Journal of Hospital Infection最新文献

{"title":"Whole-genome sequencing establishes persistence of biofilm-associated Pseudomonas aeruginosa detected from microbiological surveillance of gastrointestinal endoscopes","authors":"G.S.E. Tan ,&nbsp;G.J.M. Chia ,&nbsp;N.M. Thevasagayam ,&nbsp;S.Q.D. Loy ,&nbsp;S.R.S. Prakki ,&nbsp;Z.Q. Lim ,&nbsp;J.Y. Chua ,&nbsp;J.W.Z. Chia ,&nbsp;K. Marimuthu ,&nbsp;S. Vasoo ,&nbsp;O.T. Ng ,&nbsp;B.F. Poh ,&nbsp;B.S.P. Ang","doi":"10.1016/j.jhin.2024.07.007","DOIUrl":"10.1016/j.jhin.2024.07.007","url":null,"abstract":"<div><h3>Background</h3><p>An increased incidence of <em>Pseudomonas aeruginosa</em> in microbiological surveillance (MS) cultures from gastrointestinal endoscopes was detected between March 2020 and March 2023 in Tan Tock Seng Hospital Singapore.</p></div><div><h3>Aim</h3><p>To describe the use of whole-genome sequencing (WGS) in this investigation.</p></div><div><h3>Methods</h3><p>WGS was performed for all <em>P. aeruginosa</em> isolates with pairwise comparison of isolates to assess for genomic linkage. Comprehensive review of reprocessing practices and environmental sampling was performed.</p></div><div><h3>Findings</h3><p>Twenty-two <em>P. aeruginosa</em> isolates were detected from endoscopic MS cultures. Fifteen (68%) isolates were available for WGS. Eighteen pairwise comparisons of isolates were made, of which 10 were found to be genomically linked. One endoscope had <em>P. aeruginosa</em> repeatedly cultured from subsequent MS that were genomically linked and persistent despite repeat endoscopic reprocessing, establishing the persistence of biofilm that could not be eradicated with routine reprocessing. All <em>P. aeruginosa</em> isolates cultured from other different endoscopes were genetically distinct. Investigation into reprocessing practices revealed the use of air/water valves connected to endoscopes during clinical use. Inspection of these valves revealed the presences of cracks and tears. All other environmental samples were negative.</p></div><div><h3>Conclusion</h3><p>The WGS findings helped to deprioritize common source contamination and supported the hypothesis of biofilm build-up within endoscopes, leading to repeatedly positive MS cultures that were genomically linked. This was possibly related to incomplete reprocessing of the damaged air/water valves, resulting in biofilm build-up. All faulty valves were changed and subsequently cleaned separately with ultrasonic cleaning followed by sterilization which resolved this incident.</p></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141768021","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":"A comprehensive evaluation of water, sanitation and hygiene (WASH) in health facilities: a systematic review and meta-analysis","authors":"S. Gnanasekaran ,&nbsp;V. Jayaraj ,&nbsp;Yazhini V.B. ,&nbsp;P.S. Mohanraj ,&nbsp;C. Babu ,&nbsp;N. Rajendran ,&nbsp;V. Rajendran","doi":"10.1016/j.jhin.2024.06.018","DOIUrl":"10.1016/j.jhin.2024.06.018","url":null,"abstract":"<div><p>Despite global recognition, WHO reports reveal significant gaps, with one in four healthcare facilities lacking basic water services, affecting over 1.8 billion people, and 21% lacking sanitation services, impacting 1.5 billion people, especially prevalent in low- and middle-income countries. This study aimed to critically evaluate the current state of water, sanitation and hygiene (WASH) facilities across a diverse range of healthcare settings. This review included various databases such as PubMed, MEDLINE, EMBASE, CINAHL, Scopus and grey literature; eligible studies employing various designs were scrutinized for WASH infrastructure and practices. Methodological quality was rigorously evaluated using the QuADS checklist. Data analysis, performed with R software, involved deriving pooled estimates of WASH intervention effects. Sensitivity analyses were conducted, employing statistical methods such as funnel plots to ensure robustness and mitigate biases. Of the 13,250 articles screened, 18 were included in this review. Meta-analyses revealed significant effect sizes for WASH interventions across domains – water (67.38%), sanitation (53.93%), waste management (40.82%), environment (56.58%), hygiene (66.83%), and management (42.30%). Widespread disparities in WASH persist across healthcare facilities, with rural areas facing notable deficits. Challenges in water quality, sanitation and waste management demand comprehensive, multi-sectoral approaches for improvement.