Transmission Of Healthcare-associated Infections Research Articles

Rapid Whole Genome Characterization of High-Risk Pathogens Using Long-Read Sequencing to Identify Potential Healthcare Transmission.

Routine use of whole genome sequencing (WGS) has been shown to help identify transmission of pathogens causing healthcare-associated infections (HAIs). However, the current gold standard of short-read, Illumina-based WGS is labor and time-intensive. In light of recent improvements in long-read Oxford Nanopore Technologies (ONT) sequencing, we sought to establish a low resource utilization approach capable of providing accurate WGS-based comparisons of HAI pathogens within a time frame allowing for infection prevention and control (IPC) interventions. WGS was prospectively performed on antimicrobial-resistant pathogens at increased risk of potential healthcare transmission using the ONT MinION sequencer with R10.4.1 flow cells and Dorado basecalling algorithm. Potential transmission was assessed via Ridom SeqSphere+ for core genome multilocus sequence typing and MINTyper for reference-based core genome single nucleotide polymorphisms using previously published cut-off values. The accuracy of our ONT pipeline was determined relative to Illumina-based WGS data generated from the same genomic DNA sample. Over a six-month period, 242 bacterial isolates from 216 patients were sequenced by a single operator. Compared to the Illumina gold-standard data, our ONT pipeline achieved a Q score of 60 for assembled genomes, even with a coverage rate of as low as 40X. The mean time from initiating DNA extraction to complete genetic analysis was 2 days (IQR 2-3.25 days). We identified five potential transmission clusters comprising 21 isolates (8.7% of all sequenced strains). Combining ONT WGS data with epidemiological data, >70% (15/21) of the isolates originated from patients with potential healthcare transmission links. Via a stand-alone ONT pipeline, we detected potentially transmitted HAI pathogens rapidly and accurately, aligning closely with epidemiological data. Our low-resource method has the potential to assist in the efficient detection and deployment of preventative measures against HAI transmission.

Rapid Genomic Characterization of High-Risk, Antibiotic Resistant Pathogens Using Long-Read Sequencing to Identify Nosocomial

Background: Current epidemiological methods have limitations in identifying transmission of bacteria causing healthcare-associated infections (HAIs). Recent whole genome sequencing (WGS) studies found that genetically related strains can cause HAIs without meeting standard epidemiologic definitions, but these results could not provide data in a timely fashion needed for intervention. Given recent advances in Oxford Nanopore Technologies (ONT) sequencing, we sought to establish a validated ONT pipeline capable of providing accurate WGS-based comparisons of clinical pathogens within a short time frame that would allow for infection control interventions. Method: Using electronic medical record data, we identified potential healthcare acquisition of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and carbapenem-resistant gram-negative rods. Bacterial genomic DNA was directly extracted from clinical microbiology lab plates. Sequencing was conducted with the ONT MinION sequencer and R10.4.1 flow cell. MINTyper for single nucleotide polymorphism (SNP) calling and Ridom SeqSphere+ for core genome MLST were used to determine genetic relatedness. The main outcome was time from pathogen identification to completed genetic analysis. Result: The weekly workflow, from genomic DNA extraction to complete data analysis, averaged 2.6 days with a standard deviation of 1.3 days. (range: 1 to 6 days). Starting in August 2023, we have sequenced a total of 177 bacterial isolates from 156 unique patients. Isolates came from blood (38%), tissue/wound/body fluid (24%), urinary tract (20%), respiratory tract (16%), and rectal swab (2%). To date, six genetically related clusters have been identified. Three clusters involved ST117 vancomycin-resistant Enterococcus faecium (VREfm), comprising a total of 13 unique patients distributed as 2, 3, and 8 patients in each group, with pairwise SNP differences of 20, 11, and 14. Patients within the same clusters showed epidemiological links through overlapping admissions and temporally shared ICU stays. Additionally, another cluster consisted of five genetically related ST633 Pseudomonas aeruginosa isolates, with a pairwise SNP difference of 57.5. Each patient in this cluster had potential epidemiological links through overlapping admission times, despite the absence of identified shared spaces. The last two clusters involved Klebsiella pneumoniae and Escherichia coli (two cases each), with pairwise SNP differences of 18 and 9, respectively. In both cases, each patient showed potential epidemiological links through overlapping admission times. Conclusion: Our stand-alone ONT pipeline was able to rapidly and accurately detect genetically related AMR pathogens, aligning closely with epidemiological data. Our approach has the potential to assist in the efficient detection and deployment of preventative measures against healthcare-associated infection transmission.

