Standard Infection Control Measures Research Articles

Antimicrobial envelopes and endocarditis: innovative solutions for CIEDs infection

Abstract Introduction Endocarditis recurrence in patients with cardiac implantable electronic devices (CIEDs) remains a serious concern, demanding effective preventive measures. There is not always the possibility of extraction with a contralateral implant or the implantation of innovative devices. In recent years, two innovative technologies, TYRX and CanGaroo, have emerged as promising solutions to reduce the risk of endocarditis recurrence and improve patient outcomes. TYRX and CanGaroo are two cutting-edge medical technologies designed to address a critical concern in the management of patients with cardiac implantable electronic devices (CIEDs): the prevention and treatment of infected pockets. Both TYRX and CanGaroo offer unique approaches to mitigate this risk and improve patient outcomes. The TYRX is composed of a mesh envelope containing two antimicrobial agents, minocycline, and rifampin, that providing local and sustained delivery of antimicrobial agents directly at the device pocket. Instead, the primary function of the CanGaroo is to create a physical barrier between the CIED and the surrounding tissues, reducing the risk of bacterial contamination. The CanGaroo is particularly valuable in cases where patients have a higher risk of endocarditis recurrence due to underlying health conditions, compromised immune systems, or previous episodes of infection. By minimizing the direct contact between the CIED and adjacent tissues, the CanGaroo helps reduce the risk of bacterial adherence and biofilm formation. Objectives Educate the patient and caregiver to recognize signs of infection and avoid contamination. Improve training and education of cardiology nurse specialists for the prevention and recurrence of endocarditis on intra-operative management using these new devices and the post-operative course. Materials and Methods Database research and field evaluations. Outcome and Discussion TYRX and CanGaroo are groundbreaking technologies that demonstrate the potential to reduce the recurrence of endocarditis in patients with CIEDs. Their innovative designs and positive clinical outcomes highlight their importance as valuable tools in infection prevention strategies for CIED recipients. Conclusion Both TYRX and CanGaroo offer innovative approaches to prevent endocarditis recurrence in patients with CIEDs. By utilizing their unique mechanisms, these devices contribute to a multi-pronged infection prevention strategy. The TYRX envelope's localized antimicrobial delivery and the CanGaroo envelope's physical protection complement standard infection control measures during implantation. It is important to note that while TYRX and CanGaroo offer significant advances in infection prevention, they are not standalone solutions. A comprehensive approach, including stringent infection control protocols, patient selection, and diligent post-implantation monitoring, is crucial in reducing the risk of endocarditis recurrence effectively.tryx

Preventing Respiratory Viral Illness Invisibly (PRiVII): protocol for a pragmatic cluster randomized trial evaluating far-UVC light devices in long-term care facilities to reduce infections

BackgroundRespiratory viral illness (RVI)—e.g., influenza, COVID-19—is a serious threat in long-term care (LTC) facilities. Standard infection control measures are suboptimal in LTC facilities because of residents’ cognitive impairments, care needs, and susceptibility to loneliness and mental illness. Further, LTC residents living with high degrees of frailty who contract RVIs often develop the so-called atypical symptoms (e.g., delirium, worse mobility) instead of typical cough and fever, delaying infection diagnosis and treatment. Although far-UVC (222 nm) light devices have shown potent antiviral activity in vitro, clinical efficacy remains unproven.MethodsFollowing a study to assay acceptability at each site, this multicenter, double-blinded, cluster-randomized, placebo-controlled trial aims to assess whether far-UVC light devices impact the incidence of RVIs in LTC facilities. Neighborhoods within LTC facilities are randomized to receive far-UVC light devices (222 nm) or identical placebo light devices that emit only visible spectrum light (400–700 nm) in common areas. All residents are monitored for RVIs using both a standard screening protocol and a novel screening protocol that target atypical symptoms. The 3-year incidence of RVIs will be compared using intention-to-treat analysis. A cost-consequence analysis will follow.DiscussionThis trial aims to inform decisions about whether to implement far-UVC light in LTC facilities for RVI prevention. The trial design features align with this pragmatic intent. Appropriate additional ethical protections have been implemented to mitigate participant vulnerabilities that arise from conducting this study. Knowledge dissemination will be supported through media engagement, peer-reviewed presentations, and publications.Trial registrationClinicalTrials.gov NCT05084898. October 20, 2021.