</p></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735690","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":"The quality of antimicrobial prescribing in skin and soft tissue management in Australian hospitals: an analysis of the National Antimicrobial Prescribing Survey data","authors":"S. Park ,&nbsp;K. Thursky ,&nbsp;L. Zosky-Shiller ,&nbsp;R. James ,&nbsp;R. Cheah ,&nbsp;L. Hall ,&nbsp;C. Ierano","doi":"10.1016/j.jhin.2024.06.016","DOIUrl":"10.1016/j.jhin.2024.06.016","url":null,"abstract":"<div><h3>Background</h3><p>Skin and soft tissue infections (SSTIs) are among the most common indications for antimicrobial prescribing in hospitals. Inappropriate antimicrobial use can lead to increased morbidity, unnecessary hospital re-admission and increased antimicrobial resistance. This study aimed to assess the quality of antimicrobial prescribing practices in SSTI management within Australian hospitals to provide guidance for future practice.</p></div><div><h3>Methods</h3><p>A retrospective analysis was conducted with data from the National Antimicrobial Prescribing Survey (NAPS). SSTI prescribing data from Hospital NAPS (2013–2022) and surgical site infection data from Surgical NAPS (2016–2022) datasets were analysed. Variables assessed included guideline compliance, appropriateness as per the structured NAPS algorithm, and reasons for inappropriateness.</p></div><div><h3>Results</h3><p>From the Hospital NAPS dataset, 40,535 antimicrobial prescriptions for SSTIs were analysed. The most common indication was cellulitis (34.1%, <em>N</em>=13,822), and the most prescribed antimicrobial was flucloxacillin (18.8%, <em>N</em>=7,638). SSTI indications had a lower rate of guideline compliance but a higher rate of appropriateness compared with all other indications for antimicrobial prescriptions (guideline compliance 66.3%, <em>N</em>=21,035 vs 67.4%, <em>N</em>=156,285; appropriateness 75.6%, <em>N</em>=30,639 vs 72.7%, <em>N</em>=209,383). The most common reason for inappropriateness was incorrect dose or frequency (29.3%, <em>N</em>=2367). From the Surgical NAPS dataset, 5674 prescriptions for surgical site infections were analysed. Of these, 68.2% (<em>N</em>=3867) were deemed to be appropriate. The most common reason for inappropriateness was incorrect dose or frequency (27.7%, <em>N</em>=350).</p></div><div><h3>Conclusions</h3><p>As SSTIs are a common indication for prescribing an antimicrobial in Australian hospitals, identifying effective antimicrobial stewardship strategies to optimize antimicrobial use for SSTI management is recommended to improve patient outcomes.</p></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0195670124002469/pdfft?md5=6ff07825e9c93017bf829ca130959a54&pid=1-s2.0-S0195670124002469-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735723","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":"Risk factors for infection associated with the use of external ventricular drainage: a systematic review with meta-analysis.","authors":"Alessandra Yuri Takehana de Andrade, Adriane Reis Barletta Canicoba, Ramon Antônio Oliveira, Juliana Rizzo Gnatta, Vanessa de Brito Poveda","doi":"10.1016/j.jhin.2024.07.004","DOIUrl":"https://doi.org/10.1016/j.jhin.2024.07.004","url":null,"abstract":"<p><strong>Background: </strong>Infection associated with the use of the External Ventricular Drainage (EVD) catheter in neurosurgery is linked to high morbidity and mortality, and various mechanisms are related to its occurrence. This systematic review aims to summarise and update the risk factors associated with EVD-related infection.