Self-contamination with use of personal protective equipment: Concept analysis using Rodgers’ evolutionary method

Background: Although self-contamination has been identified through relevant studies on the safe utilization of personal protective equipment (PPE) by healthcare personnel and the prevention of healthcare-associated infection transmission, there is a lack of in-depth understanding of self-contamination. This study aimed to review previous research on self-contamination and clarify the concept. By understanding this concept, healthcare personnel can improve their conscientiousness regarding self-contamination and gain a foundation for the requisite interventions to reduce self-contamination in healthcare settings. Method: MeSH terms such as “Health Personnel,” “Students, Health Occupations,” and keywords related to PPE combined with “contaminat*” and “self-contamination” to retrieve literature in OVID, EMBASE, Cochrane, CINAHL, and PsycINFO databases without time limits through December 2023 (Figure 1). The concept of self-contamination’s antecedents, attributes, and consequences were explained based on Rodgers’ evolutionary Results: After eliminating duplicates from the 2,195 studies that were initially searched, the authors reviewed the articles and determined eligibility independently. A total of 25 articles, published between 2006 and 2023, were included and analyzed. Antecedents to self-contamination were classified into three groups for each component (Figure 2). First, PPE factors included 1) types of PPE and/or ensemble choices, and 2) problems with PPE designs and/or their functions. Second, user factors involved 1) mistakes (errors of intent), 2) violations (deviations from recommendations), and 3) slips (natural flaws in humans). Third, organizational factors covered 1) unstandardized PPE protocol, 2) suboptimal and inconsistent PPE training, and 3) inadequate clinical environment. In total, five major concept attributes were the conveyance of organisms, unintentional behavior, preventable action, incidental contact, and difficulty discerning. Consequences were categorized into: 1) raising concerns about occupationally acquired infections, and 2) the potential transmission of the infection to the environment or other people (cross-contamination). Conclusion: While studies have raised questions about whether self-contamination causes infection, self-contamination was obvious among healthcare personnel when dealing with PPE. Considering the wide range of causes and potential results of self-contamination, multifaceted interventions, including improvement of the PPE design, tailoring protocols, and training for specific ensembles, should be implemented over an extended time period with suitable intervals to optimize interventions’ effectiveness.

Microbial ecology of protective isolation room: Air and Surfaces.

Healthcare-associated infections pose a significant public health burden, leading to morbidity, mortality, prolonged hospital stays, and substantial social and economic costs. Immunocompromised patients are at a heightened risk of nosocomial infections. This prospective study conducted at Mohammed VI University Hospital of Oujda aimed to assess the microbial ecology of surfaces and air in an immunosuppressed patient room compared to a double hospitalization room. Microbiological air purity tests were conducted employing both the sedimentation method and the collision method with the assistance of Microflow Alpha. The sedimentation method used Mueller Hinton with 5% human blood, facilitating the free fall of contaminated dust particles. The collection program employed was set for 10 minutes per 1 m3. For surface sampling, swabs were taken from a 25 cm2 surface. The swabs were immediately forwarded to the Microbiology Laboratory. We carried out both macroscopic and microscopic identification of colonies, followed by definitive biochemical identification using the BD phoenixTM system. Antibiotic susceptibility was assessed through agar diffusion on Muller Hinton medium coupled with the determination of the minimum inhibitory concentration. The results revealed a decreased bacterial count within the protective isolation room, in contrast to the standard hospital room. We noted the predominance of coagulase-negative Staphylococcus spp and Bacillus spp. Staphylococcus aureus and Aspergillus spp, common pathogens in healthcare-associated infections, were notably absent in the protective isolation room. The findings underline the pivotal role of hospital environments in the transmission of healthcare-associated infections. The protective isolation room demonstrated effective control of microbial contamination, with fewer and less resistant germs. The study highlighted the significance of air treatment systems in preventing the spread of opportunistic infections. Our study underscored the critical role of microbiological cleanliness in preventing nosocomial infections.

