Journal of Hospital Infection最新文献

{"title":"Vancomycin Resistant Enterococcus (VRE) - emergence to endemicity in a tertiary hospital in Singapore.","authors":"Indumathi Venkatachalam, May Kyawt Aung, Deborah Chooi Mun Lai, Mabel Zhi Qi Foo, Jean Xiang Ying Sim, Shalvi Arora, Aung Myat Oo, Yuke Tien Fong, Kwee Yuen Tan, Lai Chee Lee, Moi Lin Ling","doi":"10.1016/j.jhin.2025.02.017","DOIUrl":"https://doi.org/10.1016/j.jhin.2025.02.017","url":null,"abstract":"<p><strong>Objective: </strong>To describe the evolving epidemiology and risk associations of vancomycin-resistant Enterococcus (VRE) between 2018 and 2023 in a tertiary hospital in Singapore.</p><p><strong>Methods: </strong>Inpatients in Singapore General Hospital (SGH) between January 2018 and December 2023 were included. VRE surveillance criteria changed in August 2020 and November 2022. Incidence of any VRE (VRE (all)), VRE from surveillance (VRE (surveillance)), clinical VRE isolates (VRE (clinical)), healthcare-associated VRE infections (HA-VRE (infections)) and bacteremia (VRE (bacteremia)) were reviewed. Three case-control studies were conducted. Environmental screening was performed.</p><p><strong>Results: </strong>Over the six-year study period there were 5,173 patients with VRE, of whom 3,141 (60.7%) had HA-VRE, 5157 (99.7%) had E.faecium and 4,336 (84%) carried vanA.121 (2.2%) patients had VRE bacteraemia with mortality 50.4%. There were significant changes in incidence of VRE (all), VRE (surveillance) and VRE (clinical) but HA-VRE (infections) and VRE (bacteremia) remained stable. VRE acquisition was associated with presence of concurrent MRSA (OR 9.4, 95% CI 1.3-66.8, p-value < 0.02), CPE (OR 7.2, 95% CI 2.0-26.0, p-value <0.001), ICU admission (OR 6.1, 95% CI 2.8-13.2, p<0.001), hemodialysis (OR 4.6, 95% CI 1.8-12.0, p<0.001), surgery (OR 3.7, 95% CI 1.6-8.3, p<0.001), vancomycin use (OR 28.2, 95% CI 5.4-146.5, p<0.001) and metronidazole use (OR 4.4, 95% CI 1.0-19.0, p-value 0.04) in the preceding three-months. VRE infection had similar risk associations. 12.5% of environmental samples were VRE positive.</p><p><strong>Conclusion: </strong>VRE endemic state in SGH is associated with significant patient and environmental VRE burden. VRE acquisition and infection have been associated with co-carriage of MRSA or CPE, vancomycin and metronidazole use, ICU admission and prior surgery. Targeted infection prevention and antimicrobial-stewardship programs may reduce VRE (infections).</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143598423","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"What factors are associated with surgical site infections after intracranial neurosurgical procedures? An exploratory register study.","authors":"Ida-Linnea Böregård, Lisa Arvidsson, Sven Bringman, Christine Leo Swenne, Ann-Christin Von Vogelsang","doi":"10.1016/j.jhin.2025.02.013","DOIUrl":"https://doi.org/10.1016/j.jhin.2025.02.013","url":null,"abstract":"<p><strong>Background: </strong>Surgical site infections (SSIs) after intracranial neurosurgical procedures derive from both endogenous and exogenous factors and are associated with increased morbidity, mortality and additional socio-economic costs. The addition of mobile laminar airflow (MLAF) units to the operating room ventilation decreases bacteria-carrying particles, but its influence on SSI incidence, and along with concurrence with other factors, is unclear. This is a continuation study of a previous study using MLAF units.</p><p><strong>Aim: </strong>To explore factors associated with surgical site infections after intracranial procedures during a period when MLAF units were used.</p><p><strong>Methods: </strong>This retrospective register study had an explorative design. The electronic medical records of patients undergoing intracranial neurosurgical procedures were retrospectively reviewed for signs or symptoms of SSIs using a 45-item protocol. Demographic, patient and procedure specific variables were collected as well as exogenous factors and SSI variables regarding depth, type of bacteria, time to infection and treatment. Data was analysed using univariate and multivariate logistic regression.</p><p><strong>Findings: </strong>An SSI occurred in 55 of 800 included patients (6.9%). In univariate and multivariate analysis, only remote infections during the hospital stay were associated with the risk of an SSI (OR: 2.02; 95% CI: 1.07-3.82; P = 0.031). The most common infection depth was superficial SSIs. Median time to infection was 18 days and the most offending microorganism was Staphylococcus aureus.