Natural ventilation as a key Airborne Infection Control Measure for Tuberculosis Care Facilities.

Mapping Intimacies ◽

10.35543/osf.io/cvdz8 ◽

2019 ◽

Author(s):

Raja Singh

Keyword(s):

Infection Control ◽

Natural Ventilation ◽

Environmental Control ◽

Control Measure ◽

Infection Control Measure ◽

Special Focus ◽

Term Care ◽

Airborne Infection ◽

Care Facilities

Tuberculosis or TB has a large number of cases in India. India is fighting TB with the aim of eliminating it by 2025 (1) (2). TB, an airborne disease, has a risk of being hospital acquired (nosocomial) by the patients, visitors and the healthcare workers (HCWs). As a fact, till 2004, there were no studies on nosocomial Tuberculosis in India. (1) (3) The Guidelines on AIC or Airborne Infection Control (4) in Healthcare and other settings, released by the Directorate General of Health Services(Government of India) highlights the role of architects and engineers in Health Infrastructure Design for better infection control. The National Strategic Plan For Tuberculosis Elimination 2017–2025 (2) mentions AIC by highlighting the role of Natural Ventilation in limiting the infection spread in TB care facilities. Like TB, there are other diseases which also spread through the airborne route like Legionella pneomophila, Serratia marcescens and SARS (5). These are also linked to the ventilation of the hospital and have at multiple times revived the interest in the area of Indoor Air Quality for Healthcare facilities though there is an equal risk in Prisons, hostels, homeless facilities and long term care facilities. It was confirmed by the SARS epidemic in 2003 that the ‘mechanisms of respiratory disease transmission are still poorly understood.’ (6) and, there is a ‘lack of scientific evidence underpinning minimum ventilation rate guidelines (5).’ The Indian government literature too, mentioned above doesn’t have quantitative ventilation guidelines. The AIC guidelines have three types of measures namely, Administrative, Personal Protective and engineering/environmental control (7). The cost of many suggested engineering measures are high, and the more affordable measures include improving natural ventilation by opening the windows (8). Ventilation systems not only have an issue with air changes but also are likely to be compromised by poor design, faulty construction or inadequate maintenance which has led to the occurrences of TB (and related diseases) outbreaks. (8)There have been studies in Thailand and Peru which state that naturally ventilated rooms had a higher air change rate. (8) (9)The study in Peru also went on to state that the highest risk of infection occurred in mechanically ventilated rooms with sealed windows, despite being ventilated at recommended rates. As the thrust towards energy-efficient buildings increases, there is a higher chance of making compact spaces which are airtight and use HVAC. (10)Such buildings have been studied to report an increasing trend of airborne infections. There is a need to consolidate the literature available and perform further studies to provide functional and quantitative guidelines to architects for better AIC. (1) Architects, and other infrastructure professionals, need to play a proactive role driven by performance-based research and evidence-based design to design better TB care facilities with the aim of reducing the airborne infection. For this, there needs to be a special focus on the use of natural ventilation and its unexplored potential for infection control.

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Reducing Morbidity and Mortality Rates from COVID-19, Influenza and Pneumococcal Illness in Nursing Homes and Long-Term Care Facilities by Vaccination and Comprehensive Infection Control Interventions

Geriatrics ◽

10.3390/geriatrics6020048 ◽

2021 ◽

Vol 6 (2) ◽

pp. 48

Author(s):

Roger E. Thomas

Keyword(s):

