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Bocquier A, Erkilic B, Babinet M, Pulcini C, Agrinier N. Resident-, prescriber-, and facility-level factors associated with antibiotic use in long-term care facilities: a systematic review of quantitative studies. Antimicrob Resist Infect Control 2024; 13:29. [PMID: 38448955 PMCID: PMC10918961 DOI: 10.1186/s13756-024-01385-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 02/29/2024] [Indexed: 03/08/2024] Open
Abstract
BACKGROUND Antimicrobial stewardship programmes are needed in long-term care facilities (LTCFs) to tackle antimicrobial resistance. We aimed to identify factors associated with antibiotic use in LTCFs. Such information would be useful to guide antimicrobial stewardship programmes. METHOD We conducted a systematic review of studies retrieved from PubMed, Cochrane Library, Embase, APA PsycArticles, APA PsycINFO, APA PsycTherapy, ScienceDirect and Web of Science. We included quantitative studies that investigated factors associated with antibiotic use (i.e., antibiotic prescribing by health professionals, administration by LTCF staff, or use by residents). Participants were LTCF residents, their family, and/or carers. We performed a qualitative narrative synthesis of the findings. RESULTS Of the 7,591 screened records, we included 57 articles. Most studies used a longitudinal design (n = 34/57), investigated resident-level (n = 29/57) and/or facility-level factors (n = 32/57), and fewer prescriber-level ones (n = 8/57). Studies included two types of outcome: overall volume of antibiotic prescriptions (n = 45/57), inappropriate antibiotic prescription (n = 10/57); two included both types. Resident-level factors associated with a higher volume of antibiotic prescriptions included comorbidities (5 out of 8 studies which investigated this factor found a statistically significant association), history of infection (n = 5/6), potential signs of infection (e.g., fever, n = 4/6), positive urine culture/dipstick results (n = 3/4), indwelling urinary catheter (n = 12/14), and resident/family request for antibiotics (n = 1/1). At the facility-level, the volume of antibiotic prescriptions was positively associated with staff turnover (n = 1/1) and prevalence of after-hours medical practitioner visits (n = 1/1), and negatively associated with LTCF hiring an on-site coordinating physician (n = 1/1). At the prescriber-level, higher antibiotic prescribing was associated with high prescription rate for antibiotics in the previous year (n = 1/1). CONCLUSIONS Improving infection prevention and control, and diagnostic practices as part of antimicrobial stewardship programmes remain critical steps to reduce antibiotic prescribing in LTCFs. Once results confirmed by further studies, implementing institutional changes to limit staff turnover, ensure the presence of a professional accountable for the antimicrobial stewardship activities, and improve collaboration between LTCFs and external prescribers may contribute to reduce antibiotic prescribing.
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Affiliation(s)
- Aurélie Bocquier
- Université de Lorraine, Inserm, INSPIIRE, Nancy, F-54000, France.
| | - Berkehan Erkilic
- Université de Lorraine, Inserm, INSPIIRE, Nancy, F-54000, France
| | - Martin Babinet
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie clinique, Nancy, F-54000, France
| | - Céline Pulcini
- Université de Lorraine, Inserm, INSPIIRE, Nancy, F-54000, France
- Centre régional en antibiothérapie du Grand Est AntibioEst, Université de Lorraine, CHRU-Nancy, Nancy, F-54000, France
| | - Nelly Agrinier
- Université de Lorraine, Inserm, INSPIIRE, Nancy, F-54000, France
- CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie clinique, Nancy, F-54000, France
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Tropea J, Francis JJ, Bennett N, Lim LL, Fetherstonhaugh D, Buising KL, Marshall C, Flynn M, Lim WK, Peters S. Assessing infection prevention and control programs in residential aged care in Australia: A multi-methods cross-sectional study. Geriatr Gerontol Int 2024; 24 Suppl 1:358-363. [PMID: 38171346 DOI: 10.1111/ggi.14791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 11/22/2023] [Accepted: 12/07/2023] [Indexed: 01/05/2024]
Abstract
AIM To assess infection prevention and control programs in residential aged care facilities. METHODS A cross-sectional survey and structured interviews from 10 residential aged care facilities in Victoria, Australia, were used. Infection prevention and control nurse leads from each facility completed a purpose-built survey based on best practice infection prevention control program core components, including staff training, policies and procedures, governance, and surveillance. Follow-up interviews with residential aged care staff, residents and family visitors were carried out to elaborate and verify survey data. RESULTS Surveys from all 10 facilities were received and 75 interviews carried out. All facilities had an infection prevention and control lead nurse who had undergone additional training, and 60% of facilities had an infection prevention and control lead position description. All facilities had a committee to oversee their infection prevention and control program, and all had policies and procedures for standard and transmission-based precautions. One facility did not have a policy on healthcare-associated infection surveillance, and two facilities did not have an antimicrobial stewardship policy. All facilities provided staff training in hand hygiene and personal protective equipment use, but not all routinely assessed competency in these. CONCLUSIONS The residential aged care facilities' infection prevention and control programs were generally in a strong position, although there were some areas that require improvement. Further assessment of the quality of infection prevention and control program components, such as content of education and training, and policies and procedures, and ongoing evaluation of programs is recommended. Geriatr Gerontol Int 2024; 24: 358-363.
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Affiliation(s)
- Joanne Tropea
- Department of Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, RMH, University of Melbourne, Melbourne, Victoria, Australia
| | - Jill J Francis
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Department of Health Services Research, Peter MacCallum Cancer Center, Melbourne, Victoria, Australia
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Melbourne, Victoria, Australia
- Ottawa Hospital Research Institute, Center for Implementation Research, Ottawa, Ontario, Canada
| | - Noleen Bennett
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Center, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- National Center for Antimicrobial Stewardship, University of Melbourne, Melbourne, Victoria, Australia
- Department of Nursing, Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Lyn-Li Lim
- Victorian Healthcare Associated Infection Surveillance System (VICNISS) Coordinating Center, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
| | - Deirdre Fetherstonhaugh
- Australian Center for Evidence Based Aged Care (ACEBAC), La Trobe University, Melbourne, Victoria, Australia
| | - Kirsty L Buising
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Victorian Infectious Diseases Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Caroline Marshall
- Department of Infectious Diseases, University of Melbourne at the Peter Doherty Institute for Infection and Immunity, Melbourne, Victoria, Australia
- Infection Prevention and Surveillance Service, Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Madelaine Flynn
- Infection Prevention, Northern Health, Melbourne, Victoria, Australia
| | - Wen K Lim
- Department of Aged Care, Royal Melbourne Hospital, Melbourne, Victoria, Australia
- Department of Medicine, RMH, University of Melbourne, Melbourne, Victoria, Australia
| | - Sanne Peters
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
- Department of Public Health and Primary Care, University of Leuven, KU Leuven, Louvain, Belgium
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Dembiński Ł, Grzybowska-Chlebowczyk U, Toporowska-Kowalska E, Walkowiak J, Gładysiewicz B, Dądalski M, Korczowski B, Czkwianianc E, Zagierski M, Jarocka-Cyrta E, Soroczyńska-Wrzyszcz A, Pytrus T, Krawiec P, Banaszkiewicz A. Pediatric endoscopy in times of pandemic: A nationwide retrospective analysis. J Infect Public Health 2024; 17:396-400. [PMID: 38246113 DOI: 10.1016/j.jiph.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 12/16/2023] [Accepted: 12/31/2023] [Indexed: 01/23/2024] Open
Abstract
BACKGROUND Gastrointestinal endoscopy is a procedure that carries an increased risk of transmission of SARS-CoV-2 infection to medical staff. In patients, COVID-19 is a risk factor for adverse events of medical procedures. This study analyzed the real-life risk of, and factors contributing to, infection transmission to endoscopic personnel, and possible adverse events of the endoscopy procedure and anesthesia in children with COVID-19. METHODS Nationwide retrospective analysis of medical records of children with confirmed SARS-CoV-2 infection who underwent gastrointestinal endoscopy in Poland between February 2020 and February 2022. RESULTS Fifty-eight patients were included in the analysis, 35% of whom had COVID-19 symptoms at the time of endoscopy. The dominant indications for endoscopy were foreign body or corrosive substance ingestion and gastrointestinal bleeding. Nine cases of virus transmission were registered among endoscopic personnel. In all of these cases, the endoscopy team was unaware of the patient's infection (p < 0.01), although symptoms were present in 78% of the children. Lack of use of personal protective equipment was the strongest predictor of SARS-CoV-2 transmission (p < 0.01). The risk of infection was not statistically significantly dependent on the method of anesthesia, intubation or the type of endoscopy. No statistically significant correlation was found between symptomatic infection and adverse events of endoscopy or anesthesia occurrence. There was one reported anesthesia-related adverse event involving extubation difficulties due to worsening respiratory infection symptoms. CONCLUSIONS The risk of transmitting SARS-CoV-2 to endoscopic personnel during procedures in children is low and depends on compliance with infection prevention and control measures. Performing gastrointestinal endoscopy in children with COVID-19 does not appear to be associated with an increased risk of adverse events.
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Affiliation(s)
- Łukasz Dembiński
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland.
| | | | - Ewa Toporowska-Kowalska
- Department of Pediatric Allergology, Gastroenterology and Nutrition, Medical University of Lodz, Lodz, Poland
| | - Jarosław Walkowiak
- Department of Pediatric Gastroenterology and Metabolic Diseases, Poznan University of Medical Sciences, Poznan, Poland
| | - Beata Gładysiewicz
- Department of Gastroenterology and Hepatology, Pediatrics Clinic, Regional Polyclinical Hospital, Kielce, Poland
| | - Maciej Dądalski
- Department of Gastroenterology, Hepatology, Feeding Disorders and Pediatrics, The Children's Memorial Health Institute, Warsaw, Poland
| | - Bartosz Korczowski
- Department of Pediatrics and Pediatric Gastroenterology, Institute of Medical Sciences, Medical College, University of Rzeszów, Rzeszów, Poland
| | - Elżbieta Czkwianianc
- Department of Gastroenterology, Allergology and Pediatrics, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland
| | - Maciej Zagierski
- Department of Pediatrics, Gastroenterology, Allergology and Nutrition, Medical University of Gdańsk, Gdańsk, Poland
| | - Elżbieta Jarocka-Cyrta
- Department of Clinical Pediatrics, Faculty of Medical Sciences, University of Warmia and Mazury in Olsztyn, Provincial Specialist Children's Hospital, Olsztyn, Poland
| | | | - Tomasz Pytrus
- Department of Pediatrics, Gastroenterology and Nutrition, Wroclaw Medical University, Wroclaw, Poland
| | - Paulina Krawiec
- Department of Pediatrics and Gastroenterology, Medical University of Lublin, Lublin, Poland
| | - Aleksandra Banaszkiewicz
- Department of Pediatric Gastroenterology and Nutrition, Medical University of Warsaw, Warsaw, Poland
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Gastaldi S, Festa MG, Nieddu A, Zavagno G, Cau E, Barbieri C, Beccaria E, D'Ancona F. Identification of essential contents and a standard framework for the development of an Infection Prevention and Control manual for healthcare facilities: A scoping review. Am J Infect Control 2024; 52:358-364. [PMID: 37689122 DOI: 10.1016/j.ajic.2023.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/31/2023] [Accepted: 08/31/2023] [Indexed: 09/11/2023]
Abstract
BACKGROUND Several international organizations have outlined the components of infection prevention and control (IPC) programs. To successfully implement an IPC program, hospital staff may adopt a manual that provides support for implementing the IPC measures, even requiring significant efforts. This study aims to identify essential aspects and develop a standardized structure for an IPC manual. The IPC manual framework can be customized and utilized by any health care facility, thereby facilitating adherence to international and national legislation. METHODS The study was conducted using the Joanna Briggs Institute methodology for scoping reviews. Reporting followed the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews standard. The search for evidence was performed on PubMed and Web of Science. Methodological quality was evaluated blindly by 2 reviewers using the Critical Appraisal Skills Program checklist. RESULTS Nineteen papers were included in the review. Data extraction considered the most recent guidelines and the categorization into the 8 Core Components established by the World Health Organization. Through the literature review, the essential elements and challenges of an IPC hospital manual were identified, and a framework was proposed. CONCLUSIONS By incorporating these essential elements into their IPC manual, health care facilities can establish a robust IPC framework. A potential future development stemming from this work could involve the creation of a standardized national IPC manual tailored for hospital settings.