</p><p><strong>Conclusions: </strong>In clinical context, considerations are recommended for neurosurgical patients with ongoing remote infections during their hospital stay. Further perioperative studies are needed in the field of surgical infection prevention.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Risk of Duodenoscope-Associated Colonization (DAC) and Duodenoscope-Associated Infection (DAI): A Prospective Observational Study.","authors":"Koen van der Ploeg, Corné H W Klaassen, Saskia H J Renkens, Bibi C G C Mason-Slingerland, Juliëtte A Severin, Marco J Bruno, Margreet C Vos","doi":"10.1016/j.jhin.2025.02.014","DOIUrl":"https://doi.org/10.1016/j.jhin.2025.02.014","url":null,"abstract":"<p><strong>Background and study aims: </strong>The risk of duodenoscope-associated colonisations (DAC) and infections (DAI) after endoscopic retrograde cholangiopancreatography (ERCP) with a contaminated duodenoscope remains unknown. Determining the incidence of these events is crucial for developing prevention strategies. This study aimed to assess the incidence of DACs and DAIs.</p><p><strong>Methods: </strong>This prospective observational study included adult patients who underwent ERCP from January 2022 to December 2023. Duodenoscopes were sampled prior to each procedure. Contamination was defined as the presence of microorganisms of gut or oral origin (MGO). Post-ERCP, upon availability of culture results, patients exposed to contaminated duodenoscopes were asked to provide a stool sample and were followed for six months. Microorganisms isolated from patient samples and clinical cultures were compared with those found in the duodenoscopes. Whole-genome sequencing (WGS) was used to confirm DAC or DAI.</p><p><strong>Findings: </strong>Among 341 ERCP patients, 73 (21.4%) procedures involved MGO-contaminated duodenoscopes. No duodenoscope-associated outbreaks occurred during the study. Stool samples were returned by 45 of the 73 patients (61.6%). Additionally, 80 MGOs from clinical cultures and 37 residual samples were stored. WGS was performed on eight duodenoscope-patient microorganism pairs from six patients. No DAC or DAI cases were detected.</p><p><strong>Conclusion: </strong>In a non-outbreak setting, supported by monthly routine microbiological surveillance and a quarantine protocol for duodenoscopes, the risk of DAC and DAI appears low. These findings suggest limited value in intensive patient surveillance for DACs/DAIs. Further research is warranted to confirm these results and address knowledge gaps regarding risk factors for DACs and DAIs.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outbreak and persistence of dual carbapenemase (OXA-23 and NDM-1) producing Acinetobacter baumannii international clone 2 (ST2) in a tertiary hospital intensive care unit in Brazil.","authors":"Pedro Olimpio Siqueira Castilho, Fernanda Martelli Takahashi, Maria Julia Onça Moreira, Thais Martins-Gonçalves, Floristher Elaine Carrara, Nilton Lincopan, Eliana Carolina Vespero","doi":"10.1016/j.jhin.2025.02.016","DOIUrl":"https://doi.org/10.1016/j.jhin.2025.02.016","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143588304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the accuracy of point prevalence surveys: a comparative analysis with Hungarian National Nosocomial Surveillance (NNSR) data","authors":"K.E. Horváthné,&nbsp;Z. Balogh","doi":"10.1016/j.jhin.2024.12.011","DOIUrl":"10.1016/j.jhin.2024.12.011","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"157 ","pages":"Pages 83-84"},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142958669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Revisiting Antimicrobial Stewardship in the Paediatric Intensive Care Unit: Insights from an Unconventional Approach.","authors":"C Liberati, G Brigadoi, E Gres, E Barbieri, F Cavagnero, L Maestri, S Trivellato, A Zenere, M De Pieri, C Di Chiara, D Mengato, F Venturini, E De Canale, C Del Vecchio, A Tessari, A Tosoni, C Zaggia, C Contessa, C Giaquinto, E Carrara, E Tacconelli, A Amigoni, D Donà","doi":"10.1016/j.jhin.2025.02.010","DOIUrl":"https://doi.org/10.1016/j.jhin.2025.02.010","url":null,"abstract":"<p><strong>Background: </strong>Patients admitted to the Paediatric Intensive Care Unit (PICU) constitute a high-risk group with a heightened likelihood of receiving inappropriate antimicrobial prescriptions. This study describes an Antimicrobial Stewardship Programme (ASP) in the PICU of a tertiary hospital in Italy.