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Healthcare-associated infections (HAIs) are a global public health threat. Italy is one of the countries with the highest prevalence of HAI. Hand hygiene (HH) is a pillar of infection prevention and control. Monitoring HH is necessary to improve HH compliance, and direct observation is considered the gold standard. Transcription and analysis of data collected during direct observation of HH compliance with the WHO paper form are time-consuming. We collected, during a 9-day observation period, HH opportunities and compliance both with a smartphone application (SpeedyAudit) and with the WHO paper form. Then, we investigated the difference in the required time for data transcription and analysis between the WHO paper form and the use of the app. The difference in the required time for data transcription and analysis was significant with a mean time of 2 s using the app and about 14-54 min/day using paper form (p = .004) while no significant difference was found in measured compliance rates between the two data collecting methods. HH monitoring with an app is time-saving, and the app we used was easy to use., (© 2022 Wiley Periodicals LLC.)

Transmission with endoscopes, particularly duodenoscope, of potential lethal infections prompted different scientific societies to deliver recommendations aimed reducing this risk. Some International societies extended recommendations on microbial surveillance to all the endoscopes and devices used in the reprocessing procedure. Considering the relevance of the topic, 8 Italian scientific societies of physicians, nurses and technical operators prepared a concerted document taking into account Institutional advisories and facilities in Italy. The rules for a correct microbial surveillance on endoscopes were detailed in term of what, how and when to perform the procedure, also suggesting behaviors in case of contamination., Competing Interests: Declaration of Competing Interest none declared., (Copyright © 2021 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.)

Clostridioides difficile infection is an increasing presence worldwide. Prevention is multipronged, reflecting a complex and evolving epidemiology. Multiple guidelines exist regarding the prevention of C. difficile infection in healthcare settings; however, existing guidelines do not address C. difficile in low- and middle-income countries (LMIC). Nevertheless, the prevalence of C. difficile in LMIC likely parallels, if not exceeds, that of high-income countries, and LMIC may experience additional challenges in C. difficile diagnosis and control. A panel of experts was convened by the International Society for Infectious Diseases (ISID) to review the current state of C. difficile infections globally and make evidence-based recommendations for infection prevention that are broadly applicable., (Copyright © 2020. Published by Elsevier Ltd.)

Telemedicine allows the remote exchange of medical data between patients and healthcare professionals. It is used to increase patients' access to care and provide effective healthcare services at a distance. During the recent coronavirus disease 2019 (COVID-19) pandemic, telemedicine has thrived and emerged worldwide as an indispensable resource to improve the management of isolated patients due to lockdown or shielding, including those with hypertension. The best proposed healthcare model for telemedicine in hypertension management should include remote monitoring and transmission of vital signs (notably blood pressure) and medication adherence plus education on lifestyle and risk factors, with video consultation as an option. The use of mixed automated feedback services with supervision of a multidisciplinary clinical team (physician, nurse, or pharmacist) is the ideal approach. The indications include screening for suspected hypertension, management of older adults, medically underserved people, high-risk hypertensive patients, patients with multiple diseases, and those isolated due to pandemics or national emergencies.

Introduction: The COVID-19 pandemic has led to the suspension of programmed activity in most of the Endoscopy Units in our environment. The aim of this document is to facilitate the resumption of elective endoscopic activity in an efficient and safe manner., Material and Methods: A series of questions considered to be of clinical and logistical relevance were formulated. In order to elaborate the answers, a structured bibliographic search was carried out in the main databases and the recommendations of the main Public Health and Digestive Endoscopy institutions were reviewed. The final recommendations were agreed upon through telematic means., Results: A total of 33 recommendations were made. The main aspects discussed are: 1) Reassessment and prioritization of the indication, 2) Restructuring of spaces, schedules and health personnel, 3) Screening for infection, 4) Hygiene measures and personal protective equipment., Conclusion: The AEG and SEED recommend restarting endoscopic activity in a phased, safe manner, adapted to local resources and the epidemiological situation of SARS-CoV-2 infection., (Copyright © 2020 Elsevier España, S.L.U. All rights reserved.)