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Affiliation(s)
- Silvana Gastaldi
- National Association of Nurses for Prevention of Hospital Infections (ANIPIO), Bologna, Italy.
| | | | - Alma Nieddu
- HAI Group Contact, Hospital and Territory Clinical Government Operating Unit, USL Parma, Parma, Italy
| | - Giulia Zavagno
- Sant'Antonio Hospital, San Daniele del Friuli (ASUFC-Azienda Sanitaria Universitaria Friuli Centrale), Udine, Italy
| | - Ennio Cau
- Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco", Catania, Italy
| | - Corinna Barbieri
- AULSS 3 Serenissima, Medical Department Ospedale dell'Angelo - Mestre, Venice, Italy
| | | | - Fortunato D'Ancona
- Department of Communicable Diseases, Istituto Superiore di Sanità, Rome, Italy
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Horgan S, Hegarty J, Drennan J, Keane D, Saab MM. The effect of interventions on the incidence of surgical site infections in acute care settings: A systematic review. J Tissue Viability 2024; 33:75-88. [PMID: 37977894 DOI: 10.1016/j.jtv.2023.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 09/22/2023] [Accepted: 11/08/2023] [Indexed: 11/19/2023]
Abstract
AIM Surgical site infections (SSIs) are common healthcare associated infections with serious consequences for patients and healthcare organisations. It is critical that healthcare professionals implement prevention strategies to reduce the incidence of such infections. Prevention strategies are key to reducing the incidence of SSIs. The aim of this systematic review is to describe the effect of interventions conducted in acute care settings on the incidence of SSIs (primary outcome), length of stay, intensive care unit admission, and mortality rate (secondary outcomes). MATERIALS AND METHODS This review is reported using the Preferred Reporting Items for Systematic review and Meta-Analysis checklist. A search was undertaken in Academic Search Complete, CINAHL, ERIC, MEDLINE, PsycARTICLES, PsycINFO and Web of Science for studies published between January 2017 and March 2022. Studies that focused on interventions within acute hospital settings in patients undergoing elective surgery with the aim of reducing the incidences of SSIs were included. Due to heterogeneity results were synthesised narratively. RESULTS In total, 23 studies were included. Findings show that interventions that are effective in reducing the incidences of SSIs have multiple components including care bundles, stakeholder engagement, targeted surveillance and education. Few studies were identified that evaluated the effect of SSI prevention interventions on length of stay and mortality, and none assessed intensive care admission rates. CONCLUSIONS The included interventions varied widely, which made it difficult to draw definitive conclusions regarding specific interventions that reduce SSI. Multicomponent interventions and care bundles showed promise in reducing the occurrence of SSIs. Further studies should focus on standardised evidence-based interventions and compliance using randomised controlled designs.
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Affiliation(s)
- Sinéad Horgan
- South/South West Hospitals Group, Department of Nursing and Midwifery, Erinville, Western Road, Cork, Ireland; Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland.
| | - Josephine Hegarty
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland.
| | - Jonathan Drennan
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland.
| | - Danielle Keane
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland.
| | - Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, College of Medicine and Health, University College Cork, Cork, Ireland.
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Song MS, Jeong SY, Park S. Infection Control Experiences and Educational Needs of Geriatric Care Workers in Long-Term Care Facilities: A Pilot Study. Healthcare (Basel) 2024; 12:301. [PMID: 38338186 PMCID: PMC10855566 DOI: 10.3390/healthcare12030301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 01/05/2024] [Accepted: 01/18/2024] [Indexed: 02/12/2024] Open
Abstract
BACKGROUND In the post-COVID-19 condition, infection control education is important for geriatric care workers who care for the elderly and are vulnerable to emerging infectious diseases. This study was conducted to enhance the insight into the experiences of geriatric care workers in managing novel infectious diseases (COVID-19) and to identify the newly required educational requirements necessary to effectively implement infectious disease control. METHODS This is a qualitative and pilot study using focus group interviews. Data from 10 participants were collected using a focus group interview. The data were analyzed using Qualitative content analysis. RESULTS The findings showed that geriatric healthcare workers experienced difficulties following infection control protocols and emotional distress related to visitor restrictions and had an increased workload. The participants requested further education regarding general knowledge of infectious diseases to decrease their fears of infection and reported that visual and practical teaching methods were preferable. CONCLUSIONS Further attention is needed regarding the education of infection control to strengthen infection prevention in long-term care facilities vulnerable to the spread of emerging infectious diseases.
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Affiliation(s)
- Min Sun Song
- College of Nursing, Konyang University, 158, Gwanjeodong-ro, Seogu, Daejeon 35365, Republic of Korea; (M.S.S.); (S.Y.J.)
| | - Sun Young Jeong
- College of Nursing, Konyang University, 158, Gwanjeodong-ro, Seogu, Daejeon 35365, Republic of Korea; (M.S.S.); (S.Y.J.)
| | - Soohyun Park
- Department of Nursing, Eulji University, Seongnam, 553 Sanseong-daero, Sujeong-gu, Seongnam-si 13135, Republic of Korea
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Urrutia AR, Schlener SD, Eid S, Bock KA, Worrilow KC. The Effects of an Advanced Air Purification Technology on Environmental and Clinical Outcomes in a Long-Term Care Facility. J Gerontol A Biol Sci Med Sci 2023; 78:2325-2332. [PMID: 37132185 PMCID: PMC10692422 DOI: 10.1093/gerona/glad113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Long-term care facilities (LTCFs) are constantly working to reduce sources of infectious pathogens to improve resident care. LTCF residents are particularly susceptible to health care-associated infections (HAIs), many of which originate from the air. An advanced air purification technology (AAPT) was designed to comprehensively remediate volatile organic compounds (VOCs) and all airborne pathogens including all airborne bacteria, fungi, and viruses. The AAPT contains a unique combination of proprietary filter media, high-dose ultraviolet germicidal irradiation, and high-efficiency particulate air (HEPA) filtration. METHODS The AAPT was installed in an LTCF's heating, ventilation, and air-conditioning ductwork and 2 floors were studied: the study floor with comprehensive AAPT remediation and HEPA filtration and the control floor with only HEPA filtration. VOC loading and airborne and surface pathogen loading were measured in 5 locations on both floors. Clinical metrics such as HAI rates were also studied. RESULTS There was a statistically significant 98.83% reduction in airborne pathogens, which are responsible for illness and infection, an 89.88% reduction in VOCs, and a 39.6% reduction in HAIs. Surface pathogen loading was reduced in all locations except 1 resident room where the detected pathogens were linked to direct touch. CONCLUSIONS The removal of airborne and surface pathogens by the AAPT led to a dramatic reduction in HAIs. The comprehensive removal of airborne contaminants has a direct positive impact on resident wellness and quality of life. It is critical that LTCFs incorporate aggressive airborne purification methods with their current infection control protocols.
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Affiliation(s)
| | | | - Sherrine Eid
- Sherrine Eid Consulting, Macungie, Pennsylvania, USA
| | - Kelly A Bock
- Phoebe Ministries Allentown, Allentown, Pennsylvania, USA
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Bloch N, Männer J, Gardiol C, Kohler P, Kuhn J, Münzer T, Schlegel M, Kuster SP, Flury D. Effective infection prevention and control measures in long-term care facilities in non-outbreak and outbreak settings: a systematic literature review. Antimicrob Resist Infect Control 2023; 12:113. [PMID: 37853477 PMCID: PMC10585745 DOI: 10.1186/s13756-023-01318-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/05/2023] [Indexed: 10/20/2023] Open
Abstract
BACKGROUND Healthcare-associated infections in long-term care are associated with substantial morbidity and mortality. While infection prevention and control (IPC) guidelines are well-defined in the acute care setting, evidence of effectiveness for long-term care facilities (LTCF) is missing. We therefore performed a systematic literature review to examine the effect of IPC measures in the long-term care setting. METHODS We systematically searched PubMed and Cochrane libraries for articles evaluating the effect of IPC measures in the LTCF setting since 2017, as earlier reviews on this topic covered the timeframe up to this date. Cross-referenced studies from identified articles and from mentioned earlier reviews were also evaluated. We included randomized-controlled trials, quasi-experimental, observational studies, and outbreak reports. The included studies were analyzed regarding study design, type of intervention, description of intervention, outcomes and quality. We distinguished between non-outbreak and outbreak settings. RESULTS We included 74 studies, 34 (46%) in the non-outbreak setting and 40 (54%) in the outbreak setting. The most commonly studied interventions in the non-outbreak setting included the effect of hand hygiene (N = 10), oral hygiene (N = 6), antimicrobial stewardship (N = 4), vaccination of residents (N = 3), education (N = 2) as well as IPC bundles (N = 7). All but one study assessing hand hygiene interventions reported a reduction of infection rates. Further successful interventions were oral hygiene (N = 6) and vaccination of residents (N = 3). In outbreak settings, studies mostly focused on the effects of IPC bundles (N = 24) or mass testing (N = 11). In most of the studies evaluating an IPC bundle, containment of the outbreak was reported. Overall, only four articles (5.4%) were rated as high quality. CONCLUSION In the non-outbreak setting in LTCF, especially hand hygiene and oral hygiene have a beneficial effect on infection rates. In contrast, IPC bundles, as well as mass testing seem to be promising in an outbreak setting.
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Affiliation(s)
- Nando Bloch
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland.
| | - Jasmin Männer
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | | | - Philipp Kohler
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Jacqueline Kuhn
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Thomas Münzer
- Geriatrische Klinik St.Gallen, St.Gallen, Switzerland
| | - Matthias Schlegel
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Stefan P Kuster
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
| | - Domenica Flury
- Division of Infectious Diseases and Hospital Epidemiology, Cantonal Hospital St.Gallen, St.Gallen, Switzerland
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Alvim ALS, Couto BRMG, Gazzinelli A. Qualidade das práticas de profissionais dos programas de controle de infecção no Brasil: estudo transversal. ESCOLA ANNA NERY 2023. [DOI: 10.1590/2177-9465-ean-2022-0229pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
RESUMO Objetivo Analisar a qualidade das práticas de profissionais dos programas de controle de infecção em relação aos componentes de estrutura, processo e resultado. Método Trata-se de um estudo de abordagem quantitativa, do tipo descritivo e transversal realizado em 114 serviços de controle de infecção hospitalar das cinco regiões oficiais do Brasil. Coletaram-se os dados por meio de um instrumento estruturado, cujas propriedades psicométricas foram validadas previamente. O tratamento dos dados foi realizado pela análise de componentes principais e o teste não paramétrico Kruskal-Wallis. Resultados O melhor índice de qualidade dos programas de controle de infecção foi atribuído à região Sul, aos hospitais que continham 300 leitos ou mais, aos que utilizavam o critério National Healthcare Safety Network para vigilância das infecções e aos locais que realizavam busca ativa prospectiva como método de vigilância. Conclusão e implicações para a prática O índice de qualidade dos programas de controle de infecção está relacionado à localização, ao tamanho do hospital e ao método adotado para vigilância de infecções. A criação de um índice de qualidade, até então inédito em estudos nacionais, chama atenção para o desempenho precário dos serviços de saúde.
