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Background Oral care with gel is a common method for preventing aspiration in high-risk patients. An oral care gel is used to clean and moisturize the oral cavity. However, the effects of gel care on the oral bacteria remain unclear. In this pilot study, we described a matching transformation system (MA-T) for elderly high-risk patients. MA-T is an on-demand aqueous chlorine dioxide solution that provides excellent safety and has various antimicrobial activities, even in the presence of abundant organic compounds. This study investigated the effects of MA-T gel in patients requiring nursing care. Materials and methods Patients who were hospitalized for nursing care were included in this study. No drugs and foods were administered orally. Oral bacteria and intraoral humidity were examined by daily care using MA-T gel. Moreover, oral membranous substances were analyzed and material from the oral cavity was cultured on selective media for identifying opportunistic organisms. Results Membranous substances were present in the oral cavities of all patients. The number of bacteria decreased, and oral moisture improved, after treatment with MA-T gel. Moreover, oral humidity was also controlled with the continued use of MA-T gel. MA-T gels should be used not only for professional care but also on a daily basis for better oral care. Furthermore, the results of bacterial cultures showed that MA-T controls the propagation of opportunistic bacterial infections. Conclusion Membranous substances may be observed in the oral cavity of individuals requiring nursing care for tube feeding. The results of this pilot study suggest that MA-T, a novel disinfectant, can be used for oral care in the elderly to reduce the risk of aspiration-pneumonia.

Introduction: Health care-associated infections have high costs and increased mortality rates, reducing people's quality of life. Objective: Mapping the factors that influence adherence to standard precautions among/by nurses. Methods: The Joanna Briggs Institute methodology will be used. The research considered the criteria defined and adapted to the databases included in the identification of relevant studies. Databases consulted CINAHL® Plus with Full Text and Nursing & Allied Health Collection via EBSCO, MEDLINE® via PubMed. Articles will be analyzed by title and abstract, eliminating those that do not meet the defined criteria. Data will be extracted by two independent reviewers. The inclusion criteria will be studies written in Portuguese, English and Spanish published in the last five years and extracted to the Rayyan QCRIÒ platform. Two independent reviewers will proceed with the analysis of the relevance of the articles, extraction and synthesis of the data, with the elaboration of the respective flowchart. Results: The mapping of evidence will allow analyzing and knowing the factors that influence adherence to standard precautions among/by nurses. The results will be presented using an evidence table according to the objectives. Conclusion: It is expected that this review will constitute a starting point for the critical analysis of studies related to factors that influence knowledge in nurses' adherence to standard precautions, helping to optimize practice and promote research and dissemination of knowledge, Introdução: As infecções associadas aos cuidados de saúde apresentam custos elevados e aumento da taxa de mortalidade, reduzindo a qualidade de vida das pessoas. Objetivo: Mapear os fatores que influenciam a adesão às precauções padrão entre/pelos enfermeiros. Métodos: Recorrer-se-á à metodologia de Joanna Briggs Institute. A pesquisa considerou os critérios definidos e adaptados às bases de dados incluídas na identificação de estudos relevantes. As bases de dados consultadas CINAHL® Plus with Full Text e Nursing & Allied HealthCollection via EBSCO, MEDLINE® via PubMed. Proceder-se-á à análise dos artigos pelo título e resumo eliminando os que não cumpram os critérios definidos. Os dados serão extraídos por dois revisores independentes. Os critérios de inclusão serão os estudos redigidos em português, inglês e espanhol publicados nos últimos cinco anos e extraídos para a plataforma Rayyan QCRI. Dois revisores independentes irão proceder à análise de relevância dos artigos, extração e síntese dos dados, com elaboração do respetivo fluxograma. Resultados: O mapeamento das evidências permitirá analisar e conhecer os fatores que influenciam a adesão às precauções padrão entre/pelos enfermeiros. Os resultados serão apresentadoscom recurso a uma tabela de evidências segundo os objetivos. Conclusão: Prevê-se que esta revisão constitua um ponto de partida para a análise crítica dos estudos relativos aos fatores que influenciam o conhecimento na adesão às precauções padrão dos enfermeiros, contribuindo para otimizar a prática e promover a investigação e disseminação do conhecimento., Introducción: Las infecciones asociadas a la atención de la salud tienen altos costos y mayores tasas de mortalidad, lo que reduce la calidad de vida de las personas. Objetivo: Mapeo de los factores que influyen en la adherencia a las precauciones estándar entre/por las enfermeras. Método: Se utilizará la metodología del Instituto Joanna Briggs. La investigación consideró los criterios definidos y adaptados a las bases de datos incluidas en la identificación de estudios relevantes. Bases de datos consultadas CINAHL® Plus with Full Text y Nursing & Allied Health Collection via EBSCO, MEDLINE® via PubMed. Los artículos serán analizados por título y resumen, eliminando aquellos que no cumplan con los criterios definidos. Los datos serán extraídos por dos revisores independientes. Los criterios de inclusión serán estudios escritos en portugués, inglés y español publicados en los últimos cinco años y extraídos a la plataforma Rayyan QCRI. Dos revisores independientes procederán al análisis de la relevancia de los artículos, extracción y síntesis de los datos, con la elaboración del respectivo diagrama de flujo. Resultados: El mapeo de evidencias permitirá analizar y conocer los factores que influyen en la adherencia a las precauciones estándar entre/por los enfermeros. Los resultados se presentarán mediante una tabla de evidencias de acuerdo con los objetivos. Conclusión: Se espera que esta revisión constituya un punto de partida para el análisis crítico de los estudios relacionados con los factores que influyen en el conocimiento en la adherencia de los enfermeros a las precauciones estándar, ayudando a optimizar la práctica y promover la investigación y la difusión del conocimiento.

Background/Aim. There is no standard protocol for cleaning and disinfection of used endodontic instruments before their sterilization and reuse. The aim of this study was to determine the efficiency of the different methods of removing biological debris from different types of used hand stainless steel endodontic instruments. Methods. A total of 120 hand stainless steel endodontic instruments: KerrTM reamers, KerrTM files, and HedströmTM files, each forty ISO 25, used for root canal treatment on extracted teeth, were analyzed. The used instruments were divided into four groups based on different decontamination protocols. The evaluation of the efficiency of the cleaning methods was based on the evaluation of the amount of stained organic residues on the instruments (Van Gieson staining). Samples were analyzed by stereomicroscopy (x40). Statistical analysis was performed using the Mann-Whitney U test for the KerrTM reamers and HedströmTM files, while the One-Way ANOVA/Bonferroni test was used for the KerrTM files, at a significance level of 5% (a = 0.05). Results. Residual biological debris was observed on 93.3% of all the samples taken. The thermal disinfectant cleaning method showed the lowest contamination values for all types of instruments. The method of mechanical cleaning showed that the mean value of maximum biologic contamination (MBC) was 58.5% for the KerrTM reamers and 56.2% for KerrTM files, while for HedströmTM files, the highest MBC (50.2%) was shown by the ultrasonic method of cleaning. Conclusion. The use of a thermal disinfectant was the most efficient cleaning method for all three types of hand endodontic instruments., Uvod/Cilj. Ne postoji standard za čišćenje i dezinfekciju upotrebljenih endodontskih instrumenata pre njihove sterilizacije i ponovnog korišćenja. Cilj rada bio je da se ustanovi efikasnost različitih metoda uklanjanja ostataka biološkog materijala sa radnih površina upotrebljenih ručnih endodontskih instrumenata od nerđajućeg čelika. Metode. Analizirano je ukupno 120 ručnih endodontskih instrumenata od nerđajućeg čelika: po četrdeset KerrTM proširivača, KerrTM turpija i HedströmTM turpija ISO 25, upotrebljenih za obradu kanala korena na ekstrahovanim zubima. Na osnovu protokola koji je korišćen za dekontaminaciju instrumenata, upotrebljeni instrumenti su podeljeni u četiri grupe. Procena efikasnosti korišćenih metoda čišćenja zasnovana je na proceni količine prebojenih organskih ostataka na instrumentima (bojenje po Van Gieson-u). Uzorci su analizirani stereomikroskopijom (x40). Statistička analiza dobijenih rezultata izvršena je MannWhitney U testom za KerrTM proširivače i HedströmTM turpije dok je za KerrTM turpije korišćen One-Way ANOVA/Bonferoni test, na nivou pouzdanosti od 5% (a = 0,05). Rezultati. Prisustvo rezidualnih ostataka biološkog materijala uočeno je na 93,3% svih analiziranih instrumenata. Metoda čišćenja toplotnim dezinfikatorom pokazala je najniže vrednosti kontaminacije za sve tipove instrumenata. Metoda mehaničkog čišćenja pokazala je da je srednja vrednost parametra maksimum biološke kontaminacije (MBK) bila 58,5% za KerrTM proširivače i 56,2% za KerrTM turpije, dok je za HedströmTM turpije najviša vrednost MBK (50,2%) bila posle ultrazvučne metode čišćenja instrumenata. Zaključak. Primena toplotnog dezinfikatora je najefikasnija metoda čišćenja za sva tri tipa ručnih endodontskih instrumenata.

