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The global burden associated with antimicrobial resistance is of increasing concern. To evaluate risk factors associated with multidrug-resistant (MDR) infection and its clinical impact in a cohort of patients with healthcare-associated bacteraemic urinary tract infections (BUTIs). This was a prospective, multicentre, post-hoc analysis of patients with healthcare-associated-BUTI (ITUBRAS-2). The primary outcome was MDR profile. Secondary outcomes were clinical response (at 48–72 h and at hospital discharge) and length of hospital stay from onset of BUTI. Logistic regression was used to evaluate variables associated with MDR profile and clinical response. Length of hospital stay was evaluated using multivariate median regression. In all, 443 episodes were included, of which 271 (61.17%) were classified as expressing an MDR profile. In univariate analysis, MDR profile was associated with E. coli episodes (odds ratio (OR): 3.13; 95% confidence interval (CI): 2.11–4.69, P < 0.001) and the extensively drug-resistant (XDR) pattern with P. aeruginosa aetiology (7.84; 2.37–25.95; P = 0.001). MDR was independently associated with prior use of fluoroquinolones (adjusted OR: 2.43; 95% CI: 1.25–4.69), cephalosporins (2.14; 1.35–3.41), and imipenem or meropenem (2.08; 1.03–4.20) but not with prior ertapenem. In terms of outcomes, MDR profile was not associated with lower frequency of clinical cure, but was associated with longer hospital stay. MDR profile was independently associated with prior use of fluoroquinolones, cephalosporins, imipenem, and meropenem, but not with prior ertapenem. MDR-BUTI episodes were not associated with worse clinical cure, although they were independently associated with longer duration of hospital stay. [ABSTRACT FROM AUTHOR]

Antimicrobial resistance (AMR) constitutes a major global health threat, to a very large extent due to the inadequate use of antibiotics. Additionally, the misuse of disinfectants can also trigger the selection of resistant clones, where micro-organisms develop an adaptative response and progress to resistance mechanisms. Cross-resistance may occur when a biocide's selective pressure induces antimicrobial resistance. To acknowledge the potential relationship between repeated and/or prolonged exposure to disinfectants and antimicrobial resistance profile adjustment. This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies published until December 2023 that were related to the interaction between disinfectants and antimicrobials were included. Further selection was based on the methodology of exposure. Selected studies included testing about 'exposure to sublethal concentrations' for seventeen disinfectants. The mechanism of action for the majority of the disinfectants involved interactions with the cell membrane. Chlorhexidine was the most studied disinfectant. Adaptation phenomena related to disinfectant exposure were documented and development of cross-resistance to antimicrobials was verified for several species, including Streptococcus spp., Klebsiella pneumoniae , Acinetobacter baumannii , Staphylococcus aureus , Pseudomonas aeruginosa , and Candida spp. Changes associated with disinfectant exposure also influenced biofilm formation, colony morphology, and efflux pump activity – three relevant determinants of loss of antibiotic efficacy. [ABSTRACT FROM AUTHOR]

Healthcare-associated infections present a challenge to healthcare systems, particularly critical care units. Hand hygiene emerges as a crucial element in infection control, acting as a vital link between healthcare workers, patients, and pathogens. Positive attitudes, motivated by a genuine concern for patient safety, are recognized as major predictors of hand hygiene compliance among healthcare workers. This study aims to assess the attitudes of ICU staff toward hand hygiene and identify factors that influence these attitudes. A cross-sectional survey of intensive care unit staff in seven large Saudi hospitals was conducted using an anonymous, self-reporting questionnaire to examine the attitudes of ICU personnel about hand hygiene and determine the factors that impact these attitudes. A regression analysis was used to determine the determinants of hand hygiene attitudes. Of the 600 respondents, 93% rated their hand hygiene knowledge as good, and 71% received hand hygiene training from their hospital. Most respondents (78%) had previously experienced healthcare-associated infections. The majority reported a favorable overall attitude toward hand hygiene (M = 4.15, SD = 0.85). Attitudes toward hand hygiene were significantly associated with perceived knowledge (β = 0.32, p < 0.001), prior hand hygiene training (β = 0.13, p < 0.05), and years of experience (β = − 0.10, p < 0.05). Healthcare workers in the ICU have a generally positive attitude toward hand hygiene. Such attitudes were correlated with hand hygiene knowledge, prior training, and job experience. The study’s findings can help to inform health promotion initiatives and campaigns aimed at achieving long-term improvements in hand hygiene behaviors. [ABSTRACT FROM AUTHOR]

Background: Alcohol-based handrub (ABHR) is the gold standard for hand hygiene (HH) and is a cornerstone of infection prevention and control (IPC) strategies. However, several factors influence the efficient use of ABHR by health workers. This study evaluated the tolerability and acceptability of a locally produced ABHR product and HH behaviour among health workers. Methods: A longitudinal hospital-based intervention study was conducted in accordance with the WHO's standardized protocol for evaluating ABHR tolerability and acceptability (Method 1). Sixty health workers across 4 hospitals in Sierra Leone were observed over a 30-day period at three separate visits (days 1, 3–5, and 30) by trained observers. The outcomes of interest included skin tolerability and product acceptabilityevaluated using subjective and objective measures. Results: Objective and subjective evaluations demonstrated strong skin tolerability and high acceptability with the product. At all three visits, the skin tolerability score assessed by trained observers was < 2 in ≥ 97% of participants, exceeding the WHO benchmark score (BMS = < 2 in ≥ 75%). Participants' self-evaluations of overall skin integrity were 97% (visit 2) and 98% (visit 3) for scores > 4 (BMS = > 4 in ≥ 75%). The primary acceptability criteria increased up to 95% (colour) and 88% (smell) at visit 3 (BMS = > 4 in ≥ 50%). Despite high acceptability, the product's drying effect remained low at 52% and 58% during visits 2 and 3, respectively (BMS = > 4 in ≥ 75%). There were positive HH behaviours (n = 53, 88%), with more than half (n = 38, 63%) of them exhibiting HH at almost every HH moment. The mean ABHR was notably high (76.1 ml, SD ± 35), especially among nurses (mean = 80.1 ml) and doctors (mean = 74.0 ml). Conclusion: The WHO-formulated, locally produced ABHR was well tolerated and accepted by health workers. These findings support the continuous utilization of evidence-based, cost-effective hand hygiene interventions in resource-limited settings. High handrub consumption and frequent HH practices were noticeable HH behaviours. Further research is recommended to optimize product formulations for skin dryness and investigate the association between ABHR consumption and hand hygiene compliance. [ABSTRACT FROM AUTHOR]

Background: Surgical site infection (SSI) is an important cause of disease burden and healthcare costs. Fully manual surveillance is time-consuming and prone to subjectivity and inter-individual variability, which can be partly overcome by semi-automated surveillance. Algorithms used in orthopaedic SSI semi-automated surveillance have reported high sensitivity and important workload reduction. This study aimed to design and validate different algorithms to identify patients at high risk of SSI after hip or knee arthroplasty. Methods: Retrospective data from manual SSI surveillance between May 2015 and December 2017 were used as gold standard for validation. Knee and hip arthroplasty were included, patients were followed up for 90 days and European Centre for Disease Prevention and Control SSI classification was applied. Electronic health records data was used to generate different algorithms, considering combinations of the following variables: ≥1 positive culture, ≥ 3 microbiological requests, antimicrobial therapy ≥ 7 days, length of hospital stay ≥ 14 days, orthopaedics readmission, orthopaedics surgery and emergency department attendance. Sensitivity, specificity, negative and predictive value, and workload reduction were calculated. Results: In total 1631 surgical procedures were included, of which 67.5% (n = 1101) in women; patients' median age was 69 years (IQR 62 to 77) and median Charlson index 2 (IQR 1 to 3). Most surgeries were elective (92.5%; n = 1508) and half were hip arthroplasty (52.8%; n = 861). SSI incidence was 3.8% (n = 62), of which 64.5% were deep or organ/space infections. Positive culture was the single variable with highest sensitivity (64.5%), followed by orthopaedic reintervention (59.7%). Twenty-four algorithms presented 90.3% sensitivity for all SSI types and 100% for deep and organ/space SSI. Workload reduction ranged from 59.7 to 67.7%. The algorithm including ≥ 3 microbiological requests, length of hospital stay ≥ 14 days and emergency department attendance, was one of the best options in terms of sensitivity, workload reduction and feasibility for implementation. Conclusions: Different algorithms with high sensitivity to detect all types of SSI can be used in real life, tailored to clinical practice and data availability. Emergency department attendance can be an important variable to identify superficial SSI in semi-automated surveillance. [ABSTRACT FROM AUTHOR]

