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Several single-center studies have suggested that eliminating isolation for vancomycin-resistant enterococci (VRE) control in the context of endemic or nonoutbreak settings, has no impact on infection rates. We performed a systematic review and meta-analysis on the impact of discontinuing isolation. We searched PubMed, Embase, the Cochrane Library, and Web of Science through April 10, 2024 for studies evaluating discontinuation of isolation for VRE. Subgroup analyses assessed sources of heterogeneity. Nine studies were included in the final review. Four reported the incidence of hospital-acquired VRE (HA-VRE) infections and 5 reported the incidence of hospital-acquired VRE bloodstream infections (HA-VRE BSI). No significant difference between the rates of HA-VRE infection before and after stopping isolation was observed (risk ratios, 0.93; 95% confidence interval, 0.68-1.26; P =.62), as well as no significant difference on the incidence of HA-VRE BSI (risk ratios, 0.68; 95% confidence interval, 0.44-1.07, P =.09). Furthermore, we conducted 2 subgroup analyses: one stratified by whether the studies were conducted during Coronavirus Disease 19 (COVID-19), and the other stratified by whether clinicians continued to use personal protective equipment. Both analyses revealed no significant differences in the incidence of HA-VRE BSI and termination of isolation between the subgroups. In the context of endemic or nonoutbreak settings, discontinuation of isolation for VRE patients has not been associated with an increased rate of HA-VRE infections. • Examined VRE isolation discontinuation impact in endemic/non-outbreak settings. • Latest evidence on VRE isolation discontinuation. • Discontinuation not linked to higher VRE infections in endemic/non-outbreak. [ABSTRACT FROM AUTHOR]

Data on multiple consecutive health care-associated infections (HAIs) in patients undergoing extracorporeal membrane oxygenation (ECMO) are limited. We aim to identify the characteristics and outcomes of multiple, consecutive HAIs. This retrospective study included adult patients who underwent ECMO in a single cardiac ICU in China from May 2015 to December 2022. The incidence, clinical characteristics, risk factors, and impact on in-hospital mortality among patients with non-HAI, single HAI, and multiple HAIs were analyzed. Pathogens and infection sites for each new episode were compared. Of 192 patients, 92 (47.92%) developed 141 separate infections, with 41 (21.35%) experiencing multiple infections during a single ECMO period. Respiratory tract infections (RTIs) constituted the majority (75.89%), and gram-negative bacteria were the predominant pathogens (71.63%). RTIs decreased from 86.9% in the first infection to 14.3% in the third (P <.001), while bloodstream infections increased from 10.9 % to 57.1% (P <.001). The proportion of gram-positive bacteria increased from 9.8% to 42.9% (P =.032). Prolonged ECMO duration was the only independent risk factor for multiple consecutive HAIs (odds ratio (OR) = 1.220, P <.001). Multiple consecutive HAIs during ECMO were frequent, with distinct microbiological changes between initial and subsequent HAIs. • Infection episodes during ECMO present significant challenges to patients. • One-quarter of patients had multiple consecutive infections during ECMO support. • The microbiology of the first infection differed from subsequent ones during ECMO. • Predictors for consecutive multiple infections during ECMO were identified. [ABSTRACT FROM AUTHOR]

Medical waste bins are a potential source of microbial contamination in the hospital environment, while there is no clear guidance for the management of them. We aimed to assess the impact of medical waste bins on patient's environment. This experimental study simulated microbial contamination by performing medical procedures on a patient model with fluorescent lotion. The waste bin was set as initially empty or two-thirds filled with waste, open or with a lid. The percentage of fluorescent-contaminated area in designated patient's environments was analyzed by 2 independent observers. Among a total of 120 experiments, the sides of the bins were more contaminated in open-occupied bins compared to open-empty bins and in open-occupied bins compared to lid-occupied bins (median 1.9175% vs 0.0916% [ P =.001] and 1.9175% vs 0.0899% [ P =.003], respectively). The top of the bedside equipment trolley for preparing medical procedures was more contaminated in lid-occupied bins than open-occupied bins (median 0.0080% vs 0.0040%, P =.013). In addition to reducing contamination of the bin itself, the manually operated lid had a potential risk of contributing to microbial transmission by contaminating the equipment trolley. Medical waste bins should be kept no more than two-thirds full, and caution should be taken when using the manually operated lid, to avoid cross-contamination. • The guidance on medical waste bins, potential source of pathogen, is needed. • Two-thirds filled waste bins were more contaminated than empty bins. • Open waste bins were more contaminated than lidded bins. • Equipment trolley was more contaminated in bins with manually operated lids. • Occupied waste bin and manually operated lid may be sources of contact transmission. [ABSTRACT FROM AUTHOR]