</p><p><strong>Method: </strong>Systematic review with meta-analysis, utilising grey literature and indexed databases.</p><p><strong>Findings: </strong>Thirty studies were included, of which nine contributed to the meta-analysis. The reported frequency of EVD-related infection varied from 1.9% to 36%, and the diagnostic criteria for infection were not standardized, with the presence of a positive culture being the most common. The primary microorganisms identified were Staphylococcus sp. and Pseudomonas sp. Key risk factors included duration of catheterisation, frequency of maintenance care, reinsertion, or number of drains. The results of the meta-analysis showed a significant effect in patients with prolonged use of EVDs, with an increase in risk of 1.47 (OR) [CI 95%, 1.03; 2,10] for each day of use (p=0.03), and showed that the number of cerebrospinal fluid collections was higher in the group with infection (p=0.00), while a greater number of EVDs used was related to a significant effect on infection rates (p=0.00), which were revealed from studies with low heterogeneity (I²: 0%).</p><p><strong>Conclusion: </strong>The results indicated studies with high heterogeneity and low quality of evidence, with risk factors associated with the maintenance or management of EVD.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735721","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":"Comparison of complication rates between midline catheters and peripherally inserted central catheters: a systematic review and meta-analysis of randomized controlled trials","authors":"J-Y. Lai ,&nbsp;M-J Wu ,&nbsp;M.S.N. Gautama ,&nbsp;T-W. Huang","doi":"10.1016/j.jhin.2024.07.003","DOIUrl":"10.1016/j.jhin.2024.07.003","url":null,"abstract":"<div><p>Midline catheters (MCs) and peripherally inserted central catheters (PICCs) are essential for reliable vascular access in patients. Despite their prevalent use, comparative risk assessments of these catheters, particularly from randomized controlled trials (RCTs), remain scarce. This meta-analysis primarily focuses on RCTs to evaluate and compare the incidence of complications associated with MCs and PICCs. We conducted a comprehensive search of databases including the Cochrane Library, PubMed, Embase, Web of Science, ScienceDirect, Scopus and ProQuest, up to April 2024. The primary outcomes analysed were total complications and catheter-related bloodstream infections (CRBSIs), while secondary outcomes included catheter dwell time and thrombosis incidence. Meta-analyses were performed using a random-effects model. Of 831 initially identified articles, five trials involving 608 patients met the inclusion criteria. MCs exhibited a significantly higher rate of total complications compared with PICCs (relative risk = 1.95, 95% confidence interval = 1.23–3.08, <em>P</em>=0.005, <em>I</em>² <em>=</em> 0%). MCs also had shorter dwell times and a higher incidence of premature removal. However, no significant differences were observed in the rates of CRBSIs or thrombosis between MCs and PICCs. PICCs are associated with fewer total complications and longer dwell times compared with MCs, which tend to be more often removed prematurely. Thrombosis rates were similar between the two catheter types, underscoring the need for careful catheter selection based on specific patient conditions and treatment duration. Further research, particularly additional RCTs, is necessary to confirm these findings and guide optimal catheter selection in clinical practice.</p></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735691","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":"Empowered hospitalized patients are involved in shared decision making on antibiotic therapy: a quantitative analysis","authors":"A. Chow ,&nbsp;H. Guo ,&nbsp;A. Ho ,&nbsp;T.M. Ng ,&nbsp;D.C-B. Lye","doi":"10.1016/j.jhin.2024.07.006","DOIUrl":"10.1016/j.jhin.2024.07.006","url":null,"abstract":"<div><h3>Background</h3><p>Half of hospitalized patients receive antibiotics, but they are rarely involved in shared decision making (SDM) on antibiotic therapy. We sought to understand the association between patient empowerment and their involvement in SDM on antibiotic therapy.