HAI

HAI
  • 文章类型: Journal Article
    在感染预防和控制活动的背景下,医疗保健相关感染控制数据的培训至关重要;COVID-19大流行进一步强调了确保此类专业人员长期具有广泛和稳定的技能水平的必要性.本工作旨在将艾米利亚-罗马涅地区医疗机构工作人员的数量和培训需求确定为“与医疗保健相关的感染控制数字”。
    数据是通过区域小组“预防和控制抗生素耐药性培训”的专家创建的一项调查收集的。问卷探讨了数量,专业和教育背景,艾米利亚-罗马涅的医疗保健相关感染控制数字的培训要求。
    有73个数字专门用于医疗保健相关感染控制,艾米利亚-罗马涅地区似乎符合欧洲标准的比例(每125张床1名专业人士)。有护理背景的专业人士,50岁以上的女性在群体中占优势,而所表达的培训需求包括理论和实践两个方面。
    医疗助理和护理人员是在我们的医疗设施中实施感染预防和控制计划的基本资源;对这些专业人员进行多学科和有针对性的培训是必要的。
    UNASSIGNED: In the context of Infections Prevention and Control activities, the training of healthcare-associated infection control figures is crucial; the COVID-19 pandemic further emphasized the necessity of ensuring a widespread and stable level of skills over time for such professionals. The present work aims to identify the number and training needs of the personnel working in the Emilia-Romagna Region\'s healthcare facilities as \"healthcare-associated infection control figures\".
    UNASSIGNED: Data were collected through a survey created by experts from the Regional Group \"Training in the prevention and control of antibiotic resistance\". The questionnaire explored the number, professional and educational background, and training requirements of Healthcare-associated infections control figures in Emilia-Romagna.
    UNASSIGNED: With 73 figures dedicated to Healthcare-associated infections control, the Emilia-Romagna Region appears to be in line with the European standard ratio (1 professional every 125 beds). Professionals with a nursing background, over 50 years old and of female sex prevail in the group, while the training needs expressed include both theoretical and practical aspects.
    UNASSIGNED: Healthcare assistants and nursing staff represent a fundamental resource for the implementation of infection prevention and control programs in our healthcare facilities; continuous, multidisciplinary and targeted training of these professionals is confirmed as necessary.
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  • 文章类型: Journal Article
    背景:由于多重耐药生物体(MDROs)引起的医疗保健相关感染,如耐甲氧西林金黄色葡萄球菌(MRSA)和艰难梭菌(CDI),给我们的医疗基础设施带来沉重负担。
    目的:MDROs的筛查是防止传播的重要机制,但却是资源密集型的。这项研究的目的是开发可以使用电子健康记录(EHR)数据预测定植或感染风险的自动化工具,提供有用的信息来帮助感染控制,并指导经验性抗生素覆盖。
    方法:我们回顾性地开发了一个机器学习模型来检测在弗吉尼亚大学医院住院患者样本采集时未分化患者的MRSA定植和感染。我们使用来自患者EHR数据的入院和住院期间信息的临床和非临床特征来构建模型。此外,我们在EHR数据中使用了一类从联系网络派生的特征;这些网络特征可以捕获患者与提供者和其他患者的联系,提高预测MRSA监测试验结果的模型可解释性和准确性。最后,我们探索了不同患者亚群的异质模型,例如,入住重症监护病房或急诊科的人或有特定检测史的人,哪个表现更好。
    结果:我们发现惩罚逻辑回归比其他方法表现更好,当我们使用多项式(二次)变换特征时,该模型的性能根据其接收器操作特征-曲线下面积得分提高了近11%。预测MDRO风险的一些重要特征包括抗生素使用,手术,使用设备,透析,患者的合并症状况,和网络特征。其中,网络功能增加了最大的价值,并将模型的性能提高了至少15%。对于特定患者亚群,具有相同特征转换的惩罚逻辑回归模型也比其他模型表现更好。
    结论:我们的研究表明,使用来自EHR数据的临床和非临床特征,通过机器学习方法可以非常有效地进行MRSA风险预测。网络特征是最具预测性的,并且提供优于现有方法的显著改进。此外,不同患者亚群的异质预测模型提高了模型的性能。
    BACKGROUND: Health care-associated infections due to multidrug-resistant organisms (MDROs), such as methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile (CDI), place a significant burden on our health care infrastructure.