Aims This study aimed to investigate the presence of beta-lactams resistance genes and the clonal relationship of clinical isolates of Enterobacterales obtained from patients with and without COVID-19, in a hospital in northeastern Brazil. Methods and results The study analyzed 45 carbapenem-resistant clinical isolates using enterobacterial repetitive intergenic consensus (ERIC-PCR), PCR, and amplicon sequencing to detect resistance genes (bla KPC, bla GES, bla NDM, bla VIM, and bla IMP). The main species were Klebsiella pneumoniae, Serratia marcescens , and Proteus mirabilis. Detected genes included bla NDM (46.66%), bla KPC (35.55%), and both (17.79%). ERIC-PCR showed multiclonal dissemination and high genetic variability. The main resistance gene was bla NDM, including bla NDM-5 and bla NDM-7. Conclusions The presence of Enterobacterales carrying bla KPC and bla NDM in this study, particularly K. pneumoniae , in infections and colonizations of patients with COVID-19 and non-COVID-19, highlights genetic variability and resistance to carbapenems observed in multiple species of this order. [ABSTRACT FROM AUTHOR]

Hospitals are exposed to abundant contamination sources with limited remediation strategies. Without new countermeasures or treatments, the risk of health care-associated infections will remain high. This study explored the impact of advanced photohydrolysis continuous disinfection technology on hospital environmental bioburden. Two acute care intensive care units in different locations (ie, Kentucky, Louisiana) during different time periods were sampled every 4 weeks for 4 months for colony-forming units (CFUs) of methicillin-resistant Staphylococcus aureus (MRSA) and fungi on surfaces and floors and fungi and aerobic bacteria in the air. At both sites, surface testing showed greater than 98% reduction in mean fungi and MRSA CFUs. Floor results had reductions by more than 96% for fungi and MRSA at both sites. Aerobic bacterial air and fungal CFUs had reductions up to 72% and 89%, respectively. HAIs declined 70% when postactivation data were compared to preactivation data. The continuous nature of advanced photohydrolysis decontamination, its ability to be used in occupied rooms, and its independence of human resources provide an innovative intervention for complex health care environments. This study is on the pioneering edge of demonstrating that continuous decontamination can reduce surface, floor, and air contamination and thereby reduce the acquisition of HAIs. • Environmental contamination is continuous and contributes to infection risk. • Advanced photohydrolysis technology recreates photolysis to neutralize pathogens. • This technology provides decontamination that is continuous and persistent. • Results showed surface and air bioburdens were reduced up to 99%. • Health care-associated infections (HAIs) observed a greater than 70% decline. [ABSTRACT FROM AUTHOR]

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Background: Healthcare-associated infections (HAIs) are important indicators of healthcare quality. The aseptic non touch technique (ANTT), a standardised aseptic technique, is a crucial preventative measure against HAIs. However, there is insufficient evidence currently available regarding ANTT awareness and proficiency among nurses. This study aimed to investigate the status of ANTT proficiency in a cohort of nurses and analyse the associated risk factors, with the ultimate goal of providing a reference for promoting the application of ANTT in clinical practice. Methods: The study population was sampled from nurses working in a tertiary hospital in Zhejiang Province, China, in January 2024. A cross-sectional survey was conducted using a self-designed questionnaire to assess ANTT knowledge. Multivariate linear regression analysis was used to analyse the risk factors influencing ANTT knowledge in nurses. Results: A total of 458 nurses were included in this study. The cohort had an overall score of 49.7% correct responses on the ANTT knowledge questionnaire, with a mean score of 12.4 ± 2.4 out of 25, and 30.1% of the nurses felt that they did not need training related to ANTT. Multivariate linear regression analysis indicated that professional title, educational level, and the need for ANTT training were independently associated with ANTT knowledge in nurses. Nurses with Master's degrees and associated chief nurses were observed to have higher levels of ANTT knowledge compared to the rest. Conclusions: ANTT knowledge is insufficient among nurses in China, and its importance is not widely recognised. Continuous efforts are required to strengthen this knowledge. Constructing sustained, multiform, and stratified training programmes may represent an effective method to strengthen ANTT knowledge among nurses and promote its clinical use. [ABSTRACT FROM AUTHOR]

Background: Healthcare associated infections (HAI) pose a major threat to healthcare systems resulting in an increased burden of disease. Surveillance plays a key role in rapidly identifying these infections and preventing further transmissions. Alas, in German hospitals, the majority of surveillance efforts have been heavily relying on labour intensive processes like manual chart review. In order to be able to identify further starting points for future digital tools and interventions to aid the surveillance of HAI we aimed to gain an understanding of the current state of digitalisation in the context of the general surveillance organisation in German clinics across all care-levels. The end user perspective of infection prevention and control (IPC) professionals was chosen to identify digital interventions that have the biggest impact on the daily surveillance work routines of IPC professionals. Perceived impediments in the advancement of surveillance digitalisation should be explored. Methods: Following the development of an interview guideline, eight IPC professionals from seven German hospitals of different care levels were questioned in semi- structured interviews between December 2022 and January 2023. These included questions about general surveillance organisation, access to digital data sources, software to aid the surveillance process as well as current issues in the surveillance process and implementation of software systems. Subsequently, after full transcription, the interview sections were categorized in code categories (first deductive then inductive coding) and analysed qualitatively. Results: Results were characterised by high heterogeneity in terms of general surveillance organisation and access to digital data sources. Software configuration of hospital and laboratory information systems (HIS/LIS) as well as patient data management systems (PDMS) varied not only between hospitals of different care levels but also between hospitals of the same care level. Outside research projects, neither fully automatic software nor solutions utilising artificial intelligence have currently been implemented in clinical routine in any of the hospitals. Conclusions: Access to digital data sources and software is increasingly available to aid surveillance of HAI. Nevertheless, surveillance processes in hospitals analysed in this study still heavily rely on manual processes. In the analysed hospitals, there is an implementation and funding gap of (semi-) automatic surveillance solutions in clinical practice, especially in healthcare facilities of lower care levels. [ABSTRACT FROM AUTHOR]

Background: Healthcare-associated infections (HAIs) in intensive care unit (ICU) patients significantly complicate the normal hospitalization process and affect patients' condition, length of hospitalization, mortality, and treatment cost. In this study, we aimed to determine the prevalence and economic burden of HAIs. Methods: The study involved all patients with a confirmed HAIs (based on CDC/NHSN case-definitions); in the general ICU of a tertiary university hospital in Tehran, from April 2020 to March 2021. The patients' information, including length of hospitalization, outcome, type and cost of prescribed antibiotics, were recorded. Results: During the study period, 119 HAIs were found in 1395 (43% F / 57% M) patients. The prevalence of nosocomial infections was 8.53%. The mean duration of hospitalization in all ICU patients was 4.7 ± 3.1 days, and 31.85 ± 18.96 days in patients with HAIs. The most common organisms involved in HAIs are Acinetobacter baumannii (54.6%), Klebsiella pneumoniae (30.3%), E. coli (15.1%), and Enterococcus spp. (12%). Incidence density of ventilator-associated pneumonia (VAP), central lineassociated bloodstream infection (CLA-BSI), and catheter-associated urinary tract infection (CA-UTI) per 1000 device-days were 36.08, 17.57, and 8.86, respectively. The total cost of antibiotics for HAIs was € 105,407. Among these, the highest consumption costs were for carbapenems, followed by colistin and caspofungin. Conclusion: This study showed the high burden of nosocomial infections in ICUs. Strategies for more strict infection prevention and control are necessary to reduce this burden. [ABSTRACT FROM AUTHOR]

Hospital-acquired infections, also known as nosocomial infections, include bloodstream infections, surgical site infections, skin and soft tissue infections, respiratory tract infections, and urinary tract infections. According to reports, Gram-positive and Gram-negative pathogenic bacteria account for up to 70% of nosocomial infections in intensive care unit (ICU) patients. Biofilm production is a main virulence mechanism and a distinguishing feature of bacterial pathogens. Most bacterial pathogens develop biofilms at the solid-liquid and air-liquid interfaces. An essential requirement for biofilm production is the presence of a conditioning film. A conditioning film provides the first surface on which bacteria can adhere and fosters the growth of biofilms by creating a favorable environment. The conditioning film improves microbial adherence by delivering chemical signals or generating microenvironments. Microorganisms use this coating as a nutrient source. The film gathers both inorganic and organic substances from its surroundings, or these substances are generated by microbes in the film. These nutrients boost the initial growth of the adhering bacteria and facilitate biofilm formation by acting as a food source. Coatings with combined antibacterial efficacy and antifouling properties provide further benefits by preventing dead cells and debris from adhering to the surfaces. In the present review, we address numerous pathogenic microbes that form biofilms on the surfaces of biomedical devices. In addition, we explore several efficient smart antiadhesive coatings on the surfaces of biomedical device-relevant materials that manage nosocomial infections caused by biofilm-forming microbial pathogens. [ABSTRACT FROM AUTHOR]