Post circumcision Fournier’s gangrene in an infant: A case report

Fournier’s gangrene is a rare life-threatening condition that is characterized by rapid necrotizing spread from the scrotum and perineal area along facial planes to the abdominal wall, the flanks and the upper thighs. We present a case report of post-circumcision Fournier’s gangrene in an infant that was associated with spontaneous rupture of the lower pole of the left scrotum. This report highlights the need for practitioners of circumcision to be skillful in the procedure, use sterile instruments for it and adhere to standard infection prevention and control measures in health facilities.

WEO Newsletter.

WEO Newsletter.

Carbapenem-resistant Enterobacterales in patients with bacteraemia at tertiary academic hospitals in South Africa, 2019 - 2020: An update.

The emergence of carbapenem-resistant Enterobacterales (CRE) has become a serious and significant public health threat worldwide, owing to the limited antimicrobial therapy options, and the elevated mortality rates associated with these infections. To present an update on the epidemiology of CRE bloodstream infections among hospitalised patients reported under the Group for Enteric, Respiratory and Meningeal Diseases Surveillance in South Africa (GERMS-SA) between January 2019 and December 2020. Patients of all ages with CRE bacteraemia were included and isolates, when available, were sent to the reference laboratory for confirmatory testing and molecular characterisation. Multivariable logistic regression analysis was performed to assess factors associated with in-hospital mortality. We included 2 144 patients with CRE bacteraemia with a median age of 33 (interquartile range 1 - 51) years, of whom 1 145 (54.2%) were male. Klebsiella pneumoniae accounted for 79.8% of infections (n=863/1 082), of which 89.5% (n=611/683) were healthcare associated (HA). The most common carbapenemase genes were carbapenem-hydrolysing oxacillinase-48 (blaOXA-48-like) (76.8%; n=761/991), New Delhi metallo-β-lactamase (blaNDM) (21.1%; n=209/991) and Verona integron-encoded metallo-β-lactamase (blaVIM) (1.3%; n=13/991). None of the screened isolates with a colistin minimum inhibitory concentration >2 μg/mL harboured the mobilised colistin resistance (mcr)-1 to mcr-5 genes. The crude in-hospital mortality rate was 36.6% (n=377/1 029). Patients aged ≥60 years (v. 1.6 - 9 years) (adjusted odds ratio (aOR) 4.53; 95% confidence interval (CI) 2.21 - 9.28), those with comorbidities (diabetes, malignancy, renal and/or cardiovascular failure) (aOR 1.72; 95% CI 1.17 - 2.52), those with altered mental state (aOR 5.36; 95% CI 3.21 - 8.92) and those with previous antimicrobial use (aOR 1.88; 95% CI 1.27 - 2.77) had increased odds of in-hospital mortality. The epidemiology of CRE bloodstream infections remained similar compared with the previous surveillance report. Most infections were HA and caused by OXA-48-like carbapenemase-producing K. pneumoniae with no plasmid-mediated colistin resistance. Standard infection control measures should be strengthened.

“Beyond the guidelines” – Deviations in adherence to infection control measures in Tyrolean hospitals, Austria

BackgroundHospital-acquired infections represent increasing problems in health-care facilities worldwide. Adequate infection control measures are key elements in preventing those infections. Expert societies have published recommendations that help to reduce Hospital-acquired infections. MethodsIn November 2019, a questionnaire-based point-prevalence survey, eliciting the adherence of 14 Tyrolean hospitals to the recommendations of the Centers of Disease Control and Prevention (CDC) was performed. Additionally, standard infection control measures performed by different medical (clinical and infection control specialists) disciplines as well as the performed infection control measures of nurses and physicians were compared. ResultsThe survey revealed varying adherence to CDC-recommendations of different medical disciplines, with highest congruence by the infection control specialists and lower congruencies by all surveyed clinical disciplines. Concordance rate between nurses and physicians was high. DiscussionExplanations for the varying congruencies of clinical disciplines on the one hand and the infection control specialists on the other hand may be versatile. Possible lacks of knowledge about the required hygiene measures should be taken into account. ConclusionsThe present survey showed moderate adherence of Tyrolean hospitals to the recommendations provided by CDC, however with noticeable differences between different medical disciplines. Nurses and doctors in most cases reported identically.

