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1. Improving Hand Hygiene Compliance in Nursing Homes: Protocol for a Cluster Randomized Controlled Trial (HANDSOME Study)

Author

Teesing, Gwen R, Erasmus, Vicki, Petrignani, Mariska, Koopmans, Marion P G, de Graaf, Miranda, Vos, Margreet C, Klaassen, Corné H W, Verduijn-Leenman, Annette, Schols, Jos M G A, Richardus, Jan Hendrik, and Voeten, Helene A C M

Subjects
Medicine, Computer applications to medicine. Medical informatics, R858-859.7
Abstract

BackgroundHand hygiene compliance is considered the most (cost-)effective measure for preventing health care–associated infections. While hand hygiene interventions have frequently been implemented and assessed in hospitals, there is limited knowledge about hand hygiene compliance in other health care settings and which interventions and implementation methods are effective. ObjectiveThis study aims to evaluate the effect of a multimodal intervention to increase hand hygiene compliance of nurses in nursing homes through a cluster randomized controlled trial (HANDSOME study). MethodsNursing homes were randomly allocated to 1 of 3 trial arms: receiving the intervention at a predetermined date, receiving the identical intervention after an infectious disease outbreak, or serving as a control arm. Hand hygiene was evaluated in nursing homes by direct observation at 4 timepoints. We documented compliance with the World Health Organization’s 5 moments of hand hygiene, specifically before touching a patient, before a clean/aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching patient surroundings. The primary outcome is hand hygiene compliance of the nurses to the standards of the World Health Organization. The secondary outcome is infectious disease incidence among residents. Infectious disease incidence was documented by a staff member at each nursing home unit. Outcomes will be compared with the presence of norovirus, rhinovirus, and Escherichia coli on surfaces in the nursing homes, as measured using quantitative polymerase chain reaction. ResultsThe study was funded in September 2015. Data collection started in October 2016 and was completed in October 2017. Data analysis will be completed in 2020. ConclusionsHANDSOME studies the effectiveness of a hand hygiene intervention specifically for the nursing home environment. Nurses were taught the World Health Organization’s 5 moments of hand hygiene guidelines using the slogan “Room In, Room Out, Before Clean, After Dirty,” which was developed for nursing staff to better understand and remember the hygiene guidelines. HANDSOME should contribute to improved hand hygiene practice and a reduction in infectious disease rates and related mortality. Trial RegistrationNetherlands Trial Register (NTR6188) NL6049; https://www.trialregister.nl/trial/6049 International Registered Report Identifier (IRRID)DERR1-10.2196/17419

Published
2020
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6. Contact investigations for antibiotic-resistant bacteria: a mixed-methods study of patients’ comprehension of and compliance with self-sampling requests post-discharge

Author

van Veen, Anneloes, Lescure, Dominique L. A., Verhaegh, Suzanne J. C., de Goeij, Inge, Erasmus, Vicki, van Beeck, Ed F., Tjon-a-Tsien, Aimée, Splinter, José, Christiaanse, Jan C., Damen, Marjolein, Huijskens, Elisabeth G. W., Paltansing, Sunita, van Rijn, Michiel, Veenemans, Jacobien, Vos, Margreet C., and Severin, Juliëtte A.

Published
2023
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10. Combining epidemiological data and whole genome sequencing to understand SARS-CoV-2 transmission dynamics in a large tertiary care hospital during the first COVID-19 wave in The Netherlands focusing on healthcare workers

Author

Haanappel, Cynthia P., Oude Munnink, Bas B., Sikkema, Reina S., Voor in ’t holt, Anne F., de Jager, Herbert, de Boever, Rieneke, Koene, Heidy H. H. T., Boter, Marjan, Chestakova, Irina V., van der Linden, Anne, Molenkamp, Richard, Osbak, Kara K., Arcilla, Maris S., Vos, Margreet C., Koopmans, Marion P. G., and Severin, Juliëtte A.