Recently Candida auris has emerged as a multi-resistant fungal pathogen, with a significant clinical impact, and is able to persist for a long time on human skin and hospital environments. It is a critical issue on the WHO fungal priority list and therefore it is fundamental to reinforce hospital surveillance protocols to limit nosocomial outbreaks. The purpose of this study was to apply Fourier transform infrared spectroscopy (FT-IR) to investigate the phylogenetic relationships among isolated strains from a C. auris outbreak at the University Intensive Care Unit of a Tertiary University hospital in Turin (Italy). To calculate a clustering cut-off, intra- and inter-isolate, distance values were analysed. The data showed the presence of a major Alfa cluster and a minor Beta cluster with a defined C. auris clustering cut-off. The results were validated by an external C. auris strain and Principal Component and Linear Discriminant Analyses. The application of FT-IR technology allowed to obtain important information about the phylogenetic relationships between the analysed strains, defining for the first time a "not WGS-based" clustering cut-off with a statistical–mathematical approach. FT-IR could represent a valid alternative to molecular methods for the rapid and cost-saving typing of C. auris strains with important clinical implications. [ABSTRACT FROM AUTHOR]

Abstract Healthcare-associated infections present a challenge to healthcare systems, particularly critical care units. Hand hygiene emerges as a crucial element in infection control, acting as a vital link between healthcare workers, patients, and pathogens. Positive attitudes, motivated by a genuine concern for patient safety, are recognized as major predictors of hand hygiene compliance among healthcare workers. This study aims to assess the attitudes of ICU staff toward hand hygiene and identify factors that influence these attitudes. A cross-sectional survey of intensive care unit staff in seven large Saudi hospitals was conducted using an anonymous, self-reporting questionnaire to examine the attitudes of ICU personnel about hand hygiene and determine the factors that impact these attitudes. A regression analysis was used to determine the determinants of hand hygiene attitudes. Of the 600 respondents, 93% rated their hand hygiene knowledge as good, and 71% received hand hygiene training from their hospital. Most respondents (78%) had previously experienced healthcare-associated infections. The majority reported a favorable overall attitude toward hand hygiene (M = 4.15, SD = 0.85). Attitudes toward hand hygiene were significantly associated with perceived knowledge (β = 0.32, p

Abstract Background Practicing hand hygiene is a cost-effective method to decrease the occurrence of Healthcare-Associated Infections (HAIs). However, despite their simplicity, adhering to hand hygiene methods among healthcare workers (HCWs) can be highly challenging. We aim to examine the factors influencing hand hygiene compliance as perceived by HCWs working in the intensive care units (ICUs) at several major hospitals in Riyadh, Saudi Arabia. Method This qualitative study was conducted by adopting a content analysis to examine the interviews of HCWs who are currently working in the ICUs of various major hospitals located in the capital city of Riyadh, Saudi Arabia. Results We interviewed 49 HCWs working in ICUs, with an average age of 38 and 8 years of experience. The HCWs comprised doctors (n = 12), anesthesiologists (n = 6), and nurses (n = 31). There were 34 females and 15 males among the participants. Our analysis revealed several factors that impact hand hygiene compliance, including individual, work/environment, team, task, patient, organizational, and management concerns. Several obstacles and possibilities for enhancement have been identified. Conclusion The results of this study would enhance our comprehension of hand hygiene practices and serve as a foundation for creating future strategies and assessment methods to enhance compliance with hand hygiene protocols in ICUs.

Abstract Background Alcohol-based handrub (ABHR) is the gold standard for hand hygiene (HH) and is a cornerstone of infection prevention and control (IPC) strategies. However, several factors influence the efficient use of ABHR by health workers. This study evaluated the tolerability and acceptability of a locally produced ABHR product and HH behaviour among health workers. Methods A longitudinal hospital-based intervention study was conducted in accordance with the WHO’s standardized protocol for evaluating ABHR tolerability and acceptability (Method 1). Sixty health workers across 4 hospitals in Sierra Leone were observed over a 30-day period at three separate visits (days 1, 3–5, and 30) by trained observers. The outcomes of interest included skin tolerability and product acceptabilityevaluated using subjective and objective measures. Results Objective and subjective evaluations demonstrated strong skin tolerability and high acceptability with the product. At all three visits, the skin tolerability score assessed by trained observers was 4 (BMS = > 4 in ≥ 75%). The primary acceptability criteria increased up to 95% (colour) and 88% (smell) at visit 3 (BMS = > 4 in ≥ 50%). Despite high acceptability, the product’s drying effect remained low at 52% and 58% during visits 2 and 3, respectively (BMS = > 4 in ≥ 75%). There were positive HH behaviours (n = 53, 88%), with more than half (n = 38, 63%) of them exhibiting HH at almost every HH moment. The mean ABHR was notably high (76.1 ml, SD ± 35), especially among nurses (mean = 80.1 ml) and doctors (mean = 74.0 ml). Conclusion The WHO-formulated, locally produced ABHR was well tolerated and accepted by health workers. These findings support the continuous utilization of evidence-based, cost-effective hand hygiene interventions in resource-limited settings. High handrub consumption and frequent HH practices were noticeable HH behaviours. Further research is recommended to optimize product formulations for skin dryness and investigate the association between ABHR consumption and hand hygiene compliance.

Abstract Background Surgical site infection (SSI) is an important cause of disease burden and healthcare costs. Fully manual surveillance is time-consuming and prone to subjectivity and inter-individual variability, which can be partly overcome by semi-automated surveillance. Algorithms used in orthopaedic SSI semi-automated surveillance have reported high sensitivity and important workload reduction. This study aimed to design and validate different algorithms to identify patients at high risk of SSI after hip or knee arthroplasty. Methods Retrospective data from manual SSI surveillance between May 2015 and December 2017 were used as gold standard for validation. Knee and hip arthroplasty were included, patients were followed up for 90 days and European Centre for Disease Prevention and Control SSI classification was applied. Electronic health records data was used to generate different algorithms, considering combinations of the following variables: ≥1 positive culture, ≥ 3 microbiological requests, antimicrobial therapy ≥ 7 days, length of hospital stay ≥ 14 days, orthopaedics readmission, orthopaedics surgery and emergency department attendance. Sensitivity, specificity, negative and predictive value, and workload reduction were calculated. Results In total 1631 surgical procedures were included, of which 67.5% (n = 1101) in women; patients’ median age was 69 years (IQR 62 to 77) and median Charlson index 2 (IQR 1 to 3). Most surgeries were elective (92.5%; n = 1508) and half were hip arthroplasty (52.8%; n = 861). SSI incidence was 3.8% (n = 62), of which 64.5% were deep or organ/space infections. Positive culture was the single variable with highest sensitivity (64.5%), followed by orthopaedic reintervention (59.7%). Twenty-four algorithms presented 90.3% sensitivity for all SSI types and 100% for deep and organ/space SSI. Workload reduction ranged from 59.7 to 67.7%. The algorithm including ≥ 3 microbiological requests, length of hospital stay ≥ 14 days and emergency department attendance, was one of the best options in terms of sensitivity, workload reduction and feasibility for implementation. Conclusions Different algorithms with high sensitivity to detect all types of SSI can be used in real life, tailored to clinical practice and data availability. Emergency department attendance can be an important variable to identify superficial SSI in semi-automated surveillance.

The aim of the review is to give a brief description of the biodiversity and structure of the hospital environment microbiome based on molecular genetic research methods. Until a certain time, studies of the hospital environment microbiota for the purposes of epidemiological surveillance and control of healthcare-associated infections (HAIs) were based on routine microbiological identification of clinically relevant bacterial taxa. Discovery of DNA, the development of sequencing technologies, PCR and cloning techniques enabled the investigation of microbial communities using cultivation-independent, DNA and RNA-based approaches. At the current level of knowledge, the hospital environment can be considered as a superorganism with its own microbiome. Multiomic technologies, including meta-transcriptomic, meta-proteomic and metabolomic approaches, provide detailed information about microbial activity in the environment. Now it has been established that there is a stable core of the hospital microbiome where the vast majority of microorganisms are necessary for the functioning of the hospital ecosystem and are not classified as human pathogens. The hospital microbiome has a homogeneous structure composed by a massive dominance of a few taxa and microbial network with low connectivity forming a clustered topology. A keystone species is a taxon whose importance for maintaining community structure is relatively higher than others and its identification is of paramount importance. Due to the lack of knowledge of the hospital environment microbiome by molecular genetic technologies, there is no single shared point of view on the microbial diversity in different healthcare facilities. But there is no doubt that molecular genetic technologies will shed light on the evolution of hospital strains and determine which indicators are the most informative for monitoring and prognosis of HAIs.

