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Background Hospital-acquired pneumonia (HAP) are one of the major healthcare-associated infection but its burden and financial impact are lesser studied comparing to ventilator-associated pneumonia (VAP). The study aims to investigate the disease burden, etiology and the outcome among HAP/VAP patients in Taiwan. Methods This is a retrospective study conducted in a teaching hospital in Taiwan. We enrolled patients with HAP/VAP during 1st Jan. 2018 to 31st Dec. 2018. The definition of HAP/VAP was based on definition proposed by the Taiwan Centers of Disease Control and the hospital-wide data was audited prospectively by Center for Infection Control of the hospital. Patients with HAP were further categorized as non-ventilated HAP (nvHAP) and ventilated HAP (vHAP). The burden of HAP/VAP was estimated and the clinical outcomes were compared between nvHAP and vHAP. Results In total, 152 episodes of HAP and 8 episodes of VAP were identified. The incidence of HAP was 0.22 (95% confidence interval [CI], 0.19–0.26) per 1,000 patients-days while that of VAP was 0.27 (95% CI, 0.12–0.53) per 1,000 ventilator-days. The mortality was similar between vHAP and nvHAP in our cohort (55.6% vs. 62.6%, respectively, p = 0.58). However, vHAP was associated with higher length of hospital stay (56 vs. 37 days, p

Background/Purpose Vancomycin-resistant Enterococcus (VRE), a multidrug-resistant, difficult-to-treat pathogen of healthcare-associated infections (HAIs), is now endemic at many intensive care units (ICUs). Chlorhexidine (CHG) bathing is a simple and highly effective intervention to decrease VRE acquisition, but its effect on VRE-HAIs has not been assessed in prospective studies at ICUs. Methods This is a cluster quasi-experimental controlled study. Under active VRE surveillance and contact isolation of all identified VRE carriers, four ICUs were assigned to provide 2% CHG bathing for all patients on a daily basis (CHG group) during the intervention period, while another four ICUs were assigned to provide standard care without CHG bathing for all patients (standard care group) during the same period. Results The CHG group (n = 1501) had a 62% lower crude incidence of VRE-HAIs during the intervention period, compared with the baseline period (1.0 vs. 2.6 per thousand patient-days, P = 0.009), while VRE-HAIs incidence did not change in standard care group (n = 3299) (1.1 vs. 0.5 per thousand patient-days, P = 0.139). In multivariable analyses, CHG bathing was independently associated with a 70% lower risk of VRE-HAIs (adjusted odds ratio [OR] 0.3, 95% confidence interval [CI], 0.2 to 0.7, P = 0.006). In contrast, standard care during the same period had no effect on the risk of VRE-HAIs (adjusted OR 1.8, 95% CI: 0.7 to 4.7, P = 0.259). Conclusion CHG bathing is a highly effective approach to prevent VRE-HAIs at ICUs, in the context of active VRE surveillance with contact isolation.

Background Chlorhexidine (CHG) bathing decreases the incidence of bloodstream infections in intensive care units, but its effect has been understudied in patients with hematological malignancies in noncritical care units. Methods Adults with hematological malignancies hospitalized for cytotoxic chemotherapy in noncritical care units were offered daily 2% CHG bathing. We compared outcomes of patients who chose CHG bathing (CHG group) with outcomes of those who did not choose CHG bathing (usual-care group). The primary outcome was gram-positive cocci–related, skin flora–related, or central line–associated bloodstream infection. The negative control outcome was gut-origin bacteremia. Results The CHG group (n = 485) had a crude incidence rate of the primary outcome that was 60% lower than the rate for the usual-care group (n = 408; 3.4 vs 8.4 per 1000 patient-days, P = .02) but had a similar crude incidence rate of the negative control outcome (4.5 vs 3.2 per 1000 patient-days; P = .10). In multivariable analyses, CHG bathing was associated with a 60% decrease in the primary outcome (adjusted hazard ratio [HR], 0.4; P < .001). In contrast, CHG bathing had no effect on the negative control outcome (adjusted HR, 1.1; P = .781). CHG bathing was well tolerated by participants in the CHG group. Conclusions CHG bathing could be a highly effective approach for preventing gram-positive cocci–related, skin flora–related, or central line–associated bacteremia in patients with hematological malignancies who are hospitalized for cytotoxic chemotherapy in noncritical care units.

The thoroughness of hand hygiene (HH) was evaluated using a simulation method in which health care workers (HCWs) rubbed their hands with a fluorescent substance, washed with water, and placed their hands under an ultraviolet detector to identify areas missed. Most residue points were located in the tips of the nails (38.6%), followed by fingertips (17.4%). This stress-free "seeing is believing" program can encourage HCWs' active participation in sustaining the HH culture of health care institutions.

