scholarly journals Candida Auris, An Agent of Hospital-Associated Outbreaks: Which Challenging Issues Do We Need to Have in Mind?

2020 ◽  
Vol 8 (2) ◽  
pp. 181 ◽  
Author(s):  
Raquel Sabino ◽  
Cristina Veríssimo ◽  
Álvaro Ayres Pereira ◽  
Francisco Antunes

The emergence of Candida auris is considered as one of the most serious problems associated with nosocomial transmission and with infection control practices in hospital environment. This multidrug resistant species is rapidly spreading worldwide, with several described outbreaks. Until now, this species has been isolated from different hospital surfaces, where it can survive for long periods. There are multiple unanswered questions regarding C. auris, such as prevalence in population, environmental contamination, effectiveness of infection prevention and control, and impact on patient mortality. In order to understand how it spreads and discover possible reservoirs, it is essential to know the ecology, natural environment, and distribution of this species. It is also important to explore possible reasons to this recent emergence, namely the environmental presence of azoles or the possible effect of climate change on this sudden emergence. This review aims to discuss some of the most challenging issues that we need to have in mind in the management of C. auris and to raise the awareness to its presence in specific indoor environments as hospital settings.

2018 ◽  
Vol 1 (1) ◽  
pp. 46
Author(s):  
Erna Tsalatsatul Fitriyah ◽  
Meidiana Dwidiyanti ◽  
Luky Dwiantoro

Background: Infectious diseases have become one of the world’s serious problems including in Indonesia. Infectious diseases can originate from the community and hospital environment. Health workers performing inappropriate medical procedures could also be a cause of transmission of infectious diseases. Infection prevention and control nurses (IPCNs) as the pioneers of prevention and infection control in hospitals have not optimally played their roles.   Purpose: This study aimed to explore the roles of IPCNs and their constraints in preparing for emerging infectious diseases. Methods: The present study employed a qualitative design with the hermeneutic phenomenological approach. The samples were seven IPCNs for the primary participants, and two Infection Prevention and Control Officers (IPCOs) and 13 Infection Prevention and Control Link Nurses (IPCLNs) as the triangulation participants. The data were collected using in-depth semi-structured interviews analyzed using a content analysis technique.   Results: The results identified two themes: (1) IPCNs played roles as clinical practitioners, activity coordinators, administrators, and educators, and (2) the roles of IPCNs had not been optimal due to the lack of support from the hospital management, insufficient infrastructure, weak monitoring and evaluation, and the unavailability of appropriate rewards and  punishment.Conclusion: The majority of participants in this study agreed that IPCNs had tried well to play their roles. However, various obstacles were encountered, which hindered the IPCNs in performing their roles.


2019 ◽  
Vol 185 (3-4) ◽  
pp. 451-460
Author(s):  
Alice E Barsoumian ◽  
Steffanie L Solberg ◽  
Ashley S Hanhurst ◽  
Amanda L Roth ◽  
Tamara S Funari ◽  
...  

Abstract Introduction Infections with multidrug resistant organisms that spread through nosocomial transmission complicate the care of combat casualties. Missions conducted to review infection prevention and control (IPC) practices at deployed medical treatment facilities (MTFs) previously showed gaps in best practices and saw success with targeted interventions. An IPC review has not been conducted since 2012. Recently, an IPC review was requested in response to an outbreak of multidrug resistant organisms at a deployed facility. Materials and Methods A Joint Service team conducted onsite IPC reviews of MTFs in the U.S. Central Command area of operations. Self-assessments were completed by MTF personnel in anticipation of the onsite assessment, and feedback was given individually and at monthly IPC working group teleconferences. Goals of the onsite review were to assist MTF teams in conducting assessments, review practices for challenges and successes, provide on the spot education or risk mitigation, and identify common trends requiring system-wide action. Results Nine deployed MTFs participated in the onsite assessments, including four Role 3, three Role 2 capable of surgical support, and two Role 1 facilities. Seventy-eight percent of sites had assigned IPC officers although only 43% underwent required predeployment training. Hand hygiene and healthcare associated infection prevention bundles were monitored at 67% and 29% of MTFs, respectively. Several challenges including variability in practices with turnover of deployed teams were noted. Successes highlighted included individual team improvements in healthcare associated infections and mentorship of untrained personnel. Conclusions Despite successes, ongoing challenges with optimal deployed IPC were noted. Recommendations for improvement include strengthening IPC culture, accountability, predeployment training, and stateside support for deployed IPC assets. Variability in IPC practices may occur from rotation to rotation, and regular reassessment is required to ensure that successes are sustained through times of turnover.


