Healthcare-associated hepatitis C virus transmission among patients in an abdominal organ transplant center

Perceptions of distinctions between patient and healthcare zones among intensive care unit nurses at a Korean tertiary hospital: A cross-sectional study

BACKGROUND

Intensive care unit (ICU) patients face higher infection risks from invasive procedures, highlighting the critical role of ICU nurses in infection prevention. Clear differentiation between the patient and healthcare zones is essential for effective hand hygiene and disinfection, yet research on this topic is limited.

AIM

To assess ICU nurses' perception of the concept of patient and healthcare zones and evaluate their similarity and accuracy in identifying the zones.

METHODS

A descriptive survey was conducted at a 2,732-bed tertiary hospital in Korea from 28 July to 27 August 2022. Participants were recruited from various ICUs through flyers. 225 questionnaires-with illustrations 27 item locations for three ICU scenarios-were made available at nursing stations for voluntary completion. Participants were asked to classify items into the patient zone or the healthcare zone. Similarity scores reflected participant agreement, while accuracy scores measured the proportion of correct answers. Participants' free-text opinions regarding zone classification were analysed thematically.

FINDINGS

104 nurses participated voluntarily. Average similarity and accuracy were 84.7% and 82.7%, respectively. The top 8 items, with over 97% similarity and accuracy, were all frequently in contact with ICU patients (e.g., pulse oximeter, Levin tube, central line, urine bag, and patient bed). The bottom 7 items, with less than 80%, included the glucometer, flashlight, trolley, and sink. Participants with higher education levels had significantly higher similarity (p = .044) and accuracy (p = .033), whereas those already familiar with the patient-zone concept had significantly higher accuracy (p = .009). From the free-text analysis, participants considered factors beyond proximity to the patient, such as patient contact, room type, and distance.

CONCLUSIONS

To address zone classification challenges, clear criteria for patient and healthcare zones, space redesign, and educational programs are recommended. Further research is necessary to improve greater clarity and consensus regarding patient and healthcare zones to enhance infection control practices.

The knowledge domain and emerging trends in phytoremediation: a scientometric analysis with CiteSpace

As a cost-effective, environmentally friendly remediation technology, phytoremediation is defined as the use of green plants to remove pollutants from the environment or render them harmless and has been applied to a variety of contaminated sites throughout the world. There is a prominent phenomenon in which publications about phytoremediation increase each year and involve an increasing number of subject categories. This paper adopts the scientometric analysis method to assess the current state and explore the trends of phytoremediation research based on the bibliographic records retrieved from the Web of Science Core Collection (WoSCC). The results of this paper clearly answer the following questions. (1) What are the publishing characteristics of research on the topic of phytoremediation? What are the characteristics of academic collaboration in phytoremediation research? (2) What are the characteristics and development trends of phytoremediation research? (3) What are the hotspots and frontiers of phytoremediation research? Overall, the research method provides a new approach for the assessment of the performance of phytoremediation research. These results may help new researchers quickly integrate into the field of phytoremediation, as they can easily grasp the frontiers of phytoremediation research and obtain more valuable scientific information. This study also provides references for the follow-up research of relevant researchers.

Incorporation of Social Determinants of Health in the Peer-Reviewed Literature: A Systematic Review of Articles Authored by the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention

OBJECTIVES

Social determinants of health (SDHs) are the complex, structural, and societal factors that are responsible for most health inequities. Since 2003, the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP) has researched how SDHs place communities at risk for communicable diseases and poor adolescent health. We described the frequency and types of SDHs discussed in articles authored by NCHHSTP.

METHODS

We used the MEDLINE/PubMed search engine to systematically review the frequency and type of SDHs that appeared in peer-reviewed publications available in PubMed from January 1, 2009, through December 31, 2014, with a NCHHSTP affiliation. We chose search terms to identify articles with a focus on the following SDH categories: income and employment, housing and homelessness, education and schooling, stigma or discrimination, social or community context, health and health care, and neighborhood or built environment. We classified articles based on the depth of topic coverage as "substantial" (ie, one of ≤3 foci of the article) or "minimal" (ie, one of ≥4 foci of the article).

