International Journal of Infection Control

A review of the science and clinical use of alcohol-based hand rubs

2022-01-24T12:18:29-05:00

Alcohol has a longstanding history as an antiseptic, and the coronavirus disease 2019 (COVID-19) pandemic has sparked a renewed interest in its use as a hand sanitizer. Alcohol works by denaturing protein and rendering cell membranes permeable. It offers excellent germicidal effects against Gram-positive and Gram-negative bacteria, Mycobacterium tuberculosis, fungi, and lipid-containing viruses. However, it is less reliable against non-lipid containing viruses and is ineffective against bacterial and fungal spores. Alcohol-based hand rub (ABHR) usually contains 60–90% isopropanol or ethanol. Additives such as chlorhexidine to complement the action of alcohol and emollients to ameliorate the drying effect of alcohol are often included to improve the formulation of ABHR. In the clinical setting, ABHR provides biocidal activity against multidrug resistant bacteria such as methicillin-resistant Staphylococcus aureus as well as viruses like human coronavirus, severe acute respiratory syndrome coronavirus, and Middle East respiratory syndrome. Moreover, its use is associated with an improved compliance with hand hygiene, which has been shown to translate into better patient outcomes. However, there are cases of intoxications secondary to ingestion of ABHR or adulterated alcohol when resources are diverted away from the normal beverage production to meet the increased need for hand sanitizer during the COVID-19 pandemic. The risk of unintentional topical absorption and fire hazard among healthcare workers is low but should not be ignored. We proposed recommendations to mitigate the risk of ABHR ingestion and poisoning as well as that of fire hazard.

Hand hygiene knowledge, attitudes, and self-reported practices among medical and nursing staff of a tertiary-care military hospital: a cross-sectional study

2022-05-13T05:10:41-04:00

Hand hygiene (HH) serves as a primary public health measure against healthcare-associated infections. During the coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome (SARS) coronavirus 2 (SARS-CoV-2), HH has been fundamentally reinforced for preventing infection transmission globally. This cross-sectional study provides data as a baseline evaluation of knowledge, attitude, and self-reported practice, along with the differences of each between medical and nursing staff. A self-administered questionnaire comprising a standardized World Health Organization Hand Hygiene Knowledge Questionnaire (WHO, revised August 2009) and Likert scales for attitude and practice was employed, using convenience sampling to collect data from 383 healthcare workers (HCWs), 92 nurses (24.9%), and 277 doctors (75.1%) in a tertiary-care military hospital. Both nurses and doctors had moderate knowledge with no significant difference (P = 0.54). Moreover, attitude and practice were reported as moderate for both groups. However, the self-reported HH practice of doctors was significantly (P < 0.05) better than that of nurses, while nurses had significantly better (P < 0.01) attitudes in comparison with doctors. Participants who had received formal training in the previous 3 years were 70.65% among nurses and 44.76% among doctors. In total, 78.36% acknowledged routine use of alcohol-based hand rub. It suggested a relationship of HH to demographic variables, professional role, and departmental service. It should be noted that this study shows no relationship between knowledge and practice, and a negative correlation between knowledge and attitude. Concurrently, while further investigation is required to pinpoint the obstacles to achieving proper HH, it can be concluded that infrastructure promoting its practice among HCWs needs to be established.

Rates of urinary catheter-associated urinary tract infection in Saudi MOH hospitals: a 2-year multi-centre study

2022-03-16T08:35:14-04:00

Background: The published rates of catheter-associated urinary tract infection (CAUTI) in Saudi Arabia were derived from single-centre studies or nationally non-representative studies.

Objectives: The aim of this study was to estimate CAUTI rates and urinary catheter utilisation (UCU) ratios in 99 Saudi Ministry of Health (MOH) hospitals from all regions.