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Alvim ALS, Couto BRMG, Gazzinelli A. The quality of professional practices in infection control programs in Brazil: a cross-sectional study. ESCOLA ANNA NERY 2023. [DOI: 10.1590/2177-9465-ean-2022-0229en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
ABSTRACT Objective To analyze the quality of professional practices in infection control programs regarding structure, process, and outcome. Method This is a quantitative, descriptive, and cross-sectional study carried out in 114 hospital infection control services in the five official regions of Brazil. The data were collected using a structured instrument whose psychometric properties were previously validated. Data treatment was performed by principal component analysis and non-parametric Kruskal-Wallis test. Results The best quality index of infection control programs was attributed to the South region, to hospitals that had 300 beds or more, to those that used the National Healthcare Safety Network criterion for infection surveillance and to places that carried out an active prospective search as their surveillance method. Conclusion and implications for practice: The quality of infection control programs is related to hospital location, size, and infection surveillance method. The creation of a quality index, hitherto unheard of in Brazilian studies, draws attention to the precarious performance of health services.
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Ta'an WF, Al-Hammouri MM, Al-Faouri I, Suliman MM. The effectiveness of COPA-based training program on the infection-control competencies of newly hired healthcare professionals. TEACHING AND LEARNING IN NURSING : OFFICIAL JOURNAL OF THE NATIONAL ORGANIZATION FOR ASSCIATE DEGREE NURSING 2023; 18:160-165. [PMID: 36778202 PMCID: PMC9901205 DOI: 10.1016/j.teln.2022.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/23/2022] [Indexed: 10/16/2022]
Abstract
Competency-based education that relies on nurses' and healthcare professionals' needs assessment is crucial to tackling healthcare crises such as COVID-19. Strengthening the capacities of human resources by implementing customized infection control training programs is therefore mandatory. This study aims to measure the effectiveness and satisfaction of the Competency Outcomes and Performance Assessment (COPA)-based training program. The study implemented a single group pretest-posttest experimental design. A single-stage cluster sampling technique was used. All field hospitals in Jordan were listed, and one hospital was randomly selected. A total of 87 personnel from different disciplines agreed to participate after reading the letter of information and signing the informed consent. A panel of experts representing different disciplines and hospital units initially met and agreed upon a list of competencies required for the training program, and the program was accordingly developed. The study measured the healthcare professionals' competencies in infection control and prevention before and after the administration of the competency-based training program. The results revealed significant differences between participants' pretest and posttest scores in all infection control domains and the total scores. For example, the increase in participants' total competency scores after the training was statistically significant (P < 0.007). The mean total satisfaction score was 61.18 + 7.00 reflecting that the participants were highly satisfied with the provided training. In conclusion, it is imperative to provide healthcare professionals with adequate clinical training to ensure that healthcare services are going to be delivered in the highest possible quality and minimize the possible adverse events.
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Affiliation(s)
- Wafa'a F. Ta'an
- Community and Mental Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan,Corresponding author. Tel.: 00962-790862325
| | - Mohammed M. Al-Hammouri
- Community and Mental Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Ibrahim Al-Faouri
- Community and Mental Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad M. Suliman
- Department of Community and Mental Health Nursing, Faculty of Nursing, Al al-Bayt University, Mafraq, Jordan
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12
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Thandar MM, Rahman MO, Haruyama R, Matsuoka S, Okawa S, Moriyama J, Yokobori Y, Matsubara C, Nagai M, Ota E, Baba T. Effectiveness of Infection Control Teams in Reducing Healthcare-Associated Infections: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17075. [PMID: 36554953 PMCID: PMC9779570 DOI: 10.3390/ijerph192417075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 12/11/2022] [Accepted: 12/15/2022] [Indexed: 06/17/2023]
Abstract
The infection control team (ICT) ensures the implementation of infection control guidelines in healthcare facilities. This systematic review aims to evaluate the effectiveness of ICT, with or without an infection control link nurse (ICLN) system, in reducing healthcare-associated infections (HCAIs). We searched four databases to identify randomised controlled trials (RCTs) in inpatient, outpatient and long-term care facilities. We judged the quality of the studies, conducted meta-analyses whenever interventions and outcome measures were comparable in at least two studies, and assessed the certainty of evidence. Nine RCTs were included; all were rated as being low quality. Overall, ICT, with or without an ICLN system, did not reduce the incidence rate of HCAIs [risk ratio (RR) = 0.65, 95% confidence interval (CI): 0.45-1.07], death due to HCAIs (RR = 0.32, 95% CI: 0.04-2.69) and length of hospital stay (42 days vs. 45 days, p = 0.52). However, ICT with an ICLN system improved nurses' compliance with infection control practices (RR = 1.17, 95% CI: 1.00-1.38). Due to the high level of bias, inconsistency and imprecision, these findings should be considered with caution. High-quality studies using similar outcome measures are needed to demonstrate the effectiveness and cost-effectiveness of ICT.
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Affiliation(s)
- Moe Moe Thandar
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Md. Obaidur Rahman
- Center for Surveillance, Immunization, and Epidemiologic Research, National Institute of Infectious Diseases, Tokyo 162-8640, Japan
- Center for Evidence-Based Medicine and Clinical Research, Dhaka 1230, Bangladesh
| | - Rei Haruyama
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Sadatoshi Matsuoka
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Sumiyo Okawa
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Jun Moriyama
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Yuta Yokobori
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Chieko Matsubara
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Mari Nagai
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
| | - Erika Ota
- Global Health Nursing, Graduate School of Nursing Sciences, St. Luke’s International University, Tokyo 104-0044, Japan
- Tokyo Foundation for Policy Research, Minato, Tokyo 106-0032, Japan
| | - Toshiaki Baba
- Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
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Tchouaket EN, Kruglova K, Beogo I, Sia D, Robins S, Bélanger E, Jubinville M, Séguin C, Kilpatrick K, Boivin S, Létourneau J. Economic evaluation of healthcare-associated infection prevention and control in long-term care: a systematic review protocol. Syst Rev 2022; 11:261. [PMID: 36463274 PMCID: PMC9719189 DOI: 10.1186/s13643-022-02128-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 11/08/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Given the high risk of contracting a healthcare-associated infection in long-term care facilities, infection prevention and control are essential for the quality of care and safety of residents and staff. To develop more effective infection prevention and control interventions in long-term care facilities, it is important to assess the cost-effectiveness and cost-benefit of existing interventions. There are only a few reviews on this subject, but these are not recent and most do not perform an economic evaluation. Moreover, none uses a discounting approach which limits inter-study comparison. To address these gaps, we will conduct a systematic review of economic evaluations related to healthcare-associated infection prevention and control in long-term care facilities using a discounting approach. METHODS We will query MEDLINE, Embase, Web of Science, Cochrane, CINAHL, EconLit, JSTOR, and Scopus, as well as the gray literature databases CORDIS and ProQuest. We will include quantitative studies that evaluate four clinical best practices associated with infection prevention and control (hand hygiene, hygiene and sanitation, screening, basic, and additional precautions) and use at least one of five economic analyses (cost-effectiveness, cost-benefit, cost-minimization, cost-utility, cost-consequences). Primary outcomes will include net cost savings, incremental cost-effectiveness ratio, incremental cost per quality-adjusted life year, and incremental cost per disability-adjusted life year. Two co-authors will independently screen and select articles, extract data, and assess the quality of selected articles using the Scottish Intercollegiate Guidelines Network criteria, the Economic Evaluation criteria, and the Cochrane criteria for economic evaluation. Extracted data will be synthesized, and values will be adjusted to 2022 Canadian dollars using the discount rates of 3%, 5%, and 8%. DISCUSSION Information obtained through this systematic review may help researchers and policy makers make more efficient use of limited healthcare resources to ensure the safety and quality of long-term care. SYSTEMATIC REVIEW REGISTRATION Research registry ID: reviewregistry1210.
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Affiliation(s)
- Eric Nguemeleu Tchouaket
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada.
| | - Katya Kruglova
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
| | - Idrissa Beogo
- School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, Ontario, Canada
| | - Drissa Sia
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
| | - Stephanie Robins
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
| | - Emilie Bélanger
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
| | - Maripier Jubinville
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
| | - Catherine Séguin
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
| | - Kelley Kilpatrick
- Ingram School of Nursing, McGill University, Montréal, Québec, Canada
| | - Sandra Boivin
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
| | - Josiane Létourneau
- Department of Nursing, Université du Québec en Outaouais, St-Jérôme Campus 5, rue Saint-Joseph, Office J-2204, Québec, J7Z 0B7, Canada
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Garcia R, Barnes S, Boukidjian R, Goss LK, Spencer M, Septimus EJ, Wright MO, Munro S, Reese SM, Fakih MG, Edmiston CE, Levesque M. Recommendations for change in infection prevention programs and practice. Am J Infect Control 2022; 50:1281-1295. [PMID: 35525498 PMCID: PMC9065600 DOI: 10.1016/j.ajic.2022.04.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/18/2022] [Accepted: 04/19/2022] [Indexed: 01/25/2023]
Abstract
Fifty years of evolution in infection prevention and control programs have involved significant accomplishments related to clinical practices, methodologies, and technology. However, regulatory mandates, and resource and research limitations, coupled with emerging infection threats such as the COVID-19 pandemic, present considerable challenges for infection preventionists. This article provides guidance and recommendations in 14 key areas. These interventions should be considered for implementation by United States health care facilities in the near future.
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Affiliation(s)
- Robert Garcia
- Department of Healthcare Epidemiology, State University of New York at Stony Brook, Stony Brook, NY,Address correspondence to Robert Garcia, BS, MT(ASCP), CIC, FAPIC, Department of Healthcare Epidemiology, State University of New York at Stony Brook, 100 Nicolls Rd, Stony Brook, NY, 11580
| | - Sue Barnes
- Infection Preventionist (Retired), San Mateo, CA
| | | | - Linda Kaye Goss
- Department of Infection Prevention, The Queen's Health System, Honolulu, HI
| | | | | | | | - Shannon Munro
- Department of Veterans Affairs Medical Center, Research and Development, Salem, VA
| | - Sara M. Reese
- Quality and Patient Safety Department, SCL Health System Broomfield, CO
| | - Mohamad G. Fakih
- Clinical & Network Services, Ascension Healthcare and Wayne State University School of Medicine, Grosse Pointe Woods, MI
| | | | - Martin Levesque
- System Infection Prevention and Control, Henry Ford Health, Detroit, MI
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15
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Tadesse M, Shimelash A, Tegegne E. Level of Hand Hygiene Compliance and Its Associated Factors Among Health Care Workers at Eka Kotebe General Hospital, Addis Ababa, Ethiopia. ENVIRONMENTAL HEALTH INSIGHTS 2022; 16:11786302221113673. [PMID: 35873715 PMCID: PMC9305797 DOI: 10.1177/11786302221113673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/28/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Poor hand hygiene is an important source of infection, but maintaining hand hygiene is the most important measure to prevent infections. Hand hygiene compliance and its associated factors are not well recognized in Ethiopia. Therefore, this study was intended to determine hand hygiene compliance and its associated factors among health care workers in Eka Kotebe General Hospital. METHODS A cross-sectional study was conducted among health care workers at Eka Kotebe General Hospital. A self-administered questionnaire supplemented by a World Health Organization Hand Hygiene Technical Reference Manual was used to collect data. Data was entered using Epi Info 7.2.0.1 and exported to SPSS 23 for analysis. The data were analyzed using descriptive and inferential statistics. Statistical significance was determined using a P-value of ⩽.05 with a 95% confidence interval. RESULTS Hand hygiene compliance among healthcare workers was 22.2%. Hand hygiene training (AOR = 2.9, 95% CI: 1.13-7.52), presence of hand hygiene indication poster (AOR = 3.38, 95% CI: 1.18-9.66), hand hygiene promotion by IPC team (AOR = 4.2, 95% CI: 2.53-8.58)), working experience ⩾5 years of a health care providers (AOR = 3.96, 95% CI: 1.12-13.9), being midwife (AOR = 17.1, 95% CI: 2.8-10), being nurse (AOR = 5.3, 95% CI: 2.09-7.8) by profession, and presence of water (AOR = 2.50, 95% CI: 2.20-11.78) were significantly associated factors to hand hygiene compliance. CONCLUSION The level of hand hygiene compliance among health care providers was found to be low. Training about hand hygiene, the presence of hand hygiene indication posters, hand hygiene promotion by the IPC team, working experience of health care providers, being a nurse and midwife, and the presence of water were independent predictors of hand hygiene compliance. Health care workers need to be given training on hand hygiene as well as hand hygiene facilities shall be installed and supplied by the hospital in a sustained manner.