Abstract Background Healthcare-associated infections (HAIs) are important indicators of healthcare quality. The aseptic non touch technique (ANTT), a standardised aseptic technique, is a crucial preventative measure against HAIs. However, there is insufficient evidence currently available regarding ANTT awareness and proficiency among nurses. This study aimed to investigate the status of ANTT proficiency in a cohort of nurses and analyse the associated risk factors, with the ultimate goal of providing a reference for promoting the application of ANTT in clinical practice. Methods The study population was sampled from nurses working in a tertiary hospital in Zhejiang Province, China, in January 2024. A cross-sectional survey was conducted using a self-designed questionnaire to assess ANTT knowledge. Multivariate linear regression analysis was used to analyse the risk factors influencing ANTT knowledge in nurses. Results A total of 458 nurses were included in this study. The cohort had an overall score of 49.7% correct responses on the ANTT knowledge questionnaire, with a mean score of 12.4 ± 2.4 out of 25, and 30.1% of the nurses felt that they did not need training related to ANTT. Multivariate linear regression analysis indicated that professional title, educational level, and the need for ANTT training were independently associated with ANTT knowledge in nurses. Nurses with Master’s degrees and associated chief nurses were observed to have higher levels of ANTT knowledge compared to the rest. Conclusions ANTT knowledge is insufficient among nurses in China, and its importance is not widely recognised. Continuous efforts are required to strengthen this knowledge. Constructing sustained, multiform, and stratified training programmes may represent an effective method to strengthen ANTT knowledge among nurses and promote its clinical use.

Abstract Background Healthcare associated infections (HAI) pose a major threat to healthcare systems resulting in an increased burden of disease. Surveillance plays a key role in rapidly identifying these infections and preventing further transmissions. Alas, in German hospitals, the majority of surveillance efforts have been heavily relying on labour intensive processes like manual chart review. In order to be able to identify further starting points for future digital tools and interventions to aid the surveillance of HAI we aimed to gain an understanding of the current state of digitalisation in the context of the general surveillance organisation in German clinics across all care-levels. The end user perspective of infection prevention and control (IPC) professionals was chosen to identify digital interventions that have the biggest impact on the daily surveillance work routines of IPC professionals. Perceived impediments in the advancement of surveillance digitalisation should be explored. Methods Following the development of an interview guideline, eight IPC professionals from seven German hospitals of different care levels were questioned in semi- structured interviews between December 2022 and January 2023. These included questions about general surveillance organisation, access to digital data sources, software to aid the surveillance process as well as current issues in the surveillance process and implementation of software systems. Subsequently, after full transcription, the interview sections were categorized in code categories (first deductive then inductive coding) and analysed qualitatively. Results Results were characterised by high heterogeneity in terms of general surveillance organisation and access to digital data sources. Software configuration of hospital and laboratory information systems (HIS/LIS) as well as patient data management systems (PDMS) varied not only between hospitals of different care levels but also between hospitals of the same care level. Outside research projects, neither fully automatic software nor solutions utilising artificial intelligence have currently been implemented in clinical routine in any of the hospitals. Conclusions Access to digital data sources and software is increasingly available to aid surveillance of HAI. Nevertheless, surveillance processes in hospitals analysed in this study still heavily rely on manual processes. In the analysed hospitals, there is an implementation and funding gap of (semi-) automatic surveillance solutions in clinical practice, especially in healthcare facilities of lower care levels.

Background: Pandemic management and preparedness are more needed than ever before and there is widespread governmental interest in learning from the COVID-19 pandemic in order to ensure the availability of evidence-based Infection Prevention and Control measures. Contact tracing is integral to Infection Prevention and Control, facilitating breaks in the chain of transmission in a targeted way, identifying individuals who have come into contact with an infected person, and providing them with instruction/advice relating to testing, medical advice and/or self-isolation. Aim: This study aims to improve our understanding of the use of contact tracing technologies in healthcare settings. This research seeks to contribute to the field of Infection Prevention and Control by investigating how these technologies can mitigate the spread of nosocomial infections. Ultimately, this study aims to improve the quality and safety of healthcare delivery. Methods: A systematic literature review was conducted, and journal articles investigating the use of contact tracing technologies in healthcare settings were retrieved from databases held on the OvidSP platform between March and September 2022, with no date for a lower limit. Results: In total, 277 studies were retrieved and screened, and 14 studies were finally included in the systematic literature review. Most studies investigated proximity sensing technologies, reporting promising results. However, studies were limited by small sample sizes and confounding factors, revealing contact tracing technologies remain at a nascent stage. Investment in research and development of new testing technologies is necessary to strengthen national and international contact tracing capabilities. Conclusion: This review aims to contribute to those who intend to create robust surveillance systems and implement infectious disease reporting protocols.

Background: Effort–reward imbalance (ERI) refers to the situation where there is a mismatch between the effort that healthcare workers (HCWs) put into their work and the rewards they receive in return. Burnout, on the other hand, is a psychological syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment. This study aimed to assess the impact of ERI and burnout on the compliance with standard precautions (SPs) among nurses and midwives in Lebanese hospitals under the economic crisis and after the COVID-19 pandemic. Methods: Cross-sectional correlational study, based on self-administered questionnaire data, measuring the compliance with SPs, ERI, and burnout, in addition to the relationship between these factors, was performed among 409 nurses and midwives, working in Lebanese hospitals. Results: ERI was significantly associated with exposure to burnout among nurses and midwives, and burnout was found to be a significant predictor of nurses and midwives’ self-reported adherence with SPs. Conclusions: This study highlights the contribution of ERI and burnout to the chain of infection by decreased adherence to infection control SPs of nurses and midwives.

Abstract Background A multidrug-resistant lineage of Staphylococcus epidermidis named ST215 is a common cause of prosthetic joint infections and other deep surgical site infections in Northern Europe, but is not present elsewhere. The increasing resistance among S. epidermidis strains is a global concern. We used whole-genome sequencing to characterize ST215 from healthcare settings. Results We completed the genome of a ST215 isolate from a Swedish hospital using short and long reads, resulting in a circular 2,676,787 bp chromosome and a 2,326 bp plasmid. The new ST215 genome was placed in phylogenetic context using 1,361 finished public S. epidermidis reference genomes. We generated 10 additional short-read ST215 genomes and 11 short-read genomes of ST2, which is another common multidrug-resistant lineage at the same hospital. We studied recombination’s role in the evolution of ST2 and ST215, and found multiple recombination events averaging 30–50 kb. By comparing the results of antimicrobial susceptibility testing for 31 antimicrobial drugs with the genome content encoding antimicrobial resistance in the ST215 and ST2 isolates, we found highly similar resistance traits between the isolates, with 22 resistance genes being shared between all the ST215 and ST2 genomes. The ST215 genome contained 29 genes that were historically identified as virulence genes of S. epidermidis ST2. We established that in the nucleotide sequence stretches identified as recombination events, virulence genes were overrepresented in ST215, while antibiotic resistance genes were overrepresented in ST2. Conclusions This study features the extensive antibiotic resistance and virulence gene content in ST215 genomes. ST215 and ST2 lineages have similarly evolved, acquiring resistance and virulence through genomic recombination. The results highlight the threat of new multidrug-resistant S. epidermidis lineages emerging in healthcare settings.

Abstract Background Treatment of carbapenem-resistant Enterobacterales (CRE) infections in low-resource settings is challenging particularly due to limited treatment options. Colistin is the mainstay drug for treatment; however, nephrotoxicity and neurotoxicity make this drug less desirable. Thus, mortality may be higher among patients treated with alternative antimicrobials that are potentially less efficacious than colistin. We assessed mortality in patients with CRE bacteremia treated with colistin-based therapy compared to colistin-sparing therapy. Methods We conducted a cross-sectional study using secondary data from a South African national laboratory-based CRE bacteremia surveillance system from January 2015 to December 2020. Patients hospitalized at surveillance sentinel sites with CRE isolated from blood cultures were included. Multivariable logistic regression modeling, with multiple imputations to account for missing data, was conducted to determine the association between in-hospital mortality and colistin-based therapy versus colistin-sparing therapy. Results We included 1 607 case-patients with a median age of 29 years (interquartile range [IQR], 0–52 years) and 53% (857/1 607) male. Klebsiella pneumoniae caused most of the infections (82%, n=1 247), and the most common carbapenemase genes detected were bla OXA-48-like (61%, n=551), and blaNDM (37%, n=333). The overall in-hospital mortality was 31% (504/1 607). Patients treated with colistin-based combination therapy had a lower case fatality ratio (29% [152/521]) compared to those treated with colistin-sparing therapy 32% [352/1 086]) (p=0.18). In our imputed model, compared to colistin-sparing therapy, colistin-based therapy was associated with similar odds of mortality (adjusted odds ratio [aOR] 1.02; 95% confidence interval [CI] 0.78-1.33, p=0.873). Conclusion In our resource-limited setting, the mortality risk in patients treated with colistin-based therapy was comparable to that of patients treated with colistin-sparing therapy. Given the challenges with colistin treatment and the increasing resistance to alternative agents, further investigations into the benefit of newer antimicrobials for managing CRE infections are needed.

