Implementation methods of infection prevention measures in orthopedics and traumatology – a systematic review

Abstract Background Prevention of hospital-acquired infections, in the clinical field of orthopedics and traumatology especially surgical site infections, is one of the major concerns of patients and physicians alike. Many studies have been conducted proving effective infection prevention measures. The clinical setting, however, requires strategies to transform this knowledge into practice. Question/purpose As part of the HYGArzt-Project (“Proof Of Effectivity And Efficiency Of Implementation Of Infection Prevention (IP) Measures By The Physician Responsible For Infection Prevention Matters In Traumatology/Orthopedics”), the objective of this study was to identify effective implementation strategies for IP (infection prevention) measures in orthopedics and trauma surgery. Methods The systematic review was conducted following PRISMA guidelines. A review protocol was drafted prior to the literature search (not registered). Literature search was performed in MEDLINE, SCOPUS and COCHRANE between January 01, 1950 and June 01, 2019. We searched for all papers dealing with infection and infection control measures in orthopedics and traumatology, which were then scanned for implementation contents. All study designs were considered eligible. Exclusion criteria were language other than English or German and insufficient reporting of implementation methods. Analyzed outcome parameters were study design, patient cohort, infection prevention measure, implementation methods, involved personnel, reported outcome of the studies and study period. Results The literature search resulted in 8414 citations. 13 records were eligible for analysis (all published between 2001 and 2019). Studies were primarily prospective cohort studies featuring various designs and including single IP measures to multi-measure IP bundles. Described methods of implementation were heterogeneous. Main outcome parameters were increase of adherence (iA) to infection prevention (IP) measures or decrease in surgical site infection rate (dSSI%). Positive results were reported in 11 out of 13 studies. Successful implementation methods were building of a multidisciplinary team (considered in 8 out of 11 successful studies [concerning dSSI% in 5 studies, concerning iA in five studies]), standardization of guidelines (considered in 10/11 successful studies [concerning dSSI% in 5 studies, concerning iA in seven studies]), printed or electronic information material (for patient and/or staff; considered in 9/11 successful studies [concerning dSSI% 4/4, concerning iA 5/5]), audits and regular meetings, personal training and other interactive measures as well as regular feedback (considered in 7/11 successful studies each). Personnel most frequently involved were physicians (of those, most frequently surgeons) and nursing professions. Conclusion Although evidence was scarce and quality-inconsistent, we found that adhering to a set of implementation methods focusing on interdisciplinary and interactive /interpersonal work might be an advisable strategy when planning IP improvement interventions in orthopedics and traumatology.

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Universal Masking to Control Healthcare-Associated Transmission of SARS-CoV-2

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2021.127 ◽

2021 ◽

pp. 1-24

Author(s):

Eliza R. Thompson ◽

Faith S. Williams ◽

Pat A. Giacin ◽

Shay Drummond ◽

Eric Brown ◽

...

Keyword(s):

Large Scale ◽

Infection Prevention ◽

Index Patient ◽

Field Investigation ◽

Point Prevalence ◽

Control Measures ◽

Prevention Measures ◽

Infection Control Measures ◽

Va Health Care System ◽

Healthcare Associated

Abstract Objective: To assess extent of a healthcare-associated outbreak of SARS-CoV-2 and evaluate effectiveness of infection control measures, including universal masking Design: Outbreak investigation including 4 large-scale point-prevalence surveys Setting: Integrated VA Health Care System with 2 facilities and 330 beds Participants: Index patient and 250 exposed patients and staff Methods: We identified exposed patients and staff and classified them as probable and confirmed cases based on symptoms and testing. We performed a field investigation and assessment of patient and staff interactions to develop probable transmission routes. Infection prevention interventions implemented included droplet and contact precautions, employee quarantine, and universal masking with medical and cloth facemasks. Four point-prevalence surveys of patient and staff subsets were conducted using real-time reverse-transcriptase polymerase chain reaction for SARS-CoV-2. Results: Among 250 potentially exposed patients and staff, 14 confirmed cases of Covid-19 were identified. Patient roommates and staff with prolonged patient contact were most likely to be infected. The last potential date of transmission from staff to patient was day 22, the day universal masking was implemented. Subsequent point-prevalence surveys in 126 patients and 234 staff identified 0 patient cases and 5 staff cases of Covid-19, without evidence of healthcare-associated transmission. Conclusions: Universal masking with medical facemasks was effective in preventing further spread of SARS-CoV-2 in our facility in conjunction with other traditional infection prevention measures.