</p><p><strong>Method: </strong>A pre-post quasi experimental study was conducted between 01/01/2019 and 31/12/2022 in the PICU of the Department for Women's and Children's Health, University Hospital of Padua. The ASP intervention started in February 2021 by a multidisciplinary team using the \"handshake\" approach. The population included all patients admitted to the PICU. The primary outcome was antibiotic consumption measured as days of therapy administered (DOTs)/1000 patient-days. An interrupted time series analysis was used to assess the trend in antibiotic prescribing before and after the intervention.</p><p><strong>Results: </strong>616 patients (episodes) were admitted in the pre-intervention phase (Jan 2019 - Jan 2021) and 602 patients in the post-intervention phase (Feb 2021 - Dec 2022). For overall antibiotic consumption, the ASP implementation resulted in a significant monthly decrease of 3.0% (p< 0.0001). Monthly reductions for higher consumption antibiotics were: meropenem 4.9% (p=0.009), glycopeptides 3.8% (p=0.014), piperacillin-tazobactam 4.8% (p=0.034). The consumption of third-generation cephalosporins and amikacin did not significantly vary.</p><p><strong>Conclusions: </strong>The ASP intervention was effective in reducing the consumption of antimicrobials in such a complex setting. These results show the importance of antimicrobial stewardship in the scenario of critically ill children.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143544492","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating Decontamination Interventions to Control CPE Transmission from Sinks: A Retrospective Analysis.","authors":"Anat Arbel, Riad Abdo, Maisam Amar, Rabah Yasin, Marina Feldman, Ola Salah, Gabriel Weber, Ronza Najjar-Debbiny","doi":"10.1016/j.jhin.2025.02.011","DOIUrl":"https://doi.org/10.1016/j.jhin.2025.02.011","url":null,"abstract":"","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538180","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the risk of Clostridioides difficile infection from toilet flushing: a quantitative microbial risk assessment and implications for infection control","authors":"E.N. Paddy,&nbsp;M. Sohail,&nbsp;O.O.D. Afolabi","doi":"10.1016/j.jhin.2025.02.012","DOIUrl":"10.1016/j.jhin.2025.02.012","url":null,"abstract":"<div><h3>Background</h3><div>Despite stringent infection control measures, <em>Clostridioides difficile</em> infection (CDI) remains a challenge in healthcare settings, partly due to overlooked transmission vectors such as toilet plume bioaerosols.</div></div><div><h3>Aim</h3><div>To systematically quantify the risks associated with CDI transmission via toilet flushing and provide critical insights to inform CDI preventive strategies.</div></div><div><h3>Methods</h3><div>Impaction sampling was used to quantify airborne <em>C. difficile</em> post-flush and high-contact surfaces were swabbed to assess contamination levels, in a controlled toilet environment. A quantitative microbial risk assessment (QMRA) approach was then used to estimate the risk to subsequent users from contamination by a previously colonized individual.</div></div><div><h3>Findings</h3><div>A single flush can release <em>C. difficile</em> into the air, with bioaerosol concentrations up to 29.50 ± 10.52 cfu/m³ and deposit about 8–11 cfu on immediate surfaces. Despite a 4.4 log reduction in bacterial concentration within the toilet bowl post-flush, bacteria persist on its inner walls. Relative humidity increases by approximately 31.28% within the first 10 min post-flush, potentially enhancing the viability and transmission of aerosolized <em>C. difficile</em>. The flush button contact and inhalation-followed-by-ingestion in frequent-use hospital settings present the highest risks and exceed US EPA and WHO acceptable infection risk thresholds.</div></div><div><h3>Conclusion</h3><div>The findings of this study necessitate a review of current toilet designs, public health policies and facility management practices to mitigate the overlooked risks of CDI transmission through toilet plume bioaerosols in healthcare settings. Additionally, this study lays a foundation for developing evidence-based interventions aimed at achieving substantial behavioural and infrastructural changes in infection control practices.