International Journal of Infection Control

Mild respiratory illness in SARS-CoV-2 infection after vaccination in healthcare workers

2022-10-19T11:27:48-04:00

COVID-19 after vaccination is a consequence of multiple factors, including the variable vaccine efficacy and the emergence of new viral variants. Sixteen cases of infection after completing the primary series of vaccination in healthcare workers (HCWs) are described. Ten cases had symptoms, mainly loss of smell (four cases), cough (four cases), fever (two cases), nasal discharge or obstruction (three cases), general malaise (two cases), and dyspnea and loss of taste in one case each. The median time between the second dose of the primary vaccination and the positive severe acute respiratory syndrome coronavirus 2 polymerase-chain reaction (PCR) was 132.5 days, and the median cycle threshold value at the time of diagnosis was 25.1. Laboratory tests performed at diagnosis showed results mostly in normal parameters, and in 10 cases, pulmonary findings suggestive of COVID-19 were described. The clinical course of the disease was satisfactory, without complications or sequelae at discharge.

Conclusion: COVID-19 after vaccination in HCWs was mild, with a favorable course of the disease.

Descriptive analysis of central line-associated bloodstream infections in a pediatric hematology–oncology unit in Montevideo, Uruguay

2022-10-15T12:03:41-04:00

Background: Central lines are essential for the care of children with cancer.

Aims: To determine the risk factors, characteristics, cost of hospital care, and antibiotic use in pediatric oncology patients with central line-associated bloodstream infections (CLABSIs).

Methods: During 2018–2019, we calculated the rate of CLABSIs in our pediatric hematology–oncology unit.

Findings: Between 2018 and 2019, we detected 34 CLABSIs at our pediatric hematology–oncology unit. We identified neutropenia as the main risk factor for CLABSI (3.74 infections per 1,000 catheter days vs. 1.15 infections per 1,000 catheter days in patients without neutropenia). Three patients died of septic shock. Escherichia coli, Klebsiella species, and Pseudomonas species were frequently isolated. The total healthcare cost of the 34 CLABSIs was more than US$1.2 million.

Conclusions: CLABSI is an avoidable disease among children with cancer. Investing in CLABSI prevention will save lives and financial resources of the hospital. Preventive measures, surveillance, and reporting the rate of CLABSIs are essential for quality assurance and patient safety during cancer-directed treatment of children.

Sliding doors: how does their opening affect particulate matter levels in operating theatres?

2022-10-13T09:39:47-04:00

Background: Operating theatres (OTs) have adequate conditions to perform safe operations and to prevent surgical site infections (SSIs). Opening doors can compromise these situations. Measurement of particulate contamination is a crucial point to check the effectiveness of preventive measures in the OTs. We analysed how opening the doors interact with particulate contamination in different designs of OTs.

Methods: Between January and February 2020, a cross-sectional study was conducted in five different types of OTs of a teaching hospital in Siena. Two (OTs 1 and 2) had laminar flows, with 58 and 55 air changes/h, respectively. Three had turbulent flows: OT3 (18 air changes/h, with four inlets from the ceiling), OT4 (16 air changes/h, airflow directed from one wall to the opposite one and the main door laterally to the flow) and OT5 (23 air changes/h and airflow from the ceiling plenum). Particulate matter (PM) measurements were carried out at seven different locations in each OT, alternating two conditions: 1) doors closed and 2) opening/closing the main door twice per minute. For each spot, in each condition, we recorded for several minutes the following parameters: particles (>0.3, >0.5, >1, >3, >5 and >10 µm), room temperature (RT), relative humidity (RH) and airflow velocity (AS). International Organization for Standardization (ISO) class for PM > 0.5 µm was calculated. Comparison with the Wilcoxon signed-rank test was made using Stata 16 (StataCorp LLC, College Station, TX, USA).

Results: All five OTs had differential pressure, but all fell to 0 at door opening; negligible changes were detected on microclimatic parameters although they may be affected by different types of airflows and design. Even though the variations in the turbulent flow rooms were broader and different, there were no changes in ISO class particle classification, given the already very high initial particulate levels. In laminar flow rooms, with a better ISO classification, the variations were smaller but sufficient to worsen the class.

Conclusions: When opening the doors, the PM levels in OTs are influenced by different ventilation systems and room design. Different ventilation systems and the design of OTs influence particulate levels during door opening. Particulate variations in the laminar flows studied were smaller than in the turbulent flows, which, although lower in performance in our study, can be just as effective; however, as the heterogeneous construction and logistic characteristics of OTs result in significant variations in PMs, further research is needed to determine the actual effect of airflow on the SSI rate.

Using a Massive Open Online Course (MOOC) to promote infection prevention and control learning in healthcare education

2022-08-01T15:21:02-04:00

Background: The prevention of healthcare-associated infections (HAIs) is one of the most important subjects in healthcare education.

Aim: The aim of this study was to describe Finnish, Spanish, Portuguese, and Polish healthcare students’ perspectives on learning about HAIs using a Massive Open Online Course (MOOC). This study is part of the Erasmus+ project ‘Educating students for innovative infection prevention and control (IPC) practices in healthcare settings’ (InovSafeCare).

Methods: The descriptive cross-sectional research design was used to describe healthcare students’ perspectives on learning about HAIs using the InovSafeCare MOOC (ISC-MOOC). The participants (N = 135) were students recruited from partner institutions. The project group developed a semi-structured questionnaire that was used for data collection, containing questions of technical and pedagogical usability. The data were analyzed by statistical methods and content analysis.