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The impact of a multimodel approach to designing a new orthopedic department

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1345 ◽

2020 ◽

pp. 1-6

Author(s):

Elad Keren ◽

Abraham Borer ◽

Lior Nesher ◽

Tali Shafat ◽

Rivka Yosipovich ◽

...

Keyword(s):

Hand Hygiene ◽

Antibiotic Stewardship ◽

Infection Prevention ◽

Tertiary Care ◽

Surgical Site Infections ◽

Antibiotic Use ◽

Prevention Measures ◽

Orthopedic Department ◽

Before And After ◽

The Impact

Abstract Objective: To determine whether a multifaceted approach effectively influenced antibiotic use in an orthopedics department. Design: Retrospective cohort study comparing the readmission rate and antibiotic use before and after an intervention. Setting: A 1,000-bed, tertiary-care, university hospital. Patients: Adult patients admitted to the orthopedics department between January 2015 and December 2018. Methods: During the preintervention period (2015–2016), 1 general orthopedic department was in operation. In the postintervention period (2017–2018), 2 separate departments were created: one designated for elective “clean” surgeries and another that included a “complicated wound” unit. A multifaceted strategy including infection prevention measures and introducing antibiotic stewardship practices was implemented. Admission rates, hand hygiene practice compliance, surgical site infections, and antibiotic treatment before versus after the intervention were analyzed. Results: The number of admissions and hospitalization days in the 2 periods did not change. Seven-day readmissions per annual quarter decreased significantly from the preintervention period (median, 7 days; interquartile range [IQR], 6–9) to the postintervention period (median, 4 days; IQR, 2–7; P = .038). Hand hygiene compliance increased and surgical site infections decreased in the postintervention period. Although total antibiotic use was not reduced, there was a significant change in the breakdown of the different antibiotic classes used before and after the intervention: increased use of narrow-spectrum β-lactams (P < .001) and decreased use of β-lactamase inhibitors (P < .001), third-generation cephalosporins (P = .044), and clindamycin (P < .001). Conclusions: Restructuring the orthopedics department facilitated better infection prevention measures accompanied by antibiotic stewardship implementation, resulting in a decreased use of broad-spectrum antibiotics and a significant reduction in readmission rates.

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Nosocomial Outbreak of SARS-CoV-2 in a Non-COVID Zone of a Tertiary Care Hospital of North India: Need to Upgrade Infection Control Practices

Journal of Primary Care & Community Health ◽

10.1177/21501327211050753 ◽

2021 ◽

Vol 12 ◽

pp. 215013272110507

Author(s):

Kirtan Rana ◽

Bhawna Sharma ◽

Pinnaka Venkata Maha Lakshmi ◽

ManharPreet Kaur ◽

Mini P. Singh ◽

...

Keyword(s):

Infection Control ◽

Infection Prevention ◽

Tertiary Care Hospital ◽

Ventilation System ◽

Tertiary Care ◽

Control Measures ◽

North India ◽

Care Hospital ◽

Prevention Measures ◽

Infection Control Measures

Background Hospital acquired infections are preventable cause for morbidity and mortality worldwide. In the current pandemic era proper implementation of infection control measures can prevent the spread of such infections including SARS-CoV 2. The study was done to identified the source and reason for spread of COVID-19 infection and devise recommendations to halt the progress of infection in a non-COVID area. Methods An outbreak in a non-COVID area of a tertiary care hospital was investigated by the infection control team along with the epidemiologist when they were notified about the rising cases of COVID-19 from Advanced Trauma Center’s (ATC) disaster ward. The time, place and person distribution of the cases were studied. Recommendations based on gaps identified were developed onsite and implemented to control the outbreak. Results The outbreak lasted from 19th December 2020 to 12th January 2021, affecting 34 people (25 patients and 9 health care workers). The attack rate was 9.2%. We identified the causes of current outbreak as compromises in infection prevention measures, high bed patient ratio, irregularities in the ventilation system, overcrowding by patient attendants and communication gaps between nursing officers and doctors. Measures required to control the outbreak were implemented and no cases were reported for 2 weeks following the last positive case. Conclusion Non-COVID areas of hospitals are also at risk of nosocomial outbreaks of SARS-CoV 2 and therefore strict infection prevention measures those designated to COVID areas should be followed in non-COVID zones also to prevent such outbreaks.