</p></div><div><h3>Methods</h3><p>From March 2021 to April 2022, we conducted a cross-sectional survey on hospitalized patients receiving antibiotic therapy for ≥1 day in a 1600-bed adult general hospital in Singapore. The questionnaire included seven items (five-point Likert scale) on involvement in SDM from SDM-Q-9 and 10 items (four-point Likert scale) on patient empowerment from HCEQ-10. A multi-variable logistic regression model was constructed to assess for independent associations between the three constructs of patient empowerment and involvement in SDM on antibiotic therapy.</p></div><div><h3>Results</h3><p>Of 636 hospitalized patients, mean age was 57.6 (SD 15.5) years, 61% were males and 37% had tertiary-level education. The majority (90%) were aware that they were on antibiotic therapy, but only 11% of them knew the name of the antibiotic given. After adjusting for age, gender, ethnicity, educational level, and duration of hospital stay, patients with a high-level of involvement in decisions (adjusted odds ratio (AOR) 3.63, 95% confidence interval (CI) 2.19–6.01), interactions with healthcare professionals (AOR 1.77, 95% CI 1.03–3.02), and degree of control over their hospital care (AOR 1.90, 95% CI 1.15–3.12) were more likely to have a high-level of involvement in SDM on antibiotic therapy.</p></div><div><h3>Conclusions</h3><p>Empowering hospitalized patients with involvement in decisions, interactions with healthcare professionals, and control of their hospital care can increase their participation in SDM on antibiotic therapy in hospitals.</p></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735718","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":"Patient-level cost analysis of intensive care unit acquired infections: A prospective cohort study.","authors":"Isabella Lott Bezerra, Antonio Paulo Nassar Junior, Tiago Mendonça Dos Santos, Bruno Martins Tomazini, Viviane Cordeiro Veiga, Beatriz Arns, Giovanna Marssola Nascimento, Alexandre Biasi Cavalcanti, Daniel Tavares Malheiro, Adriano José Pereira","doi":"10.1016/j.jhin.2024.07.002","DOIUrl":"https://doi.org/10.1016/j.jhin.2024.07.002","url":null,"abstract":"<p><strong>Introduction: </strong>Hospital-associated infections (HAIs) are associated with increased mortality and prolonged hospital length-of-stay (LOS). Although some studies have shown that HAIs are associated with increased costs, these studies only used cost estimates, were carried out in a small number of centres, or only in high-income countries.</p><p><strong>Methods: </strong>We carried out a prospective cohort study in ten Brazilian intensive care units (ICUs) selected from a collaborative platform study (IMPACTO MR). We included all patients aged 18 years or older admitted from October 2019 to December 2021 and who had an ICU LOS of at least two days. The costs were adjusted for official inflation until December 2022 and converted into international dollars using the 2021 purchasing power parity (PPP) conversion rate. We used a propensity score matching method to compare patients with HAIs and patients without HAIs, and patients with and without ventilator-associated pneumonia (VAP), central-line bloodstream infection (CLABSI), catheter-associated urinary tract infection (CA-UTI) and multidrug-resistant (MDR) HAIs.</p><p><strong>Results: </strong>We included 7,953 patients in the study, of whom 574 (7.2%) had an HAI during their ICU stay. After propensity-score matching, patients with HAIs had ICU costs that were more than three times higher than those of patients without HAIs [$ 19,642 (IQR; 12,884-35,134) vs. 6,086 (IQR; 3,268-12,550); p <0.001). Patients with VAP, CLABSI, and CA-UTI, but not with MDR-HAIs also had higher total ICU costs.</p><p><strong>Conclusions: </strong>HAIs acquired in the ICU are associated with higher ICU costs. These findings were consistent across specific types of infection.