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"159 ","pages":"Pages 92-99"},"PeriodicalIF":3.9,"publicationDate":"2025-02-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143538181","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Outbreak investigations of contact patients and the hospital environment after detection of carbapenemase-producing Pseudomonas aeruginosa on general hospital wards","authors":"A.C. Büchler,&nbsp;C.H.W. Klaassen,&nbsp;I. de Goeij,&nbsp;M.C. Vos,&nbsp;A.F. Voor in ’t holt,&nbsp;J.A. Severin","doi":"10.1016/j.jhin.2025.02.009","DOIUrl":"10.1016/j.jhin.2025.02.009","url":null,"abstract":"<div><h3>Background</h3><div>Carbapenemase-producing <em>Pseudomonas aeruginosa</em> (CPPA) is known to cause outbreaks in healthcare settings. Outbreak investigations, including screening of contact patients and the environment, are key in infection prevention and control (IPC) management to contain them.</div></div><div><h3>Aim</h3><div>The aim of this study was to determine the yield of outbreak investigations performed after unexpected detections of CPPA in clinical or screening cultures of patients hospitalized on a general ward.</div></div><div><h3>Methods</h3><div>In this retrospective cohort study, we included all adult patients newly detected with CPPA (‘index patients’) while hospitalized on a general ward from June 2011 to December 2021. We evaluated the outbreak investigations performed, i.e., screening of epidemiologically linked patients (‘contact patients’) and the environment. Isolates were analysed by whole-genome sequencing (WGS).</div></div><div><h3>Findings</h3><div>Outbreak investigations of 34 of 38 (89.5%) index patients were evaluated, with screening of contact patients performed in 34 (100%) and the environment in 18 (52.9%). CPPA was detected in eight (44.4%) of the environmental screenings, and WGS confirmed relatedness to the index in four (22.2%). A total of 1707 of 1982 (86.1%) identified contact patients were screened, of which eight carried CPPA (0.5%). WGS confirmed transmission from index patient to contact patient in five of these (0.3%).</div></div><div><h3>Conclusion</h3><div>Environmental screening should be part of outbreak investigations for CPPA, as it identifies sources which enables timely installation of targeted IPC measures. Identification of index-to-contact patient transmission was rare in our setting, thus implying reconsideration of the definition of contact patients at high risk is needed.</div></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":"159 ","pages":"Pages 11-19"},"PeriodicalIF":3.9,"publicationDate":"2025-02-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476951","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Barriers and facilitators to the use of personal protective equipment in long-term care: a qualitative study.","authors":"Christian C Tsang, Jayna M Holroyd-Leduc, Vivian Ewa, John M Conly, Myles M Leslie, Jenine R Leal","doi":"10.1016/j.jhin.2025.02.008","DOIUrl":"https://doi.org/10.1016/j.jhin.2025.02.008","url":null,"abstract":"<p><strong>Background: </strong>Long-term Care (LTC) residents are vulnerable to invasive infection. Appropriate use and training on personal protective equipment (PPE) is important for protecting residents and healthcare workers (HCWs). Studies on the barriers and facilitators to PPE use are limited in LTC settings.</p><p><strong>Objective: </strong>Characterize HCWs' perceptions of barriers and facilitators to the uptake and appropriate use of PPE in LTC facilities Calgary, Alberta.</p><p><strong>Methods: </strong>Semi-structured interviews were conducted with HCWs from April to October 2022. Interview transcripts were analyzed deductively to identify themes from the Theoretical Domains Framework.</p><p><strong>Results: </strong>Seven HCWs were interviewed. Barriers and facilitators fell within six overarching themes including: availability and quality of PPE; knowing how to use PPE; familial obligations; convenience and comfort; sense of professional duty; and social influences and identity. Additional factors such as understaffing and the need for more training sessions were highlighted. Strategies to improve PPE use were identified by HCWs, including the use of PPE champions, regular audits, and constructive feedback.</p><p><strong>Conclusion: </strong>Identification of unique barriers and facilitators regarding PPE use by HCWs in LTC will facilitate targeted interventions to improve PPE use in this setting.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":" ","pages":""},"PeriodicalIF":3.9,"publicationDate":"2025-02-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143476948","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}