Introduction Prolonged use of antibiotics is closely related to antibiotic-Associated infections, antimicrobial resistance and adverse drug events. The optimal duration of antibiotic treatment for Gram-negative bacteremia (GNB) with a urinary tract source of infection is poorly defined. Methods and analysis Investigator-initiated multicentre, non-blinded, non-inferiority randomised controlled trial with two parallel treatment arms. One arm will receive shortened antibiotic treatment of 5 days and the other arm will receive antibiotic treatment of 7 days or longer. Randomisation will occur in equal proportion (1:1) no later than day 5 of effective antibiotic treatment as determined by antibiogram. Immunosuppressed patients and those with GNB due to non-fermenting bacilli (Acinetobacter spp, Pseudomonas spp), Brucella spp, Fusobacterium spp or polymicrobial growth are ineligible. The primary endpoint is 90-day survival without clinical or microbiological failure to treatment. Secondary endpoints include all-cause mortality, total duration of antibiotic treatment, hospital readmission and Clostridioides difficile infection. Interim safety analysis will be performed after the recruitment of every 100 patients. Given an event rate of 12%, a non-inferiority margin of 10%, and 90% power, the required sample size to determine non-inferiority is 380 patients. Analyses will be performed on both intention-To-Treat and per-protocol populations. Ethics and dissemination The study is approved by the Danish Regional Committee on Health Research (H-19085920) and the Danish Medicines Agency (2019-003282-17). The results of the main trial and each of the secondary endpoints will be submitted for publication in a peer-reviewed journal. Trial registration number ClinicalTrials.Gov:NCT04291768.

Objective: The aim was to evaluate the establishment of an aseptic endodontic operative field in general dentistry by assessing general dentists’ ability to reduce the amount of contamination to a non-cultivable level, and to compare the operative field asepsis at a general dentistry clinic with that at an endodontic specialist clinic. Materials and Methods: A total of 353 teeth were included in the study (153 in general dentistry, 200 at the specialist clinic). After isolation, control samples were taken, the operative fields disinfected with 30% hydrogen peroxide (1 min) followed by 5% iodine tincture or.5% chlorhexidine solution. Samples were collected from the access cavity area and buccal area, placed in a fluid thioglycolate medium, incubated (37°, 7 d), evaluated for growth/non-growth. Results: Significantly more contamination was observed at the general dentistry clinic (31.6%, 95/301), than at the endodontic specialist clinic (7.0%, 27/386) (p <.001). In general dentistry, significantly more positive samples were collected in the buccal area than in the occlusal area. Significantly more positive samples were collected when the chlorhexidine protocol had been used, both in general dentistry (p <.001) and at the specialist clinic (p =.028). Conclusions: The result from this study shows insufficient endodontic aseptic control in general dentistry. At the specialist clinic, both disinfection protocols were able to reduce the amount of microorganisms to a non-cultivable level. The observed difference between the protocols may not reflect a true difference in the effectiveness of the antimicrobial solutions, as confounding factors may have contributed to the result.

The purpose of this document is to highlight practical recommendations to assist acute-care hospitals in prioritization and implementation of strategies to prevent healthcare-associated infections through hand hygiene. This document updates the Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals through Hand Hygiene, published in 2014. This expert guidance document is sponsored by the Society for Healthcare Epidemiology (SHEA). It is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America, the Association for Professionals in Infection Control and Epidemiology, the American Hospital Association, and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise.

Mpox has recently re-emerged as a global entity of concern. We report one of the first pediatric cases in the United States and provide updated recommendations relevant to infection control and prevention measures of those in close contact with mpox.

BackgroundThere is limited evidence to evaluate screening algorithms with rapid antigen testing and exposure assessments as identification strategies for paucisymptomatic or asymptomatic Ebola virus (EBOV) infection and unrecognized EBOV disease (EVD).MethodsWe used serostatus and self-reported postexposure symptoms from a cohort study to classify contact-participants as having no infection, paucisymptomatic or asymptomatic infection, or unrecognized EVD. Exposure risk was categorized as low, intermediate, or high. We created hypothetical scenarios to evaluate the World Health Organization (WHO) case definition with or without rapid diagnostic testing (RDT) or exposure assessments.ResultsThis analysis included 990 EVD survivors and 1909 contacts, of whom 115 (6%) had paucisymptomatic or asymptomatic EBOV infection, 107 (6%) had unrecognized EVD, and 1687 (88%) were uninfected. High-risk exposures were drivers of unrecognized EVD (adjusted odds ratio, 3.5 [95% confidence interval, 2.4-4.9]). To identify contacts with unrecognized EVD who test negative by the WHO case definition, the sensitivity was 96% with RDT (95% confidence interval, 91%-99%), 87% with high-risk exposure (82%-92%), and 97% with intermediate- to high-risk exposures (93%-99%). The proportion of false-positives was 2% with RDT and 53%-93% with intermediate- and/or high-risk exposures.ConclusionWe demonstrated the utility and trade-offs of sequential screening algorithms with RDT or exposure risk assessments as identification strategies for contacts with unrecognized EVD.

OVID-19 took the world by a storm, private dental practitioners inclusive.  This perspective paper briefly highlights the challenges faced by private dental practitioners in Nigeria while the pandemic lasted. The author highlighted the response and guidelines issued by the ministry of health and how private dental practice adjusted to the new realities. It concluded with the recommendation that despite the end of COVID-19 as an emergency, infection control practices must still be upheld, post-COVID and at all times.

OVID-19 took the world by a storm, private dental practitioners inclusive.  This perspective paper briefly highlights the challenges faced by private dental practitioners in Nigeria while the pandemic lasted. The author highlighted the response and guidelines issued by the ministry of health and how private dental practice adjusted to the new realities. It concluded with the recommendation that despite the end of COVID-19 as an emergency, infection control practices must still be upheld, post-COVID and at all times.

Objective: The aim was to evaluate the establishment of an aseptic endodontic operative field in general dentistry by assessing general dentists’ ability to reduce the amount of contamination to a non-cultivable level, and to compare the operative field asepsis at a general dentistry clinic with that at an endodontic specialist clinic. Materials and Methods: A total of 353 teeth were included in the study (153 in general dentistry, 200 at the specialist clinic). After isolation, control samples were taken, the operative fields disinfected with 30% hydrogen peroxide (1 min) followed by 5% iodine tincture or.5% chlorhexidine solution. Samples were collected from the access cavity area and buccal area, placed in a fluid thioglycolate medium, incubated (37°, 7 d), evaluated for growth/non-growth. Results: Significantly more contamination was observed at the general dentistry clinic (31.6%, 95/301), than at the endodontic specialist clinic (7.0%, 27/386) (p <.001). In general dentistry, significantly more positive samples were collected in the buccal area than in the occlusal area. Significantly more positive samples were collected when the chlorhexidine protocol had been used, both in general dentistry (p <.001) and at the specialist clinic (p =.028). Conclusions: The result from this study shows insufficient endodontic aseptic control in general dentistry. At the specialist clinic, both disinfection protocols were able to reduce the amount of microorganisms to a non-cultivable level. The observed difference between the protocols may not reflect a true difference in the effectiveness of the antimicrobial solutions, as confounding factors may have contributed to the result.

Objective: The aim was to evaluate the establishment of an aseptic endodontic operative field in general dentistry by assessing general dentists’ ability to reduce the amount of contamination to a non-cultivable level, and to compare the operative field asepsis at a general dentistry clinic with that at an endodontic specialist clinic. Materials and Methods: A total of 353 teeth were included in the study (153 in general dentistry, 200 at the specialist clinic). After isolation, control samples were taken, the operative fields disinfected with 30% hydrogen peroxide (1 min) followed by 5% iodine tincture or.5% chlorhexidine solution. Samples were collected from the access cavity area and buccal area, placed in a fluid thioglycolate medium, incubated (37°, 7 d), evaluated for growth/non-growth. Results: Significantly more contamination was observed at the general dentistry clinic (31.6%, 95/301), than at the endodontic specialist clinic (7.0%, 27/386) (p <.001). In general dentistry, significantly more positive samples were collected in the buccal area than in the occlusal area. Significantly more positive samples were collected when the chlorhexidine protocol had been used, both in general dentistry (p <.001) and at the specialist clinic (p =.028). Conclusions: The result from this study shows insufficient endodontic aseptic control in general dentistry. At the specialist clinic, both disinfection protocols were able to reduce the amount of microorganisms to a non-cultivable level. The observed difference between the protocols may not reflect a true difference in the effectiveness of the antimicrobial solutions, as confounding factors may have contributed to the result.

