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1.
Am J Infect Control. 2019 Jan 10. pii: S0196-6553(18)31110-6. doi: 10.1016/j.ajic.2018.11.018. [Epub ahead of print]

Consumer knowledge and attitudes toward public reporting of health care-associated infection data.

Author information

1
School of Nursing and Midwifery, Faculty of Health, Deakin University, Victoria, Australia; Centre for Quality and Patient Safety Research Alfred Health Partnership, Alfred Health, Victoria, Australia. Electronic address: p.russo@deakin.edu.au.
2
School of Nursing and Midwifery, Faculty of Health, Deakin University, Victoria, Australia; Centre for Quality and Patient Safety Research Alfred Health Partnership, Alfred Health, Victoria, Australia.
3
School of Nursing and Midwifery, Faculty of Health, Deakin University, Victoria, Australia; Foundational Chair in Clinical Nursing, Centre for Quality and Patient Safety Alfred Health Partnership and Director of Nursing Research, Alfred Health, Victoria, Australia.

Abstract

BACKGROUND:

There is little information regarding consumer knowledge of health care-associated infection (HAI). Furthermore, it is unclear how meaningful publicly reported HAI data is to consumers, how they may use it, and the most appropriate format for data presentation. The purpose of this study was to explore consumer knowledge and attitudes toward HAI and public reporting.

METHODS:

A qualitative study design, characterized by a series of semistructured interviews, was undertaken with purposively selected, adult elective surgical inpatients at a large metropolitan acute hospital. Interviews were digitally recorded and transcribed verbatim. Analysis of the data were conducted using thematic analysis.

RESULTS:

Twenty interviews were conducted. The 5 major themes identified were: (1) awareness through experience, (2) focus on current illness, (3) patient contribution to infection prevention, (4) sources and mode of information, and (5) influence on choice of hospital.

DISCUSSION:

We found broad variation in knowledge, sources of information, and preferences for the type and delivery of information. A significant cohort of participants preferred not to be informed, whereas others were neutral or only mildly interested.

CONCLUSIONS:

If public reporting of HAI data is to be aimed at consumers, further engagement with consumers is crucial to ensure the information provided is fit for purpose.

KEYWORDS:

Infection prevention; Patient awareness; Qualitative research; Semistructured interviews; Surveillance

2.
Int J Tuberc Lung Dis. 2019 Jan 8. doi: 10.5588/ijtld.18.0268. [Epub ahead of print]

Process measure of FAST tuberculosis infection control demonstrates delay in likely effective treatment.

Author information

1
University Research Co, LLC, Hanoi.
2
National Lung Hospital/National TB Program, Hanoi.
3
Pham Ngoc Thach Hospital, Quang Nam, Viet Nam.
4
Center for Operational Research, International Union Against Tuberculosis and Lung Disease, Paris, France.
5
University Research Co, LLC, Chevy Chase, Maryland.
6
United States Agency for International Development, Washington, DC.
7
Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts.
8
Division of Global Health Equity, Brigham & Women's Hospital, Boston, Massachusetts, USA.

Abstract

<h2>SETTING:</h2>The tuberculous infection control strategy, FAST (Find cases Actively, Separate safely and Treat effectively), recommends prompt initiation of likely effective anti-tuberculosis treatment informed by Xpert&reg; MTB/RIF results.<h2>OBJECTIVE:</h2>To describe FAST implementation at Quang Nam Provincial TB and Lung Disease Hospital (QNH), Tam Ky, Viet Nam, using time to initiation of effective TB treatment as a process measure.<h2>DESIGN:</h2>Hospital logs were used to calculate the time to likely effective treatment in patients with pulmonary TB (PTB) hospitalised during the study period.<h2>RESULTS:</h2>Between 1 January and 31 December 2016, of 858 patients treated for PTB, 493 (57.5&percnt;) received likely effective treatment. The median time to likely effective treatment was 3 days (interquartile range 2.0&ndash;6.0), with 213 (43.2&percnt;) patients receiving likely effective treatment within 2 days. Of 81 patients receiving likely effective treatment for drug-susceptible TB with a positive Xpert result as their initial in-patient diagnostic test, 64 (79.0&percnt;) received likely effective treatment within 2 days compared with 10 (5.7&percnt;) who were initially smear-negative then found to be Xpert-positive (P &lt; 0.0001).<h2>CONCLUSIONS:</h2>A &lsquo;time to&apos; process measure of the FAST tuberculous infection control strategy indicates delays in the initiation of likely effective anti-tuberculosis treatment in a resource-limited hospital. Expanding access to Xpert may speed time to likely effective treatment.

3.
FP Essent. 2019 Jan;476:30-42.

Infectious Disease: Health Care-Associated Infections.

Author information

1
University of South Dakota Sanford School of Medicine, 414 E. Clark Street, Vermillion, SD 57069.
2
University of South Dakota Sanford School of Medicine Department of Family Medicine, 414 E. Clark Street, Vermillion, SD 57069.

Abstract

Health care-associated infections (HAIs) are a major cause of morbidity and mortality, with 2 million US patients per year developing HAIs. This results in 90,000 deaths and billions of dollars in preventable expenses annually. Common HAIs include central line-associated bloodstream infection, catheter-related urinary tract infection, surgical site infection, hospital-acquired pneumonia (HAP), ventilator-associated pneumonia (VAP), methicillin-resistant Staphylococcus aureus (MRSA) infection, Clostridium difficile infection (CDI), and others. Many factors contribute to HAIs, including inadequate hand hygiene by health care workers, inappropriate antibiotic use, increasing prevalence of multidrug-resistant organisms (MDROs), suboptimal disinfection and cleaning of hospital rooms and equipment, and use of invasive medical devices. HAP and VAP together represent the most common HAIs. Control of HAIs involves high- and low-tech solutions, including pulsed xenon light as a room disinfection adjunct, improving health care worker adherence to hand hygiene and standard precautions, as well as regular cleaning of cell phones and stethoscopes. Antibiotic stewardship programs have been shown to reduce inappropriate prescribing of antibiotics, a significant contributor to MDROs and CDI. Bundled interventions to control MRSA and CDI have been effective. Artificial intelligence applications likely will be involved in identification of patients at risk of HAIs in the future.