Longitudinal changes in hand hygiene adherence among healthcare workers during the COVID-19 pandemic, Dominican Republic

Hand hygiene (HH) can reduce transmission of healthcare-associated infections (HAIs) in healthcare facilities and is especially important in low- and middle-income countries where HH infrastructure may be insufficient and the burden of HAIs is highest. At baseline, we assessed HH infrastructure and practices among healthcare workers (HCWs) at two large hospitals in the Dominican Republic during the COVID-19 pandemic. HCWs were observed for HH adherence (HHA) (defined as the use of alcohol-based hand rub (ABHR) or handwashing with soap and water) before and after patient contact and donning new gloves before patient contact. The baseline assessment was repeated following implementation of local production and distribution of ABHR and a HH promotion campaign. Descriptive analyses and regression models evaluated predictors of HHA and glove use. Cumulative HHA was 18.9%. While patient-care areas with a functional HH resource increased from 47% at baseline to 92% after the intervention, HHA declined from 23.0% to 16.7%. HHA was higher after patient contact (aOR = 5.88; 95% CI = 4.17–8.33), during a period of increased COVID-19 risk (aOR = 1.69; 95% CI = 1.05–2.77), during invasive patient contacts (aOR = 1.64; 95% CI = 1.23–2.17) and when gloves were not used (aOR = 1.25; 95% CI = 1.01–1.56). The negative association between glove use and HHA diminished when access to HH resources increased. New gloves were donned before 39.6% of patient contacts. Glove use was higher among nurses (aOR = 7.12; 95% CI = 3.02–16.79) and during invasive contacts (aOR = 4.76; 95% CI = 2.27–10.0). While access to HH resources increased after the interventions, HHA did not increase. HHA was lower when COVID-19 risk was lower. Findings from this study may guide future efforts to increase HHA among HCWs.

Level of implementation of multimodal strategies for infection prevention and control interventions and prevalence of healthcare-associated infections in Northern Italy

BackgroundIn November 2022, Italy participated in the third edition of the European Centre for disease prevention and control (ECDC) point prevalence survey (PPS) of healthcare-associated infections (HAIs) in acute-care hospitals. A questionnaire based on the WHO infection prevention and control assessment framework (IPCAF) was included, which aims to investigate multimodal strategies for the implementation of IPC interventions.MethodsA PPS was conducted using the ECDC PPS protocol version 6.0. The Regional health authority of the region of Piedmont, in north-western Italy, chose to enlist all public acute-care hospitals. Data were collected within one day per each ward, within 3 weeks in each hospital, at hospital, ward and patient level. A score between 0–1 or 0–2 was assigned to each of the 9 items in the IPCAF questionnaire, with 14 points representing the best possible score. HAI prevalence was calculated at the hospital-level as the percentage of patients with at least one HAI over all included patients. Relations between HAI prevalence, IPCAF score, and other hospital-level variables were assessed using Spearman's Rho coefficient.ResultsIn total, 42 acute-care hospitals of the region of Piedmont were involved, with a total of 6865 included patients. All participant hospitals reported they employed multimodal strategies to implement IPC interventions. The median IPCAF overall score was 11/14 (interquartile range, IQR: 9.25–12). The multimodal strategy with the highest level of adherence was education and training, followed by communication and reminders. Strategies with the lowest level of adherence were safety climate and culture of change, and system change. Overall HAI prevalence was 8.06%. A weak to moderate inverse relation was found between IPCAF score and HAI prevalence (Spearman’s Rho -0.340, p 0.034). No other significant correlation was found.ConclusionsThis study found a high self-reported overall level of implementation of multimodal strategies for IPC in the region. Results of this study suggest the relevance of the multimodal approach and the validity of the IPCAF score in measuring IPC programs, in terms of effectiveness of preventing HAI transmission.

Assessment of Hand-Washing Knowledge and Practice among Nursing Undergraduates in Saudi Arabia.

The present study investigated the knowledge and practice of hand hygiene among entry-level nursing students at King Saud University in Riyadh, Saudi Arabia. Participants and Methods: A cross-sectional, institutional-based study was conducted among Saudi nursing students over a period of four months at the King Saud University College of Nursing, using a structured, self-administered questionnaire that assessed demographics, knowledge, and the practice of hand washing. A response rate of 95% was obtained. Of the 304 respondents, 66.1% (n = 201) were males. The majority of the students (94.2%) agreed that direct or indirect contact was the most important route for the transmission of healthcare-associated infection. In addition, most of the students washed their hands after contact with body secretions (89.5%), while 83.2% of them washed their hands before and after contact with patients. Furthermore, 83.6% of them applied soap water during hand washing, while 59.9% of the students used an alcohol-based hand rub for hand hygiene. Our results found that female students reported higher mean knowledge score of 10.09 ± 1.27, compared to male students 9.63 ± 1.48, indicating a significant association between the mean knowledge score of hand washing and gender (p=0.004). Similarly, the mean practice score was higher among female students (5.00 ± 1.25), in comparison to male students 4.62 ± 1.46, with a significant association between gender and mean practice score (p=0.037). The findings of this study revealed that Saudi nursing students exhibit adequate knowledge and practice of hand washing. However, the current findings revealed variation in the knowledge and practice scores with respect to gender. The present results could support students and health care professionals in improving their hygienic practice, which may help to provide the optimum therapeutic benefits to patients.