Results: The ISC-MOOC facilitated healthcare students’ independent learning and promoted their knowledge of HAI prevention and control. Study materials were easy to use (84%), and the media of the study materials were of high standard (83%). Some technical problems (14%) were also identified with the use of the materials. The study materials were relevant (70%) for IPC learning but should also be provided in different languages.

Conclusion: The MOOC will strengthen the role of the students as future healthcare professionals and will also be usable for those healthcare professionals who need to update their skills with today’s HAI requirements. MOOC should also be translated into other languages other than English.

Seroprevalence in Argentinian healthcare workers after vaccination with Sputnik V

2022-06-01T05:57:49-04:00

Background: Healthcare workers (HCW) were deeply affected by coronavirus disease 2019 (COVID-19). Therefore, vaccination of this population is crucial. However, data on Sputnik V vaccine are sparse.

Objective: The aim of this study was to evaluate serological responses in HCWs following two doses of Sputnik V vaccine.

Methods: A cross-sectional study was conducted at a tertiary-care private teaching hospital between April and May 2021. HCWs without a history of COVID-19 3 or more weeks after the second dose of Sputnik V had a fresh serum sample extracted and processed using Abbott® SARS-CoV-2 IgG II Quant. Values equal to or over 50 arbitrary units (AU)/mL were considered positive. Primary outcome was the proportion of participants who developed antibodies 21 or more days after the second dose of Sputnik V. Secondary outcomes were concentration of anti-spike IgG antibodies and comparison of such concentrations between samples taken 3–5 weeks and more than 5 weeks after the second dose.

Results: The entire population developed anti-spike IgG antibodies. The median antibody concentration was 1234.8 AU/mL. When analysing days to extraction from second vaccine dose, there was no statistical difference between 21 and 35 days versus more than 35 days.

Conclusion: Vaccination with Sputnik V in HCW at our institution demonstrated an efficacy of 100% in achieving quantifiable anti-spike IgG antibodies 21 or more days after the second dose.

Preparation of operating room for COVID-19 suspects at a tertiary care teaching hospital in New Delhi, India

2022-05-30T07:53:52-04:00

The continuous rise in the number of cases of COVID-19, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), generated an urgent need to transform the facilities of our existing operating rooms (OR) to cater for emergency surgeries for patients with suspected COVID-19. The aim was to minimise the spread of infection and to achieve the lowest risk for patients and staff while caring for COVID-19 suspects undergoing surgery. We devised a protocol in our hospital to prepare OR for patients suspected to be suffering from COVID-19 but in whom the surgical intervention could not be deferred until the result of the COVID-19 test was obtained. The key consideration was that we cater to suspected and confirmed COVID-19 patients who required emergency surgery while adhering to strict infection control measures. The study was undertaken as a pilot exercise in consultation with treating surgeons, hospital infection control committee members, hospital administrators, and engineers, along with a literature review, to transform the design and functioning of existing facilities to prepare for emergency surgeries of COVID-19 suspects at the beginning of the pandemic. While this required significant planning on paper and onsite by members of the OR staff, hospital infection control committee, administration, and engineers, the creation of a safe operating environment was possible within a 48-h period with minimal structural alterations.

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.

Hand hygiene practices in extreme resource limited situations: an integrative review of the literature

2022-08-31T03:59:17-04:00

As the COVID-19 pandemic affects more than one hundred million people, worldwide prevention measures, particularly hand hygiene (HH), are crucial to control and limit spread of disease. Yet access to clean water and soap or hand sanitiser may be scarce or unattainable in some situations. This integrative review, based on the framework of Whittemore and Knafl and the quality assessment performed in-line with the Mixed Methods Assessment Tool, aims to identify alternative HH agents and water sources that have demonstrated some efficacy in extreme resource limited situations. Four articles met inclusion criteria, with agents that create friction and repurposed water identified as alternatives to soap and water or hand sanitiser, resulting in reduced microbial load. Sand combined with repurposed cooking water, for example, can be used as an alternate HH measure in extreme resource limitations. Long term effects on skin integrity, compliance, and sustainability of these strategies must be considered.

The physical effects of wearing personal protective equipment: a scoping review

2022-06-08T10:17:45-04:00

Background: The COVID-19 pandemic has required healthcare workers to wear personal protective equipment (PPE), and although there is increasing awareness of the physical effects of wearing PPE, the literature has yet to be synthesised around this topic.

Methods: A scoping review was conducted to synthesise existing literature on the physical effects of wearing PPE and identify gaps in the literature. A comprehensive search strategy was undertaken using five databases from 1995 to July 2020.

Results: A total of 375 relevant articles were identified and screened. Twenty-three studies were included in this review. Studies were conducted across 10 countries, spanning 16 years from 2004 to 2020. Half (13/23) were randomised controlled trials or quasi-experimental studies, five surveys, two qualitative studies, two observational or case series and one Delphi study. Most (82%, 19/23) studies involved the N95 mask (either valved or unvalved). None specifically studied the filtering facepiece 3 mask. The main physical effects relate to skin irritation, pressure ulcers, fatigue, increased breathing resistance, increased carbon dioxide rebreathing, heat around the face, impaired communication and wearer reported discomfort. Few studies examined the impact of prolonged wear (akin to real life practice) on the physical effects, and different types of PPE had different effects.

Conclusions: The physical effects of wearing PPE are not insignificant. Few studies examined the physiological impact of wearing respiratory protective devices for prolonged periods whilst conducting usual nursing activity. No ideal respirators for healthcare workers exist, and the development of more ergonomic designs of PPE is required.

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.

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.

The challenges of COVID-19 vaccination in a war-torn country – Syria

2022-06-01T05:40:34-04:00

‘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