Infection preventionist staffing levels and rates of 10 types of healthcare-associated infections: A 9-year ambidirectional observation

Objective: To quantitatively evaluate relationships between infection preventionists (IPs) staffing levels, nursing hours, and rates of 10 types of healthcare-associated infections (HAIs). Design and setting: An ambidirectional observation in a 528-bed teaching hospital. Patients: All inpatients from July 1, 2012, to February 1, 2021. Methods: Standardized US National Health Safety Network (NHSN) definitions were used for HAIs. Staffing levels were measured in full-time equivalents (FTE) for IPs and total monthly hours worked for nurses. A time-trend analysis using control charts, t tests, Poisson tests, and regression analysis was performed using Minitab and R computing programs on rates and standardized infection ratios (SIRs) of 10 types of HAIs. An additional analysis was performed on 3 stratifications: critically low (2–3 FTE), below recommended IP levels (4–6 FTE), and at recommended IP levels (7–8 FTE). Results: The observation covered 1.6 million patient days of surveillance. IP staffing levels fluctuated from ≤2 IP FTE (critically low) to 7–8 IP FTE (recommended levels). Periods of highest catheter-associated urinary tract infection SIRs, hospital-onset Clostridioides difficile and carbapenem-resistant Enterobacteriaceae infection rates, along with 4 of 5 types of surgical site SIRs coincided with the periods of lowest IP staffing levels and the absence of certified IPs and a healthcare epidemiologist. Central-line–associated bloodstream infections increased amid lower nursing levels despite the increased presence of an IP and a hospital epidemiologist. Conclusions: Of 10 HAIs, 8 had highest incidences during periods of lowest IP staffing and experience. Some HAI rates varied inversely with levels of IP staffing and experience and others appeared to be more influenced by nursing levels or other confounders.

The Role of ZntA in Klebsiella pneumoniae Zinc Homeostasis

Klebsiella pneumoniae is a leading cause of healthcare-associated infections, including pneumonia, urinary tract infections, and sepsis. Treatment of K. pneumoniae infections is becoming increasingly challenging due to high levels of antibiotic resistance and the rising prevalence of carbapenem-resistant, extended-spectrum β-lactamases producing strains.

An evaluation of risk factors for Staphylococcus aureus colonization in a pre-surgical population

Staphylococcus aureus (SA) colonization has significant implications in healthcare-associated infections. Here we describe a prospective study conducted in pre-surgical outpatients, done with the aim of identifying demographic and clinical risk factors for SA colonization. We found younger age to be a potential predictor of SA colonization.

Utility of Systemic Inflammatory Syndrome Score in Predicting Healthcare-Associated Infections in Critically Ill Patients: A Matched Case-Control Study

Background Effective prevention of healthcare-associated infections (HAIs) requires early identification of at-risk patients. There is no score designed to predict HAIs. The present study was aimed to explore an available score, Systemic inflammatory syndrome (SIRS) score, on admission in predicting HAIs among critically ill patients. Methods This study was based on the Medical Information Mart for Intensive Care III (MIMIC III) version 1.4. Patients with HAIs were matched with control patients who had no HAIs in a 1:1 ratio based on age, gender, mechanical ventilation, deep venous catheterization, urethral catheterization, and surgical operation. Subgroup analyses were conducted according to various variables including infection likelihood on admission. The prognostic values of SIRS and infectious SIRS on admission in predicting HAIs were analyzed using logistic regression. Results A total of 2437 patients with HAIs and 2437 matched controls were enrolled in the final analysis. Adjusted odds ratio (ORs) (95% confidence interval [CI]) for HAIs of SIRS scores (1 to 4) on admission was 1.48 (0.77-2.83), 1.86 (0.99-3.47), 2.14 (1.15-3.98), and 2.58 (1.39-4.80). Adjusted ORs (95%CI) for HAIs of SIRS (score≥2) and infectious SIRS were 1.57 (1.27-1.94) and 1.78 (1.52-2.09), respectively. Subgroup analyses showed that SIRS on admission was an independent risk factor for HAIs in patients admitted without definite and probable infection likelihood (OR=1.54, 95%CI 1.28-1.93). However, it was not a risk factor for HAIs inpatients admitted with infection, in non-white patients, and in patients with liver disease or obesity, and in patients who received total parenteral nutrition (TPN) (all P>0.05). In addition, it was showed that infectious SIRS on admission was not a risk factor for HAIs in black patients and in patients with obesity, and those received TPN (all P>0.05). Conclusions Infectious SIRS on admission significantly predicts HAIs among critical illness patients. SIRS on admission was a predictor of HAIs in ICU patients admitted without infection but not in patients admitted with infection.

