU settings, showcasing its potential to improve resource allocation efficiency. Furthermore, the review emphasizes AI's personalized approach to infection control post-procedures, elucidating its ability to analyze patient data and create tailored control plans.

Safety of steroids in severe community-acquired pneumonia.

The systemic use of corticosteroids for patients with severe community-acquired pneumonia (sCAP) remains controversial in clinical practice, particularly in terms of the safety profile of these drugs. This narrative review aims to analyse the available literature data concerning the safety of short-term steroid use in the treatment of sCAP, while also highlighting potential future research directions. Several trials and meta-analyses have evaluated corticosteroid therapy as an adjuvant treatment for sCAP, yielding heterogeneous results regarding its efficacy and safety. Despite the wide variability in results, it is generally accepted that steroids are not associated with a significant risk of healthcare-associated infections, gastrointestinal bleeding or acute kidney injury in patients with sCAP in the short term. Nevertheless, such drugs are linked to hyperglycaemia, necessitating regular monitoring and appropriate management. The influence of steroids on long-term outcomes and their potential risks in viral sCAP still needs to be investigated.

Risk factors of healthcare-associated infection among healthcare workers in intensive care units: A multicenter cross-sectional study.

Healthcare-associated infections (HAIs) are a major global health threat, leading to higher morbidity and mortality, longer hospital stays, and increased healthcare expenses. Intensive care units (ICUs) present a particularly high risk of developing HAIs. This study aims to examine the risk factors of HAIs among healthcare workers (HCWs) in the ICUs of selected public hospitals. We employed a cross-sectional design using an online survey. Respondents were randomly selected from seven large public hospitals located in different areas of Riyadh, the capital city of Saudi Arabia. Data collection was conducted between November 1st to 15th, 2023. Logistic regression analysis was employed to examine previous exposure to HAIs as the response variable and selected predictors. A total of 600 HCWs participated in the study (response rate 88.2%). Among the study HCWs, 75.1% were female, with nurses making up 50% of the sample. Of the respondents, 78% had at least a year's experience, 71% had applied infection prevention and control (IPC) training from the infection control department, and 93% reported they had good knowledge about infection control. The level of knowledge of IPC (OR = 0.9, p < 0.05) and applied IPC training (0.1, p < 0.001) were significantly associated with a lower risk of HAIs. Additionally, a higher risk of HAIs was associated with HCWs years of clinical experience (p < 0.001). Overall, the findings indicated that HCWs who have poor knowledge of IPC, who reported no previous IPC applied training, and who have more years of clinical work experience have a greater risk of HAIs. Thus, legislators and Health officials should prioritize the prevention of infections linked to healthcare, paying particular attention to tailored and applied IPC initiatives.

How long do bacteria, fungi, protozoa, and viruses retain their replication capacity on inanimate surfaces? A systematic review examining environmental resilience versus healthcare-associated infection risk by "fomite-borne risk assessment".

SUMMARYIn healthcare settings, contaminated surfaces play an important role in the transmission of nosocomial pathogens potentially resulting in healthcare-associated infections (HAI). Pathogens can be transmitted directly from frequent hand-touch surfaces close to patients or indirectly by staff and visitors. HAI risk depends on exposure, extent of contamination, infectious dose (ID), virulence, hygiene practices, and patient vulnerability. This review attempts to close a gap in previous reviews on persistence/tenacity by only including articles (n = 171) providing quantitative data on re-cultivable pathogens from fomites for a better translation into clinical settings. We have therefore introduced the new term "replication capacity" (RC). The RC is affected by the degree of contamination, surface material, temperature, relative humidity, protein load, organic soil, UV-light (sunlight) exposure, and pH value. In general, investigations into surface RC are mainly performed in vitro using reference strains with high inocula. In vitro data from studies on 14 Gram-positive, 26 Gram-negative bacteria, 18 fungi, 4 protozoa, and 37 viruses. It should be regarded as a worst-case scenario indicating the upper bounds of risks when using such data for clinical decision-making. Information on RC after surface contamination could be seen as an opportunity to choose the most appropriate infection prevention and control (IPC) strategies. To help with decision-making, pathogens characterized by an increased nosocomial risk for transmission from inanimate surfaces ("fomite-borne") are presented and discussed in this systematic review. Thus, the review offers a theoretical basis to support local risk assessments and IPC recommendations.