Objective: The aim was to evaluate the establishment of an aseptic endodontic operative field in general dentistry by assessing general dentists’ ability to reduce the amount of contamination to a non-cultivable level, and to compare the operative field asepsis at a general dentistry clinic with that at an endodontic specialist clinic. Materials and Methods: A total of 353 teeth were included in the study (153 in general dentistry, 200 at the specialist clinic). After isolation, control samples were taken, the operative fields disinfected with 30% hydrogen peroxide (1 min) followed by 5% iodine tincture or.5% chlorhexidine solution. Samples were collected from the access cavity area and buccal area, placed in a fluid thioglycolate medium, incubated (37°, 7 d), evaluated for growth/non-growth. Results: Significantly more contamination was observed at the general dentistry clinic (31.6%, 95/301), than at the endodontic specialist clinic (7.0%, 27/386) (p <.001). In general dentistry, significantly more positive samples were collected in the buccal area than in the occlusal area. Significantly more positive samples were collected when the chlorhexidine protocol had been used, both in general dentistry (p <.001) and at the specialist clinic (p =.028). Conclusions: The result from this study shows insufficient endodontic aseptic control in general dentistry. At the specialist clinic, both disinfection protocols were able to reduce the amount of microorganisms to a non-cultivable level. The observed difference between the protocols may not reflect a true difference in the effectiveness of the antimicrobial solutions, as confounding factors may have contributed to the result.

Several retrospective studies have identified hospital sinks as reservoirs of Gram-negative bacteria. The aim of this study was to prospectively investigate the bacterial transmission from sinks to patients and if self-disinfecting sinks could reduce this risk. Samples were collected weekly from sinks (self-disinfecting, treated with boiling water, not treated) and patients in the Burn Centre at Linkoping University Hospital, Sweden. The antibiotic susceptibility of Gram-negative isolates was tested, and eight randomly chosen patient isolates and their connected sink isolates were subjected to whole genome sequencing (WGS). Of 489 sink samples, 232 (47%) showed growth. The most frequent findings were Stenotrophomonas maltophilia (n = 130), Pseudomonas aeruginosa (n = 128), and Acinetobacter spp. (n = 55). Bacterial growth was observed in 20% of the samplings from the self-disinfecting sinks and in 57% from the sinks treated with boiling water (p = 0.0029). WGS recognized one transmission of Escherichia coli sampled from an untreated sink to a patient admitted to the same room. In conclusion, the results showed that sinks can serve as reservoirs of Gram-negative bacteria and that self-disinfecting sinks can reduce the transmission risk. Installing self-disinfecting sinks in intensive care units is an important measure in preventing nosocomial infection among critically ill patients.

Enligt hälso- och sjukvårdslagen ska vården vara av en god hygienisk standard. Detta innebär att hela verksamheten är utformad så att risken för att patienter drabbas av infektion och smittspridning är så liten som möjligt. För att åstadkomma det är det centralt att använda ett infektionsförebyggande åtgärdsprogram samt att förhindra smittspridning i vården. Trots att kravet på en god hygienisk standard är lagstadgat så saknades ett verktyg för en god hygienisk standard för primärvård i Region Jönköpings län.Förbättringsarbetet handlade om att ta fram och införa en egenkontroll för god hygienisk standard anpassad för primärvård. Målet var att varje vårdcentral skulle arbeta med egenkontrollen och att antalet områden som uppfyllde hygienkraven skulle öka med minst fem procent per vårdcentral i mars 2023 jämfört med baslinjemätning. Kvantitativ metod och Nolans förbättringsmodell med PGSA användes. Förbättringsaktiviteter skapades med inspiration av COM-B. Alla åtta vårdcentraler uppnådde målet inom tidsramen.Studiens syfte var att utvärdera införandet av egenkontrollen vid deltagande vårdcentraler inom ramen av förbättringsarbetet. En kvalitativ innehållsanalys genomfördes och COM-B användes i analysen. Studien identifierade framgångsfaktorer som krävs för att vårdpersonalen ska kunna arbeta med egenkontrollen. Några av dessa var närvarande representant från Vårdhygien vid genomgång av egenkontroll och stöttning av chef för att planera och prioritera arbetet för att lyckas vid tidsbrist.Slutsatsen var att egenkontrollen var ett framgångsrikt sätt att få vårdcentralerna att arbeta mot att säkerställa en god hygienisk standard. Införandet har lett till en ökad patientsäkerhet för patienterna och ökad kunskap och förståelse hos vårdpersonalen. Pilotprojektet ska skalas upp under hösten 2023 och egenkontrollen ska införas på alla 40 vårdcentraler i regionen., According to the Health Care law, health care must be of a good hygienic standard. This means that the entire health care unit is designed so that the risk of infection is as small as possible. To achieve this, it is central to use a program for infection control. Although the requirement for a good hygienic standard is statutory, the primary care in the region did not have a checklist for this purpose.This improvement work involved introducing a checklist for a good hygienic standard for primary care. The goal was that each primary care unit would use the checklist and the number of areas that met the hygiene requirements should increase by at least five percent in March 2023 compared to the baseline. Quantitative method and Nolan's improvement model with PDSA was used. Improvement activities was created with inspiration from the COM-B model. All eight units achieved the goal.The purpose of the study was to evaluate the introduction of the checklist at the participating health centers within the framework of the improvement work.The study identified success factors that the healthcare staff required to be able to work with the checklist. Some of these were that a representative from the Infection Control unit was present during the review of the checklist and that the manager was supporting in planning and prioritizing the work when there were little time.The conclusion was that the checklist was a successful way to get the primary care units to work towards a good hygienic standard. The introduction of the checklist led to increased patient safety for the patients and increased knowledge and understanding for the health care staff. In the fall of 2023 the checklist will be introduced at all 40 primary care unit in the region.

Enligt hälso- och sjukvårdslagen ska vården vara av en god hygienisk standard. Detta innebär att hela verksamheten är utformad så att risken för att patienter drabbas av infektion och smittspridning är så liten som möjligt. För att åstadkomma det är det centralt att använda ett infektionsförebyggande åtgärdsprogram samt att förhindra smittspridning i vården. Trots att kravet på en god hygienisk standard är lagstadgat så saknades ett verktyg för en god hygienisk standard för primärvård i Region Jönköpings län.Förbättringsarbetet handlade om att ta fram och införa en egenkontroll för god hygienisk standard anpassad för primärvård. Målet var att varje vårdcentral skulle arbeta med egenkontrollen och att antalet områden som uppfyllde hygienkraven skulle öka med minst fem procent per vårdcentral i mars 2023 jämfört med baslinjemätning. Kvantitativ metod och Nolans förbättringsmodell med PGSA användes. Förbättringsaktiviteter skapades med inspiration av COM-B. Alla åtta vårdcentraler uppnådde målet inom tidsramen.Studiens syfte var att utvärdera införandet av egenkontrollen vid deltagande vårdcentraler inom ramen av förbättringsarbetet. En kvalitativ innehållsanalys genomfördes och COM-B användes i analysen. Studien identifierade framgångsfaktorer som krävs för att vårdpersonalen ska kunna arbeta med egenkontrollen. Några av dessa var närvarande representant från Vårdhygien vid genomgång av egenkontroll och stöttning av chef för att planera och prioritera arbetet för att lyckas vid tidsbrist.Slutsatsen var att egenkontrollen var ett framgångsrikt sätt att få vårdcentralerna att arbeta mot att säkerställa en god hygienisk standard. Införandet har lett till en ökad patientsäkerhet för patienterna och ökad kunskap och förståelse hos vårdpersonalen. Pilotprojektet ska skalas upp under hösten 2023 och egenkontrollen ska införas på alla 40 vårdcentraler i regionen., According to the Health Care law, health care must be of a good hygienic standard. This means that the entire health care unit is designed so that the risk of infection is as small as possible. To achieve this, it is central to use a program for infection control. Although the requirement for a good hygienic standard is statutory, the primary care in the region did not have a checklist for this purpose.This improvement work involved introducing a checklist for a good hygienic standard for primary care. The goal was that each primary care unit would use the checklist and the number of areas that met the hygiene requirements should increase by at least five percent in March 2023 compared to the baseline. Quantitative method and Nolan's improvement model with PDSA was used. Improvement activities was created with inspiration from the COM-B model. All eight units achieved the goal.The purpose of the study was to evaluate the introduction of the checklist at the participating health centers within the framework of the improvement work.The study identified success factors that the healthcare staff required to be able to work with the checklist. Some of these were that a representative from the Infection Control unit was present during the review of the checklist and that the manager was supporting in planning and prioritizing the work when there were little time.The conclusion was that the checklist was a successful way to get the primary care units to work towards a good hygienic standard. The introduction of the checklist led to increased patient safety for the patients and increased knowledge and understanding for the health care staff. In the fall of 2023 the checklist will be introduced at all 40 primary care unit in the region.

Several retrospective studies have identified hospital sinks as reservoirs of Gram-negative bacteria. The aim of this study was to prospectively investigate the bacterial transmission from sinks to patients and if self-disinfecting sinks could reduce this risk. Samples were collected weekly from sinks (self-disinfecting, treated with boiling water, not treated) and patients in the Burn Centre at Linkoping University Hospital, Sweden. The antibiotic susceptibility of Gram-negative isolates was tested, and eight randomly chosen patient isolates and their connected sink isolates were subjected to whole genome sequencing (WGS). Of 489 sink samples, 232 (47%) showed growth. The most frequent findings were Stenotrophomonas maltophilia (n = 130), Pseudomonas aeruginosa (n = 128), and Acinetobacter spp. (n = 55). Bacterial growth was observed in 20% of the samplings from the self-disinfecting sinks and in 57% from the sinks treated with boiling water (p = 0.0029). WGS recognized one transmission of Escherichia coli sampled from an untreated sink to a patient admitted to the same room. In conclusion, the results showed that sinks can serve as reservoirs of Gram-negative bacteria and that self-disinfecting sinks can reduce the transmission risk. Installing self-disinfecting sinks in intensive care units is an important measure in preventing nosocomial infection among critically ill patients.