Published
2023
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11. Markers of epidemiological success of methicillin-resistant Staphylococcus aureus isolates in European populations

Author

Baede, Valérie O., Gupta, Arya, Knight, Gwenan M., Schouls, Leo M., Laing, Ken, Tavakol, Mehri, Barray, Anaïs, de Vlas, Sake J., de Vos, Anneke S., Hendrickx, Antoni P.A., Khan, Madeeha, Kretzschmar, Mirjam E., van Wamel, Willem J.B., Lina, Gérard, Vandenesch, Francois, Vos, Margreet C., Witney, Adam A., Rasigade, Jean-Philippe, and Lindsay, Jodi A.

Published
2023
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22. Contact precautions in single-bed or multiple-bed rooms for patients with extended-spectrum β-lactamase-producing Enterobacteriaceae in Dutch hospitals: a cluster-randomised, crossover, non-inferiority study

Author

Bonten, Marc, Bootsma, Martin, de Brauwer, Els, Bruijning-Verhagen, Patricia, Buiting, Anton, Diederen, Bram, van Elzakker, Erika, Friedrich, Alexander, Hopman, Joost, Kampinga, Greetje, van Keulen, Peter, Kluytmans, Jan, Kluytmans-van den Bergh, Marjolein, al Naiemi, Nashwan, Oudhuis, Guy, Raangs, Erwin, Rosema, Sigrid, Rossen, John, Ruijs, Gijs, Savelkoul, Paul, Troelstra, Annet, Vandenbroucke-Grauls, Christina, Verduin, Kees, Verhulst, Carlo, Vos, Margreet, Voss, Andreas, Willems, Rob, Willemsen, Ina, Kluytmans-van den Bergh, Marjolein F Q, Bruijning-Verhagen, Patricia C J, Vandenbroucke-Grauls, Christina M J E, de Brauwer, Els I G B, Buiting, Anton G M, Diederen, Bram M, van Elzakker, Erika P M, Friedrich, Alex W, Rossen, John W A, Ruijs, Gijs J H M, Savelkoul, Paul H M, Vos, Margreet C, Bonten, Marc J M, and Kluytmans, Jan A J W

Published
2019
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23. Communication training for general practitioners aimed at improving antibiotic prescribing: a controlled before-after study in multicultural Dutch cities

Author

HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Lescure, Dominique L A, Erdem, Özcan, Nieboer, Daan, Huijser van Reenen, Natascha, Tjon-A-Tsien, Aimée M L, van Oorschot, Wilbert, Brouwer, Rob, Vos, Margreet C, van der Velden, Alike W, Richardus, Jan Hendrik, Voeten, Hélène A C M, HAG Infectieziekten, Infection & Immunity, JC onderzoeksprogramma Infectieziekten, Lescure, Dominique L A, Erdem, Özcan, Nieboer, Daan, Huijser van Reenen, Natascha, Tjon-A-Tsien, Aimée M L, van Oorschot, Wilbert, Brouwer, Rob, Vos, Margreet C, van der Velden, Alike W, Richardus, Jan Hendrik, and Voeten, Hélène A C M

Published
2024

24. Effect of a novel endoscope cleaning brush on duodenoscope contamination

Author

Van Der Ploeg, Koen, Haanappel, Cynthia P., Voor In 'T Holt, Anne F., De Groot, Woutrinus, Bulkmans, Adriana J.C., Erler, Nicole S., Mason-Slingerland, Bibi C.G.C., Vos, Margreet C., Bruno, Marco J., Severin, Juliëtte A., Van Der Ploeg, Koen, Haanappel, Cynthia P., Voor In 'T Holt, Anne F., De Groot, Woutrinus, Bulkmans, Adriana J.C., Erler, Nicole S., Mason-Slingerland, Bibi C.G.C., Vos, Margreet C., Bruno, Marco J., and Severin, Juliëtte A.