Background: Healthcare-associated infections (HAIs) in intensive care unit (ICU) patients significantly complicate the normal hospitalization process and affect patients’ condition, length of hospitalization, mortality, and treatment cost. In this study, we aimed to determine the prevalence and economic burden of HAIs. Methods: The study involved all patients with a confirmed HAIs (based on CDC/NHSN case-definitions); in the general ICU of a tertiary university hospital in Tehran, from April 2020 to March 2021. The patients’ information, including length of hospitalization, outcome, type and cost of prescribed antibiotics, were recorded. Results: During the study period, 119 HAIs were found in 1395 (43% F / 57% M) patients. The prevalence of nosocomial infections was 8.53%. The mean duration of hospitalization in all ICU patients was 4.7 ± 3.1 days, and 31.85 ± 18.96 days in patients with HAIs. The most common organisms involved in HAIs are Acinetobacter baumannii (54.6%), Klebsiella pneumoniae (30.3%), E. coli (15.1%), and Enterococcus spp. (12%). Incidence density of ventilator-associated pneumonia (VAP), central line-associated bloodstream infection (CLA-BSI), and catheter-associated urinary tract infection (CA-UTI) per 1000 device-days were 36.08, 17.57, and 8.86, respectively. The total cost of antibiotics for HAIs was € 105,407. Among these, the highest consumption costs were for carbapenems, followed by colistin and caspofungin. Conclusion: This study showed the high burden of nosocomial infections in ICUs. Strategies for more strict infection prevention and control are necessary to reduce this burden.

Healthcare-associated infections (HAIs) are considered to be one of the biggest health problems as they continue to be an important cause of morbidity and mortality worldwide. They cannot be completely prevented, but their incidence can be significantly limited. Preventive action is the most important measure in this case. Due to the frequent interaction between healthcare professionals and patients, the crucial importance of hand hygiene is therefore emphasised. Adherence to good disinfection and hand washing practices remains around 40%, which can be improved by using a variety of nudge tools to promote desired hygienic behaviour. We conducted an open observation of employees and visitors with participation. The aim of this study was to determine the actual status of hand disinfection in a selected healthcare facility amongst doctors, registered nurses, medical technicians, cleaners, and visitors or parents of children; then, we selected and introduced three nudge tools of desired hygiene behaviour and analysed their effectiveness; finally, we provided suggestions for the use of nudge tools of desired hygiene behaviour with the aim of influencing doctors, registered nurses, medical technicians, cleaners, and visitors or parents of children so that they disinfect their hands properly. The actual state of hand disinfection was determined on the basis of observation without introducing any changes; then, we separately introduced three nudge tools, posters with an inscription and picture, the scent of citrus, and flashing lights. The obtained results were analysed with the help of the SpeedyAudit Lite application, and the effectiveness of each nudge tool and the adequacy of hand disinfection by categories of people were compared. In general, posters with a picture and an inscription contributed the most to more consistent disinfection of employees’ hands, while the scent of citrus and flashing lights contributed slightly less.

Abstract Background Following publication of the 2009 World Health Organizations Guidelines for Hand Hygiene in Health Care, a debate has emerged regarding the relative antimicrobial efficacy of the different formats (rinse, gel, foam) of ABHRs and their ability to contribute to reduction of healthcare-associated infections (HAIs). Methods Data regarding the in-vivo antimicrobial efficacy of ABHRs and other factors that likely affect their effectiveness in reducing HAIs were reviewed, and a comprehensive review of studies that reported the effectiveness of each of the three ABHR formats to improve hand hygiene compliance and reduce HAIs was conducted. Results The amount of rubbing time it takes for hands to feel dry (dry time) is the major driver of ABHR antimicrobial efficacy. ABHR format is not a major factor, and several studies found that rinse, gel, and foam ABHRs have comparable in-vivo antimicrobial efficacy. Other factors that likely impact the ability of ABHRs to reduce transmission of healthcare-associated pathogens and HAIs include ABHR formulation, the volume applied to hands, aesthetic characteristics, skin tolerance, acceptance by healthcare personnel, and hand hygiene compliance rates. When accompanied by complementary strategies, promoting the use of each of the three ABHR formats has been associated with improvements in hand hygiene compliance rates. A review of 67 studies failed to identify an ABHR format that was significantly more effective in yielding statistically significant reductions in transmission of healthcare-associated pathogens or HAIs. Conclusions Current evidence is insufficient to definitively determine if one ABHR format is more effective in reducing transmission of healthcare-associated pathogens and HAIs. More rigorous studies such as multicenter randomized controlled trials comparing the different formats are needed to establish if one format is significantly more effective in reducing HAIs.

Healthcare-associated infections (HAIs) remain a significant patient safety problem that can lead to illness and death, despite the implementation of clinical bundles to prevent HAIs. Management practices can support HAI prevention, but their role in HAI performance monitoring and feedback is not well understood. To address this knowledge gap, we previously conducted semi-structured interviews with staff at 18 hospitals to examine the role of management practices around the prevention of central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs). Interview transcripts were analyzed to identify themes related to HAI performance monitoring and feedback. The current analysis focuses on 10 higher-performing hospitals that were successful in preventing CLABSIs and CAUTIs. These institutions had robust practices including timely event analysis, leadership engagement, and multidisciplinary participation in HAI reviews. Across these sites, we found common goals including investigating HAIs without blame and identifying opportunities for improvement. Management practices such as timely analysis of HAIs, collaboration between facility leadership and multidisciplinary team members, and a focus on identifying the failure of a procedure or protocol, rather than the failure of staff members, are all approaches that can support infection prevention efforts. These management practices may be especially important as hospitals attempt to address increases in CLABSI and CAUTI rates that may have occurred during the coronavirus pandemic.

Abstract Background This cross-sectional study investigates infection prevention and control (IPC) competencies among healthcare professionals in northwest China, examining the influence of demographic factors, job titles, education, work experience, and hospital levels. Methods Data from 874 respondents across 47 hospitals were collected through surveys assessing 16 major IPC domains. Statistical analyses, including Mann-Whitney tests, were employed to compare competencies across variables. Results Significant differences were identified based on gender, job titles, education, work experience, and hospital levels. Females demonstrated higher IPC competencies, while senior positions exhibited superior performance. Higher educational attainment and prolonged work experience positively correlated with enhanced competencies. Variances across hospital levels underscored context-specific competencies. Conclusion Demographic factors and professional variables significantly shape IPC competencies. Tailored training, considering gender differences and job roles, is crucial. Higher education and prolonged work experience positively impact proficiency. Context-specific interventions are essential for diverse hospital settings, informing strategies to enhance IPC skills and mitigate healthcare-associated infections effectively.

Abstract Background In November 2022, Italy participated in the third edition of the European Centre for disease prevention and control (ECDC) point prevalence survey (PPS) of healthcare-associated infections (HAIs) in acute-care hospitals. A questionnaire based on the WHO infection prevention and control assessment framework (IPCAF) was included, which aims to investigate multimodal strategies for the implementation of IPC interventions. Methods A PPS was conducted using the ECDC PPS protocol version 6.0. The Regional health authority of the region of Piedmont, in north-western Italy, chose to enlist all public acute-care hospitals. Data were collected within one day per each ward, within 3 weeks in each hospital, at hospital, ward and patient level. A score between 0–1 or 0–2 was assigned to each of the 9 items in the IPCAF questionnaire, with 14 points representing the best possible score. HAI prevalence was calculated at the hospital-level as the percentage of patients with at least one HAI over all included patients. Relations between HAI prevalence, IPCAF score, and other hospital-level variables were assessed using Spearman's Rho coefficient. Results In total, 42 acute-care hospitals of the region of Piedmont were involved, with a total of 6865 included patients. All participant hospitals reported they employed multimodal strategies to implement IPC interventions. The median IPCAF overall score was 11/14 (interquartile range, IQR: 9.25–12). The multimodal strategy with the highest level of adherence was education and training, followed by communication and reminders. Strategies with the lowest level of adherence were safety climate and culture of change, and system change. Overall HAI prevalence was 8.06%. A weak to moderate inverse relation was found between IPCAF score and HAI prevalence (Spearman’s Rho -0.340, p 0.034). No other significant correlation was found. Conclusions This study found a high self-reported overall level of implementation of multimodal strategies for IPC in the region. Results of this study suggest the relevance of the multimodal approach and the validity of the IPCAF score in measuring IPC programs, in terms of effectiveness of preventing HAI transmission.

