Transmission Of Healthcare-associated Infections Research Articles

Patients’ potential role in the transmission of health care-associated infections: Prevalence of contamination with bacterial pathogens and patient attitudes toward hand hygiene

Transmission of health care-associated infections (HAIs) has been primarily attributed to health care workers, and hand hygiene is considered the most important means to reduce transmission. Whereas hand hygiene research has focused on reducing health care worker hand contamination and improving hand hygiene compliance, contamination of patients' hands and their role in the transmission of HAIs remains unknown. Patients' hands were sampled by a "glove juice" recovery method and enumerated for the presence of common health care-associated pathogens. Patient demographics and other covariates were collected to determine their association with patient hand contamination. Patient attitudes and practices toward hand hygiene were also surveyed and analyzed. Of the 100 patients in the study, 39% of hands were contaminated with at least 1 pathogenic organism, and 8% were contaminated with 2 or more pathogens 48 hours after admission. Patient admission from or discharge to an outside institution and self-reported functional limitations were the only covariates that were significantly associated with hand contamination. Pathogenic organisms can be frequently detected on hands of acute care patients. Future studies are needed to better understand the relationship between patient hand contamination and the acquisition of HAIs in addition to the role patient hand hygiene can play in reducing HAIs.

Observations on hospital room contamination testing

The environment has increasingly been shown to be involved in transmission of healthcare-associated infections, but data on environmental cleanliness assessment are relatively sparse. Environmental samples were collected from 18 high touch surfaces in 10 different acute care hospital rooms before cleaning to provide data on the rank order of cleanliness by site using both adenosine triphosphate (ATP) detection and quantitative microbiology. In addition, pre-and post-cleaning pooled samples of surfaces from 10 rooms were analysed by culture and sensitivity analysis to detect organisms of concern in the hospital. Four surfaces were ranked in the top six for contamination by both ATP and culture detection (bedrail control panel, nurse call light, patient phone, and bedrail). Additionally, the top three areas for cleanliness were identical between the two methods (main light switch, mattress, and bathroom interior door handle). Overall, quantitative microbiology andATPanalysisshowed directional agreement in assessment of environmental cleanliness with higher ATP readings found on surfaces designated as ‘dirty’ by quantitative microbiology. Several organisms of concern for hospital infection control were seldomdetected in the pre-cleaning environmental samples, and not at all in the post-cleaning samples. In this study environmental bioburden decreased after cleaning, and few hazardous nosocomial organisms were noted. Although quantitative microbiology and ATP detection measure somewhat different aspects of environmental contamination, they both generally agree in distinguishing clean from dirty surfaces.

A comparative study on knowledge, attitude, and practice of injection safety among nurses in two hospitals in Ibadan, Nigeria

ABSTRACT Medical treatment is intended to save life and improve health, and health workers have a responsibility to prevent transmission of health-care associated infections. Adherence to safe injection practices and related infection control is part of that responsibility.1 This comparative study was carried out in two hospitals in Nigeria. Participants were selected conveniently while data were collected with the aid of questionnaire. A sum of 385 nurses took part in the study following ethical approval. The mean age of the respondents was 37 years and 92.5% were females. All have heard about injection safety. Their knowledge level was high, 70.4% associated unsafe injection with blood-borne infection, 55.9% had correct information that two handed recapping is not a safe injection practice, 84.4% claimed that contaminated sharps predisposes the community to bio-hazards, and 293 (76.1%) had correct information that used syringes and needles should be discarded in a sharp waste box. However, the high knowledge was not translated to practice. About half of them (50.4%) of the participants recently sustained sharp injury through intramuscular and subcutaneous injections. Only 15.6% of this number reported the injuries to their institution. Out of the total respondents, 62.9% did not know that their hospitals have injection policies, while 53.2% said that nurses are not involved in such policies. Doctors were alleged by 79.5% as health care workers who most frequently leave sharps at the patients’ bed side. Therefore, nurses as the nerve center of the healthcare enterprise must be advocate of safe injection practices. Key words: Adeoyo Maternity Hospital, Injection safety, Nurses, Practices, UCH

A pilot study of rapid benchtop sequencing of Staphylococcus aureus and Clostridium difficile for outbreak detection and surveillance

ObjectivesTo investigate the prospects of newly available benchtop sequencers to provide rapid whole-genome data in routine clinical practice. Next-generation sequencing has the potential to resolve uncertainties surrounding the route and...