Optimizing Ultrasound Probe Disinfection for Healthcare-Associated Infection Control: A Comparative Analysis of Disinfectant Efficacy.

Background/Aims: Ultrasound is a key diagnostic tool in modern medicine due to its ability to provide real-time, high-resolution images of the internal structures of the human body. Despite its undeniable advantages, there are challenges related to the contamination of ultrasound probes, with the risk of healthcare-associated infections. The aim of this review was to identify the most effective disinfectants for disinfecting ultrasound probes to prevent the transmission of pathogens between patients. Methods: A narrative review was conducted using the PubMed, CINAHL, Embase, and Cochrane Library databases, resulting in the inclusion of 16 studies from an initial 1202 records. Results: Hydrogen peroxide (H2O2) was the most effective disinfectant, especially in automated systems, achieving a >5-log10 reduction in viral load, including that of resistant pathogens like Human Papillomavirus. Chlorhexidine gluconate (4%) demonstrated strong antibacterial efficacy, eliminating 84.62% of bacterial contamination, but was less effective against viral pathogens. Glutaraldehyde was effective in some cases, though its use carried a higher risk of probe damage. The use of sodium hypochlorite varied across guidelines; some endorsed it for COVID-19 prevention, while others cautioned against its application due to potential probe damage. Conclusions: This study highlights the importance of advanced disinfection technologies and strict adherence to protocols in improving infection control. Automated systems utilizing H2O2 strike an ideal balance between antimicrobial efficacy and equipment preservation. Future research should focus on developing disinfection methods that prioritize safety, cost-effectiveness, and environmental sustainability in various clinical environments.

NURSING'S ROLE IN THE PREVENTION AND CONTROL OF HEALTHCARE-ASSOCIATED INFECTIONS (HAIS)

Healthcare-Associated Infections (HAIs) represent an important public health problem worldwide. As it is a condition associated with increased morbidity and mortality, this type of infection requires control and prevention strategies to be adopted. In this sense, nursing care is an important element in the process of reducing the risks of HAIs, as they share routines that help minimize its causes, in addition to employing aseptic techniques to prevent a high potential for environmental contamination. professional and thus reduce possible infections by microorganisms. Given the importance of these professionals, the present study aimed to investigate the role of the nursing team in preventing and controlling infections related to healthcare, describing the main nursing actions in preventing and controlling these infections. The research was developed through a bibliographical review, with the selection of articles on the topic, whose publication occurred between the years 2019 and 2024. The application of the search criteria allowed the selection of 11 articles, which presented different approaches to the theme. According to these approaches, the group of selected articles can be classified by thematic areas: risk factors for the occurrence of HAIs; prevention measures for the nursing team; nursing practices to reduce risks; importance of the hospital infection control service. From carrying out this review, it was possible to observe that nursing acts directly in the prevention and control of this type of infection, whether through safe care practices, or through surveillance, the implementation of protocols and educational practices aimed at preventing these infections.

IoT-Based Hand Hygiene Compliance Monitoring System and Validation of Its Effectiveness in Hospital Environments.