RESULTS

Of 862 articles authored by NCHHSTP, 366 (42%) addressed the SDH factors of interest. Some articles addressed >1 SDH factor (366 articles appeared 568 times across the 7 categories examined), and we examined them for each category that they addressed. Most articles that addressed SDHs (449/568 articles; 79%) had a minimal SDH focus. SDH categories that were most represented in the literature were health and health care (190/568 articles; 33%) and education and schooling (118/568 articles; 21%).

CONCLUSIONS

This assessment serves as a baseline measurement of inclusion of SDH topics from NCHHSTP authors in the literature and creates a methodology that can be used in future assessments of this topic.

Reuse of insulin pens among multiple patients at 2 Veterans Affairs medical centers

OBJECTIVE

To determine whether reuse of insulin pens among multiple patients resulted in transmission of bloodborne pathogens (BBP).

DESIGN

Retrospective cohort study.

SETTING

Two Veterans Affairs medical centers.

PATIENTS

Veterans who received insulin via insulin pens from 2010 to 2013. METHODS Patients were identified through electronic health records, notified of possible exposure, and serotested for human immunodeficiency virus, hepatitis C virus (HCV), and hepatitis B virus. Newly discovered case patients were assessed in relation to potential proximate patients to determine viral strain relatedness by HCV envelope (env) gene sequencing.

RESULTS

Of 1,791 hospitalized veterans who received insulin via insulin pen, 1,155 were tested for at least 1 viral infection after exposure. Of these, 67 patients were newly diagnosed with 1 or more viral BBPs. For human immunodeficiency virus and hepatitis B virus no additional strain testing of case or proximate patients was possible; 8 HCV cases and 45 proximates (40 unique patients; 5 patients were positive for 2 genotypes) were identified as needing strain testing. Only 3 cases and their 19 proximates had samples available for further testing. None of the 26 remaining proximate patients had blood available for further testing. Median genetic distance between the HCV env sequences of those available for additional testing ranged from 14% to 24%, indicating nonrelatedness.

CONCLUSIONS

Our investigation revealed that exposure to insulin pen reuse did not result in HCV transmission among patients who had viral genetic analysis performed. Analysis for any additional potential transmission of blood-borne pathogens was limited by the available samples.

Results from a Large-Scale Epidemiologic Look-Back Investigation of Improperly Reprocessed Endoscopy Equipment

Objective.

To determine whether improper high-level disinfection practices during endoscopy procedures resulted in bloodborne viral infection transmission.

Design.

Retrospective cohort study.

Setting.

Four Veterans Affairs medical centers (VAMCs).

Patients.

Veterans who underwent colonoscopy and laryngoscopy (ear, nose, and throat [ENT]) procedures from 2003 to 2009.

Methods.

Patients were identified through electronic health record searches and serotested for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV). Newly discovered case patients were linked to a potential source with known identical infection, whose procedure occurred no more than 1 day prior to the case patient's procedure. Viral genetic testing was performed for case/proximate pairs to determine relatedness.

Results.

Of 10,737 veterans who underwent endoscopy at 4 VAMCs, 9,879 patients agreed to viral testing. Of these, 90 patients were newly diagnosed with 1 or more viral bloodborne pathogens (BBPs). There were no case/proximate pairings found for patients with either HIV or HBV; 24 HCV case/proximate pairings were found, of which 7 case patients and 8 proximate patients had sufficient viral load for further genetic testing. Only 2 of these cases, both of whom underwent laryngoscopy, and their 4 proximates agreed to further testing. None of the 4 remaining proximate patients who underwent colonoscopy agreed to further testing. Mean genetic distance between the 2 case patients and 4 proximate patients ranged from 13.5% to 19.1%.

Conclusions.

Our investigation revealed that exposure to improperly reprocessed ENT endoscopes did not result in viral transmission in those patients who had viral genetic analysis performed. Any potential transmission of BBPs from colonoscopy remains unknown.

Results from a Large-Scale Epidemiologic Look-Back Investigation of Improperly Reprocessed Endoscopy Equipment

Objective.

To determine whether improper high-level disinfection practices during endoscopy procedures resulted in bloodborne viral infection transmission.

Design.

Retrospective cohort study.

Setting.

Four Veterans Affairs medical centers (VAMCs).

Patients.

Veterans who underwent colonoscopy and laryngoscopy (ear, nose, and throat [ENT]) procedures from 2003 to 2009.

Methods.