Abstract

Background and aims:Current duodenoscope reprocessing protocols are insufficient to prevent contamination and require adaptations to prevent endoscopy-associated infections (EAI). This study aimed to investigate the effect of a new endoscope cleaning brush on the contamination rate of ready-to-use duodenoscopes. Methods:This retrospective before-and-after intervention study collected duodenoscope surveillance culture results from March 2018 to June 2022. Contamination was defined as ≥1 colony-forming units of gastrointestinal or oral microorganisms (MGO). In December 2020, an endoscope cleaning brush with a sweeper design was introduced as the intervention in the manual cleaning of duodenoscopes. A logistic mixed effects model was used to study the effects of the intervention. Results:Data were collected from 176 culture sets before the new brush's introduction and 81 culture sets after. Pre-introduction, culture sets positive with MGO comprised 45.5% (95% CI: 38.3%-52.8%, 80/176), decreasing to 17.3% (95% CI: 10.6%-26.9%, 14/81) after implementing the new brush. Compared to the former brush, duodenoscopes cleaned with the new brush had lower odds of contamination with MGO (aOR=0.25, 95% CI: 0.11-0.58, p=0.001).Conclusions:Use of the new brush in manual cleaning reduced contamination with MGO and is expected to prevent EAIs. These findings should be confirmed in future prospective randomized studies.

Published
2024

25. A Search Strategy for Detecting Duodenoscope-Associated Infections:A Retrospective Observational Study

Author

van der Ploeg, Koen, Klaassen, Corné H W, Vos, Margreet C, Severin, Juliëtte A, Mason-Slingerland, Bibi C G C, Bruno, Marco J, van der Ploeg, Koen, Klaassen, Corné H W, Vos, Margreet C, Severin, Juliëtte A, Mason-Slingerland, Bibi C G C, and Bruno, Marco J

Abstract

Background: Duodenoscope-associated infections (DAIs) are exogenous infections resulting from the use of contaminated duodenoscopes. Though numerous outbreaks of DAI have involved multidrug-resistant micro-organisms (MDROs), outbreaks involving non-MDROs are also likely to occur. Detection challenges arise as these infections often resolve before culture or because causative strains are not retained for comparison with duodenoscope strains. Aim: To identify and analyse DAIs spanning a seven-year period in a tertiary care medical centre. Methods: This was a retrospective observational study. Duodenoscope cultures positive for gastrointestinal flora between March 2015 and September 2022 were paired with duodenoscope usage data to identify patients exposed to contaminated duodenoscopes. Analysis encompassed patients treated after a positive duodenoscope culture and those treated within the interval from a negative to a positive culture. Patient identification numbers were cross-referenced with a clinical culture database to identify patients developing infections with matching micro-organisms within one year of their procedure. A ‘pair’ was established upon a species-level match between duodenoscope and patient cultures. Pairs were further analysed via antibiogram comparison, and by whole-genome sequencing (WGS) to determine genetic relatedness. Findings: Sixty-eight pairs were identified; of these, 21 exhibited matching antibiograms which underwent WGS, uncovering two genetically closely related pairs categorized as DAIs. Infection onset occurred up to two months post procedure. Both causative agents were non-MDROs. Conclusion: This study provides crucial insights into DAIs caused by non-MDROs and it highlights the challenge of DAI recognition in daily practice. Importantly, the delayed manifestation of the described DAIs suggests a current underestimation of DAI risk.

Published
2024

26. Communication training for general practitioners aimed at improving antibiotic prescribing:A controlled before-after study in multicultural Dutch cities

Author

Lescure, Dominique L.A., Erdem, Özcan, Nieboer, Daan, Huijser van Reenen, Natascha, Tjon-A-Tsien, Aimée M.L., van Oorschot, Wilbert, Brouwer, Rob, Vos, Margreet C., van der Velden, Alike W., Richardus, Jan Hendrik, Voeten, Hélène A.C.M., Lescure, Dominique L.A., Erdem, Özcan, Nieboer, Daan, Huijser van Reenen, Natascha, Tjon-A-Tsien, Aimée M.L., van Oorschot, Wilbert, Brouwer, Rob, Vos, Margreet C., van der Velden, Alike W., Richardus, Jan Hendrik, and Voeten, Hélène A.C.M.