PMID:
30615408
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4.
Am J Infect Control. 2019 Jan 4. pii: S0196-6553(18)31143-X. doi: 10.1016/j.ajic.2018.11.022. [Epub ahead of print]

Knowledge, attitude, practice, and clinical recommendation toward infection control and prevention standards among nurses: A systematic review.

Author information

1
Department of Anesthesiology, Emam Khomeini Hospital, Urmia University of Medical Sciences, Urmia, Iran.
2
Nursing Department, Zabol University of Medical Sciences, Zabol, Iran; Student Research Committee, Nursing and Midwifery School, Iran University of Medical Sciences, Tehran, Iran.
3
Department of Obstetrics and Gynecology, Zabol University of Medical Sciences, Zabol, Iran.
4
Clinical Immunology Research Center, Ali-Ebne Abitaleb Hospital, Zahedan University of Medical Sciences, Zahedan, Iran. Electronic address: jahant1990@gmail.com.
5
Student Research Committee, School of Nursing, Bushehr University of Medical Sciences, Bushehr, Iran.
6
College of Nursing, Sultan Qaboos University, Muscat, Oman.

Abstract

BACKGROUND:

The purpose of this study was to systematically review the literature to describe nurses' knowledge and practice of and attitude toward infection control and prevention standards.

METHODS:

In the present systematic review, 4 electronic databases were searched from the inception of databases through March 2018. Quality of included studies was assessed using the Hoy tool.

RESULTS:

Eighteen studies conducted on 4,577 employed nurses and nursing students entered the final stage. Results indicated that nurses in most studies had adequate knowledge (n = 10, 40%-90%) and positive attitude (n = 4, 37%-100%). However, most studies reflected average and poor nursing practices with regard to adherence to infection control and prevention standards. The most frequent recommendations proposed for improving nurses' knowledge, attitude, and practice included periodic training via scientific conferences and relevant practical courses (n = 12), combining up-to-date theoretical and practical programs (n = 6), and training at the beginning of hospital employment (n = 4).

CONCLUSIONS:

The results of the present study indicate that although nurses in most studies had adequate knowledge of and positive attitude toward health care-associated infections, because of average and poor practices, they need systematic and integrated implementation of the presented recommendations.

KEYWORDS:

Control infection; Health Knowledge; Nursing students; Outcome assessment (health care); Systematic review

Publication type

Publication type

5.
Am J Infect Control. 2019 Jan;47(1):78-81. doi: 10.1016/j.ajic.2018.06.006. Epub 2018 Jul 4.

Cross-contamination of bacteria-colonized pierced earring holes and fingers in nurses is a potential source of health care-associated infections.

Author information

1
Department of Infection Control and Prevention, Toho University Faculty of Nursing, Ota-ku, Tokyo, Japan.
2
Department of Oral and Maxillofacial Surgery, Tokai University School of Medicine, Kanagawa, Japan.
3
Department of Infection Control and Prevention, Toho University Faculty of Nursing, Ota-ku, Tokyo, Japan. Electronic address: kobatora@med.toho-u.ac.jp.

Abstract

BACKGROUND:

In recent years, the wearing of pierced earrings for personal adornment has increased among health care workers in Japan. However, the transmission dynamics between bacteria in pierced earring holes and fingers has not been clearly shown.

METHODS:

Earlobes and fingers of 200 nurses (128 nurses with pierced earlobes and 72 nurses with unpierced earlobes) working at a university hospital were sampled to determine whether cross-transmission of bacteria-colonized pierced earring holes and fingers in nurse is possible.

RESULTS:

Of 128 nurses who had pierced earring holes, Staphylococcus aureus was recovered from earlobes of 24 nurses (18.8%) compared with 7 of 72 nurses without pierced earring holes (9.7%) (P = .09). Of those 15 nurses yielding S aureus from both earlobes and fingers, 12 were from nurses who had pierced earring holes compared with 3 nurses without pierced earring holes. Excluding 1 nurse, antimicrobial susceptibility patterns and genotypes of S aureus from both earlobe and fingers of each nurse were identical.

CONCLUSION:

Pierced earlobes can be a source of health care-associated infection via cross-transmission of bacteria from earlobe holes to fingers.

KEYWORDS:

Earlobe; Health care setting; MRSA; Pulsed-field gel electrophoresis; Staphylococcus aureus

6.
Clin Infect Dis. 2018 Dec 28. doi: 10.1093/cid/ciy1114. [Epub ahead of print]

Preventing Bloodstream Infections and Death in Zambian Neonates: Impact of a Low-cost Infection Control Bundle.

Author information

1
Right to Care-Zambia, Lusaka, Zambia.
2
Department of Global Health, Boston University School of Public Health, Boston, MA, USA.
3
Section of Infectious Diseases, Department of Medicine, Boston Medical Center, Boston, MA, USA.
4
Department of Pathology and Microbiology University Teaching Hospital and Lusaka Apex Medical University Lusaka, Zambia.
5
Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
6
Division of Biostatistics, Department of Biostatistics, Epidemiology and Informatics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
7
Neonatal Intensive Care Unit, University Teaching Hospital, Lusaka, Zambia.
8
Department of Pathology and Microbiology University Teaching Hospital, Lusaka, Zambia.
9
School of Life Sciences, University of Lincoln, Lincoln, United Kingdom.