Contribution of Mobile Phones to the Transmission of Healthcare-Associated Infections in Healthcare Settings: Cross-Sectional Study at the Tertiary Hospital in Accra, Ghana

Contribution of Mobile Phones to the Transmission of Healthcare-Associated Infections in Healthcare Settings: Cross-Sectional Study at the Tertiary Hospital in Accra, Ghana

A prospective bacterial whole-genome-sequencing-based surveillance programme for comprehensive early detection of healthcare-associated infection transmission in paediatric oncology patients

Bacterial whole-genome sequencing (WGS) and determination of genetic relatedness is an important tool for investigation of epidemiologically suspected outbreaks. This prospective cohort study evaluated a comprehensive, prospective bacterial WGS-based surveillance programme for early detection of transmission of most bacterial pathogens among patients at a paediatric oncology hospital. Cultured bacterial isolates from clinical diagnostic specimens collected prospectively from both inpatient and outpatient encounters between January 2019 and December 2021 underwent routine WGS and core genome multi-locus sequence typing to determine isolates' relatedness. Previously collected isolates from January to December 2018 were retrospectively analysed for identification of prior or ongoing transmission. Multi-patient clusters were investigated to identify potential transmission events based on temporal and spatial epidemiological links and interventions were introduced. A total of 1497 bacterial isolates from 1025 patients underwent WGS. A total of 259 genetically related clusters were detected, of which 18 (6.9%) multi-patient clusters involving 38 (3.7%) patients were identified. Sixteen clusters involved two patients each, and two clusters involved three patients. Following investigation, epidemiologically plausible transmission links were identified in five (27.8%) multi-patient clusters. None of the multi-patient clusters were suspected by conventional epidemiological surveillance. Bacterial WGS-based surveillance for early detection of hospital transmission detected several limited multi-patient clusters that were unrecognized by conventional epidemiological methods. Genomic surveillance helped efficiently focus interventions while reducing unnecessary investigations.

Barriers to hand hygiene compliance in intensive care units to prevent the spread of healthcare-associated infections

Abstract Background: Healthcare-associated infections cause significant challenges to the provision of health care. This is due to the strain on individuals, their families, and health services. Hand hygiene measures are cost-effective to reduce the spread of healthcare-associated infections and effectively prevent the transmission of microorganisms during patient care. The hands of healthcare workers have been proven to be the main route of transmission of healthcare-associated infections. Maintaining proper hand hygiene is a straightforward method for averting healthcare-associated infections. Despite its significance, evidence suggests a need for enhanced compliance among healthcare workers concerning hand hygiene practices. Multiple factors influence hand hygiene adherence. Hence, this study sought to elucidate healthcare workers’ encounters with obstacles impeding hand hygiene compliance within intensive care units (ICUs). Materials and Methods: Conducted via purposive sampling, this qualitative study involved 50 professionals, including doctors, anesthesiologists, nurses, physiotherapists, and attendants employed in ICUs. The study utilized semi-structured individual interviews to collect data, whereas data analysis was carried out using the Lundman and Graneheim method. Results: In this study, the primary theme of “obstacles hindering hand hygiene adherence” is segmented into three principal categories: 1.barriers linked to healthcare providers encompass subcategories, such as workload, inadequate knowledge, inappropriate attitudes, and incorrect behavioral patterns; 2.barriers associated with management are delineated through subcategories involving inadequate planning and training and improper departmental physical space design; and 3.barriers related to equipment and facilities, consisting of subcategories centered on insufficient availability of equipment and equipment of subpar quality. Conclusion: The outcomes of this study offer valuable insights that can assist relevant authorities in implementing effective strategies to eliminate obstacles in hand hygiene practices. These findings aim to encourage the cultivation of the correct attitudes and behaviors among healthcare workers.