COVID-19 Contraction Among Dental Healthcare Workers in the Department of Conservative Dentistry and Endodontics - A Retrospective Analysis During the Pandemic.

IntroductionThe COVID-19 pandemic has led to major challenges for the healthcare sector across the globe including dental healthcare workers (DHCWs) due to the increased risk of transmission of virus during aerosol-generating procedures. We conducted the present retrospective analysis determining the risk of contraction of COVID-19 infection among DHCWs since the outbreak of the pandemic for a year (March 2020 through March 2021) in Mumbai.MethodsIn total, 18,058 patients visited the Nair Hospital Dental College for dental treatment related to the Department of Conservative Dentistry and Endodontics during the assessed year. All the patients were subjected to intensive triage, which included recording their body temperature, oxygen saturation level, travel, and COVID-19 exposure history.ResultsA total of 26 DHCWs were responsible for attending and treating the patients with all the standard infection control measures. Seventy-four (0.40%) patients out of 18058 were referred for a nasal rapid antigen test (RAT) on giving a positive affirmation about COVID-19 like symptoms when screened at the triage. Of those 74 patients referred, 20 reported a positive nasal rapid antigen test and the infection was confirmed by Reverse Transcriptase Polymerase Chain Reaction (RT-PCR). Among 26, 9 (34,7%) DCHWs were found to have contracted the infection during the assessed year.ConclusionThe analysis found that the risk of COVID-19 infection contraction amongst the DHCWs is considerably less. This could be attributed to the intensive triage and the preventive measures taken while rendering treatment.

Use of selective gut decontamination in critically ill children: protocol for the Paediatric Intensive Care and Infection Control (PICnIC) pilot study

IntroductionHealthcare-associated infections (HCAIs) are a major cause of morbidity and mortality in critically ill children. In critically ill adults, there are data that suggest the use of Selective Decontamination of...

Exploration of Community Care Awareness about COVID-19 Sterilization.

COVID-19 affects millions of people worldwide so WHO declared the COVID-19 pandemic on 11 March 2020. Since the vaccine is in the early trial phase and until it proves its efficacy, the need of finding alternative methods, which can help to curb this pandemic is urgent, so its prevention depends on standard infection control measures. This study's aim is to assess the knowledge, awareness, and practice level of Taif population towards Corona Virus disease - 2019 (COVID-19) sterilization. A cross sectional study was conducted on 504 participants by administering a well-structured questionnaire comprising three sections including demographics, knowledge, attitude, and practice among the general population in Taif governorate KSA, over a duration of three months from July until September 2020. The descriptive analysis was carried out for demographics and dependent variables using the statistical program for social sciences. The t-test was used to detect any relationship between knowledge and practice score percentage of the general population response with respect to their gender and level of education. A p-value of < 0.05 was considered statistically significant. A total of 504 respondents willingly participated in the survey, there is a highly significant difference in the knowledge score percentage in respondents aged between 41 - 60 years old in comparison to the age group < 20 - 40 years old also between urban residence in comparison to rural residence, and a highly significant difference in the knowledge and practice score percentage in post graduate respondents in comparison to undergraduate. In addition, there was a significant difference in the practice score percentage in respondents aged between 41 - 60 years old in comparison to age group < 20 - 40, and a highly significant difference was seen in the practice score percentage in respondents living in urban areas in comparison to rural areas. The suggestion of this study was that knowledge and practice gaps among population, especially in the young age group, had to be covered by holding training programs through workshops or to include courses in the curriculum of ministry of health.

Evidence for the use of mouthwash as a preprocedural preventive measure against COVID-19: Should we rinse and repeat?