Background Medical students served as covert observers of hand hygiene (HH) compliance by health care workers (HCWs) during a recent 1-year study at a teaching hospital in Taiwan. This report describes the students' experience and their views of the major factors that led to good or poor compliance. Methods Nine upper class medical students received a basic course in HH and attended a workshop using World Health Organization standard training materials. A standardized observation tool was used to collect data on HH performance by the HCWs. On completion of the study, structured face-to-face interviews were conducted to assess the students' experiences. Results The medical students observed a total of 17,742 HH opportunities during the study period. Eight of the 9 students participated in the poststudy interviews. Overall, the students believed that they had gained considerable knowledge of the attitudes regarding HH compliance by nurses, physicians, and surgeons according to each of the 5 HH indications. Based on their experience, they recommended that compliance could be improved by ensuring an adequate supply of HH products and by promoting role modeling in the ward, reminding, education in small groups, and objective structured clinical examinations. Conclusions The opportunity for medical students to serve as covert observers broadened their knowledge of how infections are transmitted in hospitals and of the barriers that must be overcome to improve HCWs' HH compliance.

Background: Hand hygiene is an important component in infection control to protect patient safety and reduce health care-associated infection. Objective: Our aim was to evaluate the efficacy of different social media on the promotion of a hand hygiene (HH) program. Methods: The observational study was conducted from May 5 to December 31, 2014, at a 2600-bed tertiary care hospital. A 3-minute video of an HH campaign in 8 languages was posted to YouTube. The Chinese version was promoted through three platforms: the hospital website, the hospital group email, and the Facebook site of a well-known Internet illustrator. The video traffic was analyzed via Google Analytics. HH compliance was measured in November 2013 and 2014. Results: There were 5252 views of the video, mainly of the Chinese-language version (3509/5252, 66.81%). The NTUH website had 24,000 subscribers, and 151 of them viewed the video (connection rate was 151/24,000, 0.63%). There were 9967 users of the hospital email group and the connection rate was 0.91% (91/9967). The connection rate was 6.17% (807/13,080) from Facebook, significantly higher than the other 2 venues (both P

"Patient empowerment" is an important component of World Health Organization hand hygiene program, but little is known about the intentions and attitude of patients/families and health care workers (HCWs) regarding this.A cross-sectional survey using questionnaires was conducted in a tertiary teaching hospital in Taiwan to assess hand hygiene knowledge and the attitudes and intentions regarding patient empowerment among patients/families and HCWs.Among patients/families, 95.4% (329/345) had positive attitudes regarding patient empowerment; however, only 67.2% (232/345) had the positive intention to remind HCWs about hand hygiene (P.001). Risk factors for negative intention were being female (odds ratio [OR], 1.82; 95% confidence interval [CI]: 1.08-3.03), illiteracy (OR, 3.18; 95% CI: 0.86-11.7), and being patients/families in the pediatric department (OR, 1.86; 95% CI: 0.93-3.64). Among HCWs, the difference between positive attitude (81.1%; 714/880) and positive intention regarding being reminded about hand hygiene (62.8%; 553/880) was significant (P.001). Risk factors for negative intention were age25 years (OR, 3.20; 95% CI: 1.51-6.81) and a negative attitude toward patient empowerment (OR, 10.00; 95% CI: 5.88-16.67).There were significant gaps between attitude and intention regarding patient empowerment both among patients/families and HCWs. Special strategies targeting women, the pediatric population, or illiterate people may help improve patient/family participation. Additionally, hand hygiene education should be incorporated into early-stage medical/nursing education to create a facilitating environment. Patients/families and HCWs cooperation is needed to promote the hand hygiene program further.

Background Limited data describe the sustained impact of hand hygiene programs (HHPs) implemented in teaching hospitals, where the burden of healthcare-associated infections (HAIs) is high. We use a quasi-experimental, before and after, study design with prospective hospital-wide surveillance of HAIs to assess the cost effectiveness of HHPs. Methods and Findings A 4-year hospital-wide HHP, with particular emphasis on using an alcohol-based hand rub, was implemented in April 2004 at a 2,200-bed teaching hospital in Taiwan. Compliance was measured by direct observation and the use of hand rub products. Poisson regression analyses were employed to evaluate the densities and trends of HAIs during the preintervention (January 1999 to March 2004) and intervention (April 2004 to December 2007) periods. The economic impact was estimated based on a case-control study in Taiwan. We observed 8,420 opportunities for hand hygiene during the study period. Compliance improved from 43.3% in April 2004 to 95.6% in 2007 (p