Beyond duodenoscope-transmitted infections: Analysis of surface bioburden and UV-C mitigation within a tertiary care endoscopy unit

An inpatient endoscopy unit is a care hub for patients from throughout the hospital and can be the site of healthcare-associated infections (HAIs). Shared surfaces and other nonmedical devices (keyboards) have been increasingly recognized as sites of pathogen transmission. Beyond standard cleaning of high-touch target areas, we queried whether the addition of automated devices delivering low-intensity doses of ultraviolet (UV)-C radiation could further reduce bioburden in an academic endoscopy unit. Bioburden on previously identified high-touch/communal surfaces was measured before and after the installation of automated, low-intensity UV-light emitting devices (UV Angel) that passively monitor and disinfect targeted surfaces with Ultraviolet-C light (UV-C) light. High-touch sites (keyboards) had a baseline bacterial contamination of >80%, whereas individual procedure rooms and common areas had a >57% contamination rate. Following the implementation of automated UV-C light decontamination, bioburden was reduced on average by >91% at high-touch surfaces and within procedure rooms. Nonsterile hubs of patient care could serve as sites of "silent" HAI transmission. We have identified high-touch surfaces within an endoscopy unit that have a high bioburden of bacterial contamination and demonstrated that the installation of passive, automated UV-C light disinfection devices can reduce bioburden significantly, possibly mitigating HAI transmission between patients.

Implementation of a centralized, web-based surveillance for healthcare associated infections among residents of long-term care facilities in Italy

ObjectiveThe Italian National Action Plan to contrast AMR identified among its objectives the development and implementation of a national Healthcare-Associated Infection (HAI) surveillance system based on European Centre for Disease Prevention and Control (ECDC) indications, through point prevalence surveys (PPS) of HAIs and antibiotic use in acute-care hospitals and long-term care facilities (LTCFs). We aimed to assess feasibility and appropriateness of proposed tools for a national surveillance system of HAIs and antibiotic use in LTCFs. Study designPoint prevalence survey. MethodsA pilot PPS was conducted between May–June 2022, among 15 LTCFs of 7 Italian regions. Data were collected in a single day in each LTCF, at the LTCF, ward, and resident levels, using a web-based data collection tool developed ad hoc. Data collector teams of each facility were invited to complete a questionnaire investigating opinions on the proposed tools. ResultsAmong 1025 included residents, the prevalence of residents with at least one HAI was 2.5% (95% CI 1.7%-3.7%) considering all HAIs and 2.2% (95% CI 1.3%–3%) without considering SARS-CoV-2 infections. The prevalence of antimicrobial use was 3% (95% CI 0.2%–4.3%). Overall, most respondents were satisfied with the web-based software, training and protocol, even though some difficulties were reported. ConclusionsA national surveillance network was established, which will facilitate future surveillance efforts. Further studies are necessary to evaluate the impact of the pandemic on HAI transmission and antibiotic use in LTCFs.

Infant isolation and cohorting for preventing or reducing transmission of healthcare-associated infections in neonatal units.

Neonatal healthcare-associated infections (HAIs) result in increased morbidity and mortality, as well as increased healthcare costs. Patient isolation measures, i.e. single-room isolation or the cohorting of patients with similar infections, remain a recommended and commonly used practice for preventing horizontal spread of infections in the neonatal intensive care unit (NICU). OBJECTIVES: Our primary objective was to assess the effect of single-room isolation or cohorting, or both for preventing transmission of HAIs or colonization with HAI-causing pathogens in newborn infants less than six months of age admitted to the neonatal intensive care unit (NICU). Our secondary objective was to assess the effect of single-room isolation or cohorting, or both on neonatal mortality and perceived or documented adverse effects in newborn infants admitted to the NICU. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, CINAHL, the WHO ICTRP and ClinicalTrials.gov trials registries. There were no restrictions to date, language or publication type. We also checked the reference lists of studies identified for full-text review. SELECTION CRITERIA: Types of studies: cluster-randomized or quasi-randomized trials at the level of the cluster (where clusters may be defined by NICU, hospital, ward, or other subunits of the hospital). We also included cross-over trials with a washout period of more than four months (arbitrarily defined). newborn infants less than six months of age in neonatal units that implemented patient isolation or cohorting as infection control measures to prevent HAIs. Types of interventions: patient isolation measures (single-room isolation or cohorting, or both of infants with similar colonization or infections) compared to routine isolation measures. the primary outcome was the rate of transmission of HAIs as estimated by the infection and colonization rates in the NICU. Secondary outcomes included all-cause mortality during hospital stay at 28 days of age, length of hospital stay, as well as potential adverse effects of isolation or cohorting measures, or both. The standard methods of Cochrane Neonatal were used to identify studies and assess the methodological quality of eligible cluster-randomized trials. The certainty of the evidence was to be assessed by the GRADE method as evidence of high, moderate, low, or very low certainty. Infection and colonization rates were to be expressed as rate ratios for each trial and if appropriate for meta-analysis, the generic inverse variance method in RevMan was to be used. We did not identify any published or ongoing trials to include in the review. The review found no evidence from randomized trials to either support or refute the use of patient isolation measures (single-room isolation or cohorting) in neonates with HAIs. Risks secondary to infection control measures need to be balanced against the benefits of decreasing horizontal transmission in the neonatal unit for optimal neonatal outcomes. There is an urgent need to research the effectiveness of patient isolation measures for preventing the transmission of HAIs in neonatal units. Well-designed trials randomizing clusters of units or hospitals to a type of patient isolation method intervention are warranted.