Healthcare-associated infection (HAI) is the most common adverse medical event that affects patients. Internationally, healthcare workers (HCWs) are monitored for hand hygiene compliance to reduce HAI risk. While direct observation is considered the gold standard for monitoring, it has several disadvantages. To address this, the study focused on developing a comprehensive hand hygiene system that integrates the Internet of Things (IoT) hand hygiene with soap and water (HHW) and alcohol-based formulation (HHA) monitoring, incorporates real-time data visualization on a web interface to track HCWs' hand hygiene practices, and provides instant calculations of compliance and accuracy rates. This IoT system uses Bluetooth for HCW positioning and HHW detection, ultrasonic sensors for handwashing duration, and pressure sensors for HHA detection. Furthermore, a cloud server, database, and website are established to manage and display the data received by the IoT devices. To reduce HAI in Taiwan, hospitals must provide both HHW and HHA systems, and HCWs can choose either method when hand hygiene is necessary. The system achieved 72% accuracy in clinical practice within an adult intensive care unit (ICU).

Point Prevalence Survey of HAIs as a key component of Infection Prevention and Control programs

Abstract Healthcare-Associated Infections (HAIs) are a global concern, requiring surveillance strategies as Point Prevalence Surveys (PPS) to estimate their burden and investigate associated risk factors for targeted interventions in high-risk areas. This study aims to assess the prevalence of HAIs, identify determinants and evaluate antimicrobial use in a teaching hospital in Rome. A PPS was carried out from June 19th to 23rd, 2023, in accordance with the European Centre for Disease Prevention and Control (ECDC) protocol for HAIs and antimicrobial use in European acute care hospitals (version 6.1). Pearson’s chi-squared test was employed to investigate correlations between potential risk factors and HAIs. The survey included 829 patients with an average age of 56.3 years (SD: ±24.6). Of these, 48.4% were female and over half had visited the hospital’s Emergency Department (53.7%). The prevalence of active HAIs was 8.7%, with 72 patients diagnosed. Furthermore, 51.0% of all patients received at least one systemic antimicrobial agent, and 16.7% of those treated had an HAI. Penicillins (39.7%) and third-generation cephalosporins (37.8%) were the most frequently prescribed antimicrobials. The primary HAIs were bloodstream infections (34.1%), followed by urinary tract (27.3%), surgical site (23.9%), lower respiratory tract (6.8%), and gastrointestinal infections (7.9%). Escherichia coli (13.2%), Staphylococcus aureus (9.2%), and Clostridium difficile (6.6%) were the most frequently isolated pathogens. Intensive Care Unit admission, use of medical device, recent antibiotic therapy and prior hospitalization or surgery significantly correlated (p &amp;lt; 0.05) with increased HAIs risk. The detected prevalence of HAIs is lower than the national rates observed in 2022 (10.2%), which have increased since 2016. HAIs surveillance is essential for developing effective infection prevention and control programs and for optimizing resource allocation in hospital settings. Key messages • Surveillance of Healthcare-Associated Infections is crucial for developing targeted Infection Prevention and Control programs and optimizing hospital resource allocation. • Point Prevalence Surveys offer essential information for assessing the burden of Healthcare-Associated Infections and directing intervention strategies in hospitals.

Impact of age on antimicrobial prescriptions in hospitalized children at three academic centres in South Africa: a point prevalence survey.

Antimicrobial resistance is a global threat in children, and the emergence of multi-drug-resistant organisms is of concern. This secondary analysis of an antimicrobial point prevalence survey (PPS) in children evaluates the impact of age on antimicrobial use. The mean antimicrobial prescriptions were assessed in neonates, infants, young children (1-5 years), school-going children (6-12 years), and adolescents (13-15 years) from a cross-sectional PPS at three academic hospitals between September 2021 and January 2022. Primary and secondary diagnoses, antibiotic type (World Health Organization AWaRe and Anatomical Therapeutic Chemical classifications), and the incidence of healthcare-associated infections (HAI) were evaluated per age category. Multiple regression models were used to analyse age-related risk factors for HAI. The number of antimicrobials per child (1.7-1.9 per patient) was higher in neonates and infants compared to children 6-12 years old (1.4 per patient). Watch antibiotics, especially carbapenems, were commonly prescribed in neonates (32.5%) and infants (42.2%). Reserve antimicrobial use was notable in neonates (4.7%) and infants (4.1%). The incidence risk ratio (IRR) of HAI was higher in neonates and infants (IRR 2.13; 95% CI 1.23-3.70, IRR 2.20; 95% CI 1.40-3.45, respectively) compared to 6- to 12-year-olds. On multivariate analysis of participants according to age, being HIV infected, length of stay >6 days, high McCabe severity score, having surgery and receipt of blood transfusion were associated with an increased risk of HAI (P < .001 for all) while on univariate analysis only, being premature and/or underweight was associated with an increased risk of HAI in infants (P < .001 for both). Infants with risk factors for HAI significantly influenced antimicrobial prescribing, underscoring the necessity for tailored antimicrobial stewardship and enhanced surveillance. The increased use of Watch antibiotics, particularly carbapenems, in infants warrants closer scrutiny. Further research is required to identify inappropriate antimicrobial use in high-risk hospitalized young children.