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2464. Partnerships in the Field: Using Real-time Sequencing to Enhance Epidemiologic Investigation and Response to a Norovirus Outbreak

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz360.2142 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S853-S853

Author(s):

Handy K Lori ◽

Erin H Graf ◽

Linda Brostowski ◽

Lindsay Cunnigham ◽

Caitlin Dougherty ◽

...

Keyword(s):

Real Time ◽

Epidemiologic Methods ◽

Infection Prevention ◽

Control Measures ◽

Prevention Measures ◽

Epidemic Curve ◽

Epidemiologic Surveillance ◽

Infectious Gastroenteritis ◽

Prevention Interventions ◽

Stool Samples

Abstract Background Norovirus is a common cause of infectious gastroenteritis and frequently leads to hospital-based outbreaks of gastrointestinal (GI) illness. We utilized hospital-wide surveillance to detect outbreaks of GI illness among patients and healthcare workers (HCW). Real-time norovirus sequencing was applied to establish conclusive links between patient cases. Methods Patient cases of healthcare-associated GI illness were detected through house-wide microbiologic surveillance. HCW cases were defined as acute episodes of vomiting and/or diarrhea that began within 48 hours of the last shift. Outbreak procedures were implemented on a unit when 3 or more cases were identified within 48 hours. Traditional epidemiologic methods were used, including an epidemic curve and line listing, while instituting local control measures. De-identified clinical stool samples positive for norovirus from any hospital unit during the defined outbreak time period were analyzed. Sanger sequencing was performed using primer sets targeting the norovirus VP1 capsid and polymerase regions. Capillary electrophoresis was implemented on a 3500 Genetic Analyzer (Applied Biosystems) and analysis was performed via MEGA7. Results Epidemiologic surveillance identified a norovirus outbreak involving 11 patients on a single unit. Sequencing was performed on 20 norovirus positive stool samples, of which 13 shared 100% identity across both the VP1 and polymerase regions. Of these 13, 10 specimens were from patients epidemiologically linked to the outbreak; 3 specimens were from patients located on 2 geographically separate floors, not epidemiologically linked to the outbreak. Identification of cases outside of the outbreak unit prompted additional hospital-wide infection prevention interventions, including increased education and messaging, changes in hand hygiene practice, and prohibition of shared food for staff. Conclusion Real-time sequencing confirmed epidemiologically linked cases of norovirus during an outbreak and identified additional transmission events not detected by conventional epidemiologic methods. Partnership between hospital epidemiology and the laboratory identified the need for hospital-wide infection prevention measures to halt ongoing transmission. Disclosures All authors: No reported disclosures.

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Correction to: Implementation methods of infection prevention measures in orthopedics and traumatology – a systematic review

European Journal of Trauma and Emergency Surgery ◽

10.1007/s00068-021-01610-6 ◽

2021 ◽

Author(s):

Benedikt Marche ◽

Meike Neuwirth ◽

Christiane Kugler ◽

Bertil Bouillon ◽

Frauke Mattner ◽

...

Keyword(s):

Systematic Review ◽

Infection Prevention ◽

Prevention Measures

A correction to this paper has been published: https://doi.org/ 10.1007/s00432-021-03543-4

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Mosques in Japan Responding to COVID-19 Pandemic: Infection Prevention and Support Provision

10.21203/rs.3.rs-333662/v3 ◽

2021 ◽

Author(s):

Hitomu Kotani ◽

Mari Tamura ◽

Susumu Nejima

Keyword(s):