Bacterial contamination of water used as thermal transfer fluid in fluid-warming devices

Recent reports implied heater-cooler units (HCU), which are used for warming of infusions, blood or in ECMO devices, as possible origin of healthcare-associated infections (HAIs) with potentially pathogenic bacteria like nontuberculous mycobacteria [1]. This represents a source of contamination in a usually sterile setting. Aim of this study is to analyse water from infusion heating devices (IHDs) for bacterial contamination and to raise the question if IHDs act as a possible source in the transmission of HAIs. 300-500 ml of thermal transfer fluid (TTF) derived from the reservoirs of 22 independent IHDs were collected and processed on different selective and non-selective media for colony count and identification of bacteria. Strains of Mycobacterium species (spp.) were further analysed by whole genome sequencing. Bacterial growth was observed in each of the 22 collected TTFs after cultivation at 22°C and 36°C. Pseudomonas aeruginosa was the most frequent pathogen identified, being present in 13.64% (3/22) at > 100 CFU/100mL. Colonization with Mycobacterium chimaera, Ralstonia pickettii and Ralstonia mannitolilytica was detectable in 9.09% (2/22) of the isolates. Primary sequencing of the detected M. chimaera suggests a close relationship to a M. chimaera strain detected in an outbreak in Switzerland, which led to the death of two patients. A contamination of the TTF represents a germ reservoir in a sensitive setting. Handling errors of the IHD may lead to distribution of opportunistic or facultative bacterial pathogens, increasing the risk of nosocomial infection transmission.

Hand Hygiene Compliance and Healthcare Associated Infections Trends in a Tertiary Care Children Hospital, in Years 2016-2022

Healthcare workers hands are the most common vehicle for the transmission of healthcare-associated infections. Hand hygiene is considered the most effective measure for preventing microbial pathogen cross-transmission, and reducing healthcare-associated infections; thus, it’s key to maintain high healthcare workers compliance with this practice.
 We calculated trends of compliance to hand hygiene and healthcare-associated infections (HAIs) point prevalence in a tertiary care children hospital, in years 2016–2022. We observed a significantly increased hand hygiene compliance from 89.5% (95% CI: 89.1-89.9) in 2016 to 92.1% (95% CI: 91.7-92.4; p<0.001) in 2022. Hand hygiene compliance significantly increased for four out of five moments for hand hygiene, and for most of the professional categories observed. We observed a stable trend of HAIs point prevalence which was 1.8% (95% CI: 0.7-3.6) in 2016, and 2.0% (95% CI:1.0-3.7; p=0.6) in 2022. No significant trends were observed over time stratifying by type of HAIs.
 Our results document the increased adherence to hand hygiene in the context of pandemic emergency response, associated to maintenance of low prevalence of HAIs.