Increased awareness of the rising antimicrobial resistance problem and impending loss of suitable treatment options for infectious diseases have changed patient care. Antimicrobial/antibiotic stewardship (ABS) activities aiming to optimize antimicrobial treatment were specified in international (WHO, ECDC) and national programmes and evidence-based practice guidelines. In Germany, ABS in hospitals is enshrined in the Infection Protection Act §23 and in a national guideline. The position paper presents the goals and tasks of ABS as well as the necessary organisational and staff requirements.Qualified training and education, mandates and support from hospital directors, and the provision of sufficient resources are essential prerequisites for the successful work of the ABS team. The ABS team should work hospital-wide across clinical services. Their main tasks are developing and implementing an ABS programme tailored to local needs and the conditions of the hospital, taking into account anti-infective drug prescribing, the resistance situation and case mix. Their tasks also include drafting and implementing in-house recommendations for diagnosis, prophylaxis and treatment of important infectious diseases. The ABS team should be interdisciplinary and include specially qualified doctors and pharmacists. Doctors commissioned for ABS should support this team and take the department-specific concerns into account. The document specifies a minimum ABS staff of one full-time equivalent (FTE) per 500 beds. Depending on the case mix and specialties, additional staff may be required. It proposes that there should be 0.1 FTE doctors commissioned for ABS per 100 beds.

This paper reviews the most important clinical papers in cystic fibrosis published in 2018, having searched all the literature on Pubmed. Focus is on CFTR modulator therapy, randomised controlled trials, and infection/microbiology issues., (Copyright © 2019 Elsevier Ltd. All rights reserved.)

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Background: The role of hands in disease transmission is well established, and the importance of handwashing is recognized. However, the exits of paper-towel dispensers used in hand drying may be contaminated, and the functionality of handwashing equipment increasingly is being questioned., Objectives: We sought to study the transfer and cross-contamination potential between hands, towels, and dispenser exits if one or more is contaminated using bacteria representative of the skin's flora., Materials and Method: A generic wall-mounted paper-towel dispenser and a range of different paper towels were used. Volunteers with either clean or contaminated hands were asked to remove, using a range of protocols, towels from dispensers which themselves were either clean or contaminated. Previously clean surfaces were then microbiologically tested., Results: Recoverable bacterial transfer rates from a contaminated hand to clean dispenser exits ranged from 0.01% to 0.64% depending on the bacteria used with an even higher transfer rate for clean towels. The reverse transfer (ie, from contaminated exits to clean hands) was between 12.4% and 13.1%., Conclusions: The results indicate that zig-zag transfer of bacteria between paper-towel dispensers and hands can take place if either one is contaminated. This potential should be considered in the design, construction, and use of paper-towel dispensers.

The transmission of bloodborne viruses and other microbial pathogens to patients during routine health care procedures continues to occur because of the use of improper injection, infusion, medication vial, and point-of-care testing practices by health care personnel. These unsafe practices occur in various clinical settings and result in unacceptable and devastating events for patients. This document updates the Association for Professionals in Infection Control and Epidemiology 2010 position paper on safe injection, infusion, and medication vial practices in health care., (Copyright © 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background Since the outbreak of COVID-19, how to reduce the risk of spreading viruses and other microorganisms while performing aerosol generating procedures (AGPs) has become a challenging question within the dental and dental hygiene communities. The purpose of this position paper is to summarize the existing evidence about the effectiveness of various mitigation methods used to reduce the risk of infection transmission during AGPs in dentistry. Methods The authors searched six databases, MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, and Google Scholar, for relevant scientific evidence published in the last ten years (January 2012 to December 2022) to answer six research questions about the the aspects of risk of transmission, methods, devices, and personal protective equipment (PPE) used to reduce contact with microbial pathogens and limit the spread of aerosols. Results A total of 78 studies fulfilled the eligibility criteria. There was limited literature to indicate the risk of infection transmission of SARS-CoV-2 between dental hygienists and their patients. A number of mouthrinses are effective in reducing bacterial contaminations in aerosols; however, their effectiveness against SARS-CoV-2 was limited. The combined use of eyewear, masks, and face shields are effective for the prevention of contamination of the facial and nasal region, while performing AGPs. High volume evacuation with or without an intraoral suction, low volume evacuation, saliva ejector, and rubber dam (when appropriate) have shown effectiveness in reducing aerosol transmission beyond the generation site. Finally, the appropriate combination of ventilation and filtration in dental operatories are effective in limiting the spread of aerosols. Conclusion Aerosols produced during clinical procedures can potentially pose a risk of infection transmission between dental hygienists and their patients. The implementation of practices supported by available evidence are best practices to ensure patient and provider safety in oral health settings. More studies in dental clinical environment would shape future practices and protocols, ultimately to ensure safe clinical care delivery. [ABSTRACT FROM AUTHOR]