Investigating potential sources of transmission of healthcare-associated infections in a regional hospital, Ghana

Background:Recent research has shown that healthcare-associated infections (HAIs) are on the increase despite education.Aims:The aims of this study were to isolate, quantify, and determine antibiotic susceptibility pattern of bacteria on formites at the Central Regional Hospital, Cape Coast, Ghana.Settings and Design:Purposive sampling of likely areas of contamination and contact by patients and healthcare workers was undertaken.Materials and Methods:A total of 100 swabs were taken from door handles, working surfaces, beds and taps from the various wards, consulting rooms, OPDs, laboratory, and surgical theatre. Serial dilution was used in quantifying bacteria, MacConkey and blood agars were used in isolation, and the Kirby Bauer method applied in antibiotic sensitivity testing. Statistical analysis: Data were statistically analyzed using Statview from SAS Version 5.0. The means were separated using double-tailed paired means comparison.Results:Mean bacterial count ranges from least in wards (9.67 × 1011), working surfaces (1.64 × 1012), door handles (1.71 × 1012), and highest in taps (2.08 × 1012). Door handles had the highest isolation (23) and highest number of differential isolates were from working surfaces (7). Of the total bacterial isolates, 46.14% were pathogenic, with S. aureus being the highest (14.42%), while 53.86% were nonpathogenic made up of 45.2% of Bacillus spp. Gentamicin was 100% effective, while 6 of the total 12 antibiotics tested (50%) were 100% resistant in either gram-positive or gram-negative bacteria.Conclusion:There was a high potential of bacterial transmission from the studied surfaces requiring hospital management to monitor and enforce cleaning regimen to prevent HAIs.

The Role Played by Contaminated Surfaces in the Transmission of Nosocomial Pathogens

Studies in the 1970s and 1980s suggested that environmental surface contamination played a negligible role in the endemic transmission of healthcare-associated infections. However, recent studies have demonstrated that several major nosocomial pathogens are shed by patients and contaminate hospital surfaces at concentrations sufficient for transmission, survive for extended periods, persist despite attempts to disinfect or remove them, and can be transferred to the hands of healthcare workers. Evidence is accumulating that contaminated surfaces make an important contribution to the epidemic and endemic transmission of Clostridium difficile, vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, Acinetobacter baumannii, Pseudomonas aeruginosa, and norovirus and that improved environmental decontamination contributes to the control of outbreaks. Efforts to improve environmental hygiene should include enhancing the efficacy of cleaning and disinfection and reducing the shedding of pathogens. Further high-quality studies are needed to clarify the role played by surfaces in nosocomial transmission and to determine the effectiveness of different interventions in reducing associated infection rates.

Frequency, Level and Duration of Patient Contacts: An Observational Study and Survey of Physicians, Nurses, Clinical Staff, Non-Clinical Staff and Visitors

Direct and indirect contact with healthcare workers (HCWs) may be an important means of transmission of healthcare-associated infections (HAIs). Most HCWs provide care to multiple patients and may serve as vectors in the transmission of HAIs. However, limited information exists about how often, by whom, and to what extent patients are touched.