Bacterial Assessment of Stethoscopes Used by Healthcare Workers at a Tertiary Care Government Hospital in Bharatpur, Nepal

The transmission of healthcare-associated infections (HCAIs) in healthcare settings is a serious challenge in the medical fraternity. Medical devices, such as stethoscopes used by healthcare workers (HCWs), are likely to harbor a considerable number of pathogenic microbes, which may result in the transmission of HCAIs. This study sought to investigate bacterial contamination of stethoscopes used by HCWs at Bharatpur Hospital, Nepal. During the study period of 3 months from December 2019 to February 2020, a total of 87 stethoscopes were examined; bacterial pathogens were isolated and identified by culture and biochemical tests, and their susceptibilities against different antibiotics were determined using standard protocols of the Clinical and Laboratory Standards Institute (CLSI). The disc diffusion method was used primarily to screen for extended-spectrum beta-lactamase (ESBL)- and metallo-beta-lactamase (MBL)-producing isolates, followed by their confirmation using cephalosporin/clavulanate combination discs and the disc potentiation methods, respectively. In addition, molecular detection of blaCTX-M and blaVIM genes was performed using conventional polymerase chain reaction (PCR). Of the 87 stethoscopes examined, more than a quarter (28.7%) were colonized with different pathogenic bacteria. Bacterial contamination of stethoscopes was found to be significantly associated with various factors, such as disinfecting routine, method of disinfection, and department of the hospital (p < 0.05). A higher rate of bacterial contamination was observed on the diaphragm of the stethoscope (12.64%) and among HCWs who overlooked hand hygiene practices (45.45%). The prevalence of methicillin-resistant S. aureus (MRSA) was 44.44%, and approximately half of the Gram-negative isolates (47%) were multidrug resistant (MDR). Imipenem (81.25%) and chloramphenicol (83.33%) were found to be the most effective antibiotics for Gram-negative and Gram-positive bacteria, respectively. Phenotypic screening showed that 43.75% of isolates were ESBL producers, and 18.75% were MBL producers, but blaCTX-M and blaVIM genes were detected in only 31.25% and 6.25% of isolates, respectively. The results of the study call for effective stethoscope disinfection practices along with the judicious use of antibiotics by HCWs in order to minimize cross-contamination, emergence of resistance, and spread of nosocomial infections in clinical settings.

Applying Human Factors to Reduce Healthcare-Associated Infections Caused by Face Touching

Canada is currently facing a critical healthcare worker (HCW) shortage, in part resulting from absenteeism due to healthcare-associated infection (HAI). HCWs are at greater risk of infection and are among the most common sources of HAI transmission. Face touching is a behaviour that HCWs engage in on average 20-23 times per hour, and is one way for HCWs to infect themselves. While personal protective equipment (e.g., face masks) has been found to decrease face touching, the behaviour still occurs. We conducted a literature review on face touching, previously proposed solutions for addressing face touching, and the applications of human factors in mitigating face touching behaviours. We also conducted a pilot study of semi-structured interviews with three HCWs using the Lead User method to understand their needs and explore how best to decrease face touching, which resulted in several suggested interventions for reducing face touching.

Assessment of microbial bioburden on portable medical equipment in a hospital setting.

Although routine disinfection of portable medical equipment is required in most hospitals, frontline staff may not be able to disinfect portable medical equipment at a rate that adequately maintains low bioburden on high-use equipment. This study quantified bioburden over an extended time period for two types of portable medical equipment, workstations on wheels and vitals machines, across three hospital wards. Bioburden was quantified via press plate samples taken from high touch surfaces on 10 workstations on wheels and 5 vitals machines on each of 3 medical surgical units. The samples were taken at three timepoints each day over a 4-week period, with random rotation of timepoints and portable medical equipment, such that frontline staff were not aware at which timepoint their portable medical equipment would be sampled. The mean bioburden from the different locations and portable medical equipment was estimated and compared with Bayesian multilevel negative binomial regression models. Model estimated mean colony counts (95% credible interval) were 14.4 (7.7-26.7) for vitals machines and 29.2 (16.1-51.1) for workstations on wheels. For the workstations on wheel, colony counts were lower on the mouse, 0.22 (0.16-0.29), tray, 0.29 (0.22, 0.38), and keyboard, 0.43 (0.32-0.55), when compared to the arm, as assessed by incident rate ratios. Although routine disinfection is required, bioburden is still present across portable medical equipment on a variety of surfaces. The difference in bioburden levels among surfaces likely reflects differences in touch patterns for the different portable medical equipment and surfaces on the portable medical equipment. Although the association of portable medical equipment bioburden to healthcare-associated infection transmission was not assessed, this study provides evidence for the potential of portable medical equipment as a vector for healthcare-associated infection transmission despite hospital disinfection requirements.