Serum Leptin Levels, Nutritional Status, and the Risk of Healthcare-Associated Infections in Hospitalized Older Adults

We aimed to determine whether serum leptin levels are predictive of the occurrence of healthcare-associated infections (HAIs) in hospitalized older patients. In a prospective cohort, 232 patients had available data for leptin and were monitored for HAIs for 3 months. Admission data included comorbidities, invasive procedures, the Mini Nutritional Assessment (MNA), BMI, leptin, albumin and C-reactive protein levels, and CD4 and CD8 T-cell counts. Multivariate logistic regression modelling was used to identify predictors of HAIs. Of the 232 patients (median age: 84.8; females: 72.4%), 89 (38.4%) experienced HAIs. The leptin level was associated with the BMI (p < 0.0001) and MNA (p < 0.0001) categories. Women who experienced HAIs had significantly lower leptin levels than those who did not (5.9 μg/L (2.6–17.7) and 11.8 (4.6–26.3), respectively; p = 0.01; odds ratio (OR) (95% confidence interval): 0.67 (0.49–0.90)); no such association was observed for men. In a multivariate analysis of the women, a lower leptin level was significantly associated with HAIs (OR = 0.70 (0.49–0.97)), independently of comorbidities, invasive medical procedures, and immune status. However, leptin was not significantly associated with HAIs after adjustments for malnutrition (p = 0.26) or albuminemia (p = 0.15)—suggesting that in older women, the association between serum leptin levels and subsequent HAIs is mediated by nutritional status.

Hubungan Kepatuhan Cuci Tangan dan Penggunaan APD Perawat dengan Resiko Kejadian Healthcare Associated Infections (HAIS) pada Masa Pandemi Covid-19 di RSUD Mayjend. H.M. Ryacudu Lampung Utara

ABSTRACT: RELATIONSHIP OF HANDWASHING COMPLIANCE AND NURSE PPE USE WITH RISK OF HEALTHCARE ASSOCIATED INFECTIONS (HAIS) DURING THE COVID-19 PANDEMIC AT RSUD MAYJEN H.M. RYACUDU NORTH LAMPUNG Introduction: Infection is the invasion of the body by a pathogen or microorganism, which can cause disease or tissue damage. A hospital infection or hospital-acquired infection (HOIS) or healthcare-associated infection (HAIS) is an infection acquired during a patient's hospital stay, provided that the incubation period of the disease has not occurred at the time of admission. Objective: It is known that there is a relationship between handwashing compliance and the use of PPE for nurses with the risk of healthcare-associated infections (HAIS) during the COVID-19 pandemic at the Mayjend. H.M Ryacudu Hospital, North Lampung in 2021. Methods : The type of research used in this study is related to the descriptive nature with a cross sectional research design. The subjects of this study were all obstetrical, pediatric (perinatal and NICU) nurses, operating rooms and internal medicine at Mayjend.H.M Ryacudu Hospital, North Lampung. The number of samples used as many as 60 respondents.Results: The statistical test of nurses' compliance with the chi-square in handwashing obtained a p-value of 0.033 where the p-value < (0.033 < 0.05) then Ha, and the Odds Ration value was accepted at 0.314. By using the chi-square statistical test for nurses who use PPE, the p-value is 0.241, so the p-value < (0.241 > 0.05) and Ho is rejected, and the Odds ration value is 0.519.Conclusion: There is a relationship between handwashing compliance with the risk of health-related infections (HAIS), and there is no relationship between the use of PPE by nurses and the risk of healthcare-associated infections (HAIS) at the Mayjend H.M Ryacudu Hospital, North Lampung. Keywords: Compliance with handwashing, use of APD, HAIS INTISARI : HUBUNGAN KEPATUHAN CUCI TANGAN DAN PENGGUNAAN APD PERAWAT DENGAN RESIKO KEJADIAN HEALTHCARE ASSOCIATED INFECTIONS (HAIS) PADA MASA PANDEMI COVID-19 DI RSUD MAYJEND. H.M. RYACUDU LAMPUNG UTARA Pendahuluan : Infeksi adalah invasi tubuh oleh patogen atau mikroorganisme, yang dapat menyebabkan penyakit atau kerusakan jaringan. Infeksi rumah sakit atau infeksi yang didapat di rumah sakit (HOIS) atau infeksi terkait perawatan kesehatan (HAIS) adalah infeksi yang diperoleh selama pasien dirawat di rumah sakit, asalkan masa inkubasi penyakit belum berlangsung pada saat masuk. Tujuan : Diketahui hubungan kepatuhan cuci tangan dan penggunaan APD perawat dengan resiko kejadian healthcare associated infections (HAIS) pada masa pandemi covid-19 di RSUD Mayjend.H.M Ryacudu Lampung Utara.Metode : Jenis penelitian yang digunakan dalam penelitian ini berkaitan dengan sifat deskriptif dengan desain penelitian cross sectional. Subyek penelitian ini adalah seluruh perawat obstetri, anak (perinatal dan NICU), kamar operasi dan penyakit dalam di RSUD Mayjend.H.M Ryacudu Lampung Utara. Jumlah sample yang dipakai sebanyak 60 responden.Hasil : Uji statistik kepatuhan perawat terhadap chi-square dalam cuci tangan diperoleh nilai p sebesar 0,033 dimana nilai p < α (0,033 < 0,05) kemudian Ha, dan nilai Oods Ration diterima sebesar 0,314. Dengan menggunakan uji statistik chi-square perawat yang menggunakan APD didapatkan nilai p-value 0,241, sehingga nilai p-value < α (0,241 > 0,05) dan Ho ditolak, serta nilai Oods ration sebesar 0,519.Kesimpulan : Memiliki hubungan antara kepatuhan cuci tangan dengan risiko infeksi terkait kesehatan (HAIS), serta tidak ada hubungan antara penggunaan APD oleh perawat dengan risiko healthcare associated infections (HAIS) pada RSUD mayjend H.M Ryacudu Lampung Utara. Kata Kunci : Kepatuhan cuci tangan, penggunaan APD, HAIS