Abstract

Background:

Sepsis is a leading cause of neonatal mortality in low-resource settings. As facility-based births become more common, the proportion of neonatal deaths due to hospital-onset sepsis has increased.

Methods:

We conducted a prospective cohort study in a neonatal intensive care unit in Zambia where we implemented a multi-faceted infection prevention and control (IPC) bundle consisting of IPC training, text message reminders, alcohol hand rub, enhanced environmental cleaning, and weekly bathing of babies ≥1.5 kg with 2% chlorhexidine gluconate. Hospital-associated sepsis, bloodstream infection (BSI), and mortality (>3 days after admission) outcome data were collected for 6 months prior to and 11 months after bundle implementation.

Results:

Most enrolled neonates had a birthweight ≥1.5 kg (2131/2669, 79.8%). Hospital-associated mortality was lower during the intervention than baseline period (18.0% vs 23.6%). Total mortality was lower in the intervention than prior periods. Half of enrolled neonates (50.4%) had suspected sepsis; 40.8% of cultures were positive. Most positive blood cultures yielded a pathogen (409/549, 74.5%), predominantly Klebsiella pneumoniae (289/409, 70.1%). The monthly rate and incidence density rate of suspected sepsis were lower in the intervention period for all birthweight categories, except babies weighing <1.0 kg. The rate of BSI with pathogen was also lower in the intervention than baseline period.

Conclusions:

A simple IPC bundle can reduce sepsis and death in neonates hospitalized in high-risk, low-resource settings. Further research is needed to validate these findings in similar settings and to identify optimal implementation strategies for improvement and sustainability. Clinical Trials Registration. NCT02386592.

7.
Infect Drug Resist. 2018 Dec 4;11:2511-2519. doi: 10.2147/IDR.S178922. eCollection 2018.

Infection control perception and behavior: a question of sex and gender? Results of the AHOI feasibility study.

Author information

1
Institute of Hygiene and Environmental Medicine, Universitätsmedizin Greifswald, Greifswald, Germany, tillmann.goerig@uni-greifswald.de.
2
Department of General Surgery, Visceral, Thoracic and Vascular Surgery, Universitätsmedizin Greifswald, Greifswald, Germany.

Abstract

Purpose:

Infections, in particular with multidrug-resistant organisms, are a burden for inpatient and outpatient care and the whole community. The pathogens "roam" with patients and their relatives, forming an epidemiological bridge between different care facilities. Patients could play an important role in infection control, given that they are properly involved. The AHOI project stands for the Activation of patients, people in need of care, and care-providers for a Hygiene-conscious participatiOn in Infection prevention. To this end, a multimodal intervention bundle was developed and subjected to a feasibility study at a university hospital. Our goal was to clarify whether sex- and gender-specific characteristics are relevant in the field of infection prevention.

Materials and methods:

AHOI was tested with a cross-sectional design and a cross-media communication strategy at two surgical wards of a university hospital. Interventions included patient information brochures and motivational materials, reminders, and two video presentations. A welcome box with information material and two questionnaires was given to every inpatient. The patients were instructed to complete the questionnaires at the beginning and at the end of their stay.

Results:

A sample size of 133 inpatients who completed questionnaires at the beginning and end of hospitalization was analyzable. The analysis produced a differentiated picture of the perception and reaction behavior of the sexes. Women had a more negative expectation of the response of doctors. In addition, there were differences in the perception of the positioning of disinfectant dispensers and cleaning processes as well as in satisfaction with the general cleanliness. For all subjects mentioned above, the differences were significant at least at the P-value 0.05.

Conclusion:

The AHOI study shows sex differences in hygiene perception and behavior. Measures to improve patient safety by involving patients in infection control must take these differences into account.

KEYWORDS:

cross infection; disease transmission; hand hygiene; health communication; health education; prevention and control

Conflict of interest statement

Disclosure We disclose grants from the Federal Ministry of Health of the Federal Republic of Germany.

8.
Am J Infect Control. 2018 Dec 18. pii: S0196-6553(18)31070-8. doi: 10.1016/j.ajic.2018.11.001. [Epub ahead of print]

Antimicrobial stewardship and infection prevention and control in atopic dermatitis in children.

Author information

1
School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC, Australia. Electronic address: m.kilpatrick@deakin.edu.au.
2
School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC, Australia.
3
School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Deakin University, Geelong, VIC, Australia; Centre for Quality and Patient Safety Research, Epworth Healthcare Partnership, Richmond, VIC, Australia.

Abstract

Atopic dermatitis is a chronic, recurrent inflammatory skin disease, characterized by frequent exacerbations that can necessitate increased antibiotic use. A qualitative study was conducted at a specialist pediatric hospital to explore the perceptions of dermatology nurses on their role in antimicrobial stewardship when caring for children with atopic dermatitis. Thematic and content analysis derived that the awareness of nurses on antimicrobial stewardship was low, although they were implementing key elements in their clinical practice.

KEYWORDS:

Antimicrobial Resistance; Knowledge Translation; Nurses' Role; Nursing; Patient Advocacy; Pediatrics

9.
BMC Infect Dis. 2018 Dec 19;18(1):679. doi: 10.1186/s12879-018-3521-y.

Evidence for the effectiveness of chlorhexidine bathing and health care-associated infections among adult intensive care patients: a trial sequential meta-analysis.