Large Scale ◽

Infection Prevention ◽

Early Stage ◽

Close Contact ◽

Physical Distance ◽

Control Measures ◽

Religious Communities ◽

Prevention Measures ◽

Religious Activities ◽

Support Provision

Abstract Religious activities tend to be conducted in enclosed, crowded, and close-contact settings, which have a high potential of transmitting the coronavirus disease, 2019 (COVID-19); therefore, religious communities are expected to take appropriate infection prevention measures. Meanwhile, during past disasters, religious communities have provided various types of support to affected people; hence, their role in disaster risk reduction has received much attention. In this study, we aimed to identify the infection prevention measures and support provision implemented by mosques—Islamic institutions managed and operated mainly by foreign Muslims living in Japan—during the one year from January 2020. We collected information from newspaper articles (18 articles on 19 mosques) and interviews with representatives of three mosques. We found that various infection control measures were implemented in mosques—refraining from mass prayers and closing buildings from an early stage (around February 2020); canceling large-scale events during the month of Ramadan; moving some activities online; and ensuring indoor ventilation and safe physical distance even when continuing face-to-face prayer activities. We also found that various types of support were provided by mosques—donating masks to the local government; listening to problems of people affected by COVID-19 regardless of their nationality; providing financial support to them; translating and disseminating information to foreign Muslims; and providing religious meals for them. This study provides actual examples of infection prevention measures taken by mosques in a Muslim-minority society and suggests that mosques appropriately responded to the needs of religious minorities during disasters, including COVID-19.

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Mosques in Japan Responding to COVID-19 Pandemic: Infection Prevention and Support Provision

10.21203/rs.3.rs-333662/v1 ◽

2021 ◽

Author(s):

Hitomu Kotani ◽

Mari Tamura ◽

Susumu Nejima

Keyword(s):

Large Scale ◽

Infection Prevention ◽

Early Stage ◽

Close Contact ◽

Physical Distance ◽

Control Measures ◽

Religious Communities ◽

Prevention Measures ◽

Religious Activities ◽

Support Provision

Abstract Religious activities tend to be conducted in enclosed, crowded, and close-contact settings, which have a high potential of transmitting the coronavirus disease, 2019 (COVID-19); therefore, religious communities are expected to take appropriate infection prevention measures. Meanwhile, during past natural disasters, religious communities have provided various types of support to affected people; hence, their role in disaster risk reduction has received much attention. In this study, we aimed to identify the infection prevention measures and support provision implemented by mosques—Islamic institutions managed and operated mainly by foreign Muslims living in Japan—during the one year from January 2020. We collected qualitative information from newspaper articles (18 articles on 19 mosques) and interviews with representatives of three mosques. We found that various infection control measures were implemented in mosques—refraining from mass prayers and closing buildings from an early stage (around February 2020); canceling large-scale events during the month of Ramadan; moving some activities online; and ensuring indoor ventilation and safe physical distance even when continuing face-to-face prayer activities. We also found that various types of support were provided by mosques—donating masks to the local government; listening to problems of people affected by COVID-19 regardless of their nationality; providing financial support to them; translating and disseminating information to foreign Muslims; and providing religious meals for them. This study provides actual examples of infection prevention measures taken by mosques in a Muslim-minority society and suggests that mosques appropriately responded to the needs of religious minorities during disasters, including COVID-19.

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Mosques in Japan Responding to COVID-19 Pandemic: Infection Prevention and Support Provision

10.21203/rs.3.rs-333662/v2 ◽

2021 ◽

Author(s):

Hitomu Kotani ◽

Mari Tamura ◽

Susumu Nejima

Keyword(s):

Large Scale ◽

Infection Prevention ◽

Early Stage ◽

Close Contact ◽

Physical Distance ◽

Control Measures ◽

Religious Communities ◽

Prevention Measures ◽

Religious Activities ◽

Support Provision

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Implementation strategies to reduce surgical site infections: A systematic review

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2018.355 ◽

2019 ◽

Vol 40 (3) ◽

pp. 287-300 ◽

Cited By ~ 10

Author(s):

Promise Ariyo ◽

Bassem Zayed ◽

Victoria Riese ◽

Blair Anton ◽

Asad Latif ◽

...