Aim: To present a discussion on theoretical frameworks in infection prevention and control., Background: Infection prevention and control programmes have been in place for several years in response to the incidence of healthcare-associated infections and their associated morbidity and mortality. Theoretical frameworks play an important role in formalizing the understanding of infection prevention activities., Design: Discussion paper., Data Sources: A literature search using electronic databases was conducted for published articles in English addressing theoretical frameworks in infection prevention and control between 1980-2012., Results: Nineteen papers that included a reference to frameworks were identified in the review. A narrative analysis of these papers was completed. Two models were identified and neither included the role of surveillance., Discussion: To reduce the risk of acquiring a healthcare-associated infection, a multifaceted approach to infection prevention is required. One key component in this approach is surveillance. The review identified two infection prevention and control frameworks, yet these are rarely applied in infection prevention and control programmes. Only one framework considered the multifaceted approach required for infection prevention. It did not, however, incorporate the role of surveillance. We present a framework that incorporates the role of surveillance into a biopsychosocial approach to infection prevention and control., Conclusion: Infection prevention and control programmes and associated research are led primarily by nurses. There is a need for an explicit infection prevention and control framework incorporating the important role that surveillance has in infection prevention activities. This study presents one framework for further critique and discussion., (© 2013 John Wiley & Sons Ltd.)

This paper aims to describe, using an evidence-based approach, the importance of and the resources necessary for implementing effective infection prevention and control (IPC) programmes. The intrinsic and explicit values of such strategies are presented from a clinical, health-economic and patient safety perspective. Policy makers and hospital managers are committed to providing comprehensive, accessible, and affordable healthcare of high quality. Changes in the healthcare system over time accompanied with variations in demographics and case-mix have considerably affected the availability, quality and ultimately the safety of healthcare. The main goal of an IPC programme is to prevent and control healthcare-associated infections (HAI). Many patient-, healthcare provider-, and organizational factors are associated with an increased risk for acquiring HAIs and may impact both the quality and outcome of patient care. Evidence has been published in support of having an effective IPC programme. It has been estimated that about one-third of HAIs could be prevented if key elements of the evidence-based recommendations for IPC are adequately introduced and followed. However, several healthcare agencies from over the world have reported deficits in the essential resources and components of current IPC programmes. To meet its main goal, staffing, training, and infrastructure requirements are needed. Nevertheless, and given the economic crisis, policy makers and hospital managers may be tempted to not increase or even to reduce the budget as it consumes resources and does not generate sufficient visible revenue. IPC is a critical issue in patient safety, as HAIs are by far the most common complication affecting admitted patients. The significant clinical and health-economic burden HAIs place on the healthcare system speak to the importance of getting introduced effective IPC programmes., (Copyright © 2013 Australian College of Critical Care Nurses Ltd. Published by Elsevier Ltd. All rights reserved.)