Objective: The aim was to evaluate the establishment of an aseptic endodontic operative field in general dentistry by assessing general dentists’ ability to reduce the amount of contamination to a non-cultivable level, and to compare the operative field asepsis at a general dentistry clinic with that at an endodontic specialist clinic. Materials and Methods: A total of 353 teeth were included in the study (153 in general dentistry, 200 at the specialist clinic). After isolation, control samples were taken, the operative fields disinfected with 30% hydrogen peroxide (1 min) followed by 5% iodine tincture or.5% chlorhexidine solution. Samples were collected from the access cavity area and buccal area, placed in a fluid thioglycolate medium, incubated (37°, 7 d), evaluated for growth/non-growth. Results: Significantly more contamination was observed at the general dentistry clinic (31.6%, 95/301), than at the endodontic specialist clinic (7.0%, 27/386) (p <.001). In general dentistry, significantly more positive samples were collected in the buccal area than in the occlusal area. Significantly more positive samples were collected when the chlorhexidine protocol had been used, both in general dentistry (p <.001) and at the specialist clinic (p =.028). Conclusions: The result from this study shows insufficient endodontic aseptic control in general dentistry. At the specialist clinic, both disinfection protocols were able to reduce the amount of microorganisms to a non-cultivable level. The observed difference between the protocols may not reflect a true difference in the effectiveness of the antimicrobial solutions, as confounding factors may have contributed to the result.

Several retrospective studies have identified hospital sinks as reservoirs of Gram-negative bacteria. The aim of this study was to prospectively investigate the bacterial transmission from sinks to patients and if self-disinfecting sinks could reduce this risk. Samples were collected weekly from sinks (self-disinfecting, treated with boiling water, not treated) and patients in the Burn Centre at Linkoping University Hospital, Sweden. The antibiotic susceptibility of Gram-negative isolates was tested, and eight randomly chosen patient isolates and their connected sink isolates were subjected to whole genome sequencing (WGS). Of 489 sink samples, 232 (47%) showed growth. The most frequent findings were Stenotrophomonas maltophilia (n = 130), Pseudomonas aeruginosa (n = 128), and Acinetobacter spp. (n = 55). Bacterial growth was observed in 20% of the samplings from the self-disinfecting sinks and in 57% from the sinks treated with boiling water (p = 0.0029). WGS recognized one transmission of Escherichia coli sampled from an untreated sink to a patient admitted to the same room. In conclusion, the results showed that sinks can serve as reservoirs of Gram-negative bacteria and that self-disinfecting sinks can reduce the transmission risk. Installing self-disinfecting sinks in intensive care units is an important measure in preventing nosocomial infection among critically ill patients.

The objective is to provide a comprehensive overview of the rapidly developing field of the current state of research on in vivo use of hypochlorous acid (HOCl) to aid infection prevention and control, including naso-pharyngeal, alveolar, topical, and systemic HOCl applications. Also, examples are provided of dedicated applications in COVID-19. A brief background of HOCl's biological and chemical specifics and its physiological role in the innate immune system is provided to understand the effect of in vivo applications in the context of the body's own physiological defense mechanisms., Es wird ein umfassender Überblick über den aktuellen Stand der Forschung zum In-vivo-Einsatz von hypochloriger Säure (HOCl) zur Infektionsprävention und -bekämpfung gegeben. Der Schwerpunkt liegt auf nasalen, alveolären und topischen Anwendungen. Außerdem werden Beispiele für spezielle Anwendungen bei COVID-19 vorgestellt. Um die Wirkung von HOCl im Zusammenwirken mit körpereigenen physiologischen Abwehrmechanismen zu verstehen, werden die biologischen und chemischen Besonderheiten von HOCl und seiner physiologischen Rolle im humanen Immunsystem erläutert

Acute wounds may require cleansing to reduce the risk of infection. Stabilized hypochlorous acid in acetic buffer (HOCl + buffer) is a novel wound irrigation solution with antimicrobial properties. We performed a first-in-man, prospective, open-label pilot study to document preliminary safety and performance in the treatment of acute wounds. The study enrolled 12 subjects scheduled for a split-skin graft transplantation, where the donor site was used as a model of an acute wound. The treatment time was 75 s, given on 6 occasions. A total of 7 adverse events were regarded as related to the treatment; all registered as pain during the procedure for 2 subjects. One subject had a wound infection at the donor site. The mean colony-forming unit (CFU) decreased by 41% after the treatment, and the mean epithelialization was 96% on both days 14 (standard deviation [SD] 8%) and 21 (SD 10%). The study provides preliminary support for the safety, well-tolerance, and efficacy of HOCl + buffer for acute wounds. The pain was frequent although resolved quickly. Excellent wound healing and satisfying antimicrobial properties were observed. A subsequent in vitro biofilm study also indicated good antimicrobial activity against Pseudomonas aeruginosa with a 96% mean reduction of CFU, when used for a treatment duration of 15 min (P <.0001), and a 50% decrease for Staphylococcus aureus (P =.1010). Future larger studies are needed to evaluate the safety and performance of HOCl + buffer in acute wounds, including the promising antimicrobial effect by prolonged treatment on bacterial biofilms.

Objectives Application of hyperbaric oxygen (HBO 2) treatment in the multidisciplinary setting of necrotising soft-tissue infection (NSTI) is debated as a considerable number of studies are of low quality with marked prognostication bias due to inadequately addressing disease severity. The objective of this study was to associate HBO 2 treatment with mortality in patients with NSTI including disease severity as a prognostic variable. Design Nationwide population-based register study. Setting Denmark. Participants Danish residents with NSTI patients between January 2011 and June 2016. Primary and secondary outcome measures Thirty-day mortality was compared between patients receiving and patients not receiving HBO 2 treatment using inverse probability of treatment weighting and propensity-score matching with predetermined variables (age, sex and weighted Charlson comorbidity score, presence of septic shock and Simplified Acute Physiology Score II (SAPS II)). Results A total of 671 NSTI patients were included with a median age of 63 (52-71), 61% male sex, 30% had septic shock and a median SAPS II of 46 (34-58). Patients who received HBO 2 treatment (n=266) were younger and had lower SAPS II, but a larger fraction had septic shock compared with patients not receiving HBO 2 treatment. Overall, all-cause 30-day mortality was 19% (95% CI 17% to 23%). The statistical models were in general acceptably balanced with covariates reaching <0.1 absolute standardised mean differences and patients receiving HBO 2 treatment were associated with lower 30-day mortality (OR 0.40, 95% CI 0.30 to 0.53, p<0.001). Conclusions In analyses using inverse probability of treatment weighting and propensity score analysis, patients treated with HBO 2 treatment were associated with improved 30-day survival.

Several retrospective studies have identified hospital sinks as reservoirs of Gram-negative bacteria. The aim of this study was to prospectively investigate the bacterial transmission from sinks to patients and if self-disinfecting sinks could reduce this risk. Samples were collected weekly from sinks (self-disinfecting, treated with boiling water, not treated) and patients in the Burn Centre at Linkoping University Hospital, Sweden. The antibiotic susceptibility of Gram-negative isolates was tested, and eight randomly chosen patient isolates and their connected sink isolates were subjected to whole genome sequencing (WGS). Of 489 sink samples, 232 (47%) showed growth. The most frequent findings were Stenotrophomonas maltophilia (n = 130), Pseudomonas aeruginosa (n = 128), and Acinetobacter spp. (n = 55). Bacterial growth was observed in 20% of the samplings from the self-disinfecting sinks and in 57% from the sinks treated with boiling water (p = 0.0029). WGS recognized one transmission of Escherichia coli sampled from an untreated sink to a patient admitted to the same room. In conclusion, the results showed that sinks can serve as reservoirs of Gram-negative bacteria and that self-disinfecting sinks can reduce the transmission risk. Installing self-disinfecting sinks in intensive care units is an important measure in preventing nosocomial infection among critically ill patients.

Objectives Application of hyperbaric oxygen (HBO 2) treatment in the multidisciplinary setting of necrotising soft-tissue infection (NSTI) is debated as a considerable number of studies are of low quality with marked prognostication bias due to inadequately addressing disease severity. The objective of this study was to associate HBO 2 treatment with mortality in patients with NSTI including disease severity as a prognostic variable. Design Nationwide population-based register study. Setting Denmark. Participants Danish residents with NSTI patients between January 2011 and June 2016. Primary and secondary outcome measures Thirty-day mortality was compared between patients receiving and patients not receiving HBO 2 treatment using inverse probability of treatment weighting and propensity-score matching with predetermined variables (age, sex and weighted Charlson comorbidity score, presence of septic shock and Simplified Acute Physiology Score II (SAPS II)). Results A total of 671 NSTI patients were included with a median age of 63 (52-71), 61% male sex, 30% had septic shock and a median SAPS II of 46 (34-58). Patients who received HBO 2 treatment (n=266) were younger and had lower SAPS II, but a larger fraction had septic shock compared with patients not receiving HBO 2 treatment. Overall, all-cause 30-day mortality was 19% (95% CI 17% to 23%). The statistical models were in general acceptably balanced with covariates reaching <0.1 absolute standardised mean differences and patients receiving HBO 2 treatment were associated with lower 30-day mortality (OR 0.40, 95% CI 0.30 to 0.53, p<0.001). Conclusions In analyses using inverse probability of treatment weighting and propensity score analysis, patients treated with HBO 2 treatment were associated with improved 30-day survival.