    OBJECTIVE: Screening for MDROs is an important mechanism for preventing spread but is resource intensive. The objective of this study was to develop automated tools that can predict colonization or infection risk using electronic health record (EHR) data, provide useful information to aid infection control, and guide empiric antibiotic coverage.
    METHODS: We retrospectively developed a machine learning model to detect MRSA colonization and infection in undifferentiated patients at the time of sample collection from hospitalized patients at the University of Virginia Hospital. We used clinical and nonclinical features derived from on-admission and throughout-stay information from the patient\'s EHR data to build the model. In addition, we used a class of features derived from contact networks in EHR data; these network features can capture patients\' contacts with providers and other patients, improving model interpretability and accuracy for predicting the outcome of surveillance tests for MRSA. Finally, we explored heterogeneous models for different patient subpopulations, for example, those admitted to an intensive care unit or emergency department or those with specific testing histories, which perform better.
    RESULTS: We found that the penalized logistic regression performs better than other methods, and this model\'s performance measured in terms of its receiver operating characteristics-area under the curve score improves by nearly 11% when we use polynomial (second-degree) transformation of the features. Some significant features in predicting MDRO risk include antibiotic use, surgery, use of devices, dialysis, patient\'s comorbidity conditions, and network features. Among these, network features add the most value and improve the model\'s performance by at least 15%. The penalized logistic regression model with the same transformation of features also performs better than other models for specific patient subpopulations.
    CONCLUSIONS: Our study shows that MRSA risk prediction can be conducted quite effectively by machine learning methods using clinical and nonclinical features derived from EHR data. Network features are the most predictive and provide significant improvement over prior methods. Furthermore, heterogeneous prediction models for different patient subpopulations enhance the model\'s performance.
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  • 文章类型: Journal Article
    耐碳青霉烯类肠杆菌(CRE)被认为是紧急的,抗生素耐药威胁在美国和全球关注。公共卫生当局与医疗机构和提供者之间的积极合作对于预防和遏制这些生物是必要的。
    描述肯塔基州CRE的流行病学,并讨论建立和维持有效的预防和遏制计划的挑战和成功。
    医疗保健提供者报告的CRE分离株的回顾性描述性摘要,设施,以及2013年至2020年在肯塔基州的实验室。总结了病例报告表和实验室测试中提供的数据。
    从2013年到2020年,从1666个人报告了1805个CRE;平均年龄为66岁,男性占44%。尽管大多数报告来自住院患者,近1/3来自未在急诊医院住院的患者.报告数量普遍随着时间的推移而增加,2013年有111株CRE分离株,2020年有477株。肺炎克雷伯菌是最常见的CRE。在29%的具有碳青霉烯酶生产(CP-CRE)的CRE中,肺炎克雷伯菌碳青霉烯酶(KPC)最常见(78%)。监测和报告导致对11起CP-CRE暴发的识别和积极调查。
    发展面临挑战,实施,并保持一致,有效应对识别,预防,含有CRE。持续的公共卫生和设施资源对于预防和遏制抗生素抗性威胁和其他有关生物体将是必要的。
    UNASSIGNED: Carbapenem-resistant Enterobacterales (CRE) are considered urgent, antibiotic-resistant threats in the U.S. and are of global concern. Active collaboration between public health authorities and healthcare facilities and providers will be necessary to prevent and contain these organisms.
    UNASSIGNED: To describe the epidemiology of CRE in Kentucky and to discuss challenges and successes with building and sustaining an effective prevention and containment program.
    UNASSIGNED: Retrospective descriptive summary of CRE isolates reported by healthcare providers, facilities, and laboratories in Kentucky from 2013 through 2020. Data available from case reporting forms and laboratory testing are summarized.
    UNASSIGNED: From 2013 through 2020, 1805 CRE were reported from 1666 individuals; median age was 66 years and 44% were male. Although most reports were from hospitalized individuals, nearly one-third were from individuals not hospitalized in acute-care hospital settings. The number of reports generally increased over time, with 111 CRE isolates in 2013 and 477 in 2020. Klebsiella pneumoniae was the most frequently reported CRE. Of the 29% of CRE with identified carbapenemase production (CP-CRE), Klebsiella pneumoniae carbapenemase (KPC) was most common (78%). Surveillance and reporting resulted in identification and active investigation of 11 outbreaks of CP-CRE.