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Affiliation(s)
| | - Alebachew Shimelash
- Department of Environmental Health, Debre Markos University, Debre Markos, Ethiopia
| | - Eniyew Tegegne
- Department of Environmental Health, Debre Markos University, Debre Markos, Ethiopia
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16
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Laupland KB. Preventing healthcare-related infections among older adults: a focus on cross-transmission of antibiotic-resistant bacteria. Expert Rev Anti Infect Ther 2022; 20:1171-1178. [PMID: 35793840 DOI: 10.1080/14787210.2022.2099375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Older individuals (i.e. age ≥65 years) are at increased risk for development of infections including those due to antimicrobial-resistant bacteria, and transmission may occur between institutional and community settings. AREAS COVERED This article reviews infections in older individuals with a specific focus on healthcare-related and antimicrobial resistant infections. A structured narrative review was performed to identify articles published in English since 2010. Themes included defining the scope of the problem, establishing characteristics of older individuals that impact the burden of resistant infections, and interventions aimed at minimizing their impact. EXPERT OPINION Older individuals suffer a high burden of illness related to antimicrobial resistant infections. Individuals with chronic illnesses, frailty, and residents of nursing homes are at highest risk. Clinical trials have shown that antimicrobial stewardship interventions may reduce antibiotic use in nursing homes without compromising safety. Antimicrobial resistant bacteria are prevalent among nursing home residents, and bundled infection prevention and control interventions can reduce their transmission. Transmission of antimicrobial resistant bacteria occurs among older adults across hospital and institutional settings, which may further spread to the community. The burden of infections in older adults is expected to increase in the coming years and represents a healthcare and research priority.
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Affiliation(s)
- Kevin B Laupland
- Department of Intensive Care Services, Royal Brisbane and Women's Hospital, Brisbane, Australia.,School of Clinical Sciences, Faculty of Health, Queensland University of Technology (QUT), Brisbane, Australia
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17
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Aloweni F, Bouchoucha SL, Hutchinson A, Ang SY, Toh HX, Bte Suhari NA, Bte Sunari RN, Lim SH. Health care workers' experience of personal protective equipment use and associated adverse effects during the COVID-19 pandemic response in Singapore. J Adv Nurs 2022; 78:2383-2396. [PMID: 35170075 PMCID: PMC9111733 DOI: 10.1111/jan.15164] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 10/28/2021] [Accepted: 11/27/2021] [Indexed: 12/15/2022]
Abstract
Aim One of the greatest challenges in responding to the COVID‐19 pandemic is preventing staff exposure and infection by ensuring consistent and effective use of personal protective equipment (PPE). This study explored health care workers' experience of prolonged PPE use in clinical practice settings and their concerns regarding PPE supply, effectiveness and training needs. Design A descriptive cross‐sectional design was adopted in this study. Methods Health care workers (N = 592) from an acute care hospital completed an online survey from July to September 2020 assessing: (i) usage frequencies, side effects and interference with patient care; and (ii) perceptions of access to PPE, likelihood of exposure to infection and adequacy of PPE training. Results PPE‐related side effects were reported by 319 (53.8%) participants, the majority being nurses (88.4%) and those working in high‐risk areas such as the emergency department (39.5%), respiratory wards (acute 22.3% and non‐acute 23.8%) and COVID‐19 isolation ward (13.8%). The average time wearing PPE per shift was 6.8 h (SD 0.39). The most commonly reported symptoms were from donning N95 masks and included: pressure injuries (45.5%), mask‐induced acne (40.4%) and burning/pain (24.5%). Some 31.3% expressed that PPE‐related side effects had negatively affected their work. The odds of having PPE‐associated side effects was higher in women (OR 2.10, 95% CI [1.29–03.42], p = .003) and those working in high‐risk wards (OR 3.12, 95% CI [2.17–4.60], p < .001]. Most (90.1%) agreed that PPE supplies were readily available, sufficient for all (86.1%) and there was sufficient training in correct PPE use (93.6%). Only 13.7% of participants reported being ‘highly confident’ of overall PPE protection. Conclusions Prevention and management of PPE‐related adverse effects is vital to: preserve the integrity of PPE, improve adherence and minimize viral transmission. Impact The high incidence of PPE‐associated pressure injuries and perception that PPE use can interfere with clinical care should inform future development of PPE products, and strategies to better equip health care workers to prevent and manage PPE‐related side effects.
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Affiliation(s)
- Fazila Aloweni
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
| | - Stéphane L Bouchoucha
- Associate Head of School (International), Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University Geelong, School of Nursing and Midwifery, Victoria, Australia
| | - Ana Hutchinson
- Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Epworth Health/Deakin University Partnership, School of Nursing and Midwifery Geelong, Victoria, Australia
| | - Shin Yuh Ang
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
| | - Hui Xian Toh
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
| | | | | | - Siew Hoon Lim
- Division of Nursing, Singapore General Hospital, Singapore, Singapore
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18
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Wong VWY, Huang Y, Wei WI, Wong SYS, Kwok KO. Approaches to multidrug-resistant organism prevention and control in long-term care facilities for older people: a systematic review and meta-analysis. Antimicrob Resist Infect Control 2022; 11:7. [PMID: 35033198 PMCID: PMC8761316 DOI: 10.1186/s13756-021-01044-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 12/23/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Despite clear evidence of benefits in acute-care hospitals, controversy over the effectiveness of IPC measures for MDROs is perceptible and evidence-based practice has not been established. OBJECTIVE To investigate the effects of IPC interventions on MDRO colonization and infections in LTCFs. DATA SOURCES Ovid MEDLINE, EMBASE, and CINAHL from inception to September 2020. ELIGIBILITY CRITERIA Original and peer-reviewed articles examining the post-intervention effects on MDRO colonization and infections in LTCFs. INTERVENTIONS (i) Horizontal interventions: administrative engagement, barrier precautions, education, environmental cleaning, hand hygiene, performance improvement, and source control; and (ii) vertical intervention: active surveillance plus decolonization. STUDY APPRAISAL AND SYNTHESIS We employed a random-effects meta-analysis to estimate the pooled risk ratios (pRRs) for methicillin-resistant Staphylococcus aureus (MRSA) colonization by intervention duration; and conducted subgroup analyses on different intervention components. Study quality was assessed using Cochrane risk of bias tools. RESULTS Of 3877 studies identified, 19 were eligible for inclusion (eight randomized controlled trials (RCTs)). Studies reported outcomes associated with MRSA (15 studies), vancomycin-resistant Enterococci (VRE) (four studies), Clostridium difficile (two studies), and Gram-negative bacteria (GNB) (two studies). Eleven studies were included in the meta-analysis. The pRRs were close to unity regardless of intervention duration (long: RR 0.81 [95% CI 0.60-1.10]; medium: RR 0.81 [95% CI 0.25-2.68]; short: RR 0.95 [95% CI 0.53-1.69]). Vertical interventions in studies with a small sample size showed significant reductions in MRSA colonization while horizontal interventions did not. All studies involving active administrative engagement reported reductions. The risk of bias was high in all but two studies. CONCLUSIONS Our meta-analysis did not show any beneficial effects from IPC interventions on MRSA reductions in LTCFs. Our findings highlight that the effectiveness of interventions in these facilities is likely conditional on resource availability-particularly decolonization and barrier precautions, due to their potential adverse events and uncertain effectiveness. Hence, administrative engagement is crucial for all effective IPC programmes. LTCFs should consider a pragmatic approach to reinforce standard precautions as routine practice and implement barrier precautions and decolonization to outbreak responses only.
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Affiliation(s)
- Valerie Wing Yu Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 419, 4/F, JC School of Public Health and Primary Care Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong Special Administrative Region, China
| | - Ying Huang
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 419, 4/F, JC School of Public Health and Primary Care Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong Special Administrative Region, China
| | - Wan In Wei
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 419, 4/F, JC School of Public Health and Primary Care Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong Special Administrative Region, China
| | - Samuel Yeung Shan Wong
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 419, 4/F, JC School of Public Health and Primary Care Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong Special Administrative Region, China
| | - Kin On Kwok
- JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 419, 4/F, JC School of Public Health and Primary Care Building, Prince of Wales Hospital, Shatin, N.T., Hong Kong Special Administrative Region, China.
- Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region, China.
- Shenzhen Research Institute of The Chinese University of Hong Kong, Shenzhen, China.
- Hong Kong Institute of Asia-Pacific Studies, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong Special Administrative Region, China.
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19
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Thomas RE, Thomas BC, Conly J, Lorenzetti D. Cleaning and disinfecting surfaces in hospitals and long-term care facilities for reducing hospital and facility-acquired bacterial and viral infections: A systematic review. J Hosp Infect 2022; 122:9-26. [PMID: 34998912 DOI: 10.1016/j.jhin.2021.12.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND Multiply drug-resistant organisms (MDROs) in hospitals and long-term care facilities (LTCFs) of particular concern include meticillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus, multidrug-resistant Acinetobacter species and extended spectrum beta-lactamase producing organisms. Respiratory viruses include influenza and SARS-CoV-2. AIM To assess effectiveness of cleaning and disinfecting surfaces in hospitals and LTCFs. METHODS CINAHL, Cochrane CENTRAL Register of Controlled Trials, EMBASE, Medline, and Scopus searched inception to 28 June 2021, no language restrictions, for randomized controlled trials, cleaning, disinfection, hospitals, LTCFs. Abstracts and titles were assessed and data abstracted independently by two authors. FINDINGS Of fourteen c-RCTs in hospitals and LTCFs, interventions in ten were focused on reducing patient infections of four MDROs and/or healthcare-associated infections (HAIs). In four c-RCTs patient MDRO and/or HAI rates were significantly reduced with cleaning and disinfection strategies including bleach, quaternary ammonium detergents, ultraviolet irradiation, hydrogen peroxide vapour and copper-treated surfaces or fabrics. Of three c-RCTs focused on reducing MRSA rates, one had significant results and one on Clostridioides difficile had no significant results. Heterogeneity of populations, methods, outcomes and data reporting precluded meta-analysis. Overall risk of bias assessment was low but high for allocation concealment, and GRADE assessment was low risk. No study assessed biofilms. CONCLUSIONS Ten c-RCTs focused on reducing multiple MDROs and/or HAIs and four had significant reductions. Three c-RCTs reported only patient MRSA colonization rates (one significant reductions), and one focused on Clostridioides difficile (no significant differences). Standardised primary and secondary outcomes are required for future c-RCTs including detailed biofilm cleaning/disinfection interventions.