Nursing Homes ◽

Infection Control ◽

Strong Evidence ◽

Disease Transmission ◽

Long Term Care ◽

Term Care ◽

Care Facilities ◽

Meta Analyses ◽

Tract Infections

The COVID-19 pandemic identifies the problems of preventing respiratory illnesses in seniors, especially frail multimorbidity seniors in nursing homes and Long-Term Care Facilities (LCTFs). Medline and Embase were searched for nursing homes, long-term care facilities, respiratory tract infections, disease transmission, infection control, mortality, systematic reviews and meta-analyses. For seniors, there is strong evidence to vaccinate against influenza, SARS-CoV-2 and pneumococcal disease, and evidence is awaited for effectiveness against COVID-19 variants and when to revaccinate. There is strong evidence to promptly introduce comprehensive infection control interventions in LCFTs: no admissions from inpatient wards with COVID-19 patients; quarantine and monitor new admissions in single-patient rooms; screen residents, staff and visitors daily for temperature and symptoms; and staff work in only one home. Depending on the vaccination situation and the current risk situation, visiting restrictions and meals in the residents’ own rooms may be necessary, and reduce crowding with individual patient rooms. Regional LTCF administrators should closely monitor and provide staff and PPE resources. The CDC COVID-19 tool measures 33 infection control indicators. Hand washing, social distancing, PPE (gowns, gloves, masks, eye protection), enhanced cleaning of rooms and high-touch surfaces need comprehensive implementation while awaiting more studies at low risk of bias. Individual ventilation with HEPA filters for all patient and common rooms and hallways is needed.

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The Impact of Enhanced Antimicrobial Stewardship Support on Antibiotic Starts in Long-Term Care Facilities

Infection Control and Hospital Epidemiology ◽

10.1017/ice.2020.1212 ◽

2020 ◽

Vol 41 (S1) ◽

pp. s527-s527

Author(s):

Gabriela Andujar-Vazquez ◽

Kirthana Beaulac ◽

Shira Doron ◽

David R Snydman

Keyword(s):

Public Health ◽

Pilot Study ◽

Infection Control ◽

Antimicrobial Stewardship ◽

Long Term Care ◽

Medical Center ◽

Term Care ◽

Care Facilities ◽

The Impact

Background: The Tufts Medical Center Antimicrobial Stewardship (ASP) Team has partnered with the Massachusetts Department of Public Health (MDPH) to provide broad-based educational programs (BBEP) to long-term care facilities (LTCFs) in an effort to improve ASP and infection control practices. LTCFs have consistently expressed interest in individualized and hands-on involvement by ASP experts, yet they lack resources. The goal of this study was to determine whether “enhanced” individualized guidance provided by an ASP expert would lead to antibiotic start decreases in LTCFs participating in our pilot study. Methods: A pilot study was conducted to test the feasibility and efficacy of providing enhanced ASP and infection control practices to LTCFs. In total, 10 facilities already participating in MDPH BBEP and submitting monthly antibiotic start data were enrolled, were stratified by bed size and presence of dementia unit, and were randomized 1:1 to the “enhanced” group (defined as reviewing protocols and antibiotic start cases, providing lectures and feedback to staff and answering questions) versus the “nonenhanced” group. Antibiotic start data were validated and collected prospectively from January 2018 to July 2019, and the interventions began in April 2019. Due to staff turnover and lack of engagement, intervention was not possible in 2 of the 5 LTCFs randomized to the enhanced group, which were therefore analyzed as a nonenhanced group. An incidence rate ratios (IRRs) with 95% CIs were calculated comparing the antibiotic start rate per 1,000 resident days between periods in the pilot groups. Results: The average bed sizes for enhanced groups versus nonenhanced groups were 121 (±71.0) versus 108 (±32.8); the average resident days per facility per month were 3,415.7 (±2,131.2) versus 2,911.4 (±964.3). Comparatively, 3 facilities in the enhanced group had dementia unit versus 4 in the nonenhanced group. In the per protocol analysis, the antibiotic start rate in the enhanced group before versus after the intervention was 11.35 versus 9.41 starts per 1,000 resident days (IRR, 0.829; 95% CI, 0.794–0.865). The antibiotic start rate in the nonenhanced group before versus after the intervention was 7.90 versus 8.23 antibiotic starts per 1,000 resident days (IRR, 1.048; 95% CI, 1.007–1.089). Physician hours required for ASP for the enhanced group totaled 8.9 (±2.2) per facility per month. Conclusions: Although the number of hours required for intervention by an expert was not onerous, maintaining engagement proved difficult and in 2 facilities could not be achieved. A statistically significant 20% decrease in the antibiotic start rate was achieved in the enhanced group after interventions, potentially reflecting the benefit of enhanced ASP support by an expert.Funding: This study was funded by the Leadership in Epidemiology, Antimicrobial Stewardship, and Public Health (LEAP) fellowship training grant award from the CDC.Disclosures: None