A Nomogram of Predicting Healthcare-Associated Infections in Burned Children.

Healthcare-associated infections (HAIs) are a common clinical concern associated with adverse prognosis and mortality in burned children. This study aimed to construct a predictive nomogram of the risk of HAIs in burned children. Children admitted to the burn unit of Wuhan Third Hospital between 2020 and 2022 were included. The univariate and multivariate logistic regression analyses were adopted to ascertain predictors of HAIs. A nomogram was developed to predict the HAI risk of each patient, with receiver operating characteristic curves and calibration curves being generated to assess its predictive ability. Furthermore, decision and impact curves were used to assess the clinical utility. Of 1122 burned children, 61 (5.5%) patients experienced HAIs. The multivariate analysis indicated that total burn surface area, length of stay, surgery, central venous catheter use and urinary catheter use were the independent risk factors of HAIs. Using these variables, we developed a predictive nomogram of the occurrence of HAIs in burned children, and the internal validation results demonstrated good discrimination and calibration of the nomogram. The area under the curve values of the nomogram was 0.926 (95% CI, 0.896-0.957). The calibration curve showed high consistency between the actual and predicted HAIs. The decision and impact curve indicated that the nomogram was of good clinical utility and more credible net clinical benefits in predicting HAIs. The present study constructed a nomogram for predicting the risk of HAIs in burned children. This nomogram may strengthen the effective screening of patients at high risk of HAIs.

Environmental bacterial load during surgical and ultrasound procedures in a Swedish small animal hospital

BackgroundEnvironmental bacteria in animal healthcare facilities may constitute a risk for healthcare-associated infections (HAI). Knowledge of the bacterial microflora composition and factors influencing the environmental bacterial load can support tailored interventions to lower the risk for HAI. The aims of this study were to: (1) quantify and identify environmental bacteria in one operating room (OR) and one ultrasound room (UR) in a small animal hospital, (2) compare the bacterial load to threshold values suggested for use in human healthcare facilities, (3) characterise the genetic relationship between selected bacterial species to assess clonal dissemination, and (4) investigate factors associated with bacterial load during surgery.Settle plates were used for passive air sampling and dip slides for surface sampling. Bacteria were identified by Matrix Assisted Laser Desorption—Time Of Flight. Antimicrobial susceptibility was determined by broth microdilution. Single nucleotide polymorphism-analysis was performed to identify genetically related isolates. Linear regression was performed to analyse associations between observed explanatory factors and bacterial load.ResultsThe bacterial load on settle plates and dip slides were low both in the OR and the UR, most of the samples were below threshold values suggested for use in human healthcare facilities. All settle plates sampled during surgery were below the threshold values suggested for use in human clean surgical procedures.Staphylococcus spp. and Micrococcus spp. were the dominating species. There was no indication of clonal relationship among the sequenced isolates. Bacteria carrying genes conveying resistance to disinfectants were revealed.Air change and compliance with hygiene routines were sufficient in the OR. No other factors possibly associated with the bacterial load were identified.ConclusionsThis study presents a generally low bacterial load in the studied OR and UR, indicating a low risk of transmission of infectious agents from the clinical environment. The results show that it is possible to achieve bacterial loads below threshold values suggested for use in human healthcare facilities in ORs in small animal hospitals and thus posing a reduced risk of HAI. Bacteria carrying genes conveying resistance to disinfectants indicates that resistant bacteria can persist in the clinical environment, with increased risk for HAI.