Keyword(s):

Systematic Review ◽

Implementation Strategies ◽

Surgical Site Infections ◽

Cochrane Library ◽

Evidence Based ◽

Evidence Based Practices ◽

Implementation Model ◽

Engagement Strategies ◽

Patient Morbidity ◽

The Cochrane Library

AbstractBackground:Surgical site infections (SSIs) portend high patient morbidity and mortality. Although evidence-based clinical interventions can reduce SSIs, they are not reliably delivered in practice, and data are limited on the best approach to improve adherence.Objective:To summarize implementation strategies aimed at improving adherence to evidence-based interventions that reduce SSIs.Design:Systematic reviewMethods:We searched PubMed, Embase, CINAHL, the Cochrane Library, the WHO Regional databases, AFROLIB, and Africa-Wide for studies published between January 1990 and December 2015. The Effective Practice and Organization Care (EPOC) criteria were used to identify an acceptable-quality study design. We used structured forms to extract data on implementation strategies and grouped them into an implementation model called the “Four Es” framework (ie, engage, educate, execute, and evaluate).Results:In total, 125 studies met our inclusion criteria, but only 8 studies met the EPOC criteria, which limited our ability to identify best practices. Most studies used multifaceted strategies to improve adherence with evidence-based interventions. Engagement strategies included multidisciplinary work and strong leadership involvement. Education strategies included various approaches to introduce evidence-based practices to clinicians and patients. Execution strategies standardized the interventions into simple tasks to facilitate uptake. Evaluation strategies assessed adherence with evidence-based interventions and patient outcomes, providing feedback of performance to providers.Conclusions:Multifaceted implementation strategies represent the most common approach to facilitating the adoption of evidence-based practices. We believe that this summary of implementation strategies complements existing clinical guidelines and may accelerate efforts to reduce SSIs.

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Infection prevention measures for patients undergoing hemodialysis during the COVID-19 pandemic in Japan: a nationwide questionnaire survey

Renal Replacement Therapy ◽

10.1186/s41100-021-00350-y ◽

2021 ◽

Vol 7 (1) ◽

Author(s):

Yuka Sugawara ◽

◽

Masao Iwagami ◽

Kan Kikuchi ◽

Yoko Yoshida ◽

...

Keyword(s):

Infection Control ◽

Questionnaire Survey ◽

Infection Prevention ◽

Control Measures ◽

Nosocomial Transmission ◽

Third Wave ◽

Prevention Measures ◽

Infection Control Measures ◽

Before And After ◽

Dialysis Facilities

Abstract Background Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global pandemic affecting a variety of medical treatments, including hemodialysis. This study aims to investigate the implementation of infection control measures, to examine the shortage of personal protective equipment (PPE) and disinfectants, and to quantify the number of nosocomial COVID-19 transmissions in hemodialysis facilities in Japan during the pandemic. Methods We conducted a nationwide questionnaire survey between 20 October and 16 November 2020 (i.e., between the “second wave” and “third wave” in Japan) in the 4198 dialysis facilities of the Japanese Association of Dialysis Physicians and the Japanese Society for Dialysis Therapy. A total of 2227 facilities (53.0%) responded. The questionnaire consisted of (i) characteristics of facilities, (ii) infection prevention measures in routine dialysis practices, (iii) shortage of PPE, (iv) feasibility of various isolation measures, and (v) nosocomial transmission. Results Half of the responding facilities were hospitals with multiple departments, and the other half were clinics specialized in dialysis. Several infection prevention measures such as health checks of staff and patients, donning of masks before and after hemodialysis, and disinfection of frequently contacted areas were implemented during the COVID-19 pandemic. There was a significant improvement in the implementation rate of these measures during the pandemic, compared to before it, which reached over 90%. More than half of the facilities reported a shortage of disposable masks (67.2%) and hand sanitizer alcohol (56.7%). Isolation of COVID-19 patients in private rooms was possible only in 52.7% of the facilities. The majority of facilities (73.3%) could not accept COVID-19 dialysis patients due to lack of space and manpower. Nosocomial transmission of COVID-19 occurred in 4.0% of the facilities. Of those infected, 51.9% were staff. Conclusions This survey revealed that most hemodialysis facilities in Japan had improved implementation of infection control measures and had shortage of PPEs and disinfectants, though some facilities did not implement infection prevention measures adequately, mainly due to the limited space of the facility. It may be recommended that each facility immediately establishes isolation measures to prepare for the pandemic of COVID-19.

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