    UNASSIGNED: There are challenges with developing, implementing, and sustaining a consistent, effective response to identifying, preventing, and containing CRE. Ongoing public health and facility resources will be necessary to prevent and contain antibiotic-resistant threats and other concerning organisms.
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  • 文章类型: Journal Article
    我们描述了一名45岁的免疫功能正常的女性中由戈顿链球菌引起的严重原发性脊柱炎的罕见病例,没有相关的合并症。L4-L5显微椎间盘切除术后出现手术部位感染,并导致严重的临床残疾。对可能的疏忽作为原因的指控促使法医审查以澄清这种罕见病原体的原始来源和传播,驳回了其原因是由于治疗期间的渎职。
    We describe a rare case of severe primary spondylitis caused by Streptococcus gordonii in a 45-year-old immunocompetent woman with no relevant comorbidities. The surgical site infection arose after a L4-L5 microdiscectomy and resulted in severe clinical disability. Allegations of possible negligence as the cause prompted a forensic review to clarify the original source and transmission of this uncommon pathogen, which dismissed its cause as due to malpractice during treatment.
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  • 文章类型: Journal Article
    医疗保健机构具有高流行的传染因子。本叙述性审查审查了在医疗机构中使用WHO感染预防和控制评估框架(IPCAF)工具进行的有关感染预防和控制(IPC)的现有证据。总共有13篇来自非洲的论文,本次审查考虑了亚洲和欧洲。调查结果表明,IPCAF值从不足到高级水平存在差异。目前的审查显示,中等收入和高收入国家的IPCAF水平较高。低收入国家的IPCAF得分较低。有必要加强IPC能力建设,并提供感染预防资源,以预防医疗保健相关感染(HAI),重点是低收入国家。
    Healthcare settings have a high prevalence of infectious agents. This narrative review examines the existing evidence regarding infection prevention and control (IPC) using the WHO Infection Prevention and Control Assessment Framework (IPCAF) tool in healthcare facilities. A total of 13 full length papers from Africa, Asia and Europe were considered for this review. The findings showed that there are discrepancies in the IPCAF values from insufficient to advanced level. The current review shows an advanced IPCAF level in middle income and high income countries. Low income countries showed a lower IPCAF score. There is a need to enhance the IPC capacity building and to supply infection prevention resources to prevent healthcare associated infection (HAI) with a focus on low income countries.
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  • 文章类型: Journal Article
    医院获得性感染是患者和医疗保健专业人员发病率和死亡率的重要来源。护理专业人员构成医院任何质量相关计划的组成部分,考虑到他们对几乎所有医疗服务的监督和提供。护士的知识和态度在医疗保健服务中起着重要作用。在沙特阿拉伯,医院环境中医院获得性感染的患病率促使人们越来越重视评估旨在预防医院获得性感染的护理知识和实践标准的依从性.
    这项单中心横断面研究是在费萨尔国王医疗中心的急诊科进行的,Taif,2022年10月至12月,涉及168名护士。该研究利用了预先验证的结构化在线问卷,包括三个部分:人口统计,知识评估,和实践评估。知识和实践水平被归类为良好,中度,和可怜的使用四分位数。
    该研究涵盖了医院急诊科的168名护士,揭示他们对预防医院获得性感染的标准做法的熟练程度。值得注意的是,63.8%的参与者表现出值得称赞的“良好”知识水平,10.6%的人在知识方面表现出“中等”水平,25.5%的人表现出“差”水平。同样,关于实践水平,56.4%的人表现出了值得称赞的“良好”实践水平,22.3%保持“适度”的实践水平,21.3%的人表现出“差”的练习水平。卡方分析揭示了年龄和知识水平之间的显着关联(p=0.000)。此外,年龄(p=0.000)和临床经验年限(p=0.000)与护士的实践水平显着相关40-50岁(82%)和具有10-15年临床经验的护士(83.3%)显示出良好的知识和实践水平,分别。总的来说,大多数护士表现出有效的知识和对感染预防措施的依从性。
    年龄和临床经验等社会人口统计学因素对护士关于医院获得性感染的知识和实践产生显著影响。
    UNASSIGNED: Hospital-acquired infections constitute a significant source of morbidity and mortality for both patients and healthcare professionals. Nursing professionals constitute an integral component of any quality-related program in a hospital, given their oversight and provision of nearly all healthcare services. Nurses\' knowledge and attitudes play a significant role in healthcare delivery. Within Saudi Arabia, the prevalence of hospital-acquired infections in hospital settings has prompted a growing emphasis on evaluating nursing knowledge and adherence to practice standards aimed at hospital-acquired infection prevention.