Cleaning time and motion: an observational study on the time required to clean shared medical equipment in hospitals effectively

Despite the important role that cleaning plays in reducing the risk of healthcare-associated infections, no research has been undertaken to quantify the time required for effective cleaning and disinfection of different pieces of shared medical equipment commonly used in hospitals. This short report presents the results from a study that aimed to quantify the time required to clean common pieces of shared medical equipment effectively. An observational time and motion study was conducted in a nursing simulation laboratory to determine the time required for effective cleaning and disinfection of 12 pieces of shared medical equipment commonly used in hospital. After training, the participants cleaned and disinfected equipment, with the time taken to clean recorded. Cleaning was deemed to be effective if ≥80% of ultraviolet fluorescent dots were removed during the cleaning process. The time to clean equipment effectively ranged from 50s [blood glucose testing kit; 95% confidence interval (CI) 0:40-1:00 (min:s)] to 3min 53s [medication trolley; 95% CI 3:36-4:11 (min:s)]. The intravenous stand was cleaned most effectively, with 100% of dots removed (N= 100 dots). In contrast, the bladder scanner was the most difficult to clean, with 12 attempts required to meet the 80% threshold for effective cleaning. This study will inform staffing and training requirements to plan the cleaning and disinfection of shared medical equipment effectively. The findings can also be used for business cases, and in future cost-effectiveness evaluations of cleaning interventions that include shared medical equipment.

Bed occupancy and nosocomial infections in the intensive care unit: A retrospective observational study in a tertiary hospital.

Healthcare-associated infections (HAI) are a major problem globally, contributing to prolonged hospital admissions and poor outcomes. To examine HAI incidence and risk factors in an intensive care unit (ICU) during high v. low occupancy periods. This retrospective, descriptive analysis investigated HAI incidence among adult patients admitted to the ICU at Chris Hani Baragwanath (CHBH) during a high (H2019) and low (L2020) occupancy. Data were extracted from the clinical records of 440 eligible patients. We found an increased risk of HAI during H2019 compared with L2020 (relative risk (RR) 1.42, 95% confidence interval (CI) 1.03 - 1.94). The overall frequency density of HAI was 25/1 000 ICU days. There was no difference in the distribution of the site of infection (blood v. other) (p=0.27) or bacterial category (Gram stain) (p=0.62). Five organisms accounted for 89% of pathogens: Klebsiella (26%), Staphylococcus (21%), Acinetobacter (16%), Candida (16%) and Enterobacter (10%). The incidence of multidrug-resistant/extensively drug-resistant (MDR/XDR) organisms was 4.2-fold higher (95% CI 1.3 - 13.4) during H2019 compared with L2020. Logistic regression analysis revealed two independent predictors of nosocomial infection: ICU length of stay (odds ratio (OR) 1.12, 95% CI 1.02 - 1.22) and intercostal drain duration in days (OR 1.27, 95% CI 1.09 - 1.47). High occupancy in the ICU was associated with an increased risk of HAI and a greater incidence of MDR and XDR pathogens. Increasing ICU length of stay and invasive device duration were independent predictors of HAI. Hospital-acquired infections are a common problem and cause of morbidity and mortality in intensive care units and general wards globally. However, there is very little literature on the topic from low- and middle-income countries. This study aims to provide insite into the unique factors that contribute to these infections in the South African context.