Frost SA1,2,3,4,5, Hou YC6,7,8, Lombardo L6,8, Metcalfe L6,7, Lynch JM6,7,8, Hunt L6,7,8, Alexandrou E6,7,8,9, Brennan K6,7,10,9, Sanchez D6,11, Aneman A6,8,9, Christensen M6,7.

Author information

1
Critical Care Research in Collaboration & Evidence Translation (CCRiCET), Sydney, Australia. steven.frost@health.nsw.gov.au.
2
Centre for Applied Nursing Research, School of Nursing and Midwifery, Western Sydney University and Ingham Institute of Applied Medical Research, Sydney, Australia. steven.frost@health.nsw.gov.au.
3
Department of Intensive Care, Liverpool Hospital, Sydney, Australia. steven.frost@health.nsw.gov.au.
4
South Western Sydney Clinical School, Faculty of Medicine University of New South Wales, Sydney, Australia. steven.frost@health.nsw.gov.au.
5
Centre for Applied Nursing Research, Ingham Institute of Applied Medical Research, South Western Sydney Local Health District (SWSLHD), Level 3, room 3.45, 1-3 Campbell St Liverpool 2170, Locked Bag 7103, Liverpool BC, Sydney, NSW, 1871, Australia. steven.frost@health.nsw.gov.au.
6
Critical Care Research in Collaboration & Evidence Translation (CCRiCET), Sydney, Australia.
7
Centre for Applied Nursing Research, School of Nursing and Midwifery, Western Sydney University and Ingham Institute of Applied Medical Research, Sydney, Australia.
8
Department of Intensive Care, Liverpool Hospital, Sydney, Australia.
9
South Western Sydney Clinical School, Faculty of Medicine University of New South Wales, Sydney, Australia.
10
Department of Intensive Care Bankstown-Lidcombe Hospital, Bankstown, Australia.
11
Department of Intensive Care Campbelltown Hospital, Campbelltown, Australia.

Abstract

BACKGROUND:

Health care associated infections (HAI) among adults admitted to the intensive care unit (ICU) have been shown to increase length of stay, the cost of care, and in some cases increased the risk of hospital death (Kaye et al., J Am Geriatr Soc 62:306-11, 2014; Roberts et al., Med Care 48:1026-35, 2010; Warren et al., Crit Care Med 34:2084-9, 2006; Zimlichman et al., JAMA Intern Med 173:2039-46, 2013). Daily bathing with chlorhexidine gluconate (CHG) has been shown to decrease the risk of infection in the ICU (Loveday et al., J Hosp Infect 86:S1-S70, 2014). However, due to varying quality of published studies, and varying estimates of effectiveness, CHG bathing is not universally practiced. As a result, current opinion of the merit of CHG bathing to reduce hospital acquired infections in the ICU, is divergent, suggesting a state of 'clinical equipoise'. This trial sequential meta-analysis aims to explore the current status of evidence for the effectiveness of chlorhexidine (CHG) bathing, in adult intensive care patients, to reduce hospital acquired infections, and address the question: do we need more trials?

METHODS:

A systematic literature search was undertaken to identify trials assessing the effectiveness of chlorhexidine bathing to reduce risk of infection, among adult intensive care patients. With particular focus on: (1) Blood stream infections (BSI); (2) Central Line Associated Blood Stream Infections (CLABSI); (3) Multi-Resistant Drug Organism (MRDO); (4) Ventilator Associated Pneumonia; and, Catheter Associated Urinary Tract Infections (CAUTI). Only randomised-control or cluster randomised cross-over trials, were include in our analysis. A Trial Sequential Analysis (TSA) was used to describe the current status of evidence for the effectiveness of chlorhexidine (CHG) bathing, in adult intensive care patients, to reduce hospital acquired infections.

RESULTS:

Five trials were included in our final analysis - two trials were individual patient randomised-controlled, and the remaining cluster-randomised-crossover trials. Daily bathing with CHG was estimated to reduce BSI in the ICU by approximately 29% (Der-Simonian and Laird, Random-Effects. (DL-RE) Incidence Rate Ratio (IRR) = 0.71, 95% confidence interval (CI) 0.51, 0.98); reduce CLABSI in the ICU by approximately 40% (DL-RE IRR = 0.60, 95% CI 0.34, 1.04); reduce MDRO in the ICU by approximately 18% (DL-RE IRR = 0.82, 95% CI 0.69, 0.98); no effect in reducing VAP in the ICU (DL-RE IRR = 1.33, 95% CI 0.81, 2.18); and, no effect in reducing CAUTI in the ICU (DL-RE IRR = 0.77, 95% CI 0.52, 1.15). Upper (superiority) monitoring boundaries from TSA were not crossed for all five specific infections in the ICU.

CONCLUSION:

Routine bathing with CHG does not occur in the ICU setting, and TSA suggests that more trials are needed to address the current state of 'clinical equipoise'. Ideally these studies would be conducted among a diverse group of ICU patients, and to the highest standard to ensure generalisability of results.

KEYWORDS:

Chlorhexidine bathing; Intensive care; Meta-analysis; Preventing hospital acquired infection; Trial sequential analysis

10.
Infect Control Hosp Epidemiol. 2018 Dec 18:1-6. doi: 10.1017/ice.2018.324. [Epub ahead of print]

Patient isolation for infection control and patient experience.

