International Journal of Infection Control

Double manual versus automated cleaning of loaner depth gauges used in clinical practice

Wed, 01 Nov 2023 00:00:00 -0400

Background: Automated cleaning is recommended for reprocessing complex design surgical instruments, as it is reproducible and cleaning parameters can be controlled. However, automated equipment may not be a reality for many hospitals, particularly in lower-middle income countries.

Objective: The aim of this study was to compare the effectiveness of double manual cleaning and automated cleaning of depth gauges in use in clinical practice and supplied in a loaner system.

Design: Twenty four depth gauges available for use in a loaner system were evaluated before double manual cleaning (Group 1) or immediately after double manual cleaning (Group 2), or automated thermal disinfector cleaning (Group 3) or automated ultrasonic cleaning (Group 4). Thereafter, the depth gauges in each group were analysed by visual inspection (n = 24), bacterial culture (n = 12), and adenosine triphosphate (ATP) test (n = 12).

Results: Stains, grooves, oxidation or visible debris were detected on at least one of the depth gauges from each group, and most were positive for bacterial growth (n = 11/12). Cleaning methods significantly reduced the amount of ATP (P < 0.05), except for automated ultrasonic cleaning.

Conclusions: Double manual cleaning of depth gauges was similar to automated cleaning in a thermal disinfector, suggesting the possibility for implementing double manual cleaning as an alternative in sterilising service units where automated cleaning equipment is not avaliable.

Problem-solving training: effects on nursing students’ adherence, confidence, and application of problem solving to deal with the barriers to adherence to routine infection control practices

Abubaker M. Hamed, Donna Moralejo, April Pike, Vernon Curran — Thu, 24 Aug 2023 00:00:00 -0400

Background: Adherence to routine practices (RP) in infection control can be influenced by a number of barriers, which can potentially be dealt with using problem solving (PS) as a new approach.

Aim: This study examined the effects of a problem-solving educational program (PSEDP) on nursing students’ adherence, confidence, and application of PS to address the three identified common barriers to RP adherence.

Method: A controlled before and after study was conducted at two nursing schools in Eastern Canada. A total of 94 nursing students participated, with 62 students in the intervention group and 32 in the control group. Students in the intervention group received the PSEDP, while the control group received no intervention. Data from both groups were collected using a problem-solving questionnaire.

Results: Overall, no significant differences were found between the intervention and control groups in their adherence to RP (P = 0.580), confidence in using PS (P = 0.602), and application of PS (baseline P = 0.161, post-program P = 0.618) to deal with the three identified barriers to RP adherence. However, we found significant differences in the subscale analysis of student confidence to deal with the barrier of high nursing workload (P = 0.032) and student adherence to some of the RP components (P < 0.05).

Conclusion: The educational program provided an opportunity for the students to learn about PS to address the three identified barriers. Some improvements were found but they were smaller than expected, possibly due to limited time for practice in the clinical setting following the intervention.

Impact of a low-cost bundle of interventions on infection prevention and control during labour and delivery in rural health centres in Zambia: results from a quasi-experimental study

Mon, 12 Jun 2023 00:00:00 -0400

Infection remains an important cause of maternal and newborn morbidity and mortality globally despite evidence that it can be reduced with adherence to infection prevention and control (IPC) practices. The implementation of IPC has been especially challenging in rural health centres. This pilot study used a non-randomised quasi-experimental design to examine the impact of a low-cost intervention bundle at five rural health facilities in Southern Province of Zambia. We used the Infection Control Assessment Tool (ICAT) and surveyed the incharge nurse, observed deliveries and reviewed logbooks to collect pre- and post-intervention data on healthcare worker IPC practices and maternal and newborn outcomes. The intervention bundle included education sessions, provision of alcohol hand rubs (AHRs), short message service (SMS) text messages and poster reminders, and monthly study visits. The overall ICAT score did not significantly increase after the intervention (64.0 vs. 71.8, maximum score 133, P = 0.28). There was a significant increase in the labour and delivery practices module score (12.5 vs. 16.6, maximum score 27, P = 0.04) and a trend towards improvement in the hand hygiene module (9.1 vs. 13.6, maximum score 23, P = 0.08). There were no differences in pre- or post-intervention outcomes amongst the 654 mothers who delivered and the 655 newborns during the study period. In conclusion, a low-cost bundle of interventions did neither overall improve healthcare workers’ IPC practices in rural Zambia nor significantly change the rates of newborn and maternal complications. Identified challenges included inconsistent supplies of AHRs, protective and sterile equipment, as well as heavy workload for healthcare workers, which inhibited preventative behaviours.