Antimicrobial bathing of the critically ill for the prevention of healthcare-associated infection at a hospital in California

Background: Patients in the intensive care unit (ICU) have invasive lines increasing their risk for healthcare-associated infections (HAIs). Our objective was to determine if antimicrobial bathing with 2% chlorhexidine gluconate (CHG) compared to the colloidal silver-based antimicrobial product would reduce the incidents of central line–associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI). Methods: We performed a before-and-after study in four adult ICUs at a two-hospital facility in California. Prospective surveillance of CLABSI and CAUTI prevention bundles monitoring was established. The intervention consisted of daily bathing with CHG for all patients in the ICUs. A baseline period of one year was followed by an intervention period of one year. The incidence rates of CLABSIs and CAUTIs were compared between the baseline and intervention periods utilizing a t-test analysis. Results: A total of 10103 patients were included. At Facility A, a mean CLABSI rate of 2.43/1000 central line catheter days (CL) with 2149 patients days (Mean differences 95% CI -0.5–3.1; P&gt;0.0975), during the baseline period followed by 1.11/1000 CL days with 2193 patient days in the intervention period. At Facility B, the mean CLABSI rate of 1.82/1000 CL days with 2976 patient days (Mean differences 95% CI -0.6–2.31; P&gt;0.161) during the baseline period was followed by 1.01/1000 CL days with 2785 patient days in the intervention period. At Facility A, the mean CAUTI rate of 1.37/1000 indwelling catheter days (IUC) with 2149 ICU patient days (Mean difference 95% CI is 0.28–1.97; P 0.2160) was noted in the baseline period, followed by 0.45/1000 IUC days with 2785 in the intervention period. Conclusion: Daily bathing with CHG significantly reduced the incidence of CAUTI at Facility A. It is unclear why Facility A saw a statistically significant reduction in CAUTI, but Facility B did not. The difference in outcomes may be related to hospital size, service lines, supply constraints, and discrepancies in staffing. CHG bathing was not directly associated with a reduced risk of CLABSI at Facility A and B during our limited study, but it was encouraging enough that our organization will continue this intervention to obtain additional data to determine if bathing with CHG will reduce CLABSI and CAUTI.

Survey of Hemodialysis Patients’ Knowledge of Their Infection Risk and Acceptability of a Nasal Decolonization Intervention

Background: Patients undergoing hemodialysis are at high risk for healthcare-associated infections; they are at 100 times the risk of Staphylococcus aureus bloodstream infections (BSI) compared with U.S. adults not on hemodialysis. Prior studies found that nasal decolonization with mupirocin prevented S. aureus BSI among hemodialysis patients. We implemented a nasal decolonization intervention in which patients self-administered povidone-iodine (PVI) at each dialysis session. We aimed to assess: 1) hemodialysis patients’ knowledge of their infection risk and their willingness to take an active role in infection prevention; 2) the acceptability of the PVI nasal decolonization intervention. Methods: We performed a stepped wedge cluster randomized trial at 16 outpatient hemodialysis centers. Patients were surveyed: before starting PVI, 1 month after their center started using PVI, and ~6 months after starting PVI. We used a chi-square test to compare results. Results: 469 patients completed at least 1 survey: 400 pre-intervention, 237 at 1 month and 201 at 6 months. Overall, 56% of patients thought that their risk of infection was average or below average compared with an average person in the U.S. (Figure). Over 98% agreed with the statement “One of the most important things I can do for my health is to take an active role in my health care." In the pre-intervention survey, 73% were willing to do “a lot of effort” to prevent an infection. This proportion was similar (73%) in the 2nd survey, but decreased to 63% in the final survey (p &lt; 0 .01). Among 106 patients who reported starting PVI, 85% reported that PVI felt neutral or pleasant, 9.4% reported a side effect, and 79% reported using it during the past 3 dialysis sessions. Among 102 patients who reported using PVI at 6 months, 87% said it felt neutral/pleasant, 3.9% reported a side effect and 75% reported using it during the past 3 dialysis sessions. Side effects included nasal dripping, congestion or burning/stinging, unpleasant smell, headache, yellow tears, and minor nose bleeding. Conclusions: Hemodialysis patients are not aware of their high risk of infection. Although many were willing to expend a lot of effort to prevent an infection, this willingness decreased during an infection prevention intervention. There were few PVI side effects and most patients stated that PVI felt neutral/pleasant, yet many patients chose to not use PVI. Future research should aim to improve patient education on their risk of infection and assess barriers to adherence with infection prevention interventions.Disclosure: Marin Schweizer: Speaker- 3M; Contracted research-3M; Anitha Vijayan: Honoraria - Quanta, Baxter, Fresenius Consulting, Astute, NxStage