Several retrospective studies have identified hospital sinks as reservoirs of Gram-negative bacteria. The aim of this study was to prospectively investigate the bacterial transmission from sinks to patients and if self-disinfecting sinks could reduce this risk. Samples were collected weekly from sinks (self-disinfecting, treated with boiling water, not treated) and patients in the Burn Centre at Linkoping University Hospital, Sweden. The antibiotic susceptibility of Gram-negative isolates was tested, and eight randomly chosen patient isolates and their connected sink isolates were subjected to whole genome sequencing (WGS). Of 489 sink samples, 232 (47%) showed growth. The most frequent findings were Stenotrophomonas maltophilia (n = 130), Pseudomonas aeruginosa (n = 128), and Acinetobacter spp. (n = 55). Bacterial growth was observed in 20% of the samplings from the self-disinfecting sinks and in 57% from the sinks treated with boiling water (p = 0.0029). WGS recognized one transmission of Escherichia coli sampled from an untreated sink to a patient admitted to the same room. In conclusion, the results showed that sinks can serve as reservoirs of Gram-negative bacteria and that self-disinfecting sinks can reduce the transmission risk. Installing self-disinfecting sinks in intensive care units is an important measure in preventing nosocomial infection among critically ill patients.

ObjectivesTo identify incident SARS-CoV-2 infections and inform effective mitigation strategies in university settings, we piloted an integrated symptom and exposure monitoring and testing system among a cohort of university students and employees.DesignProspective cohort study.SettingA public university in California from June to August 2020.Participants2180 university students and 738 university employees.Primary outcome measuresAt baseline and endline, we tested participants for active SARS-CoV-2 infection via quantitative PCR (qPCR) test and collected blood samples for antibody testing. Participants received notifications to complete additional qPCR tests throughout the study if they reported symptoms or exposures in daily surveys or were selected for surveillance testing. Viral whole genome sequencing was performed on positive qPCR samples, and phylogenetic trees were constructed with these genomes and external genomes.ResultsOver the study period, 57 students (2.6%) and 3 employees (0.4%) were diagnosed with SARS-CoV-2 infection via qPCR test. Phylogenetic analyses revealed that a super-spreader event among undergraduates in congregate housing accounted for at least 48% of cases among study participants but did not spread beyond campus. Test positivity was higher among participants who self-reported symptoms (incidence rate ratio (IRR) 12.7; 95% CI 7.4 to 21.8) or had household exposures (IRR 10.3; 95% CI 4.8 to 22.0) that triggered notifications to test. Most (91%) participants with newly identified antibodies at endline had been diagnosed with incident infection via qPCR test during the study.ConclusionsOur findings suggest that integrated monitoring systems can successfully identify and link at-risk students to SARS-CoV-2 testing. As the study took place before the evolution of highly transmissible variants and widespread availability of vaccines and rapid antigen tests, further research is necessary to adapt and evaluate similar systems in the present cont

Background Oral care with gel is a common method for preventing aspiration in high-risk patients. An oral care gel is used to clean and moisturize the oral cavity. However, the effects of gel care on the oral bacteria remain unclear. In this pilot study, we described a matching transformation system (MA-T) for elderly high-risk patients. MA-T is an on-demand aqueous chlorine dioxide solution that provides excellent safety and has various antimicrobial activities, even in the presence of abundant organic compounds. This study investigated the effects of MA-T gel in patients requiring nursing care. Materials and methods Patients who were hospitalized for nursing care were included in this study. No drugs and foods were administered orally. Oral bacteria and intraoral humidity were examined by daily care using MA-T gel. Moreover, oral membranous substances were analyzed and material from the oral cavity was cultured on selective media for identifying opportunistic organisms. Results Membranous substances were present in the oral cavities of all patients. The number of bacteria decreased, and oral moisture improved, after treatment with MA-T gel. Moreover, oral humidity was also controlled with the continued use of MA-T gel. MA-T gels should be used not only for professional care but also on a daily basis for better oral care. Furthermore, the results of bacterial cultures showed that MA-T controls the propagation of opportunistic bacterial infections. Conclusion Membranous substances may be observed in the oral cavity of individuals requiring nursing care for tube feeding. The results of this pilot study suggest that MA-T, a novel disinfectant, can be used for oral care in the elderly to reduce the risk of aspiration-pneumonia.

Predictive models for airborne infection risk have been extensively used during the pandemic, but there is yet still no consensus on a common approach, which may create misinterpretation of results among public health experts and engineers designing building ventilation. In this study we applied the latest data on viral load, aerosol droplet sizes and removal mechanisms to improve the Wells Riley model by introducing the following novelties i) a new model to calculate the total volume of respiratory fluid exhaled per unit time ii) developing a novel viral dose-based generation rate model for dehydrated droplets after expiration iii) deriving a novel quanta-RNA relationship for various strains of SARS-CoV-2 iv) proposing a method to account for the incomplete mixing conditions. These new approaches considerably changed previous estimates and allowed to determine more accurate average quanta emission rates including omicron variant. These quanta values for the original strain of 0.13 and 3.8 quanta/h for breathing and speaking and the virus variant multipliers may be used for simple hand calculations of probability of infection or with developed model operating with six size ranges of aerosol droplets to calculate the effect of ventilation and other removal mechanisms. The model developed is made available as an open-source tool.

Background Little is known about the actual impact of COVID-19 on caregivers of older people with dementia and resultant collaborations among them to provide continued person-centered care while undertaking infection control measures. In this study, we explored the impact of providing dementia care during COVID-19 on caregivers involved in dementia care. Methods This is an exploratory qualitative case study. The participants were family members living with older people with dementia, care managers, and the medical and long-term care facility staff. Data were collected from 46 caregivers via face-to-face and semi-structured interviews and analyzed using thematic analysis. Results The interviews identified 22 themes related to the impact of COVID-19 on different positions of the caregivers involved in dementia care and their collaboration, and we categorized them into six categories. The core themes were “re-acknowledgement of care priorities” and “rebuilding of relationships.” When caregivers’ perceptions were aligned in the decision-making processes regarding care priorities, “reaffirmation of trust” and “strengthening of intimate relationships” emerged as positive changes in their relationships. Furthermore, the differences in the ability of each caregiver to access and select correct and appropriate information about COVID-19, and the extent of infection spread in the region were related to “anxiety during COVID-19 pandemic” and caused a “gap in perception” regarding infection control. Conclusions The present study clarified that the process of aligning the perceptions of caregivers to the objectives and priorities of care for older people with dementia during COVID-19 pandemic strengthened the relationships among caregivers. The findings of this study are useful for caregivers involved in person-centered dementia care.

Background: A new role of a regional core hospital for educating medical personnel through a regional therapy association has been previously reported in the COVID-19 crisis. In the present study, physical (PT), occupational (OT), and speech language hearing therapist (ST) and physiatrists, who have been providing COVID-19 rehabilitation in a regional core hospital, were instructed how to control infection via a webinar. The purpose of this report was to investigate the effects of webinars on therapists working in local facilities. Methods: The webinar was sponsored by the Wakayama Physical Therapy Association. A PT, OT, ST, and physiatrist from Wakayama Medical University Kihoku Hospital, who had been providing rehabilitation for mildly and/or moderately infected COVID-19 patients. All participants answered the 18-item online questionnaire after the webinar to assess the educational effects. Results: There were 41 participants in this region and 30 participants from 19 facilities responded the questionnaire (valid responses ratio was 73%) and 30% of the respondents had experienced COVID-19 rehabilitation. Most responders (83%) felt that difficulty level of the contents was appropriate and 80% of the respondents replied that rehabilitation was necessary for the patients. 70% of the respondents replied that got confidence after this webinar, even 7 of the 13 respondents (43%), who attended the webinar about infection control of COVID-19 for the first time, were involved. Conclusion: A webinar from therapists and physiatrists in a regional core hospital, who had experiences to provide COVID-19 rehabilitation, were satisfactory and effective for the education of regional therapists.