Background: Healthcare-Associated Infections (HAI) outbreaks remain a huge challenge to the healthcare sectors worldwide. Their impact on morbidity and mortality, economic and healthcare burden remains a public health problem and a challenge to the HAI surveillance system, infection control, and HAI management strategies. Aim: This study aimed to investigate the epidemiological patterns, distribution, causative agents of HAI outbreaks and the influence of age, COVID-19 co-infection, medical invasive procedures, and hospital units on mortality among HAI outbreaks cases. Methods: This chart review study involved HAI outbreak cases recorded in Ministry of Health hospitals during 2020–2021 in Saudi Arabia. HAI outbreak notification and investigation forms were used for data collection. A binary logistic regression model was performed to determine the significant predictors of mortality. Univariate analyses were performed to determine the association between hospital units, organisms, and COVID-19 co-infection to the site of infection. Results: A total of 217 HAI outbreaks with 1003 cases were recorded in 2020–2021. Gram-negative bacteria were isolated from 73.8% of the cases. The overall specific case fatality rate was 47.5%. The significant predictors of mortality were age, invasive medical procedures, COVID-19 co-infection, and intensive care units’ admission. Moreover, ventilator-associated events were more associated with cases co-infected with COVID-19. Conclusion: HAI outbreaks were most prevalent in the Western and Central region and in intensive care units. Gram negative bacteria were responsible for most of cases while ventilator-associated events and central line-associated bloodstream infections were the most common infection sites. Implementing targeted and effective prevention and control strategies is recommended.

Background: A multidrug-resistant lineage of Staphylococcus epidermidis named ST215 is a common cause of prosthetic joint infections and other deep surgical site infections in Northern Europe, but is not present elsewhere. The increasing resistance among S. epidermidis strains is a global concern. We used whole-genome sequencing to characterize ST215 from healthcare settings. Results: We completed the genome of a ST215 isolate from a Swedish hospital using short and long reads, resulting in a circular 2,676,787 bp chromosome and a 2,326 bp plasmid. The new ST215 genome was placed in phylogenetic context using 1,361 finished public S. epidermidis reference genomes. We generated 10 additional short-read ST215 genomes and 11 short-read genomes of ST2, which is another common multidrug-resistant lineage at the same hospital. We studied recombination's role in the evolution of ST2 and ST215, and found multiple recombination events averaging 30–50 kb. By comparing the results of antimicrobial susceptibility testing for 31 antimicrobial drugs with the genome content encoding antimicrobial resistance in the ST215 and ST2 isolates, we found highly similar resistance traits between the isolates, with 22 resistance genes being shared between all the ST215 and ST2 genomes. The ST215 genome contained 29 genes that were historically identified as virulence genes of S. epidermidis ST2. We established that in the nucleotide sequence stretches identified as recombination events, virulence genes were overrepresented in ST215, while antibiotic resistance genes were overrepresented in ST2. Conclusions: This study features the extensive antibiotic resistance and virulence gene content in ST215 genomes. ST215 and ST2 lineages have similarly evolved, acquiring resistance and virulence through genomic recombination. The results highlight the threat of new multidrug-resistant S. epidermidis lineages emerging in healthcare settings. [ABSTRACT FROM AUTHOR]

Background/Objectives: Hand hygiene (HH) is pivotal in mitigating infectious disease transmission and enhancing public health outcomes. This study focuses on detailing the national surveillance system for alcohol-based hand rub (ABHR) consumption in healthcare facilities across Italy, presenting results from a comprehensive three-year evaluation period, from 2020 to 2022. It aims to delineate this surveillance system and report on ABHR consumption trends in various Regions/Autonomous Provinces (Rs/APs). Methods: ABHR consumption data, collected through the ABHR Italian national surveillance system, coordinated by the Istituto Superiore di Sanità (ISS), were analyzed. Statistical methods, e.g., the Mann–Whitney test, were used to assess trends in ABHR consumption, expressed in liters per 1000 patient days (L/1000PD). Results: The results show significant variation in ABHR consumption across Rs/APs and over the years studied. National median ABHR consumption decreased from 2020 to 2022, with a significant reduction from a median of 24.5 L/1000PD in 2020 to 20.4 L/1000PD in 2021 and 15.6 L/1000PD in 2022. Conclusions: The decline in ABHR consumption raises concerns about the ongoing adherence to HH practices in Italian healthcare settings. This underscores the essential role that systematic ABHR monitoring and improved surveillance play in enhancing HH compliance, suggesting that sustained and strategic efforts are fundamental to uphold high standards of hygiene and to effectively respond to fluctuating ABHR usage trends over time. Further research is needed to explore barriers to effective ABHR use and to develop targeted strategies to improve HH practices. [ABSTRACT FROM AUTHOR]

Background: Treatment of carbapenem-resistant Enterobacterales (CRE) infections in low-resource settings is challenging particularly due to limited treatment options. Colistin is the mainstay drug for treatment; however, nephrotoxicity and neurotoxicity make this drug less desirable. Thus, mortality may be higher among patients treated with alternative antimicrobials that are potentially less efficacious than colistin. We assessed mortality in patients with CRE bacteremia treated with colistin-based therapy compared to colistin-sparing therapy. Methods: We conducted a cross-sectional study using secondary data from a South African national laboratory-based CRE bacteremia surveillance system from January 2015 to December 2020. Patients hospitalized at surveillance sentinel sites with CRE isolated from blood cultures were included. Multivariable logistic regression modeling, with multiple imputations to account for missing data, was conducted to determine the association between in-hospital mortality and colistin-based therapy versus colistin-sparing therapy. Results: We included 1 607 case-patients with a median age of 29 years (interquartile range [IQR], 0–52 years) and 53% (857/1 607) male. Klebsiella pneumoniae caused most of the infections (82%, n=1 247), and the most common carbapenemase genes detected were blaOXA-48-like (61%, n=551), and blaNDM (37%, n=333). The overall in-hospital mortality was 31% (504/1 607). Patients treated with colistin-based combination therapy had a lower case fatality ratio (29% [152/521]) compared to those treated with colistin-sparing therapy 32% [352/1 086]) (p=0.18). In our imputed model, compared to colistin-sparing therapy, colistin-based therapy was associated with similar odds of mortality (adjusted odds ratio [aOR] 1.02; 95% confidence interval [CI] 0.78-1.33, p=0.873). Conclusion: In our resource-limited setting, the mortality risk in patients treated with colistin-based therapy was comparable to that of patients treated with colistin-sparing therapy. Given the challenges with colistin treatment and the increasing resistance to alternative agents, further investigations into the benefit of newer antimicrobials for managing CRE infections are needed. [ABSTRACT FROM AUTHOR]

Healthcare-associated infections (HAIs) are considered to be one of the biggest health problems as they continue to be an important cause of morbidity and mortality worldwide. They cannot be completely prevented, but their incidence can be significantly limited. Preventive action is the most important measure in this case. Due to the frequent interaction between healthcare professionals and patients, the crucial importance of hand hygiene is therefore emphasised. Adherence to good disinfection and hand washing practices remains around 40%, which can be improved by using a variety of nudge tools to promote desired hygienic behaviour. We conducted an open observation of employees and visitors with participation. The aim of this study was to determine the actual status of hand disinfection in a selected healthcare facility amongst doctors, registered nurses, medical technicians, cleaners, and visitors or parents of children; then, we selected and introduced three nudge tools of desired hygiene behaviour and analysed their effectiveness; finally, we provided suggestions for the use of nudge tools of desired hygiene behaviour with the aim of influencing doctors, registered nurses, medical technicians, cleaners, and visitors or parents of children so that they disinfect their hands properly. The actual state of hand disinfection was determined on the basis of observation without introducing any changes; then, we separately introduced three nudge tools, posters with an inscription and picture, the scent of citrus, and flashing lights. The obtained results were analysed with the help of the SpeedyAudit Lite application, and the effectiveness of each nudge tool and the adequacy of hand disinfection by categories of people were compared. In general, posters with a picture and an inscription contributed the most to more consistent disinfection of employees' hands, while the scent of citrus and flashing lights contributed slightly less. [ABSTRACT FROM AUTHOR]

The German health authorities' guidelines for medical devices in 2012 highlighted the importance of cleaning ultrasound probes, emphasizing their validation and reliability. In addition to automated and validated options, alternative manual methods such as wipe disinfection have gained traction due to their independence from additional hardware. The study examines the effectiveness of a manual cleaning process using wipes, addressing concerns raised by the Robert Koch Institute regarding the lack of validation for wipe disinfection of semi-critical devices. The EQUINOS colored wipe disinfection kit identified wetting gaps in all cleanings across four probes tested. The results indicate significant challenges in ensuring complete surface wetting, particularly in complex device parts such as clip-on areas and fixtures for additional biopsy attachments, suggesting that manual methods alone may not adequately mitigate the risk of infection transmission (p value < 0.0001). The study concludes that while manual disinfection methods are a commonly used alternative to automated reprocessing, there is a critical need for enhanced training and potentially the development of more effective manual disinfection techniques or colored wipes to ensure patient safety and compliance with healthcare hygiene standards. [ABSTRACT FROM AUTHOR]