</p>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735720","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":"Risk factors for mortality and complications in peripheral venous catheter-associated Staphylococcus aureus bacteraemia: a large multicentre cohort study","authors":"A. Gallego Rodríguez ,&nbsp;P. Duch Llorach ,&nbsp;S. Grillo ,&nbsp;M. Piriz Marabajan ,&nbsp;V. Pomar Solchaga ,&nbsp;A. Hornero López ,&nbsp;E. Jimenez Martínez ,&nbsp;I. Oriol Bermudez ,&nbsp;A. Rivera ,&nbsp;M. Pujol Rojo ,&nbsp;J. López-Contreras González","doi":"10.1016/j.jhin.2024.06.017","DOIUrl":"10.1016/j.jhin.2024.06.017","url":null,"abstract":"<div><h3>Background</h3><p>Peripheral venous catheter-associated <em>Staphylococcus aureus</em> bacteraemia (PVC-SAB) is a potentially life-threatening nosocomial infection.</p></div><div><h3>Aim</h3><p>This cohort study aims to identify the risk factors associated with its mortality and complications.</p></div><div><h3>Methods</h3><p>Retrospective analysis of a prospective cohort study conducted at two tertiary-care hospitals in Spain. Adult patients admitted between January 2011 and July 2019 which developed PVC-SAB during their hospital stay were included. Primary outcome was all-cause 30- and 90-day mortality. Secondary outcomes were sepsis or septic shock at the onset of bacteraemia, metastatic infection and length of hospital stay. Univariate and multivariate analyses were performed.</p></div><div><h3>Findings</h3><p>A total of 256 PVC-SAB were diagnosed in 243 patients between 2011 and 2019. Thirty-day and 90-day all-cause mortality were 18.3% and 24.2%, respectively. Lack of susceptible antibiotic administration the day after blood culture collection (odds ratio: 4.14; 95% confidence interval: 1.55–11.03; <em>P</em> = 0.005), sepsis and complicated bacteraemia were identified as independent risk factors for 30- and 90-day mortality; meticillin-resistant <em>S. aureus</em> bacteraemia was identified as an independent risk factor only for 30-day mortality and functional dependence only for 90-day mortality. Persistent bacteraemia and sepsis were associated with septic metastases, which significantly increased hospital stay, and endocarditis. A greater proportion of patients experiencing septic shock were subsequently institutionalized compared to those without.</p></div><div><h3>Conclusion</h3><p>PVC-SAB remains linked to high mortality rates. Prompt administration of appropriate antibiotics is crucial for lowering mortality. A comprehensive diagnostic approach is essential, especially in patients with persistent bacteraemia and implanted cardiovascular devices, to rule out metastatic complications and endocarditis.</p></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735722","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":"Cost-effectiveness of a new multi-lumen infusion device to reduce central-venous-line-associated bloodstream infections in neonates","authors":"A. Martelin ,&nbsp;J.C. Picaud ,&nbsp;S. Faton ,&nbsp;P. Pradat ,&nbsp;B. Pastor-Diez ,&nbsp;S. Haÿs ,&nbsp;X. Armoiry","doi":"10.1016/j.jhin.2024.06.019","DOIUrl":"10.1016/j.jhin.2024.06.019","url":null,"abstract":"<div><h3>Background</h3><p>A new medical device was developed for multi-infusion in neonatal intensive care units (NICUs) with the aim of addressing issues related to drug incompatibilities and central-line-associated bloodstream infections (CLABSIs).</p></div><div><h3>Aim</h3><p>To assess the cost-effectiveness of implementing this new perfusion system in an NICU setting.</p></div><div><h3>Methods</h3><p>This single-centre, observational study was conducted in all infants admitted to the NICU within 3 days of birth, and who required a central venous line, to evaluate the cost and effectiveness before (2019) and after (2020) implementation of the new perfusion system. Costs were calculated from the hospital perspective, and the incidence of CLABSIs was examined over a time horizon from NICU admission to discharge. Resource utilization was measured (infusion device, infection-treating drugs and biological analyses), and corresponding costs were valued using tariffs for 2019. The incremental cost-effectiveness ratio (ICER) was calculated, expressed as Euros per CLABSI avoided, and one-way and multi-variate sensitivity analyses were conducted.