Abstract

Introduction: Suboptimal doctor-patient communication drives inappropriate prescribing of antibiotics. We evaluated a communication intervention for general practitioners (GPs) in multicultural Dutch cities to improve antibiotic prescribing for respiratory tract infections (RTI). Methods: This was a non-randomized controlled before-after study. The study period was pre-intervention November 2019 – April 2020 and post-intervention November 2021 – April 2022. The intervention consisted of a live training (organized between September and November 2021), an E-learning, and patient material on antibiotics and antibiotic resistance in multiple languages. The primary outcome was the absolute number of prescribed antibiotic courses indicated for RTIs per GP; the secondary outcome was all prescribed antibiotics per GP. We compared the post-intervention differences in the mean number of prescribed antibiotics between the intervention (N = 25) and the control group (N = 110) by using an analysis of covariance (ANCOVA) test, while adjusting for the pre-intervention number of prescribed antibiotics. Additionally, intervention GPs rated the training and their knowledge and skills before the intervention and 3 months thereafter. Results: There was no statistically significant difference in the mean number of prescribed antibiotics for RTI between the intervention and the control group, nor for mean number of overall prescribed antibiotics. The intervention GPs rated the usefulness of the training for daily practice a 7.3 (on a scale from 1–10) and there was a statistically significant difference between pre- and post-intervention on four out of nine items related to knowledge and skills. Discussion: There was no change in GPs prescription behavior between the intervention and control group. However, GPs found the intervention useful and showed some improvement on self-rated knowledge and communication skills.

Published
2024

27. Creating Synergy: The Partnership Between Infection Prevention & Control and Architectural Design for a Healthier Hospital.

Author

VOS, Margreet C., VOOR IN 'T HOLT, Anne F., SEVERIN, Juliëtte A., and VAN DER SCHOOR, Adriënne S.

Abstract

The symbiotic relationship between healthy hospital design and infection prevention and control (IPC) is crucial to developing a safe healthcare environment. Collaborative efforts in mitigating the risk of hospital-acquired infections (HAIs) are needed and will decrease morbidity, mortality rates, and costs. HAIs not only impact patient health but also tarnish the reputation of healthcare institutions. This paper delves into the distinctions between exogenous-derived and endogenousderived HAIs, elucidating their sources, transmission mechanisms, and preventive strategies. Exogenous-derived HAIs can be prevented by a well-designed hospital layout which minimize contamination. Endogenous-derived HAIs originate from the patient's own microbial flora, necessitating tailored infection prevention strategies such as antimicrobial prophylaxis. Standard precautions and transmissionbased precautions, as outlined by the Centers for Disease Control and Prevention (CDC), form the cornerstone of infection control efforts. Hospital design should facilitate compliance with these measures, ensuring a microbial-safe environment conducive to patient recovery. Interdisciplinary collaboration between architects, healthcare professionals, and infection control experts are needed to integrate infection control principles into hospital design processes effectively. Key considerations include optimizing patient flows, separating clean and dirty materials, and implementing robust ventilation systems to mitigate airborne transmission risks. Furthermore, selecting appropriate surface materials resistant to microbial growth and enabling effective cleaning and disinfection protocols are important to maintain a microbial safe hospital environment. Most importantly, the shift towards singleoccupancy rooms represents a significant stride in infection prevention, minimizing the risk of cross-contamination compared to multi-occupancy wards. Scientific evidence supports the efficacy of single-occupancy rooms in reducing microbial contamination and preventing HAIs. [ABSTRACT FROM AUTHOR]

Published
2024
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32. Regional Variation in the Interpretation of Contact Precautions for Multidrug-resistant Gram-negative bacteria: a cross-sectional survey

Author

van Veen, Anneloes, primary, de Goeij, Inge, additional, Damen, Marjolein, additional, Huijskens, Elisabeth G.W., additional, Paltansing, Sunita, additional, van Rijn, Michiel, additional, Bentvelsen, Robbert G., additional, Veenemans, Jacobien, additional, van der Linden, Michael, additional, Vos, Margreet C., additional, and Severin, Juliette, additional

Published
2024
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34. Communication training for general practitioners aimed at improving antibiotic prescribing: a controlled before-after study in multicultural Dutch cities