The epidemiology of carbapenem-resistant Enterobacterales in a single center in Oman

Thu, 08 Jun 2023 00:00:00 -0400

Background: Carbapenem-resistant Enterobacterales (CRE) are a global public health threat associated with significant morbidity and mortality.

Objectives: The study aims to describe the epidemiology, microbiology and outcome of patients with CRE infection or colonization during an active surveillance program and to determine the risk factors for the acquisition of such organisms in a single center in Oman.

Method: A retrospective case–control study was conducted in a tertiary care hospital in 2015 and 2016. Cases included patients who had a positive screening or clinical sample for CRE and controls included patients who were screened during the same period and never had a positive screening or clinical sample for CRE. Risk factors analyzed were demographics, comorbidities, instrumentation, and antibiotic exposures. Data were analyzed using SPSS for Windows (version 11.5). Variables of interest were analyzed by univariate analysis, and those of significance were analyzed by logistic regression.

Results: Seven hundred and twenty-eight cases were detected from active surveillance screening, and clinical samples and 749 controls were included. Males comprised 417 (57.3%) cases and females 311 (42.7%). The majority of CRE cases were adult patients (88%, n = 644) compared to 12 % (n = 84) paediatric. The total number of CRE screenings was 8,431 samples in 2015 with a positivity rate of 4.2% and 10,231 samples in 2016 with a positivity rate of 3.6%. The annual incidence rate of CRE was 0.8 per 100 admissions in 2015 and 0.76 per 100 admissions in 2016. The annual incidence density was 1.90 and 1.89 per 1000 patient days for both years, respectively. Healthcare-associated acquisition was 99.5%, and only 0.5% was attributed to the community. The most common sites of infections were urine and wound comprising 29% each. Klebsiella pneumoniae (n = 578, 79%) was the predominant organism followed by Escherichia coli (n = 101, 14%). CRE acquisition was significantly associated with the presence of a urinary catheter (odds ratio [OR]: 7.3; confidence interval [CI]: 4.6–11.6; P < 0.0001 or central line (OR: 3.5; CI: 2.068–6.011; P < 0.001), intubation (OR: 0.5; CI: 0.264–0.947; P < 0.034), antibiotic exposure (OR: 4.5; CI: 3.101–6.586; P < 0.0001), and intensive care unit (ICU) admission (OR: 0.5; CI: 0.297–0.852; P = 0.011). In addition, history of a local and an abroad hospital admission significantly increased the risk of CRE acquisition (respectively, local OR: 10.97; CI: 7.878–15.301; P < 0.000, abroad OR: 12.4; CI: 6.597–23.617; P < 0.0001). Overall mortality was 23.1 and 52.3% among bacteremia cases.

Conclusion: The annual incidence of CRE acquisition is high with a high mortality rate. A multifaceted strategy to control the spread of CRE is fundamental, considering the specific epidemiology of CRE related to our institution and country.

Stakeholders’ perceptions about a surgical site infection master training plan for a low-middle income country

Thu, 13 Apr 2023 00:00:00 -0400

Background: Training is a critical component for improving the practice of surgical site infections (SSI). We have designed a master training plan characterized by a task-based, interprofessional and reflective approach consisting of initial training of employees and subsequent refresher training. It aims to improve the practice of SSI in hospitals. The research question was: How do policymakers, teachers and managers/leaders of health care institutions perceive the outline of a master training plan for SSI?

Methods: Semi-structured interviews were conducted with a purposive sample of 28 stakeholders from three categories.

Results: Four key themes emerged from the interviews: 1) Discussion of authentic tasks fosters the transfer of knowledge to the workplace; 2) interprofessional reflective learning comes with challenges; 3) the master training plan help to change behavior, and 4) it is feasible with limited resources. However, the stakeholders pointed that interprofessional training creates friction among health care professionals (HCPs) who work together and participate in the interprofessional training sessions. To disseminate the training across healthcare facilities, stakeholders suggested developing a train-the-trainer plan. Furthermore, stakeholders suggested making HCPs accountable for actual behavior changes in the workplace.