The role of medical personnel and the environment in the transmission of healthcare-associated infections in the paediatric unit of a University Teaching Hospital

Medical personnel, the environment and devices in paediatric wards at the Lagos University Teaching Hospital (LUTH) were screened to identify possible reservoirs/routes of spread of infections and to evaluatethe effectiveness of decontamination processes. Between April and June 1995, nasal, throat and hand swabs as well as urine, stool and swabs of staff uniforms were collected from 126 personnel. Equipment, surfaces, soap, disinfectants, sterile instruments, dressings and the air were also sampled. Further, a questionnaire was administered to assess the general healthcare situation as viewed by staff. All specimens were processedaccording to standard techniques. Staphylococcus aureus isolated from nasal swabs was tested to Methicillin by Oxacillin E test. Only 74 (59%) hand swabs were sterile, whereas 52 (41%) had pure and/or mixed growthof staphylococci, enterococci, Bacillus and gram-negative bacteria. Sixty-six (52%) staff were nasal carriers of Staphylococcus aureus, 25 (38%) of which were methicillin- resistant (MIC 8->32ìg/ ml). Six (5%) staffharboured Streptococcus pyogenes in throat swabs, 2 (8%) Escherichia coli in faecal specimens and 9 (11%) had significant bacteriuria. Most frequently used equipment/materials were recontaminated within the 12 hours of sampling. Some disinfectants were contaminated by gram- negative bacteria. Understaffing, overcrowding and insufficient equipment reportedly militated against adequate patient care. These findings highlight the necessity for hospitals to ensure thorough personal, environmental and professional asepsis through implementation of appropriate guidelines or measures suggested herein.

The Potential for Transmission of Hospital-Acquired Infections by Non-critical Medical Devices: The Role of Thermometers and Blood Pressure Cuffs

Healthcare-associated infection (HAI) is a major but often neglected public health problem. Most attention to HAI prevention is given to high-risk invasive diagnostic and therapeutic healthcare tools, while the importance of less critical tools tends to be underestimated. This study was designed to assess the potential contributory role played by thermometers and blood pressure cuffs in HAI transmission in a Nigerian teaching hospital. Analysis of swabs from thermometers and blood pressure cuffs used in the teaching hospital was conducted using standard microbiological techniques.

Hand Hygiene and the Surgical Team

Health care–associated infections (HAIs) are a major cause of morbidity and mortality in health care institutions in the United States and throughout the world. These infections are associated with all aspects of health care delivery, from ambulatory care procedures to hospital admission and from general wards to intensive care units and long-term care facilities. HAIs are also associated with procedures performed in the perioperative setting from insertion of invasive devices and minimally invasive diagnostic and treatment modalities to surgical intervention and follow-up care and treatment. Such infections include urinary tract infections (UTIs), surgical site infections (SSIs), pneumonia (lung infections), and bloodstream infections. A recent report from the Centers for Disease Control and Prevention estimated the annual medical costs of treating HAIs in US hospitals to be between $28 billion and $45 billion, adjusted to 2007 dollars. 1 The potential for the transmission of multidrug-resistant organisms (MDROs), including methicillin-resistant Staphylococcus aureus; vancomycin-resistant strains of Enterococci; certain gram-negative bacteria, including those producing extended-spectrum b-lactamases; and Clostridium difficile, that are associated with higher morbidity and mortality, higher cost of treatment, and longer lengths of hospital stay than infections caused by other drug-sensitive organisms is increasing because these MDROs are becoming more and more prevalent in health care institutions and the society. 2 HAIs account for an estimated 1.7 million infections and 99,000 associated deaths each year, with 32% UTIs, 22% SSIs, 15% pneumonia, and 14% bloodstream infections. 3 Hand hygiene, simply washing the hands with soap and water or using an alcohol-based waterless product if the hands are not visibly soiled, is universally thought to be the single most important procedure health care personnel can perform to prevent the transmission of HAIs. 4 However, the observed compliance rate in health care facilities has been regarded as unacceptably poor by public health authorities. 5 A recent review of compliance with hand hygiene in health care facilities concluded that noncompliance with hand hygiene guidelines is a universal problem; the overall

Survey of teaching/learning of healthcare-associated infections in UK and Irish medical schools