• Swedish operating rooms nurses state that in their view skin disinfection is the most important intervention in order to prevent bacterial contamination and surgical site infection. • The responses indicated that many nurses believed patients' skin to be sterile after the skin disinfection process. • The erroneous assumption that the skin is sterile after skin disinfection needs to be acknowledged by all working within the operating room. The aim of this study was to explore interventions that Swedish operating room (OR) nurses considered important for the prevention of bacterial contamination and surgical site infections (SSIs). A web-based cross-sectional survey with an open-ended question was answered by OR nurses and analyzed using summative content analysis and descriptive statistics. The OR nurses (n = 890) worked within 11 surgical specialties and most of them worked at university hospitals (37%) or county hospitals (53%). The nurses described twelve important interventions to prevent bacterial contamination and SSI: skin disinfection (25.9%), the OR environment (18.2%), aseptic technique (16.4%), OR clothes (13.4%), draping (9.8%), preparation (6.1%), dressing (3.6%), basic hygiene (3.4%), normothermia (2.1%), communication (0.7%), knowledge (0.3%), and work strategies (0.2%). Skin disinfection was considered the most important intervention in order to prevent bacterial contamination and SSI. The responses indicated that many OR nurses believed the patients' skin to be sterile after the skin disinfection process. This is not a certainty, but skin disinfection does significantly decrease the amount of bacterial growth. This study shows that many OR nurses' interventions are in line with recommendations. Although, knowledge regarding the effect of skin disinfection needs further research, and continued education. [ABSTRACT FROM AUTHOR]

• We systematically explored the burden of infection for people who undertake intermittent catheterization (IC). • The frequency of urinary tract infection is people who undertake IC is high. • The role of antiseptics for the prevention of infection in people who undertake IC was comprehensively reviewed for the first time. • Research is needed on whether antiseptic cleaning prior to IC plays a role in reducing the risk of infection and bacteriuria. This systematic review had 2 aims. First to identify the incidence of urinary tract infection (UTI) and bacteriuria in people undertaking intermittent catheterization (IC), second to determine the effectiveness of antiseptic cleaning of the meatal area prior to IC in reducing the incidence of UTI and bacteriuria. A systematic review was conducted. Medline and the Cumulative Index to Nursing and Allied Health Literature electronic databases were systematically searched between January 1, 1990 and January 31, 2020, to identify studies that reported either the incidence of UTI or bacteriuria or the impact of using antiseptics for meatal cleaning prior to IC on incidence of these same outcomes. Twenty-five articles were identified for the first aim, 2 articles for the second. The proportion of participants experiencing ≥1 UTIs per year ranged from 15.4% to 86.6%. Synthesis of these studies suggest a combined incidence of 44.2% (95%CI 40.2%-48.5%) of participants having ≥1 UTIs per year. One of the 2 studies exploring the benefit of antiseptics in reducing UTI suggest some potential benefit of using chlorhexidine in reducing UTIs. Both studies have significant limitations, making interpretation difficult. A large proportion of people undertaking IC in the community have UTIs each year. Evidence on the role of antiseptics in the prevention of UTI for people who undertake IC remains unclear. [ABSTRACT FROM AUTHOR]