    UNASSIGNED: This single-center cross-sectional study was conducted at the emergency department of King Faisal Medical Complex, Taif, between October and December 2022, involving 168 nurses. The study utilized a pre-validated structured online questionnaire comprising three sections: demographics, knowledge assessment, and practice evaluation. Knowledge and practice levels were categorized as good, moderate, and poor using quartiles.
    UNASSIGNED: The study encompassed 168 nurses employed in the emergency department of the hospital, revealing their proficiency in standard practices for preventing hospital-acquired infections. Notably, 63.8% of participants demonstrated a commendable \"Good\" level of knowledge, while 10.6% exhibited a \"Moderate\" level and 25.5% manifested a \"Poor\" level in terms of knowledge. Similarly, concerning practice levels, 56.4% showcased a commendable \"Good\" practice level, 22.3% maintained a \"Moderate\" practice level, and 21.3% presented a \"Poor\" practice level. Chi-square analysis unveiled a significant association between age and knowledge levels (p = 0.000). In addition, age (p = 0.000) and years of clinical experience (p = 0.000) were significantly linked to nurses\' practice levels The nurses aged 40-50 years (82%) and those with 10-15 years of clinical experience (83.3%) showed good levels of knowledge and practice, respectively. Overall, most of the nurses demonstrated effective knowledge and compliance with infection prevention practices.
    UNASSIGNED: Sociodemographic factors such as age and clinical experience exert a notable impact on nurses\' knowledge and practices regarding hospital-acquired infections.
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  • 文章类型: Journal Article
    由多重耐药病原体引起的医疗保健相关感染正在全球增加,和目前的抗微生物选择对这些强大的物种的功效有限。WHO详细介绍了通常与医疗器械HAIs相关的至关重要的细菌和真菌物种。医疗器械的有效灭菌在预防传染病发病率和死亡率方面起着关键作用。缺乏对协议的遵守和与每种灭菌方式相关的限制,然而,允许疾病的发生。此外,与环氧乙烷气体(EtO)的致癌排放有关的问题促使EPA提议限制EtO的使用或寻求医疗设备的替代灭菌方法。美国食品和药物管理局支持使用低温VH2O2作为EtO的替代品对医疗保健产品进行灭菌。随着生物材料和医疗设备的进步以及组合产品的使用越来越多,目前的灭菌方式变得有限。医疗设备消毒和灭菌的新方法,生物材料,和治疗有必要保障公众健康。噬菌体,内溶素,和抗菌肽被认为是预防和预防传染病的有希望的选择。这一及时的审查讨论了这些生物制剂作为抗微生物剂的应用,以对抗至关重要的世卫组织病原体,包括ESKAPE细菌物种。
    Healthcare-associated infections caused by multi-drug-resistant pathogens are increasing globally, and current antimicrobial options have limited efficacy against these robust species. The WHO details the critically important bacterial and fungal species that are often associated with medical device HAIs. The effective sterilization of medical devices plays a key role in preventing infectious disease morbidity and mortality. A lack of adherence to protocol and limitations associated with each sterilization modality, however, allows for the incidence of disease. Furthermore, issues relating to carcinogenic emissions from ethylene oxide gas (EtO) have motivated the EPA to propose limiting EtO use or seeking alternative sterilization methods for medical devices. The Food and Drug Administration supports the sterilization of healthcare products using low-temperature VH2O2 as an alternative to EtO. With advances in biomaterial and medical devices and the increasing use of combination products, current sterilization modalities are becoming limited. Novel approaches to disinfection and sterilization of medical devices, biomaterials, and therapeutics are warranted to safeguard public health. Bacteriophages, endolysins, and antimicrobial peptides are considered promising options for the prophylactic and meta-phylactic control of infectious diseases. This timely review discusses the application of these biologics as antimicrobial agents against critically important WHO pathogens, including ESKAPE bacterial species.