Methods: A prospective surveillance study was conducted in 15 different types of intensive care units (ICUs) between January 2018 and December 2019. The data were entered into the Health Electronic Surveillance Network (HESN) programme. The methods of the US National Healthcare Safety Network (NHSN) and the Gulf Cooperation Council (GCC) centre for infection control were used.

Results: During 2 years of surveillance covering 919,615 patient-days and 573,720 urinary catheter days, a total of 965 CAUTI events were identified. The overall MOH CAUTI rate was 1.68 (95%confidence interval (CI) 1.58–1.79) per 1,000 urinary catheter days, and the overall UCU was 0.624 (95%CI 0.623–0.625). CAUTI rates were highest in paediatric medical (5.73) and adult medical (2.02) ICUs. UCU were highest in neurosurgical (0.795) and medical surgical (0.743) ICUs. CAUTI standardised infection ratios across different ICUs in Saudi MOH hospitals were 16% lower than NHSN hospitals, 47% lower than GCC hospitals and 69% lower than International Nosocomial Infection Control Consortium (INICC) hospitals. Urinary catheter standardised utilisation ratios across different ICUs in Saudi MOH hospitals were 15% higher than NHSN hospitals, 9% higher than INICC hospitals and 13% lower than GCC hospitals.

Conclusions: The current study is a unique national CAUTI benchmark that can potentially help in the fight against healthcare-associated infection.

Effect of environmental and behavioural factors on microbiological air quality of operating rooms

2022-01-19T11:26:05-05:00

Introduction: An operating theatre (OT) is a very complex setup, which presents numerous challenges for both patients and health care providers. A safe OT environment decreases the susceptibility of patients to postoperative infections. Therefore, a study was conducted to determine microbiological air quality for establishing baseline values and to assess concurrently the effect of environment and behavioural factors in 46 OTs of a tertiary care hospital.

Materials & Methods: The OTs were divided into two groups based on the type of air flow: laminar diffuser (Group I) or conventional diffuser (Group II). Two hundred and thirty-eight samples were collected with an active technique using a sieve impactor, sampling at 100 L/minute. Statistical analysis was conducted using Statistical Package for Social Sciences (SPSS) Version 20 (IBM Corp., Armonk, NY).

Results: In Group I OTs with the laminar diffuser, bacterial and fungal values during the lean period for environmental and behavioural factors were 47.78 colony forming units (CFM)/m³ and 0.24 CFU/m³, respectively. The bacterial and fungal values during the surgical period were 98.01 CFU/m3 and 0.40 CFU/m³, respectively. The same values for Group II OTs with the conventional diffuser were 52.83 CFU/m³ and 0.39 CFU/m³ during the lean period, and 80.06 CFU/m³ and 0.40 CFU/m³ during the surgical period.

Discussion: Both environmental and behavioural factors – temperature, humidity, percentage of fresh air in circulation, door type, controlled entry, minimal door opening and proper OT attire – were seen to contribute concurrently to maintaining air quality in operating units.

Challenges faced in the conversion of a tertiary healthcare centre into a COVID-19 hospital and developing a free-standing isolation centre in India

2022-02-16T12:26:13-05:00

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes coronavirus disease 2019 (COVID-19), which is a highly virulent disease associated with high mortality. Its outbreak into a pandemic has challenged the healthcare system of most countries around the world. A large number of infectious diseases hospitals are the need of hour to counteract this worrying infection. However, it is not possible to build such hospitals on a large scale within a short period of time; the only possibility is to convert existing healthcare facilities into COVID-19 facilities. The Centers for Disease Prevention and Control (CDC) has released guidelines for the preparation of COVID-19 hospitals, but execution at the ground level comes with many challenges. Here, we share our experience and the challenges we faced during the preparation of a tertiary healthcare centre into a COVID-19 centre, with the hope that it will help other institutions to prepare.

‘Unite for safety – clean your hands’: the 5 May 2022 World Health Organization SAVE LIVES: Clean Your Hands campaign

2022-04-28T13:56:41-04:00