Author information

1
1Department of Medicine,Johns Hopkins University School of Medicine,Baltimore, Maryland.
2
2Division of Infectious Diseases, Department of Medicine,Johns Hopkins University School of Medicine,Baltimore, Maryland.
3
3Johns Hopkins Health System Service Excellence,Johns Hopkins Medicine,Baltimore, Maryland.
4
4Hospitalist Unit,Johns Hopkins Hospital,Baltimore, Maryland.
5
5Department of Health Policy and Management,Johns Hopkins University School of Public Health,Baltimore, Maryland.

Abstract

OBJECTIVE:

Hospitalized patients placed in isolation due to a carrier state or infection with resistant or highly communicable organisms report higher rates of anxiety and loneliness and have fewer physician encounters, room entries, and vital sign records. We hypothesized that isolation status might adversely impact patient experience as reported through Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys, particularly regarding communication.

DESIGN:

Retrospective analysis of HCAHPS survey results over 5 years.

SETTING:

A 1,165-bed, tertiary-care, academic medical center.PatientsPatients on any type of isolation for at least 50% of their stay were the exposure group. Those never in isolation served as controls.

METHODS:

Multivariable logistic regression, adjusting for age, race, gender, payer, severity of illness, length of stay and clinical service were used to examine associations between isolation status and "top-box" experience scores. Dose response to increasing percentage of days in isolation was also analyzed.

RESULTS:

Patients in isolation reported worse experience, primarily with staff responsiveness (help toileting 63% vs 51%; adjusted odds ratio [aOR], 0.77; P = .0009) and overall care (rate hospital 80% vs 73%; aOR, 0.78; P &lt; .0001), but they reported similar experience in other domains. No dose-response effect was observed.

CONCLUSION:

Isolated patients do not report adverse experience for most aspects of provider communication regarded to be among the most important elements for safety and quality of care. However, patients in isolation had worse experiences with staff responsiveness for time-sensitive needs. The absence of a dose-response effect suggests that isolation status may be a marker for other factors, such as illness severity. Regardless, hospitals should emphasize timely staff response for this population.

11.
Am J Infect Control. 2018 Dec 3. pii: S0196-6553(18)30992-1. doi: 10.1016/j.ajic.2018.10.004. [Epub ahead of print]

Kamishibai cards to sustain evidence-based practices to reduce health care-associated infections.

Author information

1
Department of Medicine, Infectious Disease, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI.
2
Department of General Medical/Surgical Pediatrics, American Family Children's Hospital, Madison, WI.
3
Department of Medicine, Infectious Disease, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI; Department of Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI. Electronic address: mjknoblo@medicine.wisc.edu.
4
Department of Medicine, Infectious Disease, University of Wisconsin-Madison School of Medicine and Public Health, Madison, WI; Department of Research Service, William S. Middleton Memorial Veterans Hospital, Madison, WI.

Abstract

BACKGROUND:

Sustaining healthcare-associated infection (HAI) prevention practices is complex. We examined the use of Kamishibai Cards (K Cards) as a tool to encourage compliance interactions between leaders and staff.

METHODS:

We explored one unit of a children's hospital to assess acceptability of K Cards. Interactions were recorded (n = 14), and interviews were conducted (n = 22). We used the Health Belief Model (HBM) for analyses. Central line utilization, bundle compliance and rates of HAIs were also examined.

RESULTS:

Staff members consider K Card interactions reminders of bundle elements and acceptable for creating positive interactions. Although no causal inference can be made, during K Card implementation, CLABSI rates dropped from 1.83 in 2015 to 0.0 through June 2018. Central line utilization decreased by 3%.

DISCUSSION:

Moving beyond theory to providing practical sustainability tools is an important implementation step. Although our findings are not generalizable, capturing what occurred on one unit provides opportunity to discover how key leadership factors (communication and leadership style) influence the uptake, acceptability and sustained adoption of evidence-based practices.

CONCLUSIONS:

K Cards are a practical tool to sustain evidence-based practices and promote communication between leadership and staff - keeping compliance on the minds of frontline workers.

KEYWORDS:

Health belief model; Implementation; K cards; Learning climate; Psychological safety; Sustainability

12.
Infect Drug Resist. 2018 Nov 15;11:2321-2333. doi: 10.2147/IDR.S177247. eCollection 2018.

Health care-associated infections - an overview.

Author information

1
Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Sungai Besi, 57000 Kuala Lumpur, Malaysia, runurono@gmail.com.
2
Department of Surgery, Macerata Hospital, Via Santa Lucia 2, 62100 Macerata, Italy.
3
Swansea University School of Medicine, Swansea University, Singleton Park, Swansea, Wales SA2 8PP, UK.

Abstract

Health care-associated infections (HCAIs) are infections that occur while receiving health care, developed in a hospital or other health care facility that first appear 48 hours or more after hospital admission, or within 30 days after having received health care. Multiple studies indicate that the common types of adverse events affecting hospitalized patients are adverse drug events, HCAIs, and surgical complications. The US Center for Disease Control and Prevention identifies that nearly 1.7 million hospitalized patients annually acquire HCAIs while being treated for other health issues and that more than 98,000 patients (one in 17) die due to these. Several studies suggest that simple infection-control procedures such as cleaning hands with an alcohol-based hand rub can help prevent HCAIs and save lives, reduce morbidity, and minimize health care costs. Routine educational interventions for health care professionals can help change their hand-washing practices to prevent the spread of infection. In support of this, the WHO has produced guidelines to promote hand-washing practices among member countries.

KEYWORDS:

catheter-associated urinary tract infections; central line-associated bloodstream infections; health care-associated infections; surgical site infections; ventilator-associated pneumonia

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Publication type

Publication type

13.
Am J Infect Control. 2018 Dec 5. pii: S0196-6553(18)30998-2. doi: 10.1016/j.ajic.2018.10.007. [Epub ahead of print]

Identifying the time to cure for patients with classic scabies after infection control intervention in acute care hospital settings.