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Affiliation(s)
- Roger E Thomas
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | | | - John Conly
- Departments of Medicine, Microbiology, Immunology & Infectious Diseases, Pathology & Laboratory Medicine, Snyder Institute for Chronic Diseases and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Alberta, Canada
| | - Diane Lorenzetti
- Health Sciences Library and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta Canada
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20
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Fleifel M, Machmouchi A, Alameddine O, Hoyek K, Melki D, Hallab E, Masri K, Sidaoui HR, Stockman D, Daoud Z. The Spread of Plasmidic AmpC in a General Lebanese Hospital Over Nine Consecutive Years and the Relationship With Restricted Isolation Protocols. Front Med (Lausanne) 2021; 8:633783. [PMID: 34765610 PMCID: PMC8576109 DOI: 10.3389/fmed.2021.633783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: The dreaded bacterial infection by extended-spectrum β-lactamases (ESBL)-producers has always troubled the medical field whether on the public, scientific, or clinical levels. One of the lesser known β-lactamases, which is capable of hydrolyzing broad and extended-spectrum cephalosporins—i.e., cephamycins plus oxyimino-β-lactams—are the AmpC β-lactamases. This group, which has also been termed occasionally—and incorrectly—as ESBL Class C, confers resistance to β-lactamase inhibitors. The prevalence of plasmidic AmpC (pAmpC) strains is possibly still a matter of debate considering the unevenly matched data between phenotypically-detected and molecularly-detected pAmpC. Aim: In the absence of any study in Lebanon addressing the AmpC, our intention was to determine the numbers and percentages of AmpC Enterobacteriaceae isolates, notably plasmid-mediated ones, across different wards at the Centre Hospitalier du Nord (CHN), Lebanon, and highlight the importance of infection control protocols. Materials and Methods: Carriage and infection with pAmpC Enterobacteriaceae were retrospectively investigated between 2011 and 2015 and prospectively between 2016 and 2019 at the Centre Hospitalier du Nord Hospital, North Lebanon. The rise or decline in the numbers of such strains, in concordance with the allegedly intensive isolation of the patients, were analyzed. Results: Intensive care unit (ICU) data shows an initial rise in infection isolates from 2012 to 2014 and in the carriage isolates from 2012 to 2013 with later notable overall decrease in the both isolates' numbers with the application of the isolation protocols at CHN from 2014 onwards. Floors 2, 3, and 4 seemed to house the bulk of the isolates as well. Conclusion: Preventive measures, such as on-going surveillance of the hospital wards by specialized healthcare personnel and strict implementation of infection control practices, should be a top priority in any medical center in order to isolate such strains and try to put a limit for the development and the dissemination of any possible multidrug resistant strains.
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Affiliation(s)
- Mohamad Fleifel
- Department of Internal Medicine, The Lebanese American University Gilbert and Rose-Marie Chagoury School of Medicine, Beirut, Lebanon
| | - Ahmad Machmouchi
- Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon
| | - Omar Alameddine
- Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon
| | - Kim Hoyek
- Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon
| | - Dimitri Melki
- Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon
| | - Elsa Hallab
- Faculty of Medicine and Medical Sciences, University of Balamand, Beirut, Lebanon
| | - Khalil Masri
- Centre Hospitalier du Nord Hospital, Department of Infectious Diseases, Zgharta, Lebanon
| | - Hiam R Sidaoui
- Centre Hospitalier du Nord Hospital, Department of Infectious Diseases, Zgharta, Lebanon
| | - David Stockman
- Clinical Microbiology and Infection Prevention, Michigan Health Clinics, Saginaw, MI, United States
| | - Ziad Daoud
- Clinical Microbiology and Infection Prevention, Michigan Health Clinics and College of Medicine-Central Michigan University, Saginaw, MI, United States
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21
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Houben F, van Hensbergen M, Den Heijer CDJ, Dukers-Muijrers NHTM, Hoebe CJPA. Barriers and facilitators to infection prevention and control in Dutch residential care facilities for people with intellectual and developmental disabilities: A theory-informed qualitative study. PLoS One 2021; 16:e0258701. [PMID: 34714846 PMCID: PMC8555856 DOI: 10.1371/journal.pone.0258701] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Accepted: 10/02/2021] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Care institutions are recognised to be a high-risk setting for the emergence and spread of infections and antimicrobial-resistant organisms, which stresses the importance of infection prevention and control (IPC). Accurate implementation is crucial for optimal IPC practice. Despite the wide promotion of IPC and research thereof in the hospital and nursing home setting, similar efforts are lacking in disability care settings. Therefore, this study aimed to assess perceived barriers and facilitators to IPC among professionals working at residential care facilities (RCFs) for people with intellectual and developmental disabilities (IDD), as well as to identify professional-reported recommendations to improve IPC. METHODS This qualitative study involved semi-structured interviews (before COVID-19) with twelve professionals from five Dutch RCFs for people with IDD. An integrated theoretical approach was used to inform data collection and analysis. Thematic analysis using inductive and deductive approaches was conducted. This study followed the COnsolidated criteria for REporting Qualitative research (COREQ) guidelines. RESULTS Our findings revealed barriers and facilitators at the guideline, client, professional, professional interaction, professional client interaction, client interaction, organisational, community, and societal level. Six main themes covering multiple barriers and facilitators were identified: (1) guidelines' applicability to (work)setting; (2) professionals' cognitions and attitude towards IPC (related to educational background); (3) organisational support and priority; (4) educational system; (5) time availability and staff capacity; and (6) task division and change coaches. The main professional-reported recommendations were the introduction of tailored and practical IPC guidelines, structural IPC education and training among all professionals, and client participation. CONCLUSIONS To promote IPC, multifaceted and multilevel strategies should be implemented, with a preliminary need for improvements on the guideline, professional, and organisational level. Given the heterogeneous character, i.e., different professionals, clients and care needs, there is a need for a tailored approach to implement IPC and sustain it successfully in disability care. Our findings can inform future IPC practice improvements.
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Affiliation(s)
- Famke Houben
- Department of Sexual Health, Infectious Diseases and Environmental
Health, South Limburg Public Health Service, Heerlen, The
Netherlands
- Department of Social Medicine, Care and Public Health Research Institute
(CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University,
Maastricht, The Netherlands
| | - Mitch van Hensbergen
- Department of Sexual Health, Infectious Diseases and Environmental
Health, South Limburg Public Health Service, Heerlen, The
Netherlands
- Department of Social Medicine, Care and Public Health Research Institute
(CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University,
Maastricht, The Netherlands
| | - Casper D. J. Den Heijer
- Department of Sexual Health, Infectious Diseases and Environmental
Health, South Limburg Public Health Service, Heerlen, The
Netherlands
- Department of Social Medicine, Care and Public Health Research Institute
(CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University,
Maastricht, The Netherlands
- Department of Medical Microbiology, Care and Public Health Research
Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht
University Medical Centre (MUMC+), Maastricht, The Netherlands
| | - Nicole H. T. M. Dukers-Muijrers
- Department of Sexual Health, Infectious Diseases and Environmental
Health, South Limburg Public Health Service, Heerlen, The
Netherlands
- Department of Health Promotion, Care and Public Health Research Institute
(CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University,
Maastricht, The Netherlands
| | - Christian J. P. A. Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental
Health, South Limburg Public Health Service, Heerlen, The
Netherlands
- Department of Social Medicine, Care and Public Health Research Institute
(CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University,
Maastricht, The Netherlands
- Department of Medical Microbiology, Care and Public Health Research
Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht
University Medical Centre (MUMC+), Maastricht, The Netherlands
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22
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Christenson EC, Cronk R, Atkinson H, Bhatt A, Berdiel E, Cawley M, Cho G, Coleman CK, Harrington C, Heilferty K, Fejfar D, Grant EJ, Grigg K, Joshi T, Mohan S, Pelak G, Shu Y, Bartram J. Evidence Map and Systematic Review of Disinfection Efficacy on Environmental Surfaces in Healthcare Facilities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:11100. [PMID: 34769620 PMCID: PMC8582915 DOI: 10.3390/ijerph182111100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Revised: 10/19/2021] [Accepted: 10/20/2021] [Indexed: 01/23/2023]
Abstract
Healthcare-associated infections (HAIs) contribute to patient morbidity and mortality with an estimated 1.7 million infections and 99,000 deaths costing USD $28-34 billion annually in the United States alone. There is little understanding as to if current environmental surface disinfection practices reduce pathogen load, and subsequently HAIs, in critical care settings. This evidence map includes a systematic review on the efficacy of disinfecting environmental surfaces in healthcare facilities. We screened 17,064 abstracts, 635 full texts, and included 181 articles for data extraction and study quality assessment. We reviewed ten disinfectant types and compared disinfectants with respect to study design, outcome organism, and fourteen indictors of study quality. We found important areas for improvement and gaps in the research related to study design, implementation, and analysis. Implementation of disinfection, a determinant of disinfection outcomes, was not measured in most studies and few studies assessed fungi or viruses. Assessing and comparing disinfection efficacy was impeded by study heterogeneity; however, we catalogued the outcomes and results for each disinfection type. We concluded that guidelines for disinfectant use are primarily based on laboratory data rather than a systematic review of in situ disinfection efficacy. It is critically important for practitioners and researchers to consider system-level efficacy and not just the efficacy of the disinfectant.
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Affiliation(s)
- Elizabeth C. Christenson
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Ryan Cronk
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
- ICF, Durham, NC 27713, USA
| | - Helen Atkinson
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Aayush Bhatt
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Emilio Berdiel
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Michelle Cawley
- Health Sciences Library, University of North Carolina, Chapel Hill, NC 27599, USA; (M.C.); (K.G.); (G.P.)
| | - Grace Cho
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Collin Knox Coleman
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Cailee Harrington
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Kylie Heilferty
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Don Fejfar
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Emily J. Grant
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Karen Grigg
- Health Sciences Library, University of North Carolina, Chapel Hill, NC 27599, USA; (M.C.); (K.G.); (G.P.)
| | - Tanmay Joshi
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Suniti Mohan
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Grace Pelak
- Health Sciences Library, University of North Carolina, Chapel Hill, NC 27599, USA; (M.C.); (K.G.); (G.P.)
| | - Yuhong Shu
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
| | - Jamie Bartram
- The Water Institute, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599, USA; (E.C.C.); (R.C.); (H.A.); (A.B.); (E.B.); (G.C.); (C.K.C.); (C.H.); (K.H.); (D.F.); (E.J.G.); (T.J.); (S.M.); (Y.S.)