Author

Lescure, Dominique L. A., primary, Erdem, Özcan, additional, Nieboer, Daan, additional, Huijser van Reenen, Natascha, additional, Tjon-A-Tsien, Aimée M. L., additional, van Oorschot, Wilbert, additional, Brouwer, Rob, additional, Vos, Margreet C., additional, van der Velden, Alike W., additional, Richardus, Jan Hendrik, additional, and Voeten, Hélène A. C. M., additional

Published
2024
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35. Unveiling 8 years of duodenoscope contamination: insights from a retrospective analysis in a large tertiary care hospital

Author

van der Ploeg, Koen, primary, Haanappel, Cynthia P., additional, Voor in 't holt, Anne F., additional, de Groot, Woutrinus, additional, Bulkmans, Adriana J. C., additional, Erler, Nicole S., additional, Mason-Slingerland, Bibi C. G. C., additional, Severin, Juliëtte A., additional, Vos, Margreet C., additional, and Bruno, Marco J., additional

Published
2024
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39. Effect of novel endoscope cleaning brush on duodenoscope contamination

Author

van der Ploeg, Koen, additional, Haanappel, Cynthia P., additional, Voor in ’t holt, Anne F., additional, de Groot, Woutrinus, additional, Bulkmans, Adriana J.C., additional, Erler, Nicole S, additional, Mason-Slingerland, Bibi C.G.C., additional, Vos, Margreet C, additional, Bruno, Marco J., additional, and Severin, Juliëtte A., additional

Published
2023
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40. Universal screening or a universal risk assessment combined with risk-based screening for multidrug-resistant microorganisms upon admission: Comparing strategies

Author

van der Schoor, Adriënne S., primary, Severin, Juliëtte A., additional, Klaassen, Corné H. W., additional, van den Akker, Johannes P. C., additional, Bruno, Marco J., additional, Hendriks, Johanna M., additional, Vos, Margreet C., additional, and Voor in ‘t holt, Anne F., additional

Published
2023
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41. Global outbreak of severe Mycobacterium chimaera disease after cardiac surgery: a molecular epidemiological study

Author

van Ingen, Jakko, Kohl, Thomas A, Kranzer, Katharina, Hasse, Barbara, Keller, Peter M, Katarzyna Szafrańska, Anna, Hillemann, Doris, Chand, Meera, Schreiber, Peter Werner, Sommerstein, Rami, Berger, Christoph, Genoni, Michele, Rüegg, Christian, Troillet, Nicolas, Widmer, Andreas F, Becker, Sören L, Herrmann, Mathias, Eckmanns, Tim, Haller, Sebastian, Höller, Christiane, Debast, Sylvia B, Wolfhagen, Maurice J, Hopman, Joost, Kluytmans, Jan, Langelaar, Merel, Notermans, Daan W, ten Oever, Jaap, van den Barselaar, Peter, Vonk, Alexander B A, Vos, Margreet C, Ahmed, Nada, Brown, Timothy, Crook, Derrick, Lamagni, Theresa, Phin, Nick, Smith, E Grace, Zambon, Maria, Serr, Annerose, Götting, Tim, Ebner, Winfried, Thürmer, Alexander, Utpatel, Christian, Spröer, Cathrin, Bunk, Boyke, Nübel, Ulrich, Bloemberg, Guido V, Böttger, Erik C, Niemann, Stefan, Wagner, Dirk, and Sax, Hugo

Published
2017
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44. Prevention of severe infectious complications after colorectal surgery using oral non-absorbable antimicrobial prophylaxis: results of a multicenter randomized placebo-controlled clinical trial

Author

Mulder, Tessa, Kluytmans-van den Bergh, Marjolein, Vlaminckx, Bart, Roos, Daphne, de Smet, Anne Marie, de Vos tot Nederveen Cappel, Robert, Verheijen, Paul, Brandt, Alexandra, Smits, Anke, van der Vorm, Eric, Bathoorn, Erik, van Etten, Boudewijn, Veenemans, Jacobien, Weersink, Annemarie, Vos, Margreet, van ’t Veer, Nils, Nikolakopoulos, Stavros, Bonten, Marc, and Kluytmans, Jan

Published
2020
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