Documentation of Adherence To Infection Prevention Best Practice in Patient Records – A Mixed-Methods Investigation

Background Healthcare-associated infections remain a preventable cause of patient harm in healthcare. Full documentation of adherence to evidence-based best practices for each patient can support monitoring and promotion of infection prevention measures. Thus, we reviewed the extent, nature, and determinants of the documentation of infection prevention (IP) standards in patients with HAI. Methods We reviewed the electronic patient records (EMRs) of patients included in four annual point-prevalence studies 2013-2016 who developed a device- or procedure-related HAI (catheter-associated urinary tract infection (CAUTI), central line-associated bloodstream infection (CLABSI), ventilator-associated infection (VAP), surgical site infection (SSI)). We examined the documentation quality of mandatory preventive measures published as institutional IP standards. Additionally, we undertook semi-structured interviews with healthcare providers and a two-step inductive (grounded theory) and deductive (Theory of Planned Behaviour) content analysis. Results Of overall 2972 surveyed patients, 249 patients developed 272 healthcare-associated infections (8.4%). Of these, 116 patients met the inclusion criteria, classified as patients with CAUTI, CLABSI, VAP, SSI in 21 (18%), 7 (6%), 10 (9%), 78 (67%) cases, respectively. We found a documentation of the IP measures in electronic medical records (EMR) in 432/1308 (33%) cases. Documentation of execution existed in the study patients’ EMR for CAUTI, CLABSI, VAP, SSI, and overall, in 27/104 (26%), 26/151 (17%), 46/122 (38%), 261/931 (28%), and 360/1308 (28%) cases, respectively, and documentation of non-execution in 2/104 (2%), 3/151 (2%), 0/122 (0%), 67/931 (7%), and 72/1308 (6%) cases, respectively. Healthcare provider attitude, subjective norm, and perceived behavioural control indicated reluctance to document IP standards. Conclusions EMRs rarely included conclusive data about IP standards adherence. Documentation had to be established indirectly through data captured for other reasons. It can be projected that a mandatory institutional documentation protocol and technically automated documentation would be necessary to alleviate this shortcoming in patient safety documentation.

Multiple Secondary Healthcare-Associated Infections Due to Carbapenem-Resistant Organisms in a Critically Ill COVID-19 Patient on Extensively Prolonged Venovenous Extracorporeal Membrane Oxygenation Support—A Case Report

Patients with severe Coronavirus disease 2019 (COVID-19) are at high risk for secondary infection with multidrug-resistant organisms (MDROs). Secondary infections contribute to a more severe clinical course and longer intensive care unit (ICU) stays in patients with COVID-19. A man in his 60s was admitted to the ICU at a university hospital for severe COVID-19 pneumonia requiring mechanical ventilation. His respiratory condition worsened further due to persistent bacteremia caused by imipenem-non-susceptible Klebsiella aerogenes and he required VV-ECMO. Subsequently, he developed a catheter-related bloodstream infection (CRBSI) due to Candida albicans, ventilator-associated pneumonia (VAP) due to multidrug-resistant Pseudomonas aeruginosa (MDRP), and a perianal abscess due to carbapenem-resistant K. aerogenes despite infection control procedures that maximized contact precautions and the absence of MDRO contamination in the patient’s room environment. He was decannulated from VV-ECMO after a total of 72 days of ECMO support, and was eventually weaned off ventilator support and discharged from the ICU on day 138. This case highlights the challenges of preventing, diagnosing, and treating multidrug-resistant organisms and healthcare-associated infections (HAIs) in the critical care management of severe COVID-19. In addition to the stringent implementation of infection prevention measures, a high index of suspicion and a careful evaluation of HAIs are required in such patients.