Background Surgical site infection (SSI) is an important complication in the postoperative period of recipients of liver transplantation. The purpose of this integrative literature review is to summarize the knowledge available about the risk factors contributing to the development SSI among adults undergoing liver transplantation. Methods We reviewed the Medical Literature Analysis and Retrieval System Online/PubMed, the Cumulative Index to Nursing and Allied Health Literature, the Latin American and Caribbean Health Sciences Literature, Scopus, and Web of Science databases. Results Two hundred sixteen articles were identified and the final sample of 9 articles was analyzed in full length. The SSI rate found in the investigations ranged between 9.6% and 35.5%. Risk factors for SSI were grouped into categories related to the preoperative period, such as Model for End-Stage Renal Disease score > 35 and ventilated support on day of transplant; to the intraoperative period activity, such as transfusion of packed red blood cells, extended surgical time, hyperglycemia >200 mg/dL, use of vasopressor drugs, and ascites flow >1 L; and to the donor/recipient relationship, such as age differences >10 years, ratio of donor liver mass to recipient body mass < 0.01. Additionally, centers that annually perform <50 transplants appear to have higher rates of SSI. Conclusions Few studies have addressed the subject of SSI in relation to liver transplantation in the scientific literature. Risk factors for SSI in patients who underwent liver transplantation vary between institutions. [ABSTRACT FROM AUTHOR]

Background Cesarean section is a surgical procedure the main complication of which is surgical site infection (SSI), which is related to maternal morbidity and mortality. Objective To evaluate active monitoring by telephone to identify infection and time of SSI report in postpartum women and associated risk factors. Methods We conducted a prospective observational study from 2013-2014, at a referral service for high-risk pregnancies. Surveillance was conducted via telephone at least 30 days after cesarean delivery. Incidence ratio and time of infection occurrence (days) was analyzed. Survival analysis was conducted to assess the temporal distribution of the development of infection. Results Of a total of 353 patients, 14 (4%) cases of SSI were reported, and 10 (7.4%) of the reported cases occurred within 15 days after cesarean and average time of infection was12.21 days. American Society of Anesthesiologists score was the only risk factor associated with SSI after cesarean section. Conclusions The prevalence of SSI after cesarean section via telephone is similar to several services with different methods of surveillance, considering it could be used by services with limited resources. Superficial incisional SSI was the most common type of infection, time of infection report was mainly before the 15th day postprocedure, and American Society of Anesthesiologists score of 2 or less was protective against SSI. Telephone calls can be a viable method to identify women with infection briefly after discharge, particularly at-risk patients. [ABSTRACT FROM AUTHOR]

Background The hospital environment is susceptible to bacterial contamination along with survival in fomites and surfaces, allowing dissemination of potential pathogenic strains. The present research aimed to evaluate the influence of biological fluids in bacterial viability on fomites and surfaces commonly present in nosocomial environment. Methods Four different fomites and surfaces (ceramic floor, cotton fabric fragments and synthetic fibers, and eggcrate foam mattress) were contaminated with potential pathogens ( Staphylococcus aureus, Escherichia coli, Enterococcus faecalis, Pseudomonas aeruginosa , and Klebsiella pneumoniae ), then submitted to influence of biological fluids (blood, urine, artificial saliva). The viability of strains was evaluated at 24 hours after contamination and then in intervals of 7 days, by the colony-forming unit count technique. Results S aureus presented viability (>70 days) in all conditions tested, E faecalis and K pneumoniae had decreased viability over time, and E coli did not exhibit a growth relationship with surfaces or fluids. Persistence and adaptability capacity of potential pathogens in fomites and surfaces exposed to the patient are important for guidance, planning, and outlining of protocols for microorganism dissemination control and prevention in the health care environment. [ABSTRACT FROM AUTHOR]