To the Editor: Despite the effectiveness of vaccines in limiting severe illness, hospitalization, and death due to COVID-19, the prevention of viral transmission has proven to be a much more elusive target. The coronavirus, enriched in the upper airway, appears to spread via droplet and aerosol even in the absence of symptomatic disease. Research and guidance from otolaryngology and dentistry, specialties at a particularly high risk of exposure, have recommended that in addition to the use of standard infection control measures, patients be given a preprocedural mouth rinse in the outpatient setting.

Severe acute respiratory coronavirus virus 2 (SARS-CoV-2) nosocomial transmission dynamics, a retrospective cohort study of two healthcare-associated coronavirus disease 2019 (COVID-19) clusters in a district hospital in England during March and April 2020.

To understand the transmission dynamics of severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in a hospital outbreak to inform infection control actions. Retrospective cohort study. General medical and elderly inpatient wards in a hospital in England. Coronavirus disease 2019 (COVID-19) patients were classified as community or healthcare associated by time from admission to onset or positivity using European Centre for Disease Prevention and Control definitions. COVID-19 symptoms were classified as asymptomatic, nonrespiratory, or respiratory. Infectiousness was calculated from 2 days prior to 14 days after symptom onset or positive test. Cases were defined as healthcare-associated COVID-19 when infection was acquired from the wards under investigation. COVID-19 exposures were calculated based on symptoms and bed proximity to an infectious patient. Risk ratios and adjusted odds ratios (aORs) were calculated from univariable and multivariable logistic regression. Of 153 patients, 65 were COVID-19 patients and 45 of these were healthcare-associated cases. Exposure to a COVID-19 patient with respiratory symptoms was associated with healthcare-associated infection irrespective of proximity (aOR, 3.81; 95% CI, 1.6.3-8.87). Nonrespiratory exposure was only significant within 2.5 m (aOR, 5.21; 95% CI, 1.15-23.48). A small increase in risk ratio was observed for exposure to a respiratory patient for >1 day compared to 1 day from 2.04 (95% CI, 0.99-4.22) to 2.36 (95% CI, 1.44-3.88). Respiratory exposure anywhere within a 4-bed bay was a risk, whereas nonrespiratory exposure required bed distance ≤2.5 m. Standard infection control measures required beds to be >2 m apart. Our findings suggest that this may be insufficient to stop SARS-CoV-2 transmission. We recommend improving cohorting and further studies into bed distance and transmission factors.

SARS-CoV-2 seroprevalence in healthcare workers of a teaching hospital in a highly endemic region in the Netherlands after the first wave: a cross-sectional study

ObjectiveTo study the SARS-CoV-2 infection rate among hospital healthcare workers after the first wave of the COVID-19 pandemic, and provide more knowledge in the understanding of the relationship between infection,...

MRNA SARS-CoV-2 Immunization Confers Robust Antibody Response in Occupational Healthcare Workers and Fosters Workplace Safety.

mRNA SARS-CoV-2 Immunization Confers Robust Antibody Response in Occupational Healthcare Workers and Fosters Workplace Safety.

Serratia marcescens outbreak in a neonatal intensive care unit and the potential of whole-genome sequencing

Serratia marcescens is notorious for its increasing antimicrobial resistance and potential to cause outbreaks in neonatal intensive care units (NICUs). A promising tool in outbreak investigations is whole-genome sequencing (WGS). To describe a S.marcescens outbreak (2018-2019) in an NICU and discuss which infection control measures contributed to containment, addressing the potential of WGS. S.marcescens isolates from patients and the environment isolated during the 2018-2019 NICU outbreak were analysed. In comparison, isolates from previous presumed NICU outbreaks and adult blood cultures were included. WGS and whole-genome multi-locus sequence typing analysis were performed. Sixty-three S.marcescens isolates were analysed. The 2018-2019 outbreak was divided into three clusters, including four environmental strains (drains, N=3; baby scale, N=1). The strains differed significantly from those of an NICU outbreak in 2014 and adult blood cultures. Besides standard infection control measures, the siphons were replaced and weekly decontamination was performed with acetic acid 10%. Seven acquired-resistance genes and 29 virulence-associated genes were detected. It was assumed that both neonates and drains were reservoirs of S.marcescens cross-contamination via the hands of healthcare workers and parents. Initially, standard measures, including hand hygiene, were reinforced. However, definitive containment was achieved only after replacement of the siphons and weekly decontamination with acetic acid. WGS enables faster recognition of an outbreak with accurate mapping of the spread, facilitating the implementation of infection control measures. WGS also provides interesting information about the spread of antibiotic resistance and virulence genes.