Introduction: Healthcare associated infections not only cause morbidity and mortality, but also drain the resources in the hospitals across the globe. It has been shown repeatedly that practicing hand hygiene is a deterrent to hospital acquired infection. It is essential for the infection control committee and the hospital administrators to have a fair idea of the prevailing hand hygiene practice in the healthcare facility. This is commonly obtained direct observation, self-reporting by healthcare workers and indirect calculation based on hand hygiene disinfectant product usage., Aims: This study was planned to assess the indirect surrogates of hand hygiene among healthcare workers in an Indian hospital., Methods: We presumed that the tools used to perform hand hygiene, the alcoholic hand rub and the tissue paper towel may throw light on the prevailing hand hygiene practice. An analysis of the quantity of alcohol hand rub and the number of tissue paper towel usage against the incidence of hospital acquired infection was made., Observation: The mean incidence of HAI during the period of study was 8.5 +/- 6.7 (range 2 to 27) per month. There was a decrease in the HAI rates with increasing of alcoholic hand rub and tissue paper towels. It was predicted using the regression graphs that if the quantity of alcoholic hand rub usage increased to 2620 Ltrs/ month, the HAI would be '0'. Similarly if 427,0000 tissue paper towel pulls were used, the HAI would be '0'., Conclusion: Studying the incidence consumption of the quantity of tissue paper rolls and isopropyl alcohol may be used as a surrogate of hand hygiene practice among healthcare workers.

Outbreaks involving the transmission of bloodborne pathogens or other microbial pathogens to patients in various types of health care settings due to unsafe injection, infusion, and medication vial practices are unacceptable. Each of the outbreaks could have been prevented by the use of proper aseptic technique in conjunction with basic infection prevention practices for handling parenteral medications, administration of injections, and procurement and sampling of blood. This document provides practice guidance for health care facilities on essential safe injection, infusion, and vial practices that should be consistently implemented in such settings., (2010 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)

Infections and colonizations with methicillin resistant staphylococcus aureus (MRSA) are an increasing problem in German hospitals because they spread there more and more. In homes without predominant nursing care and without hospital-like medical care of the inhabitants, genotypically identical MRSA-strains are rarely found in room neighbours up to now. The recommendations on prevention and control of MRSA published by the Robert Koch-Institut (RKI) therefore are partially discrepant for these two fields. The setting in rehabilitation medical centres, from hygienic points of view, is in many respects similar to a medical practice or a home with predominantly independent inhabitants rather than to a hospital for patients with acute diseases. For an effective and humane stationary rehabilitation of patients with MRSA colonisation it would be desirable to define conditions under which the strict isolation-hygiene prescribed for acute hospitals could be deviated from, following e. g., the RKI recommendations for homes instead. With the input of a summary of the clinical relevance of MRSA and a comparison of both partly identical, partially however very different RKI-recommendations on prevention and control of MRSA the present article seeks to characterize the hygienic setting in (particularly oncological) stationary rehabilitation under the above aspects. A series of recommendations on MRSA hygiene in stationary rehabilitation follows, which depending on the risk profile involved is based partially on the RKI guidelines for hospitals, partially however, on the guidelines for homes. The recommendations have a preliminary character without claiming completeness or the rank of a guideline. They are intended to focus on a problem which arises more and more frequently also in rehabilitation centers. They can, in the individual case, provide a useful help for the practice in stationary rehabilitation particularly as there are no publications on the subject of MRSA hygiene so far which meet the circumstances in stationary rehabilitation in a different manner.

Background: The aim of the study was to check the validity of the electronic patient records for hospital-acquired pneumonia and to estimate their reliability., Patients and Methods: On reviewing 23,356 inpatients with admission from 1st April 2005 and discharge up to the 30th September 2005, we identified 211 cases with hospital-acquired pneumonia in the electronic patient records whereby 70 cases taken at random were included in the calculation of the positive predictive value. A second random sample of 130 cases under risk was used to calculate its sensitivity. Positive predictive value and sensitivity were combined to estimate the true rate of hospital-acquired pneumonia., Results: In 64.3 % of the cases hospital-acquired pneumonia was confirmed in the paper-based patient records (45 cases, 95 % confidence interval 51.9 - 75.4 %). Sensitivity was calculated as 42.9 % and specificity as 99.0 %. Estimation for the University Clinics Essen revealed a true rate of hospital-acquired pneumonia of 1.32 %. The estimated true rate was higher than the measured rate of 0.90 % which is covered, nevertheless, by the 95 % confidence interval., Conclusions: Results from electronic and paper-based patient records are similar for hospital-acquired pneumonia, in spite of relevant differences on the level of the individual cases. However, data quality is not sufficient for special claims of supervision, clinical hygiene and prevention, for which a further optimisation is required.