Conclusion: The stakeholders agreed with the approach that the master plan is based on. Implementing this master training plan was expected to encourage knowledge and skills to practice. Participants indicated that arranging training might be feasible in different institutions and it should be part of undergraduate, postgraduate, and continuing medical education. The stakeholders perceived the outline of the master training plan to be well-suited for implementation in low- and middle-income countries (LMICs).

Factors associated with knowledge about ‘Undetectable HIV viral load is Untransmittable’ among Zambian adults on antiretroviral therapy: a mixed method approach

Fredrick Ngwenya, Mpundu Makasa — Thu, 06 Apr 2023 00:00:00 -0400

Background: Knowledge of ‘Undetectable HIV viral load (VL) is Untransmittable’ (U=U) motivates optimal adherence to antiretroviral therapy (ART).

Objective: This study assessed factors associated with knowledge about U=U among Zambian people living with HIV on ART.

Design: The study used questionnaires and in-depth interviews (IDIs) concurrently between December 2018 and January 2019. Three high volume health facilities, Chilenje, Chipata, and Kalingalinga, were selected. A single proportion of 63.4% of HIV VL suppression (VLS) in Lusaka Province was used to calculate a sample size of 362 respondents. Probability proportional to size procedure was used to apportion the sample to the study sites while a simple random technique was employed in selecting respondents aged 18–59 years and on ART for over 9 months. Stata 14 was used to run descriptive and chi-square statistical analyses. Fifty-five respondents were drawn from 362 respondents for IDIs. The selection was based on varied VL levels. Interviews were audio-recorded, transcribed and analysed thematically, and the findings merged in the discussion.

Results: Approximately, 34.5% of the 362 respondents (n = 125) had knowledge about U=U. The VLS status was significantly associated with U=U knowledge (P = 0.01).

Discussion: Diverse information sources, symbiotic understanding of VL, and treatment-as-prevention benefits were enablers of acquiring more knowledge about U=U, while inadequate health discussion about VL and congestion and waiting time were barriers.

Conclusions: The findings suggest that increased information sharing on the implication of suppressed VL being able to prevent HIV transmission could motivate people living with HIV to adhere to ART, thus sustaining VLS.

Midwives’ experiences of utilising personal protective equipment during the COVID-19 pandemic: a qualitative descriptive study

Angela O'Farrell, Anna V. Chatzi, Owen Doody — Mon, 03 Apr 2023 00:00:00 -0400

Background: Coronavirus has placed a lot of strain on the healthcare system. As a result, major changes have occurred in the way healthcare is delivered, including pregnancy care delivery. Within the Irish healthcare system, the response to the COVID-19 pandemic has demanded frequent and ongoing adjustments to midwifery practice and the provision of personal protective equipment (PPE) and its usage have come under serious scrutiny during the COVID-19 pandemic.

Aim: To explore midwives experiences of utilising PPE during the COVID-19 pandemic.

Methods: A qualitative descriptive study utilising a purposive sampling of 10 midwives who participated in in-depth semi-structured interviews, highlighting their experiences of utilising PPE during the COVID-19 pandemic. Data obtained was analysed using the Braun and Clarkes framework and reported in line with the consolidated criteria for qualitative research reporting (COREQ).

Results: Analysed data resulted in five themes, eight subthemes and 18 codes. The themes identified represent the participants experiences and highlight the; importance of effective communication, fear and anxiety of contracting and spreading the virus, value of peer support as a coping strategy, impact of lack of resources in the midwifery practice, and education and training effectiveness.

Conclusion: The introduced strict mandatory infection prevention and control measures, predominantly the wearing of PPE, took effect with concurrent increased stress and anxiety, while caring for pregnant women.

Self-reported adherence of healthcare workers to infection prevention and control practices during the early waves of the COVID-19 pandemic in Egypt

Thu, 16 Mar 2023 00:00:00 -0400

Introduction: Considering the absence of effective treatment, the World Health Organization had recommended stringent infection prevention and control (IPC) measures against coronavirus disease 2019 (COVID-19) to reduce its transmission. The non-adherence of healthcare workers (HCWs) to these measures had been reported as a major cause of infection.

Aim: To assess the level of self-reported adherence of HCWs to IPC measures during their social life and work time.

Methods: This cross-sectional study included 559 HCWs (411 females and 148 males) working at 39 hospitals across different Egyptian governorates. A predesigned structured questionnaire about COVID-19 IPC measures was completed by trained interviewers.