Background: Exposure of health care workers (HCWs) to patients with active TB continues to occur despite implementation of TB control policies. Methods: We conducted a root-cause analysis of TB exposures at a tertiary care hospital. Clinical and management details of all confirmed cases identified in 2011 were summarized. Cases were independently reviewed by an expert panel that determined the type (ie, delay in initiating, incorrect use of or premature removal of control measures), preventability, and root cause(s) of each error (exposure). Results: Fifteen cases were reviewed. Ten errors were identified in 7 (47%) cases. Cases associated with errors were older than those without errors (68 y vs 40 y; P = .037). Most cases (12/15) were foreign born. A delay in initiating airborne precautions accounted for 70% (7/10) of the errors. The expert panel determined that 80% (8/10) of the errors were preventable or possibly preventable. The most common root causes were failure to consider TB and failure to obtain and interpret imaging. Advanced age, atypical presentation, and presence of comorbid illnesses were common among the preventable cases. Conclusions: TB control policies do not prevent all exposures. Our findings suggest that consideration of TB in elderly patients with risk factors, even if their signs and symptoms can be explained by an alternative diagnosis or are atypical, followed by a review of imaging studies, can further reduce this risk. [ABSTRACT FROM AUTHOR]

Background: Hepatitis B virus (HBV) transmission has been reported after patient-to-patient blood exposure during assisted monitoring of blood glucose (AMBG). Three assisted-living facility (ALF) residents who underwent AMBG developed acute HBV infection (HBVI) within 10 days. We investigated HBV transmission and implemented preventive measures. Methods: A retrospective cohort study was conducted. Infection control practices were assessed. HBVI screening was conducted for all staff and epidemiologically linked residents. Viral DNA sequences were compared for a subset of isolates. Results: Lancing devices and glucometers were shared among residents without proper sanitization. Serologic testing of all 34 residents with diabetes and 12 epidemiologically linked residents present during the exposure period detected 6 residents with diabetes with current HBVI and 4 residents with diabetes and 1 epidemiologically linked resident with previous HBVI. A cohort study of 32 individuals with diabetes identified AMBG as a significant risk factor for HBVI (relative risk, 6.7; 95% confidence interval, 1.7-26.3). Viral DNA sequences for 5 AMBG-exposed residents’ isolates were identical, suggesting a common source. Conclusions: AMBG was significantly associated with HBVI in ALF residents with diabetes. Despite clear preventive recommendations, bloodborne pathogen transmission continues to occur in the setting of AMBG. Strengthening direct care provider, infection preventionist, and health department partnerships with ALFs is crucial to ensure safe AMBG practices and prevent HBV transmission. [Copyright &y& Elsevier]

Background: Multimodal interventions aim to improve health care workers’ adherence to hand hygiene guidelines. Visitors are not primarily targeted, but may spread epidemic infections. Effective interventions that improve the adherence of visitors to hand hygiene guidelines are needed to prevent the transmission of epidemic infections to or from health care environments. Methods: An electronic motion sensor–triggered audible hand hygiene reminder was installed at hospital ward entrances. An 8-month preinterventional and postinterventional study was carried out to measure the adherence of hospital visitors and staff to hand hygiene guidelines. Results: Overall hand hygiene adherence increased from 7.6% to 49.9% (P < .001). The adherence of visitors and nonclinical staff increased immediately from 10.6% to 63.7% and from 5.3% to 34.8%, respectively (P < .001). Adherence of doctors, nurses, and physiotherapists increased gradually from 4.5% to 38.3%, from 5.4% to 43.4%, and from 8.7% to 49.5%, respectively (P < .001). Improved adherence was sustained among visitors and clinical staff (P < .001), but not among nonclinical staff (P = .341). Conclusions: The electronic motion sensor–triggered audible reminder immediately and significantly improved and sustained greater adherence of hospital visitors and clinical staff to hand hygiene guidelines. This is an effective addition to multimodal hand hygiene interventions and may help control epidemic infections. [Copyright &y& Elsevier]