Aim of the study was to check the validity of the electronic patient record for hospital-acquired pneumonia and to estimate its reliability. Reviewing 23,356 inpatients with admission from the 1st April 2005 and discharge up to the 30th September 2005 we identified 211 cases with hospital-acquired pneumonia in the electronic patient record whereof 70 cases taken at random were included in the validation. A second random sample of 130 cases under risk was used to calculate its completeness. For hospital-acquired pneumonia, the latest version of the definition of the Centers for Disease Control and Prevention (CDC) was applied. In 64.3% of the cases hospital-acquired pneumonia was confirmed in the paper-based patient record (45 cases, 95%-confidence interval 51.9%-75.4%). Beside 10 cases with pneumonia already existing with admission 15 cases remain where even pneumonia could not be confirmed in the paper-based patient record. Completeness was calculated as 42.9%. Estimation for the University Clinics Essen revealed a true rate of hospital-acquired pneumonia of 1.32% (308 of 23,356). The estimated true rate was higher than the measured rate of 0.90% (211 of 23,356) which is covered, nevertheless, from the 95%-confidence interval. Data from the electronic patient record seem to be sufficient to forecast the true rate of hospital-acquired pneumonia, for example, for questions of infectious disease epidemiology. However, it is not sufficient enough for special claims of the supervision, clinical hygiene and prevention for which an optimization of the data quality is required.

Several papers are discussed including the CARP (Coronary Artery Revascularisation Prophylaxis) trial, examining the role, if any, of preoperative coronary revascularisation and a study examining the heart rate in the intensive care unit (ICU) population. We also take a look at infections in the ICU with particular regard to a recent study which examined isolating patients with methicillin-resistant Staphylococcus aureus (MRSA).

Objective: To determine whether hand washing would increase with sustained feedback based on measurements of soap and paper towel consumption., Design: Prospective trial with a nonequivalent control group., Setting: Open multibed rooms in the Omaha Veterans Affairs Medical Center's Surgical Intensive Care Unit (SICU) and Medical Intensive Care Unit (MICU)., Subjects: Unit staff., Intervention: Every weekday from May 26 through December 8, 1998, we recorded daytime soap and paper towel consumption, nurse staffing, and occupied beds in the SICU (intervention unit) and the MICU (control unit) and used these data to calculate estimated hand washing episodes (EHWEs), EHWEs per occupied bed per hour, and patient-to-nurse ratios. In addition, from May 26 through June 26 (baseline period) and from November 2 through December 8 (follow-up period), live observers stationed daily for random 4-hour intervals in the MICU and the SICU counted actual hand washing episodes (CHWEs). The intervention consisted of posting in the SICU, but not in the MICU, a graph showing the weekly EHWEs per occupied bed per hour for the preceding 5 weeks., Results: Directly counted hand washing fell in the SICU from a baseline of 2.68+/-0.72 (mean +/- standard deviation) episodes per occupied bed per hour to 1.92+/-1.35 in the follow-up period. In the MICU, episodes fell from 2.58+/-0.95 (baseline) to 1.74+/-0.69. In the MICU, the withdrawal of live observers was associated with a decrease in estimated episodes from 1.36+/-0.49 at baseline to 1.01+/-0.36, with a return to 1.16+/-0.50 when the observers returned. In the SICU, a similar decrease did not persist throughout a period of feedback. Estimated hand washing correlated negatively with the patient-to-nurse ratio (r = -0.35 for the MICU, r = -0.46 for the SICU)., Conclusions: Sustained feedback on hand washing failed to produce a sustained improvement. Live observers were associated with increased hand washing, even when they did not offer feedback. Hand washing decreased when the patient-to-nurse ratio increased.

Objective: To determine the status of programs to improve antimicrobial prescribing at select US hospitals., Design: Cross-sectional survey., Participants and Setting: Pharmacy and infection control staff at all 47 hospitals participating in phase 3 of Project Intensive Care Antimicrobial Resistance Epidemiology., Results: All 47 hospitals had some programs to improve antimicrobial use, but the practices reported varied considerably. All used a formulary, and 43 (91%) used it in conjunction with at least one of the other three antimicrobial-use policies evaluated: stop orders, restriction, and criteria-based clinical practice guidelines (CPGs). CPGs were reported most commonly (70%), followed by stop orders (60%) and restriction policies (40%). Although consultation with an infectious disease physician (70%) or pharmacist (66%) was commonly used to influence initial antimicrobial choice, few (40%) reported a system to measure compliance with these consultations., Conclusions: In most hospitals surveyed, practices to improve antimicrobial use, although present, were inadequate based on recommendations in a Society for Healthcare Epidemiology of America and Infectious Disease Society of America joint position paper. There is room to improve antimicrobial-use stewardship at US hospitals.