Author information

1
Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
2
Division of Infectious Diseases, Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Soonchunhyang University College of Medicine, Seoul, Republic of Korea. Electronic address: sypark@schmc.ac.kr.
3
Soonchunhyang University Hospital, Seoul, Republic of Korea.

Abstract

Scabies is a re-emerging parasitic disease, particularly in hospitalized patients. This is a retrospective study analyzing adult patients with scabies admitted to a referral university hospital between 2008 and 2018. All patients were treated an average of 3 times using scabicides; the median isolation period and time to cure were 14 and 15 days, respectively.

KEYWORDS:

Dermatologists; Infectivity; Isolation; Outbreaks; Permethrin; Retreatment

14.
Am J Infect Control. 2018 Nov 29. pii: S0196-6553(18)30983-0. doi: 10.1016/j.ajic.2018.09.029. [Epub ahead of print]

Clinician perspectives of policy implementation: A qualitative study of the implementation of a national infection prevention policy in Australian hospitals.

Author information

1
Institute of Health and Biomedical Innovation, Queensland, Kelvin Grove, Queensland, Australia. Electronic address: s.havers@hdr.qut.edu.au.
2
Deakin University, Burwood, Victoria, Australia.
3
Institute of Health and Biomedical Innovation, Queensland, Kelvin Grove, Queensland, Australia.
4
Menzies Centre for Health Policy, University of Sydney, Sydney, New South Wales, Australia.
5
Institute of Health and Biomedical Innovation, Queensland, Kelvin Grove, Queensland, Australia; School of Public Health, University of Queensland, Herston, Queensland, Australia.

Abstract

BACKGROUND:

Clinicians play an essential role in the implementation of infection prevention policy. Despite this, little is known about how infection control policy is implemented at an organizational level or what factors influence this process. In this study, we explore these factors and the policy implementation process in the context of the introduction of a national large-scale, government-directed infection prevention policy in Australia.

METHODS:

Focus groups with infection control professionals were held in 3 states to investigate the perspectives of infection control professionals involved in the implementation of aseptic technique policy requirements in Australian hospitals. Data were analyzed using an interpretive description approach, with themes mapped to the Consolidated Framework for Implementation Research.

RESULTS:

Common contextual factors were identified across all levels of the health care system that influenced implementation of the infection control policy, including external factors associated with the policy itself and the regulatory nature of government-directed policy.

CONCLUSIONS:

This study suggests that there may be particular constructs and contextual factors that are specific to policy implementation in the hospital setting. A better understanding of these factors and their influence on policy implementation would present an opportunity for improved implementation planning, resource allocation, and more effective policy development.

KEYWORDS:

Aseptic technique; Health care–associated infection; Infection control; Nursing; Qualitative research

15.
Am J Infect Control. 2018 Nov 27. pii: S0196-6553(18)30944-1. doi: 10.1016/j.ajic.2018.09.015. [Epub ahead of print]

Infection control influence of Middle East respiratory syndrome coronavirus: A hospital-based analysis.

Author information

1
Specialty Internal Medicine, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia; Indiana University School of Medicine, Indianapolis, IN, USA; Johns Hopkins University School of Medicine, Baltimore, MD, USA. Electronic address: jaltawfi@yahoo.com.
2
Infection Control Unit, Johns Hopkins Aramco Healthcare, Dhahran, Saudi Arabia.

Abstract

BACKGROUND:

Middle East respiratory syndrome coronavirus (MERS-CoV) caused multiple outbreaks. Such outbreaks increase economic and infection control burdens. We studied the infection control influence of MERS-CoV using a hospital-based analysis.

METHODS:

Our hospital had 17 positive and 82 negative cases of MERS-CoV between April 1, 2013, and June 3, 2013. The study evaluated the impact of these cases on the use of gloves, surgical masks, N95 respirators, alcohol-based hand sanitizer, and soap, as well as hand hygiene compliance rates.

RESULTS:

During the study, the use of personal protective equipment during MERS-CoV compared with the period before MERS-CoV increased dramatically from 2,947.4 to 10,283.9 per 1,000 patient-days (P <.0000001) for surgical masks and from 22 to 232 per 1,000 patient-days (P <.0000001) for N95 masks. The use of alcohol-based hand sanitizer and soap showed a significant increase in utilized amount (P <.0000001). Hand hygiene compliance rates increased from 73% just before the occurrence of the first MERS case to 88% during MERS cases (P = .0001). The monthly added cost was $16,400 for included infection control items.

CONCLUSIONS:

There was a significant increase in the utilization of surgical masks, respirators, soap and alcohol-based hand sanitizers. Such an increase is a challenge and adds cost to the health care system.

KEYWORDS:

Cost; Economic impact; Healthcare; MERS; Personal Protective Equipment

16.
Am J Infect Control. 2018 Dec;46(12):1381-1386. doi: 10.1016/j.ajic.2018.05.017. Epub 2018 Jul 6.

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

Author information

1
White Plains Hospital, White Plains, NY. Electronic address: smccalla@wphospital.org.
2
White Plains Hospital, White Plains, NY.

Abstract

BACKGROUND:

Health care-associated infections (HAIs) are avoidable through good hand hygiene (HH) practices. Hand hygiene compliance systems (HHCSs) have been shown to reliably measure HH adherence, but data on their effectiveness at reducing HAI rates are limited.

METHODS:

This nonrandomized, pre-post intervention study was conducted at a community hospital in the United States. HAI rates were examined before and after implementation of a HHCS. Preintervention began in January 2014 and intervention began in March 2015; data were collected through September 2017. Additional infection-specific interventions were carried out. HAIs were calculated as incidence rate ratios.