Comparative Analysis of Healthcare-associated Bloodstream Infections &amp; CLABSI Surveillance in A Singaporean tertiary Hospital

Background: Healthcare-associated central line associated bloodstream infection (HA-CLABSI) surveillance is important for monitoring healthcare-associated infections (HAIs) and evaluating effectiveness of infection prevention (IP) measures. However, implementing it is a laborious and time-consuming approach. Exclusive focus on central lines neglects HAI risk due to peripheral vascular catheters. This study aimed to assess whether HA-CLABSI incidence could be inferred from HA-bloodstream infection (BSI) trends and explore shift to HA-BSI surveillance. Methods: The study was performed in a Singaporean tertiary care hospital. Electronic medical records review was performed to determine whether positive blood cultures met Centers for Disease Control/National Health Safety Network (CDC/NHSN) definitions for HA-CLABSI and HA-BSI. Incident episodes of HA-BSI were included (excluding positive cultures repeated within 14 days). Incident organisms were explored to identify common causative pathogens (excluding same organisms isolated from cultures repeated within 14 days). CLABSI and BSI occurring ≥72hrs after admission were considered healthcare-associated. Patients under oncology or hematology service were considered immunocompromised. Incidence rates (IR) per 10,000 patient-days, patient characteristics and causative pathogens were compared between both indicators. Results: From January 2022 to October 2023, mean IR for HA-CLABSI was 0.63 (n=68) and for HA-BSI was 10.06 (n=1094). Median age of patients with HA-CLABSI was 66 years and HA-BSI was 68 years. HA-CLABSI and HA-BSI were more common in males (60.86% &amp; 58.68%). Median duration between admission to HA-CLABSI was 20 days and to HA-BSI was 12 days. Median duration between central line insertion to HA-CLABSI was 16 days. Of 1094, 631 (57.7%) patients had vascular catheter(s) (i.e., IV cannula, port-a-cath, peripherally-inserted central catheter or central line) inserted at time of HA-BSI diagnosis, of whom 46 (7.3%) patients had CLABSI ±2days from positive blood culture. There was no significant correlation between monthly aggregate data from these indicators (Spearman’s correlation coefficient= 0.36, p-value=0.1). Predominant organisms causing HA-CLABSI and HA-BSI were gram negative bacteria (GNB, 40% &amp; 57.21%), gram positive bacteria (24.71% &amp; 22.23%), and fungi. Common GNB in CLABSI patients were Pseudomonas spp. and Stenotrophomonas maltophilia (8.24%), followed by Serratia marcescens and Klebsiella pneumoniae (5.88%). The frequent GNB in HA-BSI patients were Escherichia coli (15.4%), Klebsiella pneumonia (12.68%), and Pseudomonas spp. (6.69%). Common multi-drug resistant organisms were vancomycin-resistant Enterococcus faecium (10.59% &amp; 3.69%) and methicillin-resistant Staphylococcus aureus (10.59% &amp; 3.07%). Conclusion: HA-BSI did not correlate with HA-CLABSI. HA-BSI reflects heterogenous population outcomes. For utilization as surveillance indicator, further assessment on exclusion criteria is required to improve specificity.