- School of Civil Engineering, University of Leeds, Leeds LS2 9DY, UK
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23
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Bharmal A, Ng C, Vijh R. COVID-19 Prevention Assessments: A Promising Tool for Preventing Outbreaks in Long-Term Care Homes. J Am Med Dir Assoc 2021; 22:2032-2033. [PMID: 34487688 PMCID: PMC8372522 DOI: 10.1016/j.jamda.2021.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 07/19/2021] [Accepted: 08/11/2021] [Indexed: 10/26/2022]
Affiliation(s)
- Aamir Bharmal
- Office of the Medical Health Officer, Fraser Health Authority, Surrey, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.
| | - Carmen Ng
- Office of the Medical Health Officer, Fraser Health Authority, Surrey, BC, Canada
| | - Rohit Vijh
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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24
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Pue K, Westlake D, Jansen A. Does the Profit Motive Matter? COVID-19 Prevention and Management in Ontario Long-Term-Care Homes. CANADIAN PUBLIC POLICY. ANALYSE DE POLITIQUES 2021; 47:421-438. [PMID: 36039354 PMCID: PMC9400825 DOI: 10.3138/cpp.2020-151] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
We introduce evidence that for-profit long-term-care providers are associated with less successful outcomes in coronavirus disease 2019 outbreak management. We introduce two sets of theoretical arguments that predict variation in service quality by provider type: those that deal with the institution of contracting (innovative competition vs. erosive competition) and those that address organizational features of for-profit, non-profit, and government actors (profit seeking, cross-subsidization, and future investment). We contextualize these arguments through a discussion of how contracting operates in Ontario long-term care. That discussion leads us to exclude the institutional arguments while retaining the arguments about organizational features as our three hypotheses. Using outbreak data as of February 2021, we find that government-run long-term-care homes surpassed for-profit and non-profit homes in outbreak management, consistent with an earlier finding from Stall et al. (2020). Non-profit homes outperform for-profit homes but are outperformed by government-run homes. These results are consistent with the expectations derived from two theoretical arguments-profit seeking and cross-subsidization-and inconsistent with a third-capacity for future investment.
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Affiliation(s)
- Kristen Pue
- School of Public Policy and Administration, Carleton University, Ottawa, Ontario, Canada
| | - Daniel Westlake
- Department of Political Studies, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Alix Jansen
- Department of Political Science, University of Toronto, Toronto, Ontario, Canada
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25
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Daker-White G, Panagioti M, Giles S, Blakeman T, Moore V, Hall A, Jones PP, Wright O, Shears B, Tyler N, Campbell S. Beyond the control of the care home: A meta-ethnography of qualitative studies of Infection Prevention and Control in residential and nursing homes for older people. Health Expect 2021; 25:2095-2106. [PMID: 34420254 PMCID: PMC9615085 DOI: 10.1111/hex.13349] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 07/22/2021] [Accepted: 08/04/2021] [Indexed: 11/26/2022] Open
Abstract
Objective This study aimed to develop interpretive insights concerning Infection Prevention and Control (IPC) in care homes for older people. Design This study had a meta‐ethnography design. Data Sources Six bibliographic databases were searched from inception to May 2020 to identify the relevant literature. Review Methods A meta‐ethnography was performed. Results Searches yielded 652 records; 15 were included. Findings were categorized into groups: The difficulties of enacting IPC measures in the care home environment; workload as an impediment to IPC practice; the tension between IPC and quality of life for care home residents; and problems dealing with medical services located outside the facility including diagnostics, general practice and pharmacy. Infection was revealed as something seen to lie ‘outside’ the control of the care home, whether according to origins or control measures. This could help explain the reported variability in IPC practice. Facilitators to IPC uptake involved repetitive training and professional development, although such opportunities can be constrained by the ways in which services are organized and delivered. Conclusions Significant challenges were revealed in implementing IPC in care homes including staffing skills, education, workloads and work routines. These challenges cannot be properly addressed without resolving the tension between the objectives of maintaining resident quality of life while enacting IPC practice. Repetitive staff training and professional development with parallel organisational improvements have prospects to enhance IPC uptake in residential and nursing homes. Patient or Public Contribution A carer of an older person joined study team meetings and was involved in writing a lay summary of the study findings.
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Affiliation(s)
- Gavin Daker-White
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK.,Division of Population Health, Health Services Research and Primary Care, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Maria Panagioti
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK.,Division of Population Health, Health Services Research and Primary Care, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Sally Giles
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK.,Division of Population Health, Health Services Research and Primary Care, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Thomas Blakeman
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Victoria Moore
- Division of Population Health, Health Services Research and Primary Care, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK.,The University of Manchester Law School, Manchester, UK
| | - Alex Hall
- Division of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
| | - Paul P Jones
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Oliver Wright
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Bethany Shears
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK
| | - Natasha Tyler
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK.,Division of Population Health, Health Services Research and Primary Care, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Stephen Campbell
- Division of Population Health, Health Services Research and Primary Care, Centre for Primary Care and Health Services Research, The University of Manchester, Manchester, UK.,Division of Population Health, Health Services Research and Primary Care, NIHR Greater Manchester Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
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Risk Factors Associated with Nursing Home COVID-19 Outbreaks: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168434. [PMID: 34444183 PMCID: PMC8394924 DOI: 10.3390/ijerph18168434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 08/05/2021] [Accepted: 08/07/2021] [Indexed: 12/12/2022]
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic had a devastating impact on nursing homes/long-term care facilities. This study examined the relationship between geography, size, design, organizational characteristics, and implementation of infection prevention and control (IPC) measures and the extent of COVID-19 outbreaks in nursing homes in the Autonomous Province of Trento (Italy) during the time frame of March-May 2020. Methods: The analysis included 57 nursing homes (5145 beds). The association between median cumulative incidence of COVID-19 cases among residents and characteristics of nursing homes was assessed by Mann–Whitney U test, Kruskal–Wallis test or Spearman rho. To evaluate the potential confounding of geographical area, a 2-level random intercept logistic model was fitted, with level 1 units (patients in nursing homes) nested into level 2 units (nursing homes), and “being a COVID-19 case” as the dependent variable. Results: Median cumulative incidence was not significantly associated with any of the variables, except for geographical region (p = 0.002). COVID-19 cases clustered in the part of the province bordering the Italian region most affected by the pandemic (Lombardy) (45.2% median cumulative incidence). Conclusions: Structural/organizational factors and standard IPC measures may not predict the epidemiology of COVID-19 outbreaks and be sufficient alone to protect nursing homes against them.
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Mody L, Gontjes KJ, Cassone M, Gibson KE, Lansing BJ, Mantey J, Kabeto M, Galecki A, Min L. Effectiveness of a Multicomponent Intervention to Reduce Multidrug-Resistant Organisms in Nursing Homes: A Cluster Randomized Clinical Trial. JAMA Netw Open 2021; 4:e2116555. [PMID: 34269807 PMCID: PMC8285736 DOI: 10.1001/jamanetworkopen.2021.16555] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Multidrug-resistant organisms (MDROs) can cause significant morbidity and mortality. Preventing MDROs can reduce the risk of subsequent transmission and infection. OBJECTIVE To determine whether a multicomponent infection prevention intervention can reduce MDRO prevalence in nursing homes (NHs). DESIGN, SETTING, AND PARTICIPANTS This cluster randomized clinical trial of a multicomponent intervention was conducted in 6 NHs in Michigan from September 2016 to August 2018. Three NHs adopted a multicomponent intervention, while 3 control NHs continued without investigator intervention. Study visits were conducted at baseline; days 7, 14, 21, and 30; and monthly thereafter for up to 6 months or discharge. Visits included clinical data collection and MDRO surveillance culturing of multiple body sites and high-touch surfaces in patient rooms. Any patients who provided informed consent within 14 days of admission to the NH were enrolled in this study. Non-English speakers and patients receiving hospice care were ineligible. Analysis was performed from November 2018 to February 2020. INTERVENTIONS Intervention NHs adopted a multicomponent intervention that included enhanced barrier precautions, chlorhexidine bathing, MDRO surveillance, environmental cleaning education and feedback, hand hygiene promotion, and health care worker education and feedback. Control nursing homes continued standard care practices. MAIN OUTCOMES AND MEASURES The primary outcome, presence of MDROs, was measured longitudinally in the patient and room environment and was evaluated using generalized mixed effect models. The secondary outcome, time to new MDRO acquisition, was assessed using Cox proportional hazard models. RESULTS A total of 6 NHs were included, with 245 patients (mean [SD] age, 72.5 [13.6] years; 134 [54.7%] women) enrolled; 3 NHs with 113 patients (46.1%) were randomized to the intervention group and 3 NHs with 132 patients (53.9%) were randomized to the control group. A total of 132 patients (53.9%) were White, and 235 patients (95.9%) were receiving postacute care. Over 808 study visits, 3654 patient cultures and 5606 environmental cultures were obtained. The intervention reduced the odds of MDRO prevalence in patients' environment by 43% (aOR, 0.57; 95% CI, 0.35-0.94), but there was no statistically significant difference on the patient level before or after adjustment (aOR, 0.57; 95% CI, 0.29-1.14). There were no significant reductions in time to new acquisition for methicillin-resistant Staphylococcus aureus (hazard ratio [HR], 0.20; 95% CI, 0.04-1.09), vancomycin-resistant enterococci (HR, 0.84; 95% CI, 0.46-1.53), or resistant gram-negative bacilli (HR, 1.14; 95% CI, 0.73-1.78). CONCLUSIONS AND RELEVANCE This cluster randomized clinical trial found that the multicomponent intervention reduced the prevalence of MDROs in the environment of NH patients. Our findings highlight the potential for multicomponent interventions to directly and indirectly reduce MDRO prevalence in NHs. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02909946.
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Affiliation(s)
- Lona Mody
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
| | - Kyle J. Gontjes
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor
| | - Marco Cassone
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Kristen E. Gibson
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Bonnie J. Lansing
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Julia Mantey
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Mohammed Kabeto
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
| | - Andrzej Galecki
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor
| | - Lillian Min
- Division of Geriatric and Palliative Medicine, Department of Internal Medicine, University of Michigan Medical School, Ann Arbor
- Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
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28
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Malinga NZZ, Shobo CO, Molechan C, Amoako DG, Zishiri OT, Bester LA. Molecular Surveillance and Dissemination of Klebsiella pneumoniae on Frequently Encountered Surfaces in South African Public Hospitals. Microb Drug Resist 2021; 28:306-316. [PMID: 34170205 DOI: 10.1089/mdr.2020.0546] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Bacteria that cause life-threatening illnesses in humans are also capable of contaminating hospital surfaces, thus pose as a potential source of infection. This study aimed to investigate the prevalence, genetic diversity, virulence, and antibiotic resistance profile of Klebsiella pneumoniae in South Africa. In a nonoutbreak setting involving four public hospitals, 777 samples were collected in three different wards from 11 different sites. Phenotypic and genotypic methods were used for isolation and identification. The Kirby-Bauer disk-diffusion method was used to examine antibiotic resistance followed by the combination disk method to characterize extended-spectrum β-lactamases (ESBLs). Antibiotic resistance and virulence genes were screened using PCR and clonality was investigated using enterobacterial repetitive intergenic consensus (ERIC)-PCR. Seventy-five (10%) K. pneumoniae isolates were recovered. These isolates were obtained from all four hospitals and all three wards involved. However, only six frequently touched surfaces were contaminated. Thirty (40%) isolates were characterized as ESBLs showing high resistance to antibiotics and mostly harboring the blaCTX-M group one gene. Virulence genes were highly prevalent among all the isolates. ERIC-PCR showed that the isolates recovered from different sites within the same hospital were genetically similar. The study highlighted that K. pneumoniae can contaminate various surfaces and this persistence allows for the dissemination of bacteria within the hospital environment. The information from this study can assist hospitals to evaluate and improve current infection prevention and control interventions in place.