From 2019 (pre-COVID-19) to 2022 (COVID-19 years), three tertiary Greek hospitals monitored MDRO bloodstream infection (BSI) and hospital acquisition relying on laboratory data. Surveillance covered carbapenem-resistant Enterobacterales (CRE), Acinetobacter baumannii (CRAB), Pseudomonas aeruginosa (CRPA), vancomycin-resistant enterococci (VRE), and methicillin-resistant Staphylococcus aureus (MRSA), in intensive care units (ICUs) and non-ICUs. Non-ICUs experienced significant increases in CRE, CRAB and VRE during the pandemic. In ICUs, CRE increased in 2021, CRAB in 2020 and 2021, and VRE in 2021 and 2022. KPC predominated among CRE. MDRO BSI and hospital acquisition incidence rates increased, driven by CRE and CRAB. [ABSTRACT FROM AUTHOR]

Background: Pandemic management and preparedness are more needed than ever before and there is widespread governmental interest in learning from the COVID-19 pandemic in order to ensure the availability of evidence-based Infection Prevention and Control measures. Contact tracing is integral to Infection Prevention and Control, facilitating breaks in the chain of transmission in a targeted way, identifying individuals who have come into contact with an infected person, and providing them with instruction/advice relating to testing, medical advice and/or self-isolation. Aim: This study aims to improve our understanding of the use of contact tracing technologies in healthcare settings. This research seeks to contribute to the field of Infection Prevention and Control by investigating how these technologies can mitigate the spread of nosocomial infections. Ultimately, this study aims to improve the quality and safety of healthcare delivery. Methods: A systematic literature review was conducted, and journal articles investigating the use of contact tracing technologies in healthcare settings were retrieved from databases held on the OvidSP platform between March and September 2022, with no date for a lower limit. Results: In total, 277 studies were retrieved and screened, and 14 studies were finally included in the systematic literature review. Most studies investigated proximity sensing technologies, reporting promising results. However, studies were limited by small sample sizes and confounding factors, revealing contact tracing technologies remain at a nascent stage. Investment in research and development of new testing technologies is necessary to strengthen national and international contact tracing capabilities. Conclusion: This review aims to contribute to those who intend to create robust surveillance systems and implement infectious disease reporting protocols. [ABSTRACT FROM AUTHOR]

Healthcare-associated infections (HAIs) can pose significant risks to patients with cardiovascular disease due to the compromised nature of their health and potential vulnerabilities. In order to reduce the incidence of HAIs and prevent the spread of antibiotic-resistant organisms, it is mandatory to develop surveillance systems. We undertook a retrospective case–control study of all patients presenting HAIs who were admitted to the intensive care unit (ICU) to assess risk factors associated with death among patients with cardiovascular disease. Patients admitted to the ICU who died were more likely to present an infection with a multidrug-resistant bacterium, an infection with Acinetobacter baumannii, and to suffer from acute myocardial infarction. Among the patients enrolled in the study, a higher probability of death was also observed in association with certain Gram-negative pathogens such as Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudomonas aeruginosa. The longer the patient remains admitted in the ICU, the higher the risk of acquiring an infection that can often become fatal. A nosocomial infection, particularly in patients with cardiovascular disease, also increases the length of hospitalization, which will lead to increased expenditure. For this reason, new prophylactic methods and therapeutic approaches are needed, and researchers' efforts should be directed in this direction. [ABSTRACT FROM AUTHOR]

Patients with cancer experience higher rates of preventable harm from hospital-acquired bloodstream infections (haBSIs) and central-line-associated bloodstream infections (CLABSIs) compared with the general hospital population. The prevention of haBSIs and CLABSIs in patients with cancer is an urgent priority, and requires standardized surveillance and reporting efforts. The application of haBSI and CLABSI definitions, classification systems and surveillance strategies for patients with cancer is complex, and there is wide variation in clinical practice. Existing systems were not designed explicitly for patients with cancer, and have different strengths and weaknesses in the cancer setting. For these reasons, epidemiological estimates of haBSIs and CLABSIs in patients with cancer also require careful interpretation. This complexity can be a barrier to identifying appropriate targets for intervention and reducing preventable harm. This review provides an overview of key concepts and challenges in haBSI surveillance and prevention specific to patients with cancer. In addition, this review summarizes the strengths and weaknesses of commonly used surveillance definitions and denominators in the setting of cancer care; existing surveillance practice; epidemiology of haBSIs and CLABSIs; prevention strategies; and current knowledge gaps. A global collaborative effort to harmonize the surveillance of hospital-acquired infections in patients with cancer would be invaluable to improve the accuracy and utility of existing data, advance efforts to prevent hospital-acquired infections, and improve patient safety. [ABSTRACT FROM AUTHOR]

Background: Healthcare-associated infections (HAIs) and antimicrobial resistance (AMR) continue to contribute to excess morbidity and mortality among Canadians. Objective: This report describes epidemiologic and laboratory characteristics and trends of HAIs and AMR from 2018 to 2022 (Candida auris, 2012-2022) using surveillance and laboratory data submitted by hospitals to the Canadian Nosocomial Infection Surveillance Program (CNISP) and by provincial and territorial laboratories to the National Microbiology Laboratory. Methods: Data collected from 88 Canadian sentinel acute care hospitals between January 1, 2018, and December 31, 2022, for Clostridioides difficile infections (CDIs), carbapenemaseproducing Enterobacterales (CPE) infections, methicillin-resistant Staphylococcus aureus (MRSA) bloodstream infections (BSIs) and vancomycin-resistant Enterococcus (VRE) BSIs. Candida auris (C. auris) surveillance was initiated in 2019 by CNISP and in 2017 (retrospectively to 2012) by the National Microbiology Laboratory. Trend analysis for case counts, rates, outcomes, molecular characterization and AMR profiles are presented. Results: From 2018 to 2022, decreased rates per 10,000 patient days were observed for CDIs (7% decrease; 5.42-5.02) and MRSA BSIs (2.9% decrease; 1.04-1.01). Infection rates for VRE BSIs increased by 5.9% (0.34-0.36). Infection rates for CPE remained low but increased by 133% (0.06-0.14). Forty-three C. auris isolates were identified in Canada from 2012 to 2022, with the majority in Western and Central Canada (98%). Conclusion: From 2018 to 2022, the incidence of MRSA BSIs and CDIs decreased and VRE BSI and CPE infections increased in the Canadian acute care hospitals participating in a national sentinel network (CNISP). Few C. auris isolates were identified from 2012 to 2022. Reporting standardized surveillance data to inform the application of infection prevention and control practices in acute care hospitals is critical to help decrease the burden of HAIs and AMR in Canada. [ABSTRACT FROM AUTHOR]

Purpose of Review: The aim of this review is to examine healthcare-associated fungal outbreaks (HAFO) in children. Our primary objective is to dissect epidemiology and etiology aspects to contribute to the investigation, prevention, and control of HAFO in pediatric settings. Recent Findings: Latest studies have highlighted an increase in fungal infections among hospitalized children. These studies have revealed the involvement of environmental sources and cross-transmission through healthcare workers in the development of outbreaks. The diagnosis of fungal infections poses challenges, as does outbreak control due to non-routine surveillance and resistance of fungi to disinfectants and therapeutic drugs. Summary: Recognition of risk factors, etiologic agents, diagnostic methods, and types of transmission that facilitate fungal infections in children is crucial to understand the importance of prompt outbreak investigation and control. Addressing research gaps in disinfection technologies and exploring the potential application of artificial intelligence on outbreak anticipation could aid in mitigating the impact of HAFO on pediatric populations. [ABSTRACT FROM AUTHOR]

Background: Effort–reward imbalance (ERI) refers to the situation where there is a mismatch between the effort that healthcare workers (HCWs) put into their work and the rewards they receive in return. Burnout, on the other hand, is a psychological syndrome characterized by emotional exhaustion, depersonalization, and reduced personal accomplishment. This study aimed to assess the impact of ERI and burnout on the compliance with standard precautions (SPs) among nurses and midwives in Lebanese hospitals under the economic crisis and after the COVID-19 pandemic. Methods: Cross-sectional correlational study, based on self-administered questionnaire data, measuring the compliance with SPs, ERI, and burnout, in addition to the relationship between these factors, was performed among 409 nurses and midwives, working in Lebanese hospitals. Results: ERI was significantly associated with exposure to burnout among nurses and midwives, and burnout was found to be a significant predictor of nurses and midwives' self-reported adherence with SPs. Conclusions: This study highlights the contribution of ERI and burnout to the chain of infection by decreased adherence to infection control SPs of nurses and midwives. [ABSTRACT FROM AUTHOR]