Circulation of an atypical hepatitis C virus (HCV) strain at a dialysis unit in northeast India.

Patients undergoing hemodialysis are at an increased risk of hepatitis C virus (HCV) infection. The implementation of standard infection control measures can substantially decrease the risk of infections and other nosocomial infections. To study the HCV infection rates and genotypes in maintenance hemodialysis subjects in a dialysis unit. A total of 196 maintenance hemodialysis subjects were tested for HCV RNA for one year at a tertiary care teaching hospital in northeast India continuously. Genotyping was performed using direct sequencing (Sanger sequencing) of the 5′UTR‐core region. The HCV infection rate was 26.0%. On phylogenetic analysis, 29 sequences clustered around genotype 3 and subtype 3f were observed. High sequence similarities (75–100% homology) were observed among the isolated sequences. High molecular similarities in the isolates from the same dialysis unit with a high infection rate (26.0%) over a relatively short period of study (10 months) indicated an ongoing nosocomial transmission. Nosocomial transmission by subtype 3f is rare, and it has not been reported in dialysis cases previously. The strain is most likely evolving from common strains such as 3b or 3i and may spread due to migration or movement of people. Urgent implementation of adequate infection control measures is required.

Management of a Hospital-Wide COVID-19 Outbreak Affecting Patients and Healthcare Workers

To the best of our knowledge, here, we describe the first hospital-wide outbreak of SARS-CoV-2 that occurred in Germany in April 2020. We aim to share our experience in order to facilitate the management of nosocomial COVID-19 outbreaks in healthcare facilities. All patients and hospital workers were screened for SARS-CoV-2 repeatedly. An infection control team on the side was installed. Strict spatial separation of patients and intensified hygiene training of healthcare workers (HCW) were initiated. By the time of reporting, 26 patients and 21 hospital workers were infected with a cluster of cases in the geriatric department. Fourteen patients developed COVID-19 consistent symptoms and five patients with severe pre-existing medical conditions died. The outbreak was successfully contained after intensified infection control measures were implemented and no further cases among patients were detected over a period of 14 days. Strict application of standard infection control measures proved to be successful in the management of nosocomial SARS-CoV-2 outbreaks.

Coronavirus Disease 2019 in Neonates - What Is Known and What Needs to Be Known.

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) first broke out in Wuhan, China, and subsequently spread worldwide affecting all ages including newborns. The cases of coronavirus disease 2019 (COVID-19) are very less in neonates and they recover well with supportive treatment. Though the vertical transmission of infection is scarcely found, to get rid of acquiring infection by horizontal transmission one should screen all pregnant women and ensure standard infection control measures and monitoring of newborns at risk of COVID-19. Neonates may present as a refusal to feed, feeding intolerance, fever, pneumonia, shortness of breath, and lethargic. Based on available evidence, antivirals like lopinavir, ritonavir, remdesivir specific medication like chloroquine/hydroxychloroquine, azithromycin, corticosteroids, and intravenous gamma globulin, are not recommended, so early detection and supportive treatment is needed for an optimal outcome.

Personal protective equipment and evidence-based advice for surgical departments during COVID-19.