RESULTS:

The preintervention and intervention periods included 14,297 and 36,890 patients, respectively. The HHCS recorded an average of 696,928 HH opportunities/month. A significant reduction in the rate of catheter-associated urinary tract infections was observed during the intervention: IRR, 0.55; 95% CI, 0.35-0.87. Similarly, a significant reduction in the rate of central line-associated bloodstream infections was observed: IRR, 0.45; 95% CI, 0.23-0.89.

DISCUSSION AND CONCLUSIONS:

These findings suggest that monitoring HH practices with an automated system, in addition to other infection control measures, may be an effective means of reducing HAIs. Further studies are needed to isolate the potential role of HHCSs in the reduction of HAIs.

KEYWORDS:

Catheter-associated urinary tract infections; Central line-associated bloodstream infections

17.
Am J Infect Control. 2018 Dec;46(12):1348-1355. doi: 10.1016/j.ajic.2018.05.023. Epub 2018 Jul 6.

Evaluation of infection prevention and control policies, procedures, and practices: An ethnographic study.

Author information

1
Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan. Electronic address: Msalyahya@just.edu.jo.
2
Department of Health Management and Policy, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.
3
Department of Public Health and Community Medicine, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan.

Abstract

BACKGROUND:

The intensive care unit (ICU) is considered the epicenter of infections, and patients in the ICU are at higher risk of infection because of their vulnerability, age, and lengthy hospitalization.

METHODS:

The ethnographic design has been used to describe, examine, and evaluate the policies and procedures that are implemented to prevent and control hospital-acquired infections (HAIs) in the medical ICU in King Abdullah University Hospital. In-depth semi-structured interviews with 23 participants supported by nonparticipant observation and document analysis were carried out to collect triangulated data. The themes and subthemes were developed through a software package and hand-coding procedure.

RESULTS:

Health care workers were aware but not fully engaged to prevent and control HAIs; nevertheless, they presented themselves as knowledgeable. Staff recognized the importance of involving family members and visitors. However, they had serious concern toward open visitation. The nurse to patient ratio was another challenge of infection prevention and control practices. The findings demonstrated that performing continuous prospective surveillance by highly qualified and trained staff can reduce the risk of endemic HAIs.

CONCLUSIONS:

The study highlighted the importance of changing behaviors and practices of health care providers and visitors to improve adherence to infection prevention and control policies and practices.

KEYWORDS:

Clinical practices; Ethnographic study; Hospital-acquired infections; Infection; Intensive care unit; Policies and procedures

18.
Antimicrob Resist Infect Control. 2018 Nov 19;7:138. doi: 10.1186/s13756-018-0431-0. eCollection 2018.

Emergence of high drug resistant bacterial isolates from patients with health care associated infections at Jimma University medical center: a cross sectional study.

Author information

1
1School of Medical Laboratory Science, Jimma University, Jimma, Ethiopia.
2
11Institute of Health, Jimma University, P.O. Box 1368, Jimma, Ethiopia.
3
2Department of Pediatrics and Child Health, Jimma University, Jimma, Ethiopia.
4
3Department of Ophthalmology, Jimma University, Jimma, Ethiopia.
5
4Department of Surgery, Jimma University, Jimma, Ethiopia.
6
5Department of Obstetrics and Gynecology, Jimma University, Jimma, Ethiopia.
7
6Department of Health Education and Behavioral Health, Jimma University, Jimma, Ethiopia.
8
7Department of Epidemiology and Statistics, Jimma University, Jimma, Ethiopia.
9
8Head of the parasitology laboratory and deputy head of the molecular diagnostics laboratory at the Max von Pettenkofer-Institute, Ludwigs-Maximilians-University (LMU), München, Germany.
10
9Department of Internal Medicine, Jimma University, Jimma, Ethiopia.
11
WHO-TDR clinical research former fellow at AERAS Africa and Rockville, Rockville, MD USA.

Abstract

Background:

The rates of resistant microorganisms which complicate the management of healthcare associated infections (HAIs) are increasing worldwide and getting more serious in developing countries. The objective of this study was to describe microbiological features and resistance profiles of bacterial pathogens of HAIs in Jimma University Medical Center (JUMC) in Ethiopia.

Methods:

Institution based cross sectional study was carried out on hospitalized patients from May to September, 2016 in JUMC. Different clinical specimens were collected from patients who were suspected to hospital acquired infections. The specimens were processed to identify bacterial etiologies following standard microbiological methods. Antibacterial susceptibility was determined in vitro by Kirby-Bauer disk diffusion method following Clinical and Laboratory Standards Institute guidelines.

Results:

Overall, 126 bacterial etiologies were isolated from 118 patients who had HAIs. Of these, 100 (79.4%) were gram negative and the remaining were gram positive. The most common isolates were Escherichia coli 31(24.6%), Klebsiella species 30(23.8%) and Staphylococcus aureus 26 (20.6%). Of 126 bacterial isolates, 38 (30.2%), 52 (41.3%), and 24 (19%) were multidrug-resistant (MDR, resistant to at least one agent in three or more antimicrobial categories), extensively drug resistant (XDR, resistant to at least one agent in all but two or fewer antimicrobial categories (i.e. bacterial isolates remain susceptible to only one or two categories), pan-drug resistant (PDR, resistant to all antibiotic classes) respectively. More than half of isolated gram-negative rods (51%) were positive for extended spectrum beta-lactamase (ESBL) and/or AmpC; and 25% of gram negative isolates were also resistant to carbapenem antibiotics.