All medical doctors have an important role to play in the diagnosis, management and prevention of healthcare-associated infection (HCAI). Strengthening the contribution of medical doctors and medical students to HCAI prevention programmes should include measures that enhance knowledge, improve practice and develop appropriate attitudes to the safety and quality of patient care. The Hospital Infection Society (HIS) funded a review of medical education on HCAI throughout medical schools in the UK and the Republic of Ireland. A questionnaire was drafted and circulated to all medical schools and 31 of 38 (82%) responded. The prevalence and transmission of HCAI were taught by 97% and 100% of medical schools, respectively, but the importance of HCAI as a quality and safety issue was covered in only 60% of medical schools. Multiple choice questions (MCQs) and objective structure clinical examinations (OSCEs) were the most popular methods of assessment. Lectures, discussion of cases and practical demonstrations were considered useful by >90% of respondents and online material and log books by 67% and 60%, respectively. More than 80% were willing to share a common pool of educational resources. An agreed curriculum should be developed for educating medical students in HCAI prevention and control, to outline optimum methods for assessment and develop a shared pool of educational resources.

Systematic risk assessment methods for the infection control professional

Microbial and infectious disease risk models and tools are used to assess infectious hazards in the environment and to identify strategies to prevent or reduce these hazards. Although risk modeling of infectious threats represents a promising approach in applied epidemiology, there are inherent limitations to most models because of the multifactorial nature of the transmission of infections, the dynamic environment in which transmission takes place, and a paucity of available data to more fully specify model parameters. For example, the causal evidence for a link between hand hygiene and reduction in transmission of health care-associated infections is strong. Nevertheless, even though a simple mathematical model has been used to predict that very small increases in hand hygiene could bring endemic organisms under control, 1 it is still impossible to assess precisely the extent to which an incremental change in hand hygiene will increase or decrease risk of disease transmission because of the complexity and ever changing transmission factors that arise within varying health care settings. Despite these limitations, predictive tools such as models or other systematic processes to assess transmission risk can be used to help structure decision making and to identify the need for further research. A model is similar to a working hypothesis in which unknowns exist, and outcomes will depend on the interaction of these unknowns. Models can serve to predict what and where the control points will be, and subsequent studies to test the ‘‘fit’’ of the model will help to measure the magnitude of each point’s contribution to control. Hence, simple risk assessment processes can be useful tools for the infection control professional. The purposes of this paper are to (1) introduce several processes adapted from the food and consumer industries, which could be applied to assess the risk of microbial transmission and the potential impact of interventions to prevent or control transmission in health care settings and (2) describe criteria to assess the usefulness of such tools. The Food and Drug Administration (FDA) and Environmental Protection Agency (EPA) use several risk assessment formats for issues as far ranging as food safety, carcinogens, medical devices, radiation risk, pharmaceuticals, and biologics. 2,3 The use of such systems in these agencies illustrates the potential wide-scale utility of risk assessment. This report concludes with a discussion of how components of various risk assessment processes could be applied to the health care environment.

Skin Health Improvements Associated with Use of Nitrile Exam Gloves with Dermal Therapy Coating

BACKGROUND: The association between irritated, damaged skin on the hands of healthcare workers (HCWs) and increased risk of transmission of healthcare-associated infections has led the Centers for Disease Control and Prevention to recommend the use of products that help maintain skin integrity. METHOD: Nitrile exam gloves coated with ingredients involved in skin repair, moisturization, and protection of the skin's barrier properties were studied to determine the effect use of these gloves has on the hands of HCWs with compromised skin. Twenty-six HCWs with dry skin wore a nitrile exam glove with a coating comprised of ingredients proven to have beneficial effects on skin health on one hand and an equivalent nitrile exam glove without the coating on the other. RESULTS: After 12 successive 15-minute wear periods (each time with new gloves), measurements of skin moisture, erythema, transepidermal water loss, and overall skin dryness were taken from both hands of each subject at baseline and following the final wear period. Nitrile exam gloves with dermal therapy coating produced quantifiable improvements in the skin of clinicians with dry, compromised skin. Wearing exam gloves with the dermal therapy coating resulted in a greater improvement in skin moisturization, produced less erythema, reduced skin flaking, and did not increase water loss through the skin. CONCLUSIONS: Routine use of exam gloves with this dermal therapy coating has the potential to improve clinicians' skin and contribute to a reduction in the number of healthcare-associated infections by reducing scaliness of the skin and improving overall skin wellness.