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  • 文章类型: Journal Article
    医疗机构的有效消毒程序对于防止传播至关重要。化学消毒剂,过氧化氢蒸汽(HPV)系统和紫外(UV)光是常用的方法。一种新兴的方法,405nm的紫蓝光,已显示出表面消毒的希望。其抗微生物特性基于产生导致病原体失活的活性氧(ROS)。研究表明,在减少表面和空气中的细菌水平方面具有显着的功效,减少医院感染。这项研究的目的是在医院感染控制实验室中评估高接触表面上紫蓝色(405nm)LED灯的抗菌效果。在暴露于紫蓝光7天之前和之后对高接触表面进行采样。此外,研究了紫蓝光对MRSA污染表面的影响。暴露在紫蓝光下显著减少了细菌的数量,取样表面上的酵母和霉菌。培养箱手柄显示出微生物负荷低,辐照后无生长。由于阴影区域,工作台和水槽显示出不一致的减少。在第二个实验中,紫蓝光显著降低了MRSA在表面的微生物负荷,与一个更大的减少在钢表面比在塑料表面。405nm的紫蓝光已被证明是医疗保健环境中病原体灭活的有效工具紫蓝光有望作为减少医院环境中微生物污染的附加和集成工具,但必须与标准清洁实践和感染控制措施结合使用。需要进一步的研究来优化紫蓝色,405nm的消毒方法。
    Effective disinfection procedures in healthcare facilities are essential to prevent transmission. Chemical disinfectants, hydrogen peroxide vapour (HPV) systems and ultraviolet (UV) light are commonly used methods. An emerging method, violet-blue light at 405 nm, has shown promise for surface disinfection. Its antimicrobial properties are based on producing reactive oxygen species (ROS) that lead to the inactivation of pathogens. Studies have shown significant efficacy in reducing bacterial levels on surfaces and in the air, reducing nosocomial infections. The aim of this study was to evaluate the antimicrobial effectiveness of violet-blue (405 nm) LED lamps on high-contact surfaces in a hospital infection-control laboratory. High-contact surfaces were sampled before and after 7 days of exposure to violet-blue light. In addition, the effect of violet-blue light on MRSA-contaminated surfaces was investigated. Exposure to violet-blue light significantly reduced the number of bacteria, yeasts and moulds on the sampled surfaces. The incubator handle showed a low microbial load and no growth after irradiation. The worktable and sink showed an inconsistent reduction due to shaded areas. In the second experiment, violet-blue light significantly reduced the microbial load of MRSA on surfaces, with a greater reduction on steel surfaces than on plastic surfaces. Violet-blue light at 405 nm has proven to be an effective tool for pathogen inactivation in healthcare settings Violet-blue light shows promise as an additional and integrated tool to reduce microbial contamination in hospital environments but must be used in combination with standard cleaning practices and infection control protocols. Further research is needed to optimise the violet-blue, 405 nm disinfection method.
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  • 文章类型: Journal Article
    背景:这篇综述旨在综合有关感染预防和控制(IPC)干预措施的证据,以预防医护人员(HCW)或初级保健机构内的患者中的医疗保健相关感染(HAI)。
    方法:PubMed,CINAHL,在EMBASE和CENTRAL数据库中搜索了2011-2022年间发表的定量研究。研究选择,使用Cochrane和JoannaBriggs工具进行数据提取和质量评估,通过独立审查进行,并对研究选择进行额外的敏感性检查。
    结果:纳入4项研究。一项随机试验和横断面调查,分别,发现戴N95口罩的HCW与医用口罩的实验室确认流感没有统计学差异(p=0.18),并且结核病(TB)控制措施的实施与TB发病率之间存在显着负相关(p=0.02)。为了预防小手术后的手术部位感染,随机试验发现,非无菌手套(8.7%;95%CI,4.9%-12.6%)不劣于无菌手套(9.3%;95%CI,7.4%-11.1%),预防性抗生素与安慰剂相比无显著差异(p=0.064).所有研究都有很高的偏倚风险。
    结论:用于预防初级保健HAI的IPC干预措施的证据非常有限,不足以提出实践建议。然而,这些发现强调了未来研究的必要性。
    BACKGROUND: This review aimed to synthesize the evidence on infection prevention and control interventions for the prevention of health care-associated infection among health care workers or patients within primary care facilities.