Conclusions:

The pattern of drug resistant bacteria in patients with healthcare associated infection at JUMC is alarming. This calls for coordinated efforts from all stakeholders to prevent HAIs and drug resistance in the study setting.

KEYWORDS:

Antimicrobial agents; Carbapenem resistance; Drug resistant isolates; Extended spectrum beta-lactamase; Extensively resistance; Multidrug resistance; Pandrug resistance

Conflict of interest statement

The study was approved by the Institutional Review Board of Institute of Health, Jimma University with the committee’s reference number RPGe/355/2016.Not applicable – This manuscript does not contain any individual person’s data.The authors declare that they have no competing interests.Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

19.
Am J Infect Control. 2018 Nov 22. pii: S0196-6553(18)30955-6. doi: 10.1016/j.ajic.2018.09.025. [Epub ahead of print]

A multicenter point prevalence survey of health care-associated infections in Pakistan: Findings and implications.

Author information

1
School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; Department of Pharmacy Practice, University College of Pharmacy, University of the Punjab, Lahore, Pakistan.
2
School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
3
School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia; Department of Clinical Pharmacology, Karolinska Institute, Stockholm, Sweden; Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, United Kingdom; Health Economics Centre, University of Liverpool Management School, Liverpool, United Kingdom.
4
Faculty of Pharmacy and Health Sciences, University of Balochistan, Quetta, Pakistan.

Abstract

BACKGROUND:

Health care-associated infections (HAIs) are seen as a global public health threat, leading to increased mortality and morbidity as well as costs. However, little is currently known about the prevalence of HAIs in Pakistan. Consequently, this multicenter prevalence survey of HAIs was conducted to assess the prevalence of HAIs in Pakistan.

METHODS:

We used the methodology employed by the European Centre for Disease Prevention and Control to assess the prevalence of HAIs in Punjab Province, Pakistan. Data were collected from 13 hospitals using a structured data collection tool.

RESULTS:

Out of 1,553 hospitalized patients, 130 (8.4%) had symptoms of HAIs. The most common HAI was surgical site infection (40.0%), followed by bloodstream infection (21.5%), and lower respiratory tract infection (14.6%). The prevalence of HAI was higher in private sector hospitals (25.0%) and among neonates (23.8%) and patients admitted to intensive care units (33.3%). Patients without HAIs were admitted mainly to public sector hospitals and adult medical and surgical wards.

CONCLUSIONS:

The study found a high rate of HAIs among hospitals in Pakistan, especially surgical site infections, bloodstream infections, and lower respiratory tract infections. This needs to be addressed to reduce morbidity, mortality, and costs in the future, and further research is planned.

KEYWORDS:

Health care associated infection; Health policy; Hospitals; Infection control; Point prevalence survey

20.
J Hosp Infect. 2018 Nov 22. pii: S0195-6701(18)30665-0. doi: 10.1016/j.jhin.2018.11.010. [Epub ahead of print]

Implementation of influenza point-of-care testing and patient cohorting during a high-incidence season: a retrospective analysis of impact on infection prevention and control and clinical outcomes.

Author information

1
Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK. Electronic address: youngs.jonathan@gmail.com.
2
Analytical Services, Ministry of Justice, London, UK.
3
Infection Prevention and Control Team, St George's University Hospitals NHS Foundation Trust, London, UK.
4
Pharmacy Department, St George's University Hospitals NHS Foundation Trust, London, UK.
5
Department of Microbiology, East Kent Hospitals University NHS Foundation Trust, Ashford, UK.
6
Infection Care Group, St George's University Hospitals NHS Foundation Trust, London, UK; Institute of Infection and Immunity, St George's University of London, London, UK.

Abstract

BACKGROUND:

During high-incidence influenza seasons, a robust infection prevention and control policy is imperative to reduce nosocomial transmission of influenza.

AIM:

To assess the impact of influenza point-of-care testing (POCT) in an emergency department (ED) and patient cohorting on an influenza ward on infection prevention and control and clinical outcomes.

METHODS:

Influenza POCT was operational in the study ED from 21st January 2018 and patient cohorting was operational on an influenza ward from 25th January 2018. A retrospective 'before-after' analysis was performed with pre-intervention defined as 1st November 2017 to 20th January 2018 and post-intervention defined as 21st January 2018 to 30th April 2018. The primary outcome was the rate of hospital-acquired influenza. Secondary outcomes included antiviral prescription and length of stay. The length of time that inpatients remained influenza-positive was estimated by polymerase chain reaction (PCR).

FINDINGS:

There were 654 inpatients with confirmed influenza during the 2017/18 influenza season: 223 pre- and 431 post-intervention. Post-intervention, there were fewer cases of hospital-acquired influenza per day (0.66 vs 0.95, P < 0.0001), median length of stay was shorter (5.5 vs 7.5 days, P = 0.005) and antiviral prescription was more frequent (80% vs 64.1%, P < 0.0001). Cohorting released 779 single rooms for use elsewhere in the trust. The fixed probability of being PCR-negative by the next day (P) was 0.14 [95% confidence interval (CI) 0.12-0.16] for immunocompetent patients. This implies that half of immunocompetent patients are PCR-negative by five days post-diagnosis (95% CI 5-6).

CONCLUSION:

Influenza POCT in an ED and patient cohorting on an influenza ward were associated with reduced nosocomial transmission of influenza and improved patient flow. A policy of retesting immunocompetent patients five days post-diagnosis could allow half of these patients to come out of respiratory isolation earlier.

KEYWORDS:

Cohorting; Infection control; Influenza virus A; Influenza virus B; Point-of-care technology; Rapid diagnostic tests

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