Introduction: Surgical mouth mask plays an important role in each and every procedure in dental practise. It acts as a barrier and prevents transmission and spreading of pathogens through water aerosols and many microorganisms which are produced in the dental setup. In order to prevent and minimize the risk of infections, the dental practitioners and the auxiliary staff present in the clinic must wear precautious fluid resistant masks. Therefore the aim of the study is to create awareness of surgical mouth mask usage among dental students. Materials and methods: A questionnaire based survey was conducted using google forms. This standard questionnaire consisted of 12 questions and it was circulated among the students in saveetha dental college and responses were collected and statistically analysed using SPSS software. Descriptive statistics were expressed by means of number, frequency, and percentage. Chi-square test was used to find the association between year of study and Number of responses provided by the participants. Result: The age of participants ranges from 17 to 30 years. The study population was asked about awareness of wearing a mouth mask 97.25% were aware. When asked if they wear a mouth mask in public places 88.99% said yes. Conclusion: Based on the results of the present study, it was found that the awareness about the usage of surgical masks is high for the 3rd year dental students compared to the 1st, 2nd, 4th year dental students, but more awareness has to be spread in order to improve the usage of surgical masks.

ObjectiveTo describe the association between nursing home staff turnover and the presence and scope of infection control citations.Data sourcesSecondary data for all US nursing homes between March 31, 2017, through December 31, 2019 were obtained from Payroll-Based Journal (PBJ), Nursing Home Compare, and Long-Term Care: Facts on Care in the US (LTC Focus).Study designWe estimated the association between nurse turnover and the probability of an infection control citation and the scope of the citation while controlling for nursing home fixed effects. Our turnover measure is the percent of the facility's nursing staff hours that were provided by new staff (less than 60 days of experience in the last 180 days) during the 2 weeks prior to the health inspection. We calculated turnover for all staff together and separately for registered nurses, licensed practical nurses (LPNs), and certified nursing assistants.Data collection/extraction methodsWe linked nursing homes standard inspection surveys to 650 million shifts from the PBJ data. We excluded any nursing home with incomplete or missing staffing data. Our final analytic sample included 12,550 nursing homes with 30,536 surveys.Principal findingsStaff turnover was associated with an increased likelihood of an infection control citation (average marginal effect [AME] = 0.12 percentage points [pp]; 95% confidence interval [CI]: 0.05, 0.18). LPN (AME = 0.06 pp; 95% CI: 0.01, 0.11) turnover was conditionally associated with an infection control citation. Conditional on having at least an isolated citation for infection control, staff turnover was positively associated with receiving a citation coded as a "pattern" (AME = 0.21 pp; 95% CI: 0.10, 0.32). Conditional of having at least a pattern citation, staff turnover was positively associated with receiving a widespread citation (AME = 0.21 pp; 95% CI: 0.10, 0.32).ConclusionsTurnover was positively associated with the probability of an

A One Health approach to the epidemiology, management, surveillance, and control of leptospirosis relies on accessible and accurate diagnostics that can be applied to humans and companion animals and livestock. Diagnosis should be multifaceted and take into account exposure risk, clinical presentation, and multiple direct and/or indirect diagnostic approaches. Methods of direct detection of Leptospira spp. include culture, histopathology and immunostaining of tissues or clinical specimens, and nucleic acid amplification tests (NAATs). Indirect serologic methods to detect leptospiral antibodies include the microscopic agglutination test (MAT), the enzyme-linked immunosorbent assay (ELISA), and lateral flow methods. Rapid diagnostics that can be applied at the point-of-care; NAAT and lateral flow serologic tests are essential for management of acute infection and control of outbreaks. Culture is essential to an understanding of regional knowledge of circulating strains, and we discuss recent improvements in methods for cultivation, genomic sequencing, and serotyping. We review the limitations of NAATs, MAT, and other diagnostic approaches in the context of our expanding understanding of the diversity of pathogenic Leptospira spp. Novel approaches are needed, such as loop mediated isothermal amplification (LAMP) and clustered regularly interspaced short palindromic repeats (CRISPR)-based approaches to leptospiral nucleic acid detection.

PurposeThis study aims to investigate practice changes among Southern and Northern California's radiation oncology centers during the COVID-19 pandemic.MethodsOn the online survey platform SurveyMonkey, we designed 10 survey questions to measure changes in various aspects of medical physics practice. The questions covered patient load and travel rules; scopes to work from home; new protocols to reduce corona virus disease-2019 (COVID-19) infection risk; availability of telemedicine; and changes in fractionation schedules and/or type of treatment plans. We emailed the survey to radiation oncology centers throughout Northern and Southern California, requesting one completed survey per center. All responses were anonymized, and data were analyzed using both qualitative and quantitative research methods.ResultsAt the end of a 4-month collection period (July 2, 2021 to October 11, 2021), we received a total of 61 responses throughout Southern and Northern California. On average, 4111 patients were treated per day across the 61 centers. New COVID-19-related department and hospital policies, along with hybrid workflow changes, infectious control policies, and changes in patient load have been reported. Results also showed changes in treatment methods during the pandemic, such as increased use of telemedicine, hypofractionation for palliative, breast cancer, and prostate cancer cases; and simultaneous boosts, compared to sequential boosts.ConclusionOur California radiation oncology center population study shows changes in various aspects of radiation oncology practices during the COVID-19 pandemic. This study serves as a pilot study to identify possible correlations and new strategies that allow radiation oncology centers to continue providing quality patient care while ensuring the safety of both staff and patients.

ObjectiveAlthough a growing number of healthcare facilities are implementing healthcare personnel (HCP) coronavirus disease 2019 (COVID-19) vaccination requirements, vaccine exemption request management as a part of such programs is not well described.DesignCross-sectional survey.ParticipantsInfectious disease (ID) physician members of the Emerging Infections Network with infection prevention or hospital epidemiology responsibilities.MethodsEligible persons were sent a web-based survey focused on hospital plans and practices around exemption allowances from HCP COVID-19 vaccine requirements.ResultsOf the 695 ID physicians surveyed, 263 (38%) responded. Overall, 160 respondent institutions (92%) allowed medical exemptions, whereas 132 (76%) allowed religious exemptions. In contrast, only 14% (n = 24) allowed deeply held personal belief exemptions. The types of medical exemptions allowed varied considerably across facilities, with allergic reactions to the vaccine or its components accepted by 145 facilities (84%). For selected scenarios commonly used as the basis for religious and deeply held personal belief exemption requests, 144 institutions (83%) would not approve exemptions focused on concerns regarding right of consent or violations of freedom of personal choice, and 140 institutions (81%) would not approve exemptions focused on introducing foreign substances into one's body or the sanctity of the body. Most respondents noted plans for additional infection prevention interventions for HCP who received an exemption for COVID-19 vaccination.ConclusionsAlthough many respondent institutions allowed exemptions from HCP COVID-19 vaccination requirements, the types of exemptions allowed and how the exemption programs were structured varied widely.

Titanium and titanium alloys are widely used in different biomedical applications owing to their high biocompatibility, high corrosion resistance, good mechanical properties, and good osseointegration ability. Titanium and its alloys rapidly form a surface oxide layer in air and aqueous environments. This passive and thin (a few nanometers) surface oxide hinders active corrosion and ensures a low metal ion release, enhancing biocompatibility. Compared to that of other biomedical alloys, this surface oxide is exceptionally resistant to chemical attack by halides, primarily chlorides; the presence of fluorides can, in some cases, result in localized corrosion of titanium and its alloys. However, the combination of proteins, inflammatory conditions and bacteria, which for instance generate hydrogen peroxide, can result in a reduction of the corrosion resistance of titanium-based materials. Titanium and its alloying elements, such as aluminum and vanadium, can then be released as ions, which might trigger an immune system response and reduce biocompatibility. Several surface modifications have been proposed in order to improve the bone-bonding ability of titanium and its alloys, facilitate the healing process, and enhance the success of the implant with a decreased risk of micromotions. Moreover, antimicrobial ions/nanoparticles can be added to the surface to reduce the infection risk. Surface modification of titanium (e.g., with artificially grown, micrometer-thick, titanium oxide layers) can significantly increase the corrosion resistance under critical conditions (e.g., inflammatory response and infection); however, the surfaces are not completely inert and the effect of metal ion/nanoparticle release should be carefully taken into account. This chapter reviews and discusses the current strategies for modifying and controlling the surface of titanium-based implant materials, with particular focus on corrosion resistance, bone integration, inflammatory and infection c, Part of ISBN 9789811636677 9789811636660QC 20230725

PURPOSE: The ENFORCE cohort is a national Danish prospective cohort of adults who received a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine as part of the Danish National SARS-CoV-2 vaccination programme. It was designed to investigate the long-term effectiveness, safety and durability of SARS-CoV-2 vaccines used in Denmark. PARTICIPANTS: A total of 6943 adults scheduled to receive a SARS-CoV-2 vaccine in the Danish COVID-19 vaccination programme were enrolled in the study prior to their first vaccination. Participants will be followed for a total of 2 years with five predetermined follow-up visits and additional visits in relation to any booster vaccination. Serology measurements are performed after each study visit. T-cell immunity is evaluated at each study visit for a subgroup of 699 participants. Safety information is collected from participants at visits following each vaccination. Data on hospital admissions, diagnoses, deaths and SARS-CoV-2 PCR results are collected from national registries throughout the study period. The median age of participants was 64 years (IQR 53-75), 56.6% were women and 23% were individuals with an increased risk of a serious course of COVID-19. A total of 340 (4.9%) participants tested positive for SARS-CoV-2 spike IgG at baseline. FINDINGS TO DATE: Results have been published on risk factors for humoral hyporesponsiveness and non-durable response to SARS-CoV-2 vaccination, the risk of breakthrough infections at different levels of SARS-CoV-2 spike IgG by viral variant and on the antibody neutralising capacity against different SARS-CoV-2 variants following primary and booster vaccinations. FUTURE PLANS: The ENFORCE cohort will continuously generate studies investigating immunological response, effectiveness, safety and durability of the SARS-CoV-2 vaccines. TRIAL REGISTRATION NUMBER: NCT04760132.