Author(s):  
Dorota Jaślan ◽  
Jerzy Rosiński ◽  
Małgorzata Siewierska ◽  
Anna Szczypta ◽  
Marta Wałaszek ◽  
...  

Background: The results of several studies in the area of infection control in Poland are disturbing. The situation may be shaped by many factors. However, the key factor for effective infection prevention and control is dedicated personnel, especially infection prevention and control nurses (IPCN). Nevertheless, based on the available published data and the authors’ experience, in many Polish hospitals infection control is not sufficiently appreciated by managers, it is consequently underfunded, and treated by medical staff as a nuisance. This may influence the nurses willingness to work as IPCN. The aim of the study was to assess the nursing students’ perception of the work of IPCN and their interest in employment in this position, as well as the potential reasons for choosing this particular specialization. Materials and methods: The study was conducted using the authors’ anonymous questionnaire conducted among nursing students of three Polish universities. The questionnaire was prepared by a panel of experts working in the field of infection control, including nurses working both as academic teachers and infection control nurses in hospitals. The design of the questionnaire was based on the authors’ own experience, knowledge, and exchanging information with the practitioners in infection control in Poland. The reliability of the questionnaire was confirmed by the Cronbach alpha test. The raw alpha values and 95% CI for two main questions concerning opinion were: 0.76 (0.72–0.81) and 0.69 (0.63–0.75). Results: The study was conducted among 253 students, mostly women (98%) of full-time (31.4%) and extramural (68.6%) studies. The age range of the respondents was 20–58 years, median = 26 years, IQR = 19 years. To the key item in the questionnaire, i.e., “Would you like to work as an IPCN?”, 84.6% (214 respondents; first group) of the respondents answered “no” and 15.4% (39 respondents, second group) answered “yes”. The results revealed no significant differences between the two groups concerning the position responsibilities and appreciation by other medical staff. Additionally, for respondents willing to work as ICPN the most important issues were the influence on patient safety, expected salary, and possibility of professional development; for the respondents from the other group the most important issue was lack of contact with patients. The results concerning the students’ opinion on the perception of IPCN by medical personnel proved to be peculiar. About 80% of the respondents confirmed the IPCNs’ key role in ensuring patient and personnel safety, while only 31.6% declared their high standing in the hospital hierarchy. Conclusions: The obtained results indicate the necessity of thorough studies on the organization and structure of infection control in Polish hospitals, with a particular emphasis on building a positive perception of IPCNs by medical staff, as well as implementing an education campaign on infection control in the hospital environment.


Author(s):  
Aline Wolfensberger ◽  
Stefan P. Kuster ◽  
Martina Marchesi ◽  
Reinhard Zbinden ◽  
Michael Hombach

Abstract Background A multitude of definitions determining multidrug resistance (MDR) of Gram-negative organisms exist worldwide. The definitions differ depending on their purpose and on the issueing country or organization. The MDR definitions of the European Centre for Disease Prevention and Control (ECDC) were primarily chosen to harmonize epidemiological surveillance. The German Commission of Hospital Hygiene and Infection Prevention (KRINKO) issued a national guideline which is mainly used to guide infection prevention and control (IPC) measures. The Swiss University Hospital Zurich (UHZ) – in absentia of national guidelines – developed its own definition for IPC purposes. In this study we aimed to determine the effects of different definitions of multidrug-resistance on rates of Gram-negative multidrug-resistant organisms (GN-MDRO). Methods MDR definitions of the ECDC, the German KRINKO and the Swiss University Hospital Zurich were applied on a dataset comprising isolates of Escherichia coli, Klebsiella pneumoniae, Enterobacter sp., Pseudomonas aeruginosa, and Acinetobacter baumannii complex. Rates of GN-MDRO were compared and the percentage of patients with a GN-MDRO was calculated. Results In total 11′407 isolates from a 35 month period were included. For Enterobacterales and P. aeruginosa, highest MDR-rates resulted from applying the ‘ECDC-MDR’ definition. ‘ECDC-MDR’ rates were up to four times higher compared to ‘KRINKO-3/4MRGN’ rates, and up to six times higher compared to UHZ rates. Lowest rates were observed when applying the ‘KRINKO-4MRGN’ definitions. Comparing the ‘KRINKO-3/4MRGN’ with the UHZ definitions did not show uniform trends, but yielded higher rates for E. coli and lower rates for P. aeruginosa. On the patient level, the percentages of GN-MDRO carriers were 2.1, 5.5, 6.6, and 18.2% when applying the ‘KRINKO-4MRGN’, ‘UHZ-MDR’, ‘KRINKO-3/4MRGN’, and the ‘ECDC-MDR’ definition, respectively. Conclusions Different MDR-definitions lead to considerable variation in rates of GN-MDRO. Differences arise from the number of antibiotic categories required to be resistant, the categories and drugs considered relevant, and the antibiotic panel tested. MDR definitions should be chosen carefully depending on their purpose and local resistance rates, as definitions guiding isolation precautions have direct effects on costs and patient care.