Patients were identified through electronic health record searches and serotested for human immunodeficiency virus (HIV), hepatitis C virus (HCV), and hepatitis B virus (HBV). Newly discovered case patients were linked to a potential source with known identical infection, whose procedure occurred no more than 1 day prior to the case patient's procedure. Viral genetic testing was performed for case/proximate pairs to determine relatedness.

Results.

Of 10,737 veterans who underwent endoscopy at 4 VAMCs, 9,879 patients agreed to viral testing. Of these, 90 patients were newly diagnosed with 1 or more viral bloodborne pathogens (BBPs). There were no case/proximate pairings found for patients with either HIV or HBV; 24 HCV case/proximate pairings were found, of which 7 case patients and 8 proximate patients had sufficient viral load for further genetic testing. Only 2 of these cases, both of whom underwent laryngoscopy, and their 4 proximates agreed to further testing. None of the 4 remaining proximate patients who underwent colonoscopy agreed to further testing. Mean genetic distance between the 2 case patients and 4 proximate patients ranged from 13.5% to 19.1%.

Conclusions.

Our investigation revealed that exposure to improperly reprocessed ENT endoscopes did not result in viral transmission in those patients who had viral genetic analysis performed. Any potential transmission of BBPs from colonoscopy remains unknown.

Previous exposure to HCV among persons born during 1945-1965: prevalence and predictors, United States, 1999-2008

OBJECTIVES

We examined HCV exposure prevalence and predictors among persons in the United States born during 1945-1965.

METHODS

With data from the 1999-2008 National Health and Nutrition Examination Survey, we calculated the proportion of persons born during 1945-1965 who tested positive for HCV antibody (anti-HCV) and analyzed the prevalence by sociodemographic and behavioral risk factors.

RESULTS

Anti-HCV prevalence in the 1945-1965 birth cohort was 3.2% (95% confidence interval [CI] = 2.8%, 3.8%), substantially higher than among other adults (0.9%). Within the cohort, anti-HCV prevalence was higher among non-Hispanic Blacks (6.4%; 95% CI = 5.3%, 7.7%), persons with injection drug use histories (56.8%; 95% CI = 48.4%, 64.8%), and persons with elevated alanine aminotransferase levels (12.7%; 95% CI = 10.7%, 15.1%). Injection drug use (adjusted odds ratio = 98.4; 95% CI = 58.8, 164.5) was the strongest anti-HCV prevalence predictor. Among anti-HCV-positive persons, 57.8% reported having 2 or more alcoholic drinks daily.

CONCLUSIONS

With the high prevalence of HCV among persons born during 1945-1965, the increasing morbidity and mortality associated with HCV, and reductions in liver cancer and HCV-related mortality when HCV is eradicated, it is critically important to identify persons with HCV and link them to appropriate care.

Diversion of drugs within health care facilities, a multiple-victim crime: patterns of diversion, scope, consequences, detection, and prevention

Mayo Clinic has been involved in an ongoing effort to prevent the diversion of controlled substances from the workplace and to rapidly identify and respond when such diversion is detected. These efforts have found that diversion of controlled substances is not uncommon and can result in substantial risk not only to the individual who is diverting the drugs but also to patients, co-workers, and employers. We believe that all health care facilities should have systems in place to deter controlled substance diversion and to promptly identify diversion and intervene when it is occurring. Such systems are multifaceted and require close cooperation between multiple stakeholders including, but not limited to, departments of pharmacy, safety and security, anesthesiology, nursing, legal counsel, and human resources. Ideally, there should be a broad-based appreciation of the dangers that diversion creates not only for patients but also for all employees of health care facilities, because diversion can occur at any point along a long supply chain. All health care workers must be vigilant for signs of possible diversion and must be aware of how to engage a preexisting group with expertise in investigating possible diversions. In addition, clear policies and procedures should be in place for dealing with such investigations and for managing the many possible outcomes of a confirmed diversion. This article provides an overview of the multiple types of risk that result from drug diversion from health care facilities. Further, we describe a system developed at Mayo Clinic for evaluating episodes of potential drug diversion and for taking action once diversion is confirmed.

Glucose meters and opportunities for in-hospital transmission of infection: Quantitative assessment and management with and without patient assignment

BACKGROUND

Increasing use of glucose meters in hospitals has increased opportunities for infection transmission that have not been quantitatively assessed or managed.