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INFECTION CONTROL PRACTICES

The Professional Medical Journal ◽

10.29309/tpmj/18.4957 ◽

2018 ◽

Vol 25 (12) ◽

pp. 1933-1936

Author(s):

Imran Samejo ◽

Gotam Das ◽

Muhammad Haseeb Rana ◽

Muhammad Waqar Hussain

Keyword(s):

Infection Control ◽

Control Measure ◽

Financial Burden ◽

Infection Control Measure ◽

Cross Sectional Study ◽

Laboratory Work ◽

Cross Sectional ◽

The Social ◽

B Virus ◽

Study Setting

Objectives: The aim of this study was to assess the knowledge and infection control practices among private dental laboratories in Karachi. Study Design: Cross sectional study. Setting: Private Dental Laboratories of Karachi. Period: 01st September 2017 to 01st February 2018. Materials and Methods: A pre structured questionnaire comprised of 09 questions regarding infection control was used to collect the data. A total 35 questionnaires were given to dental technicians. 29 questionnaires were obtained out of 35 distributed (response rate: 83%). Statistical Package for the Social Sciences (SPSS) version 17.0 was used for data analysis. Results: Gloves were not worn by 76% of respondents while receiving the clinical items. Protective eyeglasses and protective face shield were not worn by 38% and 13% of respondents respectively during laboratory work. Few 13% of respondents were vaccinated against the hepatitis b virus. Clinical items were disinfected by 17% of respondents if not disinfected by dental clinic. Laboratory work was not disinfected by 90% of respondents before sending to clinic. Pumice slurry and water of pressure pot were changed by 6% and 6% respectively. Regarding infection control measure impose financial burden, 83% of respondents were agreed. Conclusion: The knowledge and practices of infection control were poor and below acceptable standards in private dental laboratories.

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1236. Infection Control Risk Mitigation and Implementation of Best Practice Recommendations in Long-Term Care Facilities

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1069 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S375-S376

Author(s):

Teresa Fitzgerald ◽

Regina Nailon ◽

Kate Tyner ◽

Sue Beach ◽

Margaret Drake ◽

...

Keyword(s):

Infection Control ◽

Best Practice ◽

Long Term Care ◽

Audit And Feedback ◽

Risk Assessments ◽

Term Care ◽

Practice Recommendations ◽

Care Facilities

Abstract Background Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) is a quality improvement initiative supported by the NE Department of Health and Human Services. This initiative utilizes subject matter experts (SMEs) including infectious diseases physicians and certified infection preventionists (IP) to assess and improve infection prevention and control programs (IPCP) in various healthcare settings. NE ICAP conducted on-site surveys and observations of IPCP in many volunteer facilities to include long-term care facilities (LTCF) between November 2015 and July 2017. SMEs provided on-site coaching and made best practice recommendations (BPR) for priority implementation. Impact of this intervention on LTCF IPCP was examined. Methods Using a standardized questionnaire, follow-up phone calls were made with LTCF to evaluate implementation of the BPR one-year post-assessment. Descriptive analyses were performed to examine BPR implementation in LTCF that had follow-up between 4/4/17 to 4/17/18 and to identify factors that promoted or impeded BPR implementation. Results Overall, 45 LTCF were assessed. The top 5 IC categories requiring improvement were audit and feedback practices (28 of 45, 62%), PPE supplies at point of use (62%), IC risk assessments (58%), TB risk assessments (56%), and supply and linen storage practices (56%). Follow-up assessments were completed for 270 recommendations in 25 LTCF. Recommendations reviewed ranged from three to 26 per LTCF (median = 15). The majority of the 270 recommendations (n = 162, 60%) had been either completely (35%) or partially (25%) implemented by the time of the follow-up calls. The ICAP visit itself was reported as the most helpful resource for BPR implementation (77 of 162). Lack of staffing was the most commonly mentioned barrier to implementation when LTCF implemented BPR partially or implementation was not planned (37 of 85). BPR Implementation most frequently involved additional staff training (64 of 162), review of policies and procedures (38 of 162), and implementing audit (34 of 162) and/or feedback (23 of 162) programs. Conclusion Numerous IC gaps exist in LTCF. Peer-to-peer feedback and coaching by SMEs facilitated implementation of many BPR directed toward mitigating identified IC gaps. Disclosures All authors: No reported disclosures.