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Affiliation(s)
- Nongcebo Z Z Malinga
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Christiana O Shobo
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Chantal Molechan
- Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Daniel G Amoako
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Antimicrobial Research Unit, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa.,Centre for Respiratory Diseases and Meningitis, National Institute for Communicable Diseases, Johannesburg, South Africa
| | - Oliver T Zishiri
- Discipline of Genetics, School of Life Sciences, College of Agriculture Engineering and Science, University of KwaZulu-Natal, Durban, South Africa
| | - Linda A Bester
- Biomedical Resource Unit, School of Laboratory Medicine and Medical Sciences, College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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29
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Godman B, Egwuenu A, Haque M, Malande OO, Schellack N, Kumar S, Saleem Z, Sneddon J, Hoxha I, Islam S, Mwita J, do Nascimento RCRM, Dias Godói IP, Niba LL, Amu AA, Acolatse J, Incoom R, Sefah IA, Opanga S, Kurdi A, Chikowe I, Khuluza F, Kibuule D, Ogunleye OO, Olalekan A, Markovic-Pekovic V, Meyer JC, Alfadl A, Phuong TNT, Kalungia AC, Campbell S, Pisana A, Wale J, Seaton RA. Strategies to Improve Antimicrobial Utilization with a Special Focus on Developing Countries. Life (Basel) 2021; 11:life11060528. [PMID: 34200116 PMCID: PMC8229985 DOI: 10.3390/life11060528] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/22/2021] [Accepted: 06/02/2021] [Indexed: 02/07/2023] Open
Abstract
Antimicrobial resistance (AMR) is a high priority across countries as it increases morbidity, mortality and costs. Concerns with AMR have resulted in multiple initiatives internationally, nationally and regionally to enhance appropriate antibiotic utilization across sectors to reduce AMR, with the overuse of antibiotics exacerbated by the COVID-19 pandemic. Effectively tackling AMR is crucial for all countries. Principally a narrative review of ongoing activities across sectors was undertaken to improve antimicrobial use and address issues with vaccines including COVID-19. Point prevalence surveys have been successful in hospitals to identify areas for quality improvement programs, principally centering on antimicrobial stewardship programs. These include reducing prolonged antibiotic use to prevent surgical site infections. Multiple activities centering on education have been successful in reducing inappropriate prescribing and dispensing of antimicrobials in ambulatory care for essentially viral infections such as acute respiratory infections. It is imperative to develop new quality indicators for ambulatory care given current concerns, and instigate programs with clear public health messaging to reduce misinformation, essential for pandemics. Regular access to effective treatments is needed to reduce resistance to treatments for HIV, malaria and tuberculosis. Key stakeholder groups can instigate multiple initiatives to reduce AMR. These need to be followed up.
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Affiliation(s)
- Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK;
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa;
- School of Pharmaceutical Sciences, Universiti Sains Malaysia (USM), Penang 11800, Malaysia
- Correspondence: ; Tel.: +44-0141-548-3825; Fax: +44-0141-552-2562
| | - Abiodun Egwuenu
- AMR Programme Manager, Nigeria Centre for Disease Control (NCDC), Ebitu Ukiwe Street, Jabi, Abuja 240102, Nigeria;
| | - Mainul Haque
- Unit of Pharmacology, Faculty of Medicine and Defence Health, Universiti Pertahanan Nasional Malaysia (National Defence University of Malaysia), Kem Perdana Sungai Besi, Kuala Lumpur 57000, Malaysia;
| | - Oliver Ombeva Malande
- Department of Child Health and Paediatrics, Egerton University, Nakuru, P.O. Box 536, Egerton 20115, Kenya;
- East Africa Centre for Vaccines and Immunization (ECAVI), Namela House, Naguru, Kampala P.O. Box 3040, Uganda
| | - Natalie Schellack
- Faculty of Health Sciences, Basic Medical Sciences Building, University of Pretoria, Prinshof 349-Jr, Pretoria 0084, South Africa;
| | - Santosh Kumar
- Department of Periodontology and Implantology, Karnavati University, Gandhinagar 382422, India;
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore 54000, Pakistan;
| | - Jacqueline Sneddon
- Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK; (J.S.); (R.A.S.)
| | - Iris Hoxha
- Department of Pharmacy, Faculty of Medicine, University of Medicine Tirana, 1005 Tirana, Albania;
| | - Salequl Islam
- Department of Microbiology, Jahangirnagar University, Savar, Dhaka 1342, Bangladesh;
| | - Julius Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Private Bag 0022, Gaborone, Botswana;
| | - Renata Cristina Rezende Macedo do Nascimento
- Department of Pharmacy, Postgraduate Program in Pharmaceutical Sciences (CiPharma), School of Pharmacy, Federal University of Ouro Preto, Ouro Preto 35400-000, Minas Gerais, Brazil;
| | - Isabella Piassi Dias Godói
- Institute of Health and Biological Studies, Universidade Federal do Sul e Sudeste do Pará, Avenida dos Ipês, s/n, Cidade Universitária, Cidade Jardim, Marabá 68500-00, Pará, Brazil;
- Center for Research in Management, Society and Epidemiology, Universidade do Estado de Minas Gerais, Belo Horizonte 31270-901, MT, Brazil
| | - Loveline Lum Niba
- Effective Basic Services (eBASE) Africa, Ndamukong Street, Bamenda P.O Box 5175, Cameroon;
- Department of Public Health, University of Bamenda, Bambili P.O. Box 39, Cameroon
| | - Adefolarin A. Amu
- Pharmacy Department, Eswatini Medical Christian University, P.O. Box A624, Swazi Plaza, Mbabane H101, Eswatini;
| | - Joseph Acolatse
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana; (J.A.); (R.I.)
| | - Robert Incoom
- Pharmacy Directorate, Cape Coast Teaching Hospital (CCTH), Cape Coast, Ghana; (J.A.); (R.I.)
| | - Israel Abebrese Sefah
- Pharmacy Department, Keta Municipal Hospital, Ghana Health Service, Keta-Dzelukope, Ghana;
- Pharmacy Practice Department of Pharmacy Practice, School of Pharmacy, University of Health and Allied Sciences, Ho, Volta Region, Ghana
| | - Sylvia Opanga
- Department of Pharmaceutics and Pharmacy Practice, School of Pharmacy, University of Nairobi, Nairobi P.O. Box 30197-00100, Kenya;
| | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow G4 0RE, UK;
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil 44001, Iraq
| | - Ibrahim Chikowe
- Pharmacy Department, College of Medicine, Chichiri 30096, Blantyre 3, Malawi; (I.C.); (F.K.)
| | - Felix Khuluza
- Pharmacy Department, College of Medicine, Chichiri 30096, Blantyre 3, Malawi; (I.C.); (F.K.)
| | - Dan Kibuule
- Department of Pharmacy Practice and Policy, Faculty of Health Sciences, University of Namibia, Windhoek 13301, Namibia;
| | - Olayinka O. Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Ikeja, Lagos 100271, Nigeria;
- Department of Medicine, Lagos State University Teaching Hospital, Ikeja, Lagos 100271, Nigeria
| | - Adesola Olalekan
- Department of Medical Laboratory Science, University of Lagos, Idiaraba, Lagos 100271, Nigeria;
- Centre for Genomics of Non-Communicable Diseases and Personalized Healthcare (CGNPH), University of Lagos, Akoka, Lagos 100271, Nigeria
| | - Vanda Markovic-Pekovic
- Faculty of Medicine, Department of Social Pharmacy, University of Banja Luka, 78000 Banja Luka, Bosnia and Herzegovina;
| | - Johanna C. Meyer
- Division of Public Health Pharmacy and Management, School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa;
| | - Abubakr Alfadl
- National Medicines and Poisons Board, Federal Ministry of Health, Khartoum 11111, Sudan;
- Department of Pharmacy Practice, Unaizah College of Pharmacy, Qassim University, Unaizah 56264, Qassim 56453, Saudi Arabia
| | - Thuy Nguyen Thi Phuong
- Pharmaceutical Administration & PharmacoEconomics, Hanoi University of Pharmacy, 13-15 Le Thanh Tong, Hoan Kiem District, Hanoi, Vietnam;
| | - Aubrey C. Kalungia
- Department of Pharmacy, School of Health Sciences, University of Zambia, P.O. Box 32379, Lusaka 10101, Zambia;
| | - Stephen Campbell
- Centre for Primary Care and Health Services Research, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK;
- NIHR Greater Manchester Patient Safety Translational Research Centre, School of Health Sciences, University of Manchester, Manchester M13 9PL, UK
| | - Alice Pisana
- Department of Global Public Health, Karolinska Institutet, 17177 Stockholm, Sweden;
| | - Janney Wale
- Independent Researcher, 11a Lydia Street, Brunswick, VIC 3056, Australia;
| | - R. Andrew Seaton
- Healthcare Improvement Scotland, Delta House, 50 West Nile Street, Glasgow G1 2NP, UK; (J.S.); (R.A.S.)
- Infectious Disease Department, Queen Elizabeth University Hospital, Govan Road, Glasgow G51 4TF, UK
- Department of Medicine, University of Glasgow, Glasgow G12 8QQ, UK
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Noh EY, Lee MH, Yi YM, Park YH. Implementation of a multimodal infection control strategy in the nursing home. Geriatr Nurs 2021; 42:767-771. [PMID: 33895498 DOI: 10.1016/j.gerinurse.2021.03.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/30/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
The main cause of morbidity and mortality among residents of nursing homes (NHs) is healthcare-associated infections (HAIs). We conducted infection control intervention by applying the WHO multimodal strategy for one year from January to December 2018 in the one NH in South Korea. Healthcare workers (HCWs) in NH were observed by infection control nurse from February to December 2018. Hand hygiene (HH) compliance according WHO 5 moments and type of HH, glove use were measured as main outcomes. During the intervention period, a total of 1,461 cases were observed. HH compliance among HCWs increased from 12.6% to 55.2% after the intervention. According to WHO 5 moments, HH before touching a patient and after touching a patient saw significant improvements. Further, glove misuse decreased significantly from 45.9% to 25.4%. The multifaceted infection control program in the NH group significantly improved the HH compliance of HCWs.
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Affiliation(s)
- Eun-Young Noh
- The Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul, Republic of Korea 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
| | - Min Hye Lee
- College of Nursing, Dong-A University, Busan, Republic of Korea 32, Daesingongwon-ro, Seo-gu, Busan, 49201, Republic of Korea.
| | - Yu Mi Yi
- College of Nursing, Kyungnam College of Information and Technology, Busan, Republic of Korea 45, Jurye-ro, Sasang-gu, Busan, 47011, Republic of Korea.
| | - Yeon-Hwan Park
- The Research Institute of Nursing Science, College of Nursing, Seoul National University, Seoul, Republic of Korea 103, Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
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31
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Jeffery-Smith A, Dun-Campbell K, Janarthanan R, Fok J, Crawley-Boevey E, Vusirikala A, Fernandez Ruiz De Olano E, Sanchez Perez M, Tang S, Rowland TAJ, Wynne-Evans E, Bell A, Patel B, Amin-Chowdhury Z, Aiano F, Paranthaman K, Ma T, Saavedra-Campos M, Ellis J, Lackenby A, Whitaker H, Myers R, Höschler K, Brown K, Ramsay ME, Shetty N, Chow JY, Ladhani S, Zambon M. Infection and transmission of SARS-CoV-2 in London care homes reporting no cases or outbreaks of COVID-19: Prospective observational cohort study, England 2020. THE LANCET REGIONAL HEALTH. EUROPE 2021; 3:100038. [PMID: 33870248 PMCID: PMC7826003 DOI: 10.1016/j.lanepe.2021.100038] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND Care homes have been disproportionately affected by the COVID-19 pandemic. We investigated the potential role of asymptomatic infection and silent transmission in London care homes that reported no cases of COVID-19 during the first wave of the pandemic. METHODS Five care homes with no cases and two care homes reporting a single case of COVID-19 (non-outbreak homes) were investigated with nasal swabbing for SARS-CoV-2 RT-PCR and serology for SARS-CoV-2 antibodies five weeks later. Whole genome sequencing (WGS) was performed on RT-PCR positive samples. Serology results were compared with those of six care homes with recognised outbreaks. FINDINGS Across seven non-outbreak homes, 718 (387 staff, 331 residents) individuals had a nasal swab and 651 (386 staff, 265 residents) had follow-up serology. Sixteen individuals (13 residents, 3 staff) in five care homes with no reported cases were RT-PCR positive (care home positivity rates, 0 to 7.6%) compared to 13 individuals (3.0 and 10.8% positivity) in two homes reporting a single case.Seropositivity across these seven homes varied between 10.7-56.5%, with four exceeding community seroprevalence in London (14.8%). Seropositivity rates for staff and residents correlated significantly (rs 0.84, [95% CI 0.51-0.95] p <0.001) across the 13 homes. WGS identified multiple introductions into some homes and silent transmission of a single lineage between staff and residents in one home. INTERPRETATION We found high rates of asymptomatic infection and transmission even in care homes with no COVID-19 cases. The higher seropositivity rates compared to RT-PCR positivity highlights the true extent of the silent outbreak. FUNDING PHE.