Results: Washing hands before eating (98.2%), using soap for hand wash (97.9%), washing hands after returning home (96.6%), and wearing a face mask when going outside in public places (83.7%) were the commonest daily-life practices among the 559 studied HCWs, while the least common was social distancing (46.0%). Less than half of the studied HCWs were adherent to the proper duration of handwashing (P < 0.01). Only 5.9% of the studied HCWs usually wore full personal protective equipment (PPE) at work (P = 0.051). The highest percentages of HCWs working at outpatient clinics and laboratories (98.1% each) ‘sometimes’ used PPE (P = 0.017). There was a significant difference in self-reported adherence to wearing face masks at hospitals according to specialties (P < 0.01). HCWs working at intensive care units (ICUs) recorded the highest attendance rates at IPC training (53.8%, P = 0.012). A relatively higher percentage of HCWs at COVID-19 isolation hospitals wore PPE (15.7%) versus 2.2–4.7% in other hospitals (P = 0.015).

Conclusion: The majority of HCWs sometimes complied with wearing PPE (93.6%). HCWs were more adherent to wearing masks at hospitals (94.6%) compared to community settings (42.9%). Older age and female gender were significantly associated with self-reported adherence to some IPC measures. Hand hygiene training session emphasizing the proper duration of hand wash is mandatory.

Towards a framework for a collaborative support model to assist infection prevention and control programmes in low- and middle-income countries: a scoping review

Festus Adams, Peta-Anne Zimmerman, Vanessa L. Sparke, Matt Mason — Fri, 14 Jul 2023 00:00:00 -0400

Background: Infection prevention and control (IPC) in low- and middle-income countries (LMIC) is reported to be poorly supported because of limits in financial, human and physical resources and competing priorities in health budgets. As a result, there is often a role for external agencies to assist in strengthening IPC. While there are reports of how these partnerships have been put into practice, there are no reported frameworks or guidance documents to support the development of such relationships.

Aim: The aim of this study is to identify the core elements of a collaborative support framework to assist LMIC in strengthening IPC.

Methods: To achieve this, a systematic scoping review of available literature was conducted based on the guidelines for Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA 2020). The databases MEDLINE, CINAHL, Embase and Scopus were utilised. The search strategy included different combinations of Medical Subject Heading (MeSH) terms, Emtree and keywords that are relevant to IPC collaboration in LMIC. Literature was limited to that published between 2005 and 2020 in the English language only.

Results: Six core elements of comprehensive IPC collaborative support were identified with five IPC programme areas as minimum requirements, namely: 1) Collaborative Projects, 2) Policies and Procedures, 3) Training and Professional Development, 4) Surveillance Systems and 5) Assessment and Feedback. The last element, 6) Partnerships, was identified as an enabling factor.

Conclusion: These six core elements should be considered when building a collaborative support model to assist IPC in LMIC.

Nudges as a suitable and effective intervention to improve hand hygiene compliance among healthcare workers in patient care settings: a narrative review

Muhammad Taufeeq Wahab — Thu, 15 Jun 2023 00:00:00 -0400

Hand hygiene among healthcare workers (HCWs) is critical to preventing harm to patients in the process of healthcare delivery by minimising healthcare-associated infections (HCAI) in patient care settings. However, low compliance rates of hand hygiene plague healthcare, making it a global priority. Nudges are potentially a suitable and effective intervention to improve compliance among HCWs. In this review, nudges are defined as a method of intervention that attempts to influence people’s judgement, choice or behaviour in a predictable way, without forbidding any options or significantly changing economic incentives. This review aims to determine whether nudges are a suitable and effective intervention for improving hand hygiene compliance among HCWs in patient care settings. This review finds nudges suitable for inculcating professional handwashing habits as they are a form of ritualistic and automatic behaviour driven by unconscious processes, which can be influenced by social influences and environmental cues. A literature search conducted up until January 2022 identified 19 primary studies – 10 of which belonged to a systematic review – investigating the isolated effect of nudge interventions on improving HCW hand hygiene compliance in patient care settings. There is some indication that performance feedback may be effective, but significant heterogeneity of interventions and study designs make it difficult to conclude any further. Future research should employ study designs with minimal bias, use automated hand hygiene auditing systems and should address structural and resource-related constraints before evaluating nudge interventions.

Elimination of routine screening and contact precautions for endemic methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus bacteremia: a retrospective study in intensive care units in Brazil

Fri, 10 Mar 2023 00:00:00 -0500