Health care worker carriage of drug-resistant bacteria and infection control practices at a tertiary care hospital in Uganda: a cross-sectional survey.

bacterial carriage by health care workers (HCWs) is a major risk factor for transmission of healthcare-associated infections (HAIs). Often, these pathogens are multiple drug resistant (MDR) and are transmitted from hospital environments. We aimed to study the carriage of pathogenic bacteria among HCWs at a tertiary care hospital in Uganda. a cross-sectional study was done at Naguru Regional Referral Hospital from June 2017 to August 2017. Five finger imprints of both hands-on blood and MacConkey agar were done. We assessed pathogenic bacterial carriage by HCWs and characterized drug sensitivity and relatedness of these isolates. Genotyping of extended-spectrum beta-lactamase (ESBL) and Methicillin-resistant Staphylococcus aureus (MRSA) positive isolates was done to determine intra-hospital transmission. A survey of the hospital's IPC de program was done. one hundred and eight (108) HCWs were enrolled. Carriage of pathogenic bacteria was highest in surgical and emergency wards at 36% and 35.6% respectively, p-value of 0.00. The proportion of microbial carriage was highest among nurses 16 (34.8%) followed by medical officers 11 (23.9%). Among the isolated pathogenic bacteria, 25 (36.2%) were Gram-positive and 44 (63.8%) were Gram-negative. Fifty percent of Staphylococcus aureus were methicillin-resistant, and one isolate was vancomycin-resistant. Fifty-four percent (54.6%) of HCWs had never been trained on moments of hand hygiene, only 44.4% recognized the presence of an IPC program in the hospital and 49% were not aware of problems associated with poor IPC practices. this study demonstrated that hands of HCWs at Naguru Regional Referral Hospital were colonized with pathogenic bacteria with varying prevalence, some with multidrug-resistant strains including MRSA and ESBL.

Effectiveness Evaluation of a UV-C-Photoinactivator against Selected ESKAPE-E Pathogens.

Healthcare-associated infections (HAI) worldwide includes infections by ESKAPE-E pathogens. Environmental surfaces and fomites are important components in HAI transmission dynamics, and shoe soles are vectors of HAI. Ultraviolet (UV) disinfection is an effective method to inactivate pathogenic microorganisms. In this study, we investigated whether the SANITECH UV-C shoe sole decontaminator equipment that provides germicidal UV-C radiation could effectively reduce this risk of different pathogens. Six standard strains and four clinical MDR strains in liquid and solid medium were exposed to a UV-C System at specific concentrations at other times. Bacterial inactivation (growth and cultivability) was investigated using colony counts and resazurin as metabolic indicators. SEM was performed to assess the membrane damage. Statistically significant reduction in cell viability for all ATCCs strains occurred after 10 s of exposure to the UV-C system, except for S. enterica, which only occurred at 20 s. The cell viability of P. aeruginosa (90.9%), E. faecalis and A. baumannii (85.3%), S. enterica (82.9%), E. coli (79.2%) and S. aureus (71.9%) was reduced considerably at 20 s. In colony count, after 12 s of UV-C exposure, all ATCC strains showed a 100% reduction in CFU counts, except for A. baumannii, which reduced by 97.7%. A substantial reduction of colonies above 3 log10 was observed at 12 and 20 s in all bacterial strains tested, except for A. baumannii ATCC 19606 (12 s). The exposure of ATCCs bacterial strains to the UV-C system for only 2 s was able to reduce 100% in the colony forming units (CFU) count in all ATCCs strains, S. aureus, P. aeruginosa, E. coli, A. baumannii, E. faecalis, except the S. enterica strain which had a statistically significant reduction of 99.7%. In ATCC strains, there was a substantial decrease in colonies after 4 s (sec) of exposure to the UV-C system, with a reduction ranging from 3.78-4.15 log10 CFU/mL. This reduction was observed in MDR/ESKAPE-E strains within 10 s, showing that UV-C could eliminate above 3.84 log10 CFU/mL. SEM showed a reduction of pili-like appendages after UV-C treatment in all strains except for E. coli (ATCC 25922). The Sanitech UV-C shoe sole decontaminator equipment from Astech Serv. and Fabrication Ltd. (Petrópolis, Brazil), effectively killed in vitro a series of ATCCs and MDR/ESKAPE-E bacteria of sanitary interest, commonly found in the hospital environment.