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Affiliation(s)
- Anna Jeffery-Smith
- Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Kate Dun-Campbell
- London Health Protection team, National Infection Service, Public Health England, London, UK
| | - Roshni Janarthanan
- London Health Protection team, National Infection Service, Public Health England, London, UK
| | - Jonathan Fok
- London Health Protection team, National Infection Service, Public Health England, London, UK
| | - Emma Crawley-Boevey
- London Health Protection team, National Infection Service, Public Health England, London, UK
| | - Amoolya Vusirikala
- London Health Protection team, National Infection Service, Public Health England, London, UK
| | | | - Marina Sanchez Perez
- London Health Protection team, National Infection Service, Public Health England, London, UK
| | - Suzanne Tang
- London Health Protection team, National Infection Service, Public Health England, London, UK
| | - Thomas AJ Rowland
- Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Edward Wynne-Evans
- London Health Protection team, National Infection Service, Public Health England, London, UK
| | - Anita Bell
- London Health Protection team, National Infection Service, Public Health England, London, UK
| | - Bharat Patel
- London Health Protection team, National Infection Service, Public Health England, London, UK
| | - Zahin Amin-Chowdhury
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Felicity Aiano
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | | | - Thomas Ma
- Field Service, National Infection Service, Public Health England, UK
| | | | - Joanna Ellis
- Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Angie Lackenby
- Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Heather Whitaker
- Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Richard Myers
- Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Katja Höschler
- Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Kevin Brown
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Mary E Ramsay
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - Nandini Shetty
- Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
| | - J. Yimmy Chow
- London Health Protection team, National Infection Service, Public Health England, London, UK
| | - Shamez Ladhani
- Immunisation and Countermeasures Division, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
- Paediatric Infectious Diseases Research Group, St. George's University of London, UK
| | - Maria Zambon
- Virus Reference department, Public Health England, 61 Colindale Avenue, London NW9 5EQ, UK
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32
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Tinelli M, Tiseo G, Falcone M. Prevention of the spread of multidrug-resistant organisms in nursing homes. Aging Clin Exp Res 2021; 33:679-687. [PMID: 33428170 DOI: 10.1007/s40520-020-01746-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 10/22/2020] [Indexed: 01/17/2023]
Abstract
The increase in the aged population led to a global rise in the demand for elderly healthcare services, such as long-term care facilities (LTCFs), nursing homes, residential homes. Unfortunately, the spread of multidrug-resistant organisms (MDROs) in these structures represent an urgent public health threat requiring immediate action. The aim of this review is to provide a practice guide for the prevention of infections in European LTCFs. A team of experts identify specific problems and proposed practical solutions for the management of colonized and infected patients residing in LTCFs. The heterogeneity of LTCF represents one of the main problems for the implementation of standardized surveillance and infection control programs. Crucial steps involved in the spread of infections among LTCF residents are represented by patient's accommodation, MDRO screening on admission, management of patients with rectal colonization by MDROs, management of patients at high risk of MDRO infections, MDRO transmission by staff and implementation of antimicrobial stewardship. Efforts to implement specific actions in each of these fields are required to reduce the infections in this setting.
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Affiliation(s)
- M Tinelli
- Istituto Auxologico Italiano, IRCCS, San Luca Hospital, Milan, Italy.
| | - G Tiseo
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - M Falcone
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
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33
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Mwita JC, Ogunleye OO, Olalekan A, Kalungia AC, Kurdi A, Saleem Z, Sneddon J, Godman B. Key Issues Surrounding Appropriate Antibiotic Use for Prevention of Surgical Site Infections in Low- and Middle-Income Countries: A Narrative Review and the Implications. Int J Gen Med 2021; 14:515-530. [PMID: 33633461 PMCID: PMC7901404 DOI: 10.2147/ijgm.s253216] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 01/07/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND There is a concern with the growing use of antimicrobials across countries increasing antimicrobial resistance (AMR) rates. A key area within hospitals is their use for the prevention of surgical site infections (SSI) with concerns with timing of the first dose, which can appreciably impact on effectiveness, as well as duration with extended prophylaxis common among low- and middle-income countries (LMICs). This is a concern as extended duration increases utilization rates and AMR as well as adverse events. Consequently, there is a need to document issues of timing and duration of surgical antibiotic prophylaxis (SAP) among LMICs together with potential ways forward to address current concerns. METHODS Narrative review of timings and duration of SAP among LMICs combined with publications documenting successful approaches to improve SAP to provide future direction to all key stakeholder groups. RESULTS There were documented concerns with the timing of the first dose of antibiotics, with appropriate timing as low as 6.7% in Egypt, although as high as 81.9% in Turkey. There was also an extensive duration of SAP, ranging from long duration times in all patients in a study in Nigeria with a mean of 8.7 days and 97% of patients in Egypt to 42.9% of patients in Pakistan and 35% in Turkey. Successful interventions to improve SAP typically involved multiple approaches including education of all key stakeholder groups, monitoring of usage against agreed guidelines,as well as quality targets. Multiple approaches typically improved timing and duration as well as reduced costs. For instance, in one study appropriateness increased from 30.1% to 91.4%, prolonged duration reduced to 5.7% of patients, and mean costs of antibiotics decreased 11-fold. CONCLUSION There are considerable concerns with the timing and duration of SAP among LMICs. Multiple interventions among LMICs can address this providing future directions.
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Affiliation(s)
- Julius C Mwita
- Department of Internal Medicine, Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Olayinka O Ogunleye
- Department of Pharmacology, Therapeutics and Toxicology, Lagos State University College of Medicine, Lagos, Nigeria
- Department of Medicine, Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Adesola Olalekan
- Department of Medical Laboratory Science, University of Lagos, Lagos, Nigeria
- Centre for Genomics of Non-Diseases and Personalized Healthcare (CGNPH), University of Lagos, Lagos, Nigeria
| | | | - Amanj Kurdi
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- Department of Pharmacology, College of Pharmacy, Hawler Medical University, Erbil, Iraq
| | - Zikria Saleem
- Department of Pharmacy Practice, Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | | | - Brian Godman
- Strathclyde Institute of Pharmacy and Biomedical Sciences, Strathclyde University, Glasgow, UK
- School of Pharmacy, Sefako Makgatho Health Sciences University, Pretoria, South Africa
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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34
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Recommendations for detection and rapid management of carbapenemase-producing Enterobacterales outbreaks. Infect Prev Pract 2020; 2:100086. [PMID: 34368719 DOI: 10.1016/j.infpip.2020.100086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 08/19/2020] [Indexed: 12/29/2022] Open
Abstract
There is large heterogeneity in approaches to tackling nosocomial outbreaks caused by carbapenemase-producing Enterobacterales (CPE), however there is limited guidance on how to approach their management. Rapid and robust infection prevention and control interventions can be effective in preventing and reducing the impact of outbreaks in healthcare environments. We present a stepwise approach to aspects of CPE outbreak management, including the development of an action plan, engagement and communication with key stakeholders, developing a dynamic risk assessment, and staff education. These can provide a blueprint for organisations to create templates and checklists to inform their own outbreak response.
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35
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Lynch C, Mahida N, Oppenheim B, Gray J. Looking back on 2019 and commemorating 40 years of HIS and JHI. J Hosp Infect 2020; 104:1-3. [DOI: 10.1016/j.jhin.2019.11.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Accepted: 11/28/2019] [Indexed: 10/25/2022]
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36
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Katz MJ, Osei PM, Vignesh A, Montalvo A, Oresanwo I, Gurses AP. Respiratory Practices in the Long-term Care Setting: A Human Factors-Based Risk Analysis. J Am Med Dir Assoc 2019; 21:1134-1140. [PMID: 31791901 DOI: 10.1016/j.jamda.2019.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/18/2019] [Accepted: 10/20/2019] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To systematically assess safety risks pertaining to tracheostomy care in the long-term care (LTC) setting using a human factors engineering approach. DESIGN We utilized a 5-part approach to complete our proactive risk assessment: (1) performed a hierarchical task analysis of the processes of tracheostomy stoma and suctioning; (2) identified failure modes where a subtask may be completed inappropriately; (3) prioritized each failure mode based on a risk priority scale; (4) identified contributing factors to and consequences for each of the prioritized failure modes; and (5) identified potential solutions to eliminate or mitigate risks. SETTING Three high-acuity LTC facilities with ventilator units across Maryland. METHODS The hierarchical task analysis was conducted jointly by 2 human-factors experts and an infectious disease physician based on respiratory care policies from the Centers for Disease Control and Prevention and existing policies at each LTC facility. The findings were used to guide direct observations with contextual inquiry and focus group sessions to assess safety risks for residents receiving tracheostomy care. RESULTS Direct observations of tracheostomy care and suctioning in the LTC setting revealed significant variations in practice. Respiratory therapists working in LTC reported lack of training and ambiguity concerning recommended procedures to reduce infection transmission in daily care. Highest risk steps identified in tracheostomy care and suctioning included hand hygiene, donning gloves, and providing intermittent suctioning as the suction catheter was withdrawn. Participants identified risk mitigation strategies targeting these high-risk failure modes that addressed contributing factors related to 5 work system components: person (knowledge and competency), task (eg, urgency or time constraints), tools and technology (eg, availability of hand sanitizer), environment (eg, communal rooms), and organization (eg, patient safety culture). CONCLUSIONS AND IMPLICATIONS Human factors analysis of the highest-risk steps in respiratory care activities in the LTC setting suggest several potential mitigation strategies to decrease the risk of infection transmission. Clear procedure guidelines with training are needed to reduce ambiguity and improve care in this setting. Involving frontline staff in patient safety issues using human factors principles and risk analysis may encourage participation and improve the infection prevention culture in LTC.
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Affiliation(s)
- Morgan J Katz
- Johns Hopkins University, Department of Medicine, Division of Infectious Disease, Baltimore, MD.
| | - Patience M Osei
- Johns Hopkins Armstrong Institute for Patient Safety and Quality, Baltimore, MD
| | - Arjun Vignesh
- Johns Hopkins Armstrong Institute for Patient Safety and Quality, Baltimore, MD
| | | | - Ifeoluwa Oresanwo
- Johns Hopkins Armstrong Institute for Patient Safety and Quality, Baltimore, MD
| | - Ayse P Gurses
- Johns Hopkins Armstrong Institute for Patient Safety and Quality, Baltimore, MD
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