Interprofessional learning (IPL) is a key challenge in Malaysia in incorporating the approach into the current profession-specific heathcare training and service. Safe practices would be enhanced with improved collaboration among the health professionals (HPs) when they learn with, from, and about each other. This study evaluated the effectiveness of an innovative approach using interprofessional simulation scenarios (IPSS) in improving knowledge, attitude, and practice (KAP) of hospitalacquired infection control (HAIC) among HPs.The quasi-experimental pre-post test study was conducted in a teaching hospital in Malaysia. Purposive sampling was used to recruit participants from surgical, intensive care, and other units due to constraints in getting participants to attend intervention. Thirty-six health professionals in the experimental and forty in the control group completed the study. All subjects participated in an interactive lecture and demonstrated four IPSS on HAIC (i) taking blood specimen (ii) bedsore dressing (iii) collecting sputum for acid-fast bacilli and (iv) intermittent bladder catheterization. Each team consisted of a doctor and a nurse. A self-administered questionnaire consists of three sections namely i) demography details ii) University of West England Interprofessional (UWEIP) questionnaire with four interprofessional aspects (IP) namely, self-assessment on communication and teamwork skills (CTW), attitude on IPL and interprofessional relationship (IPR) and, perception towards interprofessional interaction (IPI) iii) KAP on HAIC was completed by participants in the pre, immediately and post-intervention timelines. The mean score differences between pre-and post-intervention within groups were tested by employing parametric and non-parametric tests eg., paired sample t-test and, between experimental vs control groups with independence t-test for normally distributed variables. The non-normally distributed data was tested with Wilcoxan signed-rank

Interprofessional learning (IPL) is a key challenge in Malaysia in incorporating the approach into the current profession-specific heathcare training and service. Safe practices would be enhanced with improved collaboration among the health professionals (HPs) when they learn with, from, and about each other. This study evaluated the effectiveness of an innovative approach using interprofessional simulation scenarios (IPSS) in improving knowledge, attitude, and practice (KAP) of hospitalacquired infection control (HAIC) among HPs.The quasi-experimental pre-post test study was conducted in a teaching hospital in Malaysia. Purposive sampling was used to recruit participants from surgical, intensive care, and other units due to constraints in getting participants to attend intervention. Thirty-six health professionals in the experimental and forty in the control group completed the study. All subjects participated in an interactive lecture and demonstrated four IPSS on HAIC (i) taking blood specimen (ii) bedsore dressing (iii) collecting sputum for acid-fast bacilli and (iv) intermittent bladder catheterization. Each team consisted of a doctor and a nurse. A self-administered questionnaire consists of three sections namely i) demography details ii) University of West England Interprofessional (UWEIP) questionnaire with four interprofessional aspects (IP) namely, self-assessment on communication and teamwork skills (CTW), attitude on IPL and interprofessional relationship (IPR) and, perception towards interprofessional interaction (IPI) iii) KAP on HAIC was completed by participants in the pre, immediately and post-intervention timelines. The mean score differences between pre-and post-intervention within groups were tested by employing parametric and non-parametric tests eg., paired sample t-test and, between experimental vs control groups with independence t-test for normally distributed variables. The non-normally distributed data was tested with Wilcoxan signed-rank

Objectives To assess healthcare workers' (HCWs) compliance with the infection prevention and control (IPC) practices and identify the factors influencing this compliance using the Health Belief Model as the theoretical framework. Design Quantitative data from an explanatory sequential mixed-methods study were employed in this research. Participants and settings From 17 May to 30 August 2020, 604 physicians and nurses working at six randomly selected tertiary care facilities in Dhaka City in Bangladesh took part in this study. Primary and secondary outcome measures Compliance with the WHO's guidance on IPC measures, as well as the associated factors, was the primary outcome. Results A mean compliance score of 0.49 (+/- 0.25) was observed on a 0-1 scale. HCWs were most compliant with the medical mask wearing guidelines (81%) and were least compliant with the high-touch surface decontamination regulations (23%). Compliance with the IPC guidance was significantly associated with increasing age, female sex, working as a nurse, having non-communicable diseases and history of exposure to patients with COVID-19. Perceived benefits (B=0.039, 95% CI 0.001 to 0.076), self-efficacy (B=0.101, 95% CI 0.060 to 0.142) and cues to action (B=0.045, 95% CI 0.002 to 0.088) were positively associated with compliance. Compliance with IPC guidance was 0.061 times greater among participants who reported low perceived barriers compared with those with high perceived barriers. Conclusion Overall, compliance with IPC guidance among HCWs was unsatisfactory. As self-efficacy exerted the greatest contribution to compliance, it should be emphasised in any endeavour to improve HCWs' IPC adherence. Such interventions should also focus on perceived barriers, including unreliability of the information sources, unsafe working places and unavailability of protective equipment and cues to action, including trust in the administration and availability of adequate IPC guidance.

Introduction: Public transportation is an essential societal function in crisis situations like the coronavirus disease 2019 (COVID-19) pandemic. Bus drivers and other public transport workers are essential workers that need to keep working despite the risk of contagion. The SARS-CoV-2 virus may pose an occupational health risk to public transport workers and especially to bus drivers as they interact with passengers in a confined area. By analyzing antibodies towards SARS-CoV-2 proteins in blood samples it is possible to measure if an individual has been infected by COVID-19. Here, we report the prevalence of antibodies among bus drivers and other public transport employees in Stockholm, Sweden and relate it to socio-demographic factors. Methods: Seroprevalence of IgG antibodies towards SARS-CoV-2 proteins was investigated in a sample of 262 non-vaccinated public transport workers (182 men and 40 women) recruited between April 26 and May 7, 2021. Most of the participants were bus drivers (n = 222). The relationship between socio-demographic factors and seroprevalence was investigated with logistic regression. Results: The seroprevalence was 50% in the total sample of public transport workers. Among bus drivers, 51% were seropositive compared to 44% seropositive among the other public transport workers. The difference was not significant. The seroprevalence was higher than the national seroprevalence in Sweden during the same period (18.3% in non-vaccinated people aged 20–64 years). The logistic regression model using Wald forward selection showed that men had a higher risk of being seropositive (OR 2.7, 95% CI 1.3 – 5.8) and there was a higher risk with increasing number of people in the household (OR 1.3, 95% CI 1.1 – 1.6). Conclusions: These findings could imply an occupational risk for COVID-19 infection among public transport workers. Infection control measures are warranted during virus epidemics to assure bus drives’ safety and reduce transmission in public t

We describe an approach used by a rural healthcare provider to convert surgical helmets into emergency powered air-purifying respirators (PAPRs) at the onset of the COVID-19 pandemic. The approach uses common materials and efficacy was demonstrated against aerosols measuring 7 nm to 25 mu m in diameter.

We describe an approach used by a rural healthcare provider to convert surgical helmets into emergency powered air-purifying respirators (PAPRs) at the onset of the COVID-19 pandemic. The approach uses common materials and efficacy was demonstrated against aerosols measuring 7 nm to 25 mu m in diameter.

BackgroundLittle is known about the actual impact of COVID-19 on caregivers of older people with dementia and resultant collaborations among them to provide continued person-centered care while undertaking infection control measures. In this study, we explored the impact of providing dementia care during COVID-19 on caregivers involved in dementia care.MethodsThis is an exploratory qualitative case study. The participants were family members living with older people with dementia, care managers, and the medical and long-term care facility staff. Data were collected from 46 caregivers via face-to-face and semi-structured interviews and analyzed using thematic analysis.ResultsThe interviews identified 22 themes related to the impact of COVID-19 on different positions of the caregivers involved in dementia care and their collaboration, and we categorized them into six categories. The core themes were “re-acknowledgement of care priorities” and “rebuilding of relationships.” When caregivers’ perceptions were aligned in the decision-making processes regarding care priorities, “reaffirmation of trust” and “strengthening of intimate relationships” emerged as positive changes in their relationships. Furthermore, the differences in the ability of each caregiver to access and select correct and appropriate information about COVID-19, and the extent of infection spread in the region were related to “anxiety during COVID-19 pandemic” and caused a “gap in perception” regarding infection control.ConclusionsThe present study clarified that the process of aligning the perceptions of caregivers to the objectives and priorities of care for older people with dementia during COVID-19 pandemic strengthened the relationships among caregivers. The findings of this study are useful for caregivers involved in person-centered dementia care.