BackgroundInconsistencies regarding the use of appropriate personal protective equipment (PPE) have raised concerns for the safety of surgical staff during the coronavirus disease 2019 (COVID‐19) pandemic. This rapid review synthesizes the literature and includes input from clinical experts to provide evidence‐based guidance for surgical services.MethodsThe rapid review comprised of targeted searches in PubMed and grey literature. Pertinent findings were discussed by a working group of clinical experts, and consensus recommendations, consistent with Australian and New Zealand Government guidelines, were formulated.ResultsThere was a paucity of high‐quality primary studies specifically investigating appropriate surgical PPE for healthcare workers treating patients possibly infected with COVID‐19. SARS‐CoV‐2 is capable of aerosol, droplet and fomite transmission, making it essential to augment standard infection control measures with appropriate PPE, especially during surgical emergencies and aerosol‐generating procedures. All biological material should be treated a potential source of SARS‐COV‐2. Staff must have formal training in the use of PPE and should be supervised by a colleague during donning and doffing. Patients with suspected or confirmed COVID‐19 should wear a surgical mask during transfer to and from theatre. Potential solutions exist in the literature to extend the use of surgical P2/N95 respirators in situations of limited supply.ConclusionPPE is advised for all high‐risk procedures and when a patient's COVID‐19 status is unknown. Surgical departments should facilitate staggered rostering, remote meeting attendance, and self‐isolation of symptomatic staff. Vulnerable surgical staff should be identified and excluded from operations with a high risk of COVID‐19 infection.

Impact of coronavirus disease 2019 on professional practices of audiologists and speech-language pathologists in India: A knowledge, attitude and practices survey

BackgroundCoronavirus disease 2019 (COVID-19) has spread throughout the world and become a global pandemic. This has hampered and led to drastic changes in the functioning of healthcare services, forcing the professionals to adapt and work efficiently. The present study aimed to explore the impact of COVID-19 on the professional practices of audiologists and speech-language pathologists in India using a cross-sectional knowledge, attitude and practices survey. Material and methodsThe study was conducted in two phases; phase one involved development and validation of the questionnaire, while phase II involved data collection. A cross-sectional self-reported internet-based study using convenience sampling was carried out. ResultsTwo hundred and eleven audiologists and speech-language pathologists responded to the survey. Overall, the professionals exhibited good knowledge levels regarding the COVID-19 outbreak. However, there were differences in their attitudes towards service delivery in the midst of the pandemic. Further, poor practices towards infection control measures especially in terms of hand washing was noted. ConclusionThe findings of the present study are useful in highlighting the need to create better awareness among these professionals about appropriate and standard infection control measures. There is a need to have in place standard operating protocols for hand wash and infection control as well as inclusion in curriculum.

Knowledge, attitude, and perceptions towards the 2019 Coronavirus Pandemic: A bi-national survey in Africa.

The current Coronavirus (COVID-19) pandemic has impacted and changed lives on a global scale since its emergence and spread from China in late 2019. It has caused millions of infections, and thousands of deaths worldwide. However, the control of this pandemic still remains unachievable in many African countries including Egypt and Nigeria, despite the application of some strict preventive and control measures. Therefore, this study assessed the knowledge, attitude, and perceptions of Egyptians and Nigerians towards the COVID-19 pandemic. This study was designed as a cross-sectional community-based questionnaire survey in both countries. Participants’ demography, knowledge, attitude, and perceptions towards the COVID-19 outbreak were obtained using a convenience sampling technique. Data collected were subjected to descriptive statistics and logistic regression analysis. A total of 1437 respondents were included in this preliminary report. The mean knowledge score was 14.7±2.3. The majority of the respondents (61.6%) had a satisfactory knowledge of the disease. Age (18–39 years), education (College/bachelors), and background of respondents were factors influencing knowledge levels. The attitude of most respondents (68.9%) towards instituted preventive measures was satisfactory with an average attitude score of 6.9 ± 1.2. The majority of the respondents (96%) practiced self-isolation and social-distancing but only 36% follow all health recommendations. The perception of most respondents (62.1%) on the global efforts at controlling the virus and preventing further spread was satisfactory with an average score of 10.9 ± 2.7. Only 22% of the respondents were satisfied with their country’s handling of the pandemic. An apprehensive understanding of the current status in Africa through studies like KAP is crucial to avoid Africa being the next epicenter of the pandemic. For the populace to follow standard infection prevention and control measures adequately, governments need to gain the trust of citizens by strengthening the health systems and improving surveillance activities in detecting cases, to offer the optimum health services to their communities.