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Frequently Identified Infection Control Gaps Related to Hand Hygiene in Long-Term Care Facilities

Open Forum Infectious Diseases ◽

10.1093/ofid/ofx163.1018 ◽

2017 ◽

Vol 4 (suppl_1) ◽

pp. S407-S407

Author(s):

Kate Tyner ◽

Regina Nailon ◽

Sue Beach ◽

Margaret Drake ◽

Teresa Fitzgerald ◽

...

Keyword(s):

Hand Hygiene ◽

Infection Control ◽

Prevention And Control ◽

Infection Prevention ◽

Long Term Care ◽

Infection Prevention And Control ◽

Term Care ◽

Care Facilities ◽

And Control

Abstract Background Little is known about hand hygiene (HH) policies and practices in long-term care facilities (LTCF). Hence, we decided to study the frequency of HH-related infection control (IC) gaps and the factors associated with it. Methods The Nebraska (NE) Infection Control Assessment and Promotion Program (ICAP) in collaboration with NE Department of Health and Human Services conducted in-person surveys and on-site observations to assess infection prevention and control programs (IPCP) in 30 LTCF from 11/2015 to 3/2017. The Centers for Disease Control and Prevention (CDC) Infection Prevention and Control Assessment tool for LTCF was used for on-site interviews and the Centers for Medicare and Medicaid (CMS) Hospital IC Worksheet was used for observations. Gap frequencies were calculated for questions (6 on CDC survey and 8 on CMS worksheet) representing best practice recommendations (BPR). The factors studied for the association with the gaps included LTCF bed size (BS), hospital affiliation (HA), having trained infection preventionists (IP), and weekly hours (WH)/ 100 bed spent by IP on IPCP. Fisher’s exact test and Mann Whitney test were used for statistical analyses. Results HH-related IC gap frequencies from on-site interviews are displayed in Figure 1. Only 6 (20%) LTCF reported having all 6 BPR in place and 10 (33%) having 5 BPR. LTCF with fewer gaps (5 to 6 BPR in place) appear more likely to have HA as compared with the LTCF with more gaps but the difference didn’t reach statistical significance (37.5% vs. 7.1%, P = 0.09). When analyzed separately for each gap, it was found that LTCF with HA are more likely to have a policy on preferential use of alcohol based hand rubs than the ones without HA. (85.7%, vs. 26.1% P = 0.008). Several IC gaps were also identified during observations (Figure 2) with one of them being overall HH compliance of <80%. LTCF that have over 90% HH compliance are more likely to have higher median IP WH/100 beds dedicated towards IPCP as compared with the LTCFs with less than 90% compliance (16.4 vs. 4.4, P < 0.05). Conclusion Many HH-related IC gaps still exist in LTCF and require mitigation. Mitigation strategies may include encouraging LTCF to collaborate with IP at local acute care hospitals for guidance on IC activities and to increase dedicated IP times towards IPCP in LTCF. Disclosures All authors: No reported disclosures.

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