</p></div><div><h3>Findings</h3><p>Among 609 infants selected, clinical characteristics were similar across both periods. The CLABSI rate decreased significantly (rate ratio 0.22, 95% confidence interval 0.07–0.56), and total costs reduced from €65,666 to €63,932 per 1000 catheter-days (<em>P</em>&lt;0.001) after implementation of the new perfusion system, giving an ICER of €251 saved per CLABSI avoided. The majority of sensitivity analyses showed that the new intervention remained economically dominant.</p></div><div><h3>Conclusion</h3><p>This single-centre study showed a significant decrease in the incidence of CLABSIs after implementation of the new perfusion system, without incurring additional costs. Further prospective multi-centre randomized studies are needed to confirm these results in other NICUs.</p></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0195670124002494/pdfft?md5=ed534cb06e13af4b1dfa3667667b90c9&pid=1-s2.0-S0195670124002494-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735717","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":"Is screening of patients for Pseudomonas aeruginosa groin/rectal carriage useful in identifying those at risk of bacteraemia in haematology and other high-risk clinical settings?","authors":"Ö. Yetiş ,&nbsp;S. Ali ,&nbsp;P. Coen ,&nbsp;P. Wilson","doi":"10.1016/j.jhin.2024.07.005","DOIUrl":"10.1016/j.jhin.2024.07.005","url":null,"abstract":"<div><h3>Background</h3><p><em>Pseudomonas aeruginosa</em> is a leading cause of healthcare-associated infections in patients exposed to hospital waters. A rising incidence of <em>P. aeruginosa</em> bacteraemia at our tertiary teaching hospital prompted investigation.</p></div><div><h3>Aim</h3><p>Microbiological screening at patient admission to support early identification of acquisition.</p></div><div><h3>Methods</h3><p>A 41-bed haematology ward (800-bed teaching-hospital, London) was surveyed between January 24^th, 2020 and May 13^th, 2020. Concurrent rectal and groin swabs were collected in duplicate upon admission weekly. Results were compared with historical shower, drain, and tap water contamination data.</p></div><div><h3>Findings</h3><p>A total of 606 groin/rectal swabs were collected from 154 patients; 61 female and 93 male. Six out of 154 patients admitted (3.9%) were positive for <em>P. aeruginosa</em>. Two patients (1.3%; 95% confidence interval (CI): 0.16 to 4.6) were colonized at admission while four patients (2.6%; CI: 0.7 to 6.5) became colonized by 33 days (interquartile range: 13 to 54) of stay. Concurrent duplicate sampling yielded both positive and negative results in all colonized patient-cases. One patient subsequently developed <em>P. aeruginosa</em> bacteraemia. Shower water and corresponding drains from the four patient rooms where <em>P. aeruginosa</em> was acquired were heavily contaminated (&gt;300 cfu/100 mL) with <em>P. aeruginosa</em> 265 days (median; range: 247–283) before patient admission.</p></div><div><h3>Conclusion</h3><p>Rectal/groin swab-screening at admission to hospital might be valuable for early detection of patient colonization but it is intrusive, resource-demanding, and yield may be low. In high-risk settings, enhanced environmental monitoring, decontamination of surfaces and drains, and point-of-use filter-barriers is recommended, especially if expected duration of stay exceeds 30 days.</p></div>","PeriodicalId":54806,"journal":{"name":"Journal of Hospital Infection","volume":null,"pages":null},"PeriodicalIF":3.9,"publicationDate":"2024-07-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.sciencedirect.com/science/article/pii/S0195670124002548/pdfft?md5=15b3c8883086b1ea670e0e14d4c33b7b&pid=1-s2.0-S0195670124002548-main.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141735719","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}