2019 ◽  
Vol 6 (1) ◽  
pp. 1
Author(s):  
Erna Tsalatsatul Fitriyah ◽  
Meidiana Dwidiyanti ◽  
Luky Dwiantoro

<p><em>Health</em><em>c</em><em>are-Associated</em><em> Infections (HAIs) are infections that patients get while undergoing treatment and medical procedures in </em><em>the </em><em>hospital or other healthcare facilities after more than 48 hours. Improving the quality of hand hygiene practices can reduce pathogen transmission that causes HAIs. Infection and Prevention Control Nurses (IPCNs) as the pioneers of infection prevention and control should play an active role in cultivating hand hygiene in the hospital environment. Unfortunately, until the present time, there is evidence that IPCNs have not played their roles optimally in making hand hygiene a culture in </em><em>the </em><em>hospital. This study aimed to explore the experiences of IPCNs in cultivating hand hygiene at the inpatient wards in a regional hospital in Semarang</em><em>, Indonesia</em><em>. This study used a qualitative research design with a phenomenological approach. The samples were recruited using purposive sampling</em><em> technique</em><em>, consisting of three IPCNs as the main participants, and one Infection Prevention </em><em>a</em><em>nd Control Officer (IPCO) and three Infection Prevention and Control Link Nurses (IPCLNs) as </em><em>the </em><em>triangulation participants. Data were collected using semi-structured in-depth interviews and analyzed using </em><em>the </em><em>content analysis. The results revealed two themes. First, the </em><em>appropriate </em><em>education implementation and its documentation </em><em>are </em><em>important to provide an adequate understanding of medical and non-medical staffs, patients and families so that they are willing to perform hand hygiene properly. Second, the implementation of hand hygiene requires complete infrastructures and facilities, proper monitoring and evaluation system, </em><em>as well as </em><em>appropriate role models and motivation so that hand hygiene can become a positive culture. This study concludes that IPCNs have positive and negative experiences while trying to cultivate hand hygiene. IPCNs understand and agree that their ability to provide proper education and sensitivity to the factors affecting the implementation of hand hygiene can improve the </em><em>people’s </em><em>understanding and </em><em>compliance with </em><em>hand hygiene</em><em>. </em><em>In the end, hand hygiene will eventually become one of the positive cultures in the hospitals.</em></p><p><strong><em> </em></strong></p><p><strong>Keywords<em>:</em></strong><em> IPCNs, hand hygiene</em></p>


2020 ◽  
Author(s):  
Qian Zhou ◽  
Xiaoquan Lai ◽  
Xinping Zhang

Abstract BackgroundInfection prevention and control (IPC) is important to prevent the spread of multidrug resistant organisms (MDROs). We aimed to enhance and explore the implementation of preventing and controlling MDROs using audit and feedback and the benchmark. MethodsThis quasi-experimental design was conducted in three hospitals from 1st March 2018 to 30th September 2019. A multimodal intervention treated audit and feedback and benchmark as key components for MDROs IPC was conducted in Wuhan, China. A checklist of 40 implementation indicators based on IPC measures was formed to guide the audit twice a week. Immediate feedback was verbally given after each audit on the spot, and written feedbacks containing benchmark and individual implementation levels were delivered monthly or quarterly in three hospitals. The intervention effect was evaluated by Chi-square and Poisson segmented linear regression. Impacts of implementation of indicators on the incidence were modeled by mixed-effect regressions. ResultsThe incidence of nosocomial MDROs decreased by 19.39%, 20.55%, and 24.03% in A, B, and C hospital, respectively. The lowest implementation compliance of indicators was the use of personal protective equipment of doctors (50.24%). The highest was isolated warning signs of nurses (96.46%). The implementation on hand hygiene of doctors (Coef. = -27.87, p=0.001) and nurses (Coef. = -35.44, p=0.001), clean of surrounding instruments and bed unit (Coef. = -4.84, p=0.030), education to patients and relatives (Coef. = -59.51, p=0.031), and sending of specimen inspection timely (Coef. = -9.95, p<0.001) were negatively associated with the incidence of nosocomial MDROs infection. Conclusions The multimodal intervention by strengthening the implementation of audit and feedback and the benchmark is feasible and effective in China. The checklist is an effective and practical tool to measure the level of implementation. Education to patients and relatives, hand hygiene, clean of surrounding instruments and bed unit, and sending of specimen inspection timely are especially crucial.


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