    METHODS: PubMed, CINAHL, EMBASE, and CENTRAL databases were searched for quantitative studies published between 2011 and 2022. Study selection, data extraction, and quality assessment using Cochrane and Joanna Briggs tools, were conducted by independent review with additional sensitivity checking performed on study selection.
    RESULTS: Four studies were included. A randomized trial and a cross-sectional survey, respectively, found no statistical difference in laboratory-confirmed influenza in health care workers wearing N95 versus medical masks (P = .18) and a significant inverse association between the implementation of tuberculosis control measures and tuberculosis incidence (P = .02). For the prevention of surgical site infections following minor surgery, randomized trials found nonsterile gloves (8.7%; 95% confidence interval, 4.9%-12.6%) to be noninferior to sterile gloves (9.3%; 95% confidence interval, 7.4%-11.1%) and no significant difference between prophylactic antibiotics compared to placebo (P = .064). All studies had a high risk of bias.
    CONCLUSIONS: Evidence for infection prevention and control interventions for the prevention of health care-associated infection in primary care is very limited and insufficient to make practice recommendations. Nevertheless, the findings highlight the need for future research.
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  • 文章类型: Observational Study
    背景:医院感染或医院获得性感染是日益增长的公共卫生威胁,增加了患者的发病率和死亡率。风险最高的患者是重症监护病房的患者。因此,我们的目的是对成人外科重症监护病房(ICU)发生的医院感染进行模式分析.
    方法:本研究是一项回顾性观察性研究,在安纳加国立大学医院(NNUH)的6张病床的外科重症监护病房(SICU)进行,以检测2020年1月至2021年12月的医院感染发生率。研究组包括157名在SICU住院期间接受抗生素治疗的患者。
    结果:医院感染发生率,怀疑或证实,在SICU中占26.9%(352例入院患者中有95例).肺炎(36.8%),其次是皮肤和软组织感染(35.8%)是最常见的原因。最常见的致病微生物依次为:铜绿假单胞菌(26.3%),鲍曼不动杆菌(25.3%),超广谱β内酰胺酶(ESBL)-大肠杆菌(23.2%)和肺炎克雷伯菌(15.8%)。SICU医院感染患者平均住院时间为18.5天。
    结论:尽管现行的感染控制措施,医院感染的发生率仍在逐步增加,这是危重病人死亡率增加的原因。这项研究的结果可能有助于提高人们的意识,以实施新的策略来监视和预防巴勒斯坦医院和医疗保健中心的医院获得性感染。
    BACKGROUND: Nosocomial infections or hospital-acquired infections are a growing public health threat that increases patient morbidity and mortality. Patients at the highest risk are those in intensive care units. Therefore, our objective was to provide a pattern analysis of nosocomial infections that occurred in an adult surgical intensive care unit (ICU).
    METHODS: This study was a retrospective observational study conducted in a 6-bed surgical intensive care unit (SICU) at An-Najah National University Hospital (NNUH) to detect the incidence of nosocomial infections from January 2020 until December 2021. The study group included 157 patients who received antibiotics during their stay in the SICU.
    RESULTS: The incidence of nosocomial infections, either suspected or confirmed, in the SICU was 26.9% (95 out of 352 admitted patients). Pneumonia (36.8%) followed by skin and soft tissue infections (35.8%) were the most common causes. The most common causative microorganisms were in the following order: Pseudomonas aeruginosa (26.3%), Acinetobacter baumannii (25.3%), extended-spectrum beta lactamase (ESBL)-Escherichia coli (23.2%) and Klebsiella pneumonia (15.8%). The average hospital stay of patients with nosocomial infections in the SICU was 18.5 days.
    CONCLUSIONS: The incidence of nosocomial infections is progressively increasing despite the current infection control measures, which accounts for an increased mortality rate among critically ill patients. The findings of this study may be beneficial in raising awareness to implement new strategies for the surveillance and prevention of hospital-acquired infections in Palestinian hospitals and health care centers.
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