METHODS

Before-and-after study of the effects of augmentation of glucose meter inventory and of assignment of glucose meters to individual patients on the sequential use of glucose meters on different patients in a 214-bed hospital.

RESULTS

During October 2008, 11,665 measurements were performed using 38 glucose meters on 803 patients. A total of 9,302 tests (79.7%) was performed sequentially within 24 hours on different patients. From October 28 through November 27, 2009, the glucose meter inventory on 3 high-use units glucose meters was increased (from 22 to 87) with meters assigned to individual patients; on 4 low-use units, glucose meter inventory was increased (from 16 to 28) without assignment to individual patients. Sequential glucose meter use on different patients within 24 hours decreased by 95.1% on high-use units and increased by 17% on low-use units.

CONCLUSION

Use of glucose meters was associated with a high number of opportunities to transmit infections, and those opportunities were reduced only when glucose meters were assigned to individual patients. Recent guidance from the Centers for Disease Control and Prevention and the US Food and Drug Administration to assign glucose meters to individual persons whenever possible is relevant to inpatient care.

Early interferon-based treatment after detection of persistent hepatitis C virus infection: a critical decision

Approximately 170 million people are infected with the hepatitis C virus (HCV) worldwide. Infection with this pathogen is persistent in more than 80% of cases, frequently developing severe forms of liver damage such as cirrhosis and hepatocellular carcinoma. No preventive vaccine is available against HCV, and current treatment based on the combination of pegylated interferon and ribavirin is effective in ∼55% of patients infected with genotype 1, the most prevalent genotype. This review analyzes several factors influencing the achievement of a sustained virological response, namely undetectable HCV RNA at 6 months after conclusion of therapy. Particularly, the relevant issue of age and duration of infection is discussed in detail. Indeed, the final decision for starting treatment should be a case-by-case point. However, the cost-benefit analysis seems to indicate that in patients who are motivated and without contraindications, starting the treatment as early as possible is probably the best choice for success.

Multiple clusters of hepatitis virus infections associated with anesthesia for outpatient endoscopy procedures

BACKGROUND & AIMS

Hepatitis B virus (HBV) and hepatitis C virus (HCV) can be transmitted during administration of intravenous anesthesia when medication vials are used for multiple patients using incorrect technique. We investigated an outbreak of acute HBV and HCV infections among patients who received anesthesia during endoscopy procedures from the same anesthesiologist (anesthesiologist 1), in 2 different gastroenterology clinics.

METHODS

Chart reviews, patient interviews, clinic site visits and infection control assessments, and molecular sequencing of patient isolates were performed. Patients treated by anesthesiologist 1 on specific procedure days were offered testing for blood-borne pathogens. Endoscopy and anesthesia procedures were reviewed; HCV quasispecies analysis was performed.

RESULTS

Six cases of outbreak-associated HCV infection and 6 cases of outbreak-associated HBV infection were identified in clinic 1. One outbreak-associated HCV infection was identified in clinic 2. HCV quasispecies sequences from the patients were nearly identical (96.9%-100%) to those from source patients with chronic viral hepatitis. All affected patients in both clinics received propofol from anesthesiologist 1, who inappropriately used a single-patient-use vial of propofol for multiple patients. Reuse of syringes to redose patients, with resulting contamination of medication vials used for subsequent patients, likely resulted in viral transmission.

CONCLUSIONS

Twelve persons acquired HBV and HCV infections (6 hepatitis C, 5 hepatitis B, and 1 coinfection) in 2 separate offices as a result of receiving anesthesia from anesthesiologist 1. Gastroenterologists are urged to review carefully the injection, medication handling, and other infection control practices of all staff under their supervision, including providers of anesthesia services.

US outbreak investigations highlight the need for safe injection practices and basic infection control

Current understanding of viral hepatitis transmission in United States health care settings indicates progress over the past several decades with respect to the risks from transfusions or blood products. Likewise, risks to health care providers from sharps injuries and other blood and body fluid exposures have been reduced as a consequence of widespread hepatitis B vaccination and the adoption of safer work practices. Increasing recognition of outbreaks involving patient-to-patient spread of hepatitis B and hepatitis C virus infections, however, has uncovered a disturbing trend. This article highlights the importance of basic infection control and the need for increased awareness of safe injection practices.