Healthcare-associated infections (HAIs) remain a significant patient safety problem that can lead to illness and death, despite the implementation of clinical bundles to prevent HAIs. Management practices can support HAI prevention, but their role in HAI performance monitoring and feedback is not well understood. To address this knowledge gap, we previously conducted semi-structured interviews with staff at 18 hospitals to examine the role of management practices around the prevention of central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs). Interview transcripts were analyzed to identify themes related to HAI performance monitoring and feedback. The current analysis focuses on 10 higher-performing hospitals that were successful in preventing CLABSIs and CAUTIs. These institutions had robust practices including timely event analysis, leadership engagement, and multidisciplinary participation in HAI reviews. Across these sites, we found common goals including investigating HAIs without blame and identifying opportunities for improvement. Management practices such as timely analysis of HAIs, collaboration between facility leadership and multidisciplinary team members, and a focus on identifying the failure of a procedure or protocol, rather than the failure of staff members, are all approaches that can support infection prevention efforts. These management practices may be especially important as hospitals attempt to address increases in CLABSI and CAUTI rates that may have occurred during the coronavirus pandemic. [ABSTRACT FROM AUTHOR]

Background: Healthcare-associated infections (HAIs) pose a grave threat to patient safety, morbidity, and mortality, contributing to antimicrobial resistance. Thus, we estimated the point prevalence, risk factors, types, and pathogens of HAIs in hospitalized pediatric patients. Methods: A point prevalence survey (PPS) of HAIs in hospitalized pediatric patients < 18 years old was conducted from March to May 2021. Outcomes, risk factors, and types of HAIs associated with HAIs in 41 hospitals across Thailand were collected. Results: The prevalence of HAIs was 3.9% (95% CI 2.9–5.0%) (56/1443). By ages < 1 month, 1 month–2 years, 2–12 years, and 12–18 years, the prevalence of HAIs was 4.2%, 3.3%, 4.1%, and 3.0%, respectively (p = 0.80). Significant independent risk factors were extended hospital length of stay (LOS) and central venous catheter (CVC) use. Compared to an LOS of <4 days, LOSs of 4–7 days, 8–14 days, and >14 days had adjusted odds ratios (aORs) of 2.65 (95% CI 1.05, 6.68), 5.19 (95% CI 2.00, 13.4), and 9.03 (95% CI 3.97, 20.5), respectively. The use of a CVC had an aOR of 2.45 (95% CI 1.06–5.66). Lower respiratory tract infection (LRTI) was the most common HAI type (46.4%: 26/56). The highest prevalence of HAIs was predominantly observed in LRTI diagnoses, with the highest among these in the <1 month age category at 2.3% (17/738). Conclusion: The prevalence of HAIs in hospitalized pediatric patients was 3.9%. Extended LOS and use of CVC were HAI risk factors. A strategy for reducing LOS and reviewing insertion indications or the early planned removal of a CVC was implemented. The surveillance of HAIs stands as a cornerstone and fundamental component of IPC, offering invaluable insights that enhance hospital IPC interventions aimed at preventing HAIs. [ABSTRACT FROM AUTHOR]

Background: Following publication of the 2009 World Health Organizations Guidelines for Hand Hygiene in Health Care, a debate has emerged regarding the relative antimicrobial efficacy of the different formats (rinse, gel, foam) of ABHRs and their ability to contribute to reduction of healthcare-associated infections (HAIs). Methods: Data regarding the in-vivo antimicrobial efficacy of ABHRs and other factors that likely affect their effectiveness in reducing HAIs were reviewed, and a comprehensive review of studies that reported the effectiveness of each of the three ABHR formats to improve hand hygiene compliance and reduce HAIs was conducted. Results: The amount of rubbing time it takes for hands to feel dry (dry time) is the major driver of ABHR antimicrobial efficacy. ABHR format is not a major factor, and several studies found that rinse, gel, and foam ABHRs have comparable in-vivo antimicrobial efficacy. Other factors that likely impact the ability of ABHRs to reduce transmission of healthcare-associated pathogens and HAIs include ABHR formulation, the volume applied to hands, aesthetic characteristics, skin tolerance, acceptance by healthcare personnel, and hand hygiene compliance rates. When accompanied by complementary strategies, promoting the use of each of the three ABHR formats has been associated with improvements in hand hygiene compliance rates. A review of 67 studies failed to identify an ABHR format that was significantly more effective in yielding statistically significant reductions in transmission of healthcare-associated pathogens or HAIs. Conclusions: Current evidence is insufficient to definitively determine if one ABHR format is more effective in reducing transmission of healthcare-associated pathogens and HAIs. More rigorous studies such as multicenter randomized controlled trials comparing the different formats are needed to establish if one format is significantly more effective in reducing HAIs. [ABSTRACT FROM AUTHOR]

Around 5% to 10% of hospitalized patients develop a hospital-acquired infection (HAI). Scrubs are a potential vector of HAIs. To compare the antimicrobial characteristics of scrubs with and without an antimicrobial fabric coating, as tested in the laboratory (in vitro) and hospital (in vivo) environments. Two protocols were conducted to address the purpose. The in vitro protocol was a laboratory study that involved observing the microbe growth after inoculating coated and uncoated scrub fabric swatches with S. aureus and then processing them in moist and dry environments. The in vivo protocol was a clinical trial that measured microbe growth on coated and uncoated scrubs prior to and following nursing staff completing a 12-hr shift on an acute care unit, as measured by colony forming units (CFUs). For high-humidity environments, the in vitro study indicated that swatches treated with an antimicrobial coating exhibited minimal microbe growth, while untreated swatches exhibited significant microbe growth. For low-humidity environments, coated and uncoated swatches were all found to exhibit minimal microbe growth. In the in vivo study, the CFUs increased on scrubs worn by nurses over a 12-hr shift with no significant difference in CFUs for coated and uncoated scrubs. For bacteria in a warm and moist environment, the antimicrobial coating was found to be important for inhibiting growth. For bacteria in a warm and dry environment, both coated and uncoated fabrics performed similarly as measured at 24 hr, with minimal bacterial growth observed. In a hospital environment, microbe growth was observed, but no significant difference was detected when comparing coated and uncoated scrubs. This may have been due to the short time between exposure and culturing the scrubs for analysis immediately at the end of the shift not allowing for enough time to kill or inhibit growth. Contact time between the bacteria and scrub fabric (coated or uncoated) in the in vivo study more directly correlated with the 0-hr observations for the in vitro study, suggesting that the ineffectiveness of the treated scrubs in the clinical results may be due in part to short residence times before collection. [ABSTRACT FROM AUTHOR]

Candida auris, a multidrug-resistant yeast, poses significant challenges in healthcare settings worldwide. Understanding its environmental reservoirs is crucial for effective control strategies. This systematic review aimed to review the literature regarding the natural and environmental reservoirs of C. auris. Following the PRISMA guidelines, published studies until October 2023 were searched in three databases: PubMed, Web of Science, and Scopus. Information regarding the origin, sampling procedure, methods for laboratory identification, and antifungal susceptibility was collected and analyzed. Thirty-three studies published between 2016 and 2023 in 15 countries were included and analyzed. C. auris was detected in various environments, including wastewater treatment plants, hospital patient care surfaces, and natural environments such as salt marshes, sand, seawater, estuaries, apples, and dogs. Detection methods varied, with molecular techniques often used alongside culture. Susceptibility profiles revealed resistance patterns. Phylogenetic studies highlight the potential of environmental strains to influence clinical infections. Despite methodological heterogeneity, this review provides valuable information for future research and highlights the need for standardized sampling and detection protocols to mitigate C. auris transmission. [ABSTRACT FROM AUTHOR]

Increasingly common and associated with healthcare settings, Candida infections are very important, since some species of this genus can develop antifungal resistance. We contribute data on the epidemiology, antifungal susceptibility, and genetic diversity of Candida non-albicans and non-auris affecting critically ill patients in a fourth-level hospital in Colombia. Ninety-seven isolates causing invasive infections, identified by conventional methods over 18 months, were studied. Data from patients affected by these yeasts, including sex, age, comorbidities, treatment, and outcome, were analysed. The antifungal susceptibility of the isolates was determined, and the ribosomal DNA was sequenced. Candida parapsilosis, Candida tropicalis, Candida glabrata, Candida dubliniensis, and Candida guilliermondii caused 48.5% of all cases of invasive candidiasis. The species were mainly recovered from blood (50%). Patients were mostly men (53.4%), between 18 days and 93 years old, hospitalized in the ICU (70.7%). Overall mortality was 46.6%, but patients in the ICU, using antibiotics, with diabetes mellitus, or with C. glabrata infections were more likely to die. Resistant isolates were identified in C. parapsilosis, C. tropicalis, and C. glabrata. This study provides epidemiological data for the surveillance of emerging Candida species, highlighting their clinical impact, as well as the emergence of antifungal resistance and clonal dispersal. [ABSTRACT FROM AUTHOR]