Background: A new role of a regional core hospital for educating medical personnel through a regional therapy association has been previously reported in the COVID-19 crisis. In the present study, physical (PT), occupational (OT), and speech language hearing therapist (ST) and physiatrists, who have been providing COVID-19 rehabilitation in a regional core hospital, were instructed how to control infection via a webinar. The purpose of this report was to investigate the effects of webinars on therapists working in local facilities. Methods: The webinar was sponsored by the Wakayama Physical Therapy Association. A PT, OT, ST, and physiatrist from Wakayama Medical University Kihoku Hospital, who had been providing rehabilitation for mildly and/or moderately infected COVID-19 patients. All participants answered the 18-item online questionnaire after the webinar to assess the educational effects. Results: There were 41 participants in this region and 30 participants from 19 facilities responded the questionnaire (valid responses ratio was 73%) and 30% of the respondents had experienced COVID-19 rehabilitation. Most responders (83%) felt that difficulty level of the contents was appropriate and 80% of the respondents replied that rehabilitation was necessary for the patients. 70% of the respondents replied that got confidence after this webinar, even 7 of the 13 respondents (43%), who attended the webinar about infection control of COVID-19 for the first time, were involved. Conclusion: A webinar from therapists and physiatrists in a regional core hospital, who had experiences to provide COVID-19 rehabilitation, were satisfactory and effective for the education of regional therapists.

Antimicrobial resistance (AMR) is a significant and growing global health threat. Efficient detection and identification of AMR transmission is critical to inform AMR surveillance and public health interventions. However, routine microbiological methods lack resolution to reliably identify transmission of AMR pathogens. Whole genome sequencing (WGS), or ‘genomics’, offers high-resolution identification of AMR mechanisms, pathogen typing and resolution of transmission networks. These data are increasingly being used at multiple levels, from the individual patient to hospitals to national surveillance. This thesis primarily describes the investigation of the use of genomics for AMR surveillance of bacterial pathogens relevant to human health, although these methods are also applicable to other pathogens and settings. Carbapenemase-producing Enterobacterales (CPE) are significant pathogens with resistance to carbapenems, considered last-line antimicrobials. Whilst small numbers of endemic CPE had been present in Australia since 2002, serious incursions with local transmission were not identified until 2012. In Chapter 2, a detailed analysis of CPE in the state of Victoria, Australia is presented, integrating genomic, phenotypic and epidemiologic data. Genomic analysis demonstrated a polyclonal population of CPE organisms, with three principal carbapenemase classes represented, and many different species represented. Study outcomes include facilitation of the state-wide CPE surveillance program by informing genomic analysis methods and baseline historical data, the establishment of phenotypic guidelines for suspected CPE, and designation of a genomic relatedness threshold for inferring CPE transmission. Genomic sequencing also has the potential to identify transmission of AMR pathogens in hospital settings, to inform infection control practices. Employing a ‘sequence first’ approach, prospectively sequencing all target AMR pathogens from hospital patients, represents a

PURPOSE: The ENFORCE cohort is a national Danish prospective cohort of adults who received a severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) vaccine as part of the Danish National SARS-CoV-2 vaccination programme. It was designed to investigate the long-term effectiveness, safety and durability of SARS-CoV-2 vaccines used in Denmark. PARTICIPANTS: A total of 6943 adults scheduled to receive a SARS-CoV-2 vaccine in the Danish COVID-19 vaccination programme were enrolled in the study prior to their first vaccination. Participants will be followed for a total of 2 years with five predetermined follow-up visits and additional visits in relation to any booster vaccination. Serology measurements are performed after each study visit. T-cell immunity is evaluated at each study visit for a subgroup of 699 participants. Safety information is collected from participants at visits following each vaccination. Data on hospital admissions, diagnoses, deaths and SARS-CoV-2 PCR results are collected from national registries throughout the study period. The median age of participants was 64 years (IQR 53-75), 56.6% were women and 23% were individuals with an increased risk of a serious course of COVID-19. A total of 340 (4.9%) participants tested positive for SARS-CoV-2 spike IgG at baseline. FINDINGS TO DATE: Results have been published on risk factors for humoral hyporesponsiveness and non-durable response to SARS-CoV-2 vaccination, the risk of breakthrough infections at different levels of SARS-CoV-2 spike IgG by viral variant and on the antibody neutralising capacity against different SARS-CoV-2 variants following primary and booster vaccinations. FUTURE PLANS: The ENFORCE cohort will continuously generate studies investigating immunological response, effectiveness, safety and durability of the SARS-CoV-2 vaccines. TRIAL REGISTRATION NUMBER: NCT04760132.

Objectives To assess healthcare workers' (HCWs) compliance with the infection prevention and control (IPC) practices and identify the factors influencing this compliance using the Health Belief Model as the theoretical framework. Design Quantitative data from an explanatory sequential mixed-methods study were employed in this research. Participants and settings From 17 May to 30 August 2020, 604 physicians and nurses working at six randomly selected tertiary care facilities in Dhaka City in Bangladesh took part in this study. Primary and secondary outcome measures Compliance with the WHO's guidance on IPC measures, as well as the associated factors, was the primary outcome. Results A mean compliance score of 0.49 (+/- 0.25) was observed on a 0-1 scale. HCWs were most compliant with the medical mask wearing guidelines (81%) and were least compliant with the high-touch surface decontamination regulations (23%). Compliance with the IPC guidance was significantly associated with increasing age, female sex, working as a nurse, having non-communicable diseases and history of exposure to patients with COVID-19. Perceived benefits (B=0.039, 95% CI 0.001 to 0.076), self-efficacy (B=0.101, 95% CI 0.060 to 0.142) and cues to action (B=0.045, 95% CI 0.002 to 0.088) were positively associated with compliance. Compliance with IPC guidance was 0.061 times greater among participants who reported low perceived barriers compared with those with high perceived barriers. Conclusion Overall, compliance with IPC guidance among HCWs was unsatisfactory. As self-efficacy exerted the greatest contribution to compliance, it should be emphasised in any endeavour to improve HCWs' IPC adherence. Such interventions should also focus on perceived barriers, including unreliability of the information sources, unsafe working places and unavailability of protective equipment and cues to action, including trust in the administration and availability of adequate IPC guidance.

Aims: To investigate the differences between Sweden, Denmark, Finland and Norway regarding residential/home care units' and frontline managers' background factors, the resources allocated and measures taken during the initial phases of the COVID-19 pandemic, and whether and how these differences were associated with COVID-19 among older people in residential/home units. Methods: Register- and survey-based data. Responses from managers in municipal and private residential/home units. Number of municipal COVID-19 cases from national registries. Multilevel logistic multivariate regression analysis with presence of COVID-19 among older people in residential/home units as the outcome variable. Results: The proportions of residential/home units with client COVID-19 cases, mid-March-April 2020 were Denmark 22.7%, Finland 9.0%, Norway 9.7% and Sweden 38.8%, most cases found in clusters. The proportions were similar among employees. Client likelihood of having COVID-19 was six-fold higher if the employees had COVID-19. Mean client cases per residential/home unit were Denmark 0.78, Finland 0.46, Norway 0.22 and Sweden 1.23. For the same municipal infection incidence class, Sweden's mean client infection levels were three-fold those of other countries. The regression analysis variables country, municipal COVID-19 incidence proportion, and care type were associated with client cases at p <= .001. Compared with Denmark, the odds ratios (ORs) for Sweden, Norway and Finland were 1.86, 0.41 and 0.35 respectively. The variable difficulties in preventive testing had an OR of 1.56, p <= .05. Conclusions: Municipal COVID-19 incidence, employee cases, and the lack of testing resources somewhat explained the confirmed COVID-19 cases among older people in residential/home units. A two- to five-fold unexplained inter-country difference in ORs in the multivariate analyses was notable. The level of protection of vulnerable older clients in municipal and private residential/home units d

Objectives To investigate differences in antibiotic prescription for patients with hard-to-heal ulcers assessed using a digital decision support system (DDSS) compared with those assessed without using a DDSS. A further aim was to examine predictors for antibiotic prescription. Design Register-based study. Setting In 2018-2019, healthcare staff in primary, community and specialist care in Sweden tested a DDSS that offers a mobile application for data and photograph transfer to a platform for multidisciplinary consultation and automatic transmission of data to the Registry of Ulcer Treatment (RUT). Register-based data from patients assessed and diagnosed using the DDSS combined with the RUT was compared with register-based data from patients whose assessments were merely registered in the RUT. Participants A total of 117 patients assessed using the DDSS combined with the RUT (the study group) were compared with 1784 patients whose assessments were registered in the RUT without using the DDSS (the control group). Primary and secondary outcome measures The differences in antibiotic prescription were analysed using the Pearson's chi(2) test. A logistic regression analysis was used to check for influencing factors on antibiotic prescription. Results Patients assessed using a DDSS in combination with the RUT had significantly lower antibiotic prescription than patients entered in the RUT without using the DDSS (8% vs 26%) (p=0.002) (only healed ulcers included). Predictors for antibiotic prescription were diabetes; long healing time; having an arterial, neuropathic or malignant ulcer. Conclusions A DDSS with data and photograph transfer that enables multidisciplinary communication appears to be a suitable tool to reduce antibiotic prescription for patients with hard-to-heal ulcers.