Background: The burden of central line–associated bloodstream infections (CLABSI) in Canadian intensive care units (ICUs) is not well established. The present study aimed to describe CLABSI epidemiology in Quebec ICUs during 2003-2009. Methods: The study population was a retrospective dynamic cohort of 58 ICUs that participated in the Surveillance Provinciale des Infections Nosocomiales program during 2003-2009. We calculated annual CLABSI incidence rates (IRs), central venous catheter (CVC) utilization ratios, and case-fatality proportions, and described the pathogens involved. We analyzed data using descriptive statistics and standardized incidence ratios. Results: A total of 891 CLABSIs were identified during 446,137 CVC-days. In 2003-2009, CLABSI IRs were 1.67 CLABSI/1,000 CVC-days in adult ICUs, 2.20 CLABSIs/1,000 CVC-days in pediatric ICUs, and 4.40 CLABSIs/1,000 CVC-days in neonatal ICUs. Since 2007, CLABSI IRs in adult, pediatric and neonatal ICUs have decreased by 11%, 50%, and 18%, respectively. Pediatric ICUs had the highest CVC utilization ratio (median, 0.61; interquartile range, 0.57-0.66). Coagulase-negative staphylococci caused 53% of the CLABSIs. The proportion of methicillin-resistant Staphylococcus aureus declined from 70% to <40% after 2006. Conclusions: CLABSIs result in a considerable burden of illness in Quebec ICUs. However, CLABSI IRs have decreased since 2007, and the proportion of methicillin-resistant S aureus has remained <40% since 2006. Continuous surveillance is essential to determine whether these changes are sustainable. [Copyright &y& Elsevier]

Background: In 2003, the Surveillance Provinciale des Infections Nosocomiales (SPIN) program was launched to gather data on incidence rates of central line–associated bloodstream infections (CLABSIs) in intensive care units (ICUs) in the Province of Quebec. To improve the generalizability of SPIN benchmarks, in 2007 participation in SPIN became mandatory for all ICUs with ≥10 beds. Objective: To describe the implementation process, surveillance methods, and overall results of the SPIN program between 2003 and 2009. Methods: SPIN surveillance methods are based on the National Healthcare Safety Network. Participation is open to all Quebec ICUs and as of January 2007 is mandatory for all units with ≥10 beds. Data include CLABSI incidence rates for 2003-2009 and the epidemiology of CLABSI cases. Results: Mandatory participation in the SPIN program increased the number of ICUs by 100% (from 30 to 60 units). For 2003-2009, the overall CLABSI incidence rates were 1.67 CLABSIs/1,000 catheter-days for adult ICUs, 2.24 CLABSIs/1,000 catheter-days for pediatric ICUs, and 4.40 CLABSIs/1,000 catheter-days for neonatal ICUs. The patients with CLABSI were predominately female (60%), mean patient age was 44 ± 32 years, and 64% of the patients had a regular central venous line in place. Conclusion: The implementation of mandatory participation was essential to increase the generalizability of SPIN CLABSI incidence rates, which also improved the quality of these data for use as provincial benchmarks. [Copyright &y& Elsevier]

We performed a prospective multicenter study to assess the dryness and irritation of the hands in health care facilities, and to evaluate whether that disinfection with an alcohol-based hand rub (ABHR) is better tolerated than classic handwashing with mild soap and water. Our study was conducted in 9 sites in the summer and winter. A team of investigators evaluated dryness and irritation. This study takes into account most of the individual and environmental risk factors (age, sex, use of a protective agent, constitutional factors, personal factors, external factors, institution, function, and number of consecutive working days). The results from the 1932 assessments collected show that traditional handwashing is a risk factor for dryness and irritation, whereas the use of ABHR causes no skin deterioration and might have a protective effect, particularly in intensive use. These results provide a strong argument to counter the rear-guard resistance to the use of ABHRs. [Copyright &y& Elsevier]

We conducted a randomized controlled trial in a tertiary-care hospital in a real-time setting to evaluate the effectiveness of 3 hand hygiene protocols in reducing hand carriage of methicillin-resistant and methicillin-sensitive Staphylococcus aureus among health care workers. Our study shows that use of alcohol handrub, either covering all hand surfaces in no particular order or using the 7-step technique, and chlorhexidine handwashing were equally effective in removing hand carriage of these pathogens. [ABSTRACT FROM AUTHOR]

Microbial contamination of used, unprocessed internal components of dental handpieces (HPs) was assessed. HPs were dismantled aseptically, immersed in phosphate-buffered saline, ultrasonicated, and cultured. A median of 200 CFU per turbine (n = 40), 400 CFU per spray channel (n = 40), and 1000 CFU per item of surgical gear (n = 20) was detected. Isolates included oral streptococci, Pseudomonas spp, and Staphylococcus aureus . Recovery of S aureus confirms the need for appropriate HP cleaning and sterilization after each patient to prevent cross-infection. [ABSTRACT FROM AUTHOR]