Background: Clostridioides difficile (C. diff) infection causes significant morbidity for hospitalized patients. A large medical intensive care unit had an increase in C. diff infection rates., Objectives: The aim of this project was to reduce the C. diff polymerase chain reaction (PCR) test positivity rate and the rate of C. diff PCR tests ordered. Rates were compared between preintervention (July 2017 to December 2019) and postintervention (January 2021 to December 2022) timeframes., Methods: Unit leadership led a robust quality improvement project, including use of quality improvement tools such as A3, Gemba walks, and plan-do-study-act cycles. Interventions were tailored to the barriers identified, including standardization of in-room supply carts; use of single-packaged oral care kits; new enteric precautions signage; education to staff, providers, and visitors; scripting for patients and visitors; and use of a C. diff testing algorithm. Statistical process control charts were used to assess for improvements., Results: The average rate of C. diff PCR test positivity decreased from 34.9 PCR positive tests per 10 000 patient days to 12.3 in the postintervention period, a 66% reduction. The average rate of PCR tests ordered was 28 per 1000 patient days in the preintervention period; this decreased 44% to 15.7 in the postintervention period., Discussion: We found clinically significant improvements in the rate of C. diff infection and PCR tests ordered as a result of implementing tailored interventions in a large medical intensive care unit. Other units should consider using robust quality improvement methods and tools to conduct similar initiatives to reduce patient harm and improve care and outcomes., (Copyright © 2024 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: To assess the impact of active surveillance and decolonization strategies on methicillin-resistant Staphylococcus aureus (MRSA) infection rates in a NICU., Study Design: MRSA infection rates were compared before (2014-2016) and during (2017-2022) an active surveillance program. Eligible infants were decolonized with chlorohexidine gluconate (CHG) bathing and/or topical mupirocin. Successful decolonization and rates of recolonization were assessed., Results: Fifty-two (0.57%) of 9 100 hospitalized infants had invasive MRSA infections from 2014 to 2022; infection rates declined non-significantly. During the 6-year surveillance program, the risk of infection was 16.9-times [CI 95 8.4, 34.1] higher in colonized infants than uncolonized infants. Those colonized with mupirocin-susceptible MRSA were more likely successfully decolonized (aOR 9.7 [CI 95 4.2, 22.5]). Of 57 infants successfully decolonized who remained hospitalized, 34 (60%) became recolonized., Conclusions: MRSA infection rates did not significantly decline in association with an active surveillance and decolonization program. Alternatives to mupirocin and CHG are needed to facilitate decolonization., (© 2024. The Author(s), under exclusive licence to Springer Nature America, Inc.)

The Association for Practitioners in Infection Control (APIC), in existence now for 16 years, is still considered to be a relatively young professional organization. During that time its many accomplishments include membership growth to more than 7500 persons, establishment of a national office, annual revenues of more than $700,000, publications of a bimonthly scientific journal, publication of the standard reference work for infection control practice, establishment of the process leading to a certifying examination in infection control, an annual educational conference attended by more than 1000 persons, and increasing recognition by other professional groups, state and federal agencies, and the scientific community as a leading voice that represents professionals involved in infection control practice in the United States. These accomplishments have been due in large part to the dedication and hard work of its members, especially the hundreds of persons who have filled local and national positions of leadership. However, APIC now finds itself at a crossroads; changes in the current health care climate and publication of the results of a national study on the efficacy of infection control practice have contributed to a reassessment of infection control programs and the role and scope of persons involved in the field. The purpose of this editorial is to review the background of our two position papers, to comment on an expanded role of hospital epidemiology, and to examine the response of APIC to our membership in terms of commitments identified in the two papers.