The aim of this cross-sectional study was to investigate the implementation of and compliance with international infection control standards by patients and staff in dialysis centers in Shiraz, Iran. The results indicate negligence in various aspects of infection control. Providing staff education and training programs, establishing effective surveillance systems, and enforcing regulations in the hospitals should help improve infection prevention. [Copyright &y& Elsevier]

Although maintaining a distance of 1 m between persons with cystic fibrosis (CF) is a universal recommendation to prevent respiratory cross-infections such as Pseudomonas aeruginosa, evidence supporting this preventive measure is scarce. Examining 336 samples from 42 patients with CF collected experimentally from sterile surfaces after speaking and coughing, we found that transmission of P aeruginosa beyond 1 m is possible during both talking and coughing, although the probability is low (1.7%). [Copyright &y& Elsevier]

Background Legionnaires' disease (LD) is recognized as an important hospital-acquired disease. Despite the several methods available, the optimal method to control hospital-acquired LD is not well established and their overall efficacy requires further evaluation. Objective To systematically review all controlled trials evaluating the efficacy of interventions to prevent hospital-acquired LD in patients at high risk of developing the disease and its effects on environmental colonization. Methods A database search was performed through PubMed and the Cochrane Central Register of Controlled Trials (inception-November 2014). Eligible studies included all controlled studies evaluating interventions to prevent hospital-acquired LD in patients at high risk or evaluating the effect on environmental colonization. Both individual and pooled risk estimates were reported using risk ratio (RR) and 95% confidence intervals (95% CIs). Results There were no studies evaluating the risk reduction in hospital-acquired LD, but 4 studies evaluated the influence of copper-silver ionization and ultraviolet light in the reduction of environmental reservoirs of Legionella . The meta-analysis showed a significant 95% risk reduction of Legionella positivity in environmental samples using copper-silver ionization (RR, 0.05; 95% CI, 0.01-0.17) and 97% risk reduction with ultraviolet light (RR, 0.03; 95% CI, 0.002-0.41). Conclusions The best available evidence suggests that copper-silver ionization and ultraviolet light are effective in reducing Legionella positivity in environmental samples. Nevertheless, the low quality of evidence weakens the robustness of conclusions. [ABSTRACT FROM AUTHOR]

Background: The standard of outbreak reports must be improved to a level where they are robust enough to properly influence preventive strategies. We aimed to verify compliance with mandatory outbreak notification, describing epidemiologic characteristics and management, and evaluating the quality of outbreak reports on health care-associated infections in São Paulo State, Brazil., Methods: A systematic search was carried out on PubMed, the Latin American and Caribbean Health Sciences Literature database, Embase, Outbreak Database, the Annals of Brazilian Conferences on Healthcare-Associated Infection Prevention and Infectious Diseases, and reports from the São Paulo State Hospital Infection Division. The quality of reports was evaluated according to the Outbreak Reports and Intervention studies of Nosocomial Infection (ORION) statement guidelines., Results: A total of 87 outbreak reports were identified; however, only 15 outbreaks (17.2%) were reported to the São Paulo State Hospital Infection Division. Bloodstream infection and neonatal intensive care units were mostly implicated (23% and 19.5%, respectively). Quality, evaluated according to ORION statement recommendations, was generally poor. The ORION categories of Background, Objectives, Participants, Setting, Infection-Related Outcomes, and Generality were properly described in 32.2%, 74.7%, 2.3%, 46%, 2.3%, and 12.6% of reports, respectively. Interventions and Culture-Typing were described with details in 51.9% and 55.2% of outbreak reports, respectively., Conclusions: Our findings pointed out the need for strategies to improve competence in outbreak reports, and the ORION statement guidelines may help in this matter. Efforts to promote confidence and consequent compliance with mandatory notification of outbreak reports are essential., (Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)