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BACKGROUND As healthcare is responsible for 7% of Australia's carbon emissions, it was recognised that a policy implemented at St George Hospital, Sydney to reduce non-urgent pathology testing to two days per week and on other days only if essential, would also result in a reduction in carbon emissions. The aim of the study was to measure the impact of this intervention on pathology collections and associated carbon emissions and pathology costs. METHODS The difference in the number of pathology collections, carbon dioxide equivalents (CO2 e) for five common blood tests, and pathology cost per admission were compared between a 6-month reference period and 6-month intervention period. CO2 e were estimated from published pathology CO2 e impacts. Cost was derived from pathology billing records. Outcomes were modelled using multivariable negative binomial, generalised linear, and logistic regression. RESULTS In total, 24,585 pathology collections in 5,695 patients were identified. In adjusted analysis, the rate of collections was lower during the intervention period (rate ratio 0.90, 95% CI, 0.86 to 0.95; P

Introduction Patients with nursing and healthcare-associated pneumonia (NHCAP) commonly receive empiric antibiotic therapy according to the guideline's recommendation corresponding to the patient's deteriorated conditions. However, it is unclear whether guideline-concordant treatment (GCT) could be effective or not. Patients and methods To evaluate the efficacy and validity of GCT according to the current guideline for pneumonia, we conducted this retrospective study. NHCAP patients who were admitted to our institute between 2014 and 2017 were enrolled. Based on the initial antibiotic treatment, these patients were divided into two groups, the GCT group (n = 83) and the non-GCT group (n = 146). Propensity score matching (PSM) was used to balance the baseline characteristics and potential confounders between the two groups. After PSM, patients’ characteristics, microbial profiles, and clinical outcomes were evaluated. Results Both groups were well-balanced after PSM, and 78 patients were selected from each group. There were no differences in patients’ characteristics or microbial profiles between the two groups. As for outcomes, there were no differences in 30-day, in-hospital mortality rate, duration of antibiotic treatment, or admission. The severity of pneumonia was more severe in patients with the GCT group than those with the non-GCT group. Anti-pseudomonal agents as initial treatment were more frequently seen in patients with the GCT group than those in the non-GCT group. Conclusion Unlike previous studies, GCT's recommendation for management of pneumonia by the JRS in 2017 would appear to be valid and does not increase the mortality rate.

New or preexisting atrial fibrillation (AF) is frequent in patients undergoing aortic valve replacement. We evaluated whether the presence of AF during transcatheter aortic valve implantation (TAVI) or surgical aortic valve replacement (SAVR) impacts the length of stay, healthcare adjusted costs, and inpatient mortality. The median length of stay in the patients with AF increased by 33.3% as compared with those without AF undergoing TAVI and SAVR (5 [3 to 8] days vs 3 [2 to 6] days, p

Introduction Information on healthcare-associated C.difficile infection (HA-CDI) in COVID-19 patients is limited. We aimed to assess the characteristics of HA-CDI acquired during and before the COVID-19 pandemic.Methods We conducted a retrospective study in a tertiary care hospital, in which since March 2020 exclusively COVID-19 patients are hospitalized. We compared HA-CDI adult patients hospitalized in March 2020-February 2021 with those hospitalized during the same period in 2017-2018.Results We found 51 cases during 2020-2021 (COVID-19 group), incidence 5.6/1000 adult discharge and 99 cases during 2017-2018 (pre-COVID-19 group), incidence 6.1/1000 adult discharge (p=0.6). The patients in COVID-19 group compared to pre-COVID-19 group were older (median age 66 vs 62 years), with similar rate of comorbidities, but with higher rate of cardiovascular diseases (62.7% vs 42.4%) and less immunosuppression (21.6% vs 55.6%), they had a higher proton pump inhibitors use (94.1% vs 32.3%), and a longer hospitalization (median 19 vs 14 days).Eighty-five (85.9%) patients in pre-COVID-19 group versus 44 (86.3%) patients in COVID-19 group received antimicrobial treatment - mainly cephalosporins (34,1%), quinolones (22,3%) and glycopeptides (21,1%) in pre-COVID-19 group and mainly cephalosporins and macrolides (63,6% each) in COVID-19 group. We found four HA-CDI-related deaths in pre-COVID-19 group and none in the COVID-19 group.Conclusions The HA-CDI incidence in COVID-19 group did not change versus the same period of time during 2017-2018. The antibiotic use was the most important factor associated with HA-CDI. We identified a high use of broad-spectrum antibiotics despite the lack of empirical antimicrobial recommendations in COVID-19.What is important: Information on healthcare-acquired C.difficile in COVID-19 patients is limited, but not only C.difficile infection remains a worrying issue, but is also an emerging topic. We found that antibiotic use seems to be the most important factor associated with CDI and our data emphasize the need for rational use of antibiotics and for ongoing attention regarding CDI in COVID-19 patients.

With this survey, we investigated healthcare-associated invasive mold infection (HA-IMI) surveillance and air sampling practices in US acute-care hospitals. More than half of surveyed facilities performed HA-IMI surveillance and air sampling. HA-IMI surveillance was more commonly performed in academic versus nonacademic facilities. HA-IMI case definitions and sampling strategies varied widely among respondents.

Objective:To evaluate the impact of a vancomycin-resistant Enterococcus (VRE) screening policy change on the incidence of healthcare-associated (HA)-VRE bacteremia in an endemic hospital setting.Design:A quasi-experimental before-and-after study.Setting:A 1,989-bed tertiary-care referral center in Seoul, Republic of Korea.Methods:Since May 2010, our hospital has diminished VRE screening for admitted patients transferred from other healthcare facilities. We assessed the impact of this policy change on the incidence of HA-VRE bacteremia using segmented autoregression analysis of interrupted time series from January 2006 to December 2014 at the hospital and unit levels. In addition, we compared the molecular characteristics of VRE blood isolates collected before and after the screening policy change using multilocus sequence typing and pulsed-field gel electrophoresis.Results:After the VRE screening policy change, the incidence of hospital-wide HA-VRE bacteremia increased, although no significant changes of level or slope were observed. In addition, a significant slope change in the incidence of HA-VRE bacteremia (change in slope, 0.007; 95% CI, 0.001–0.013; P = .02) was observed in the hemato-oncology department. Molecular analysis revealed that various VRE sequence types appeared after the policy change and that clonally related strains became more predominant (increasing from 26.1% to 59.3%).Conclusions:The incidence of HA-VRE bacteremia increased significantly after VRE screening policy change, and this increase was mainly driven by high-risk patient populations. When planning VRE control programs in hospitals, different approaches that consider risk for severe VRE infection in patients may be required.

An examination of all coronavirus disease 2019 (COVID-19) cases and patient movements in Geneva indicated important disease activity within the healthcare system since the beginning of the pandemic. We estimate that 4.3% of all COVID-19 cases were likely acquired within the healthcare system, contributing to 62% of the COVID-19–related deaths.

Aim: We sought to determine if opioid exposure may have a detrimental effect on the course of Clostridioides difficile infection (CDI). Materials & methods: We compared opioid exposure in patients with well-defined severe CDI and non-severe CDI. Results: Following exclusions, 403 records were reviewed. Of this group, 128/403 (31.7%) were determined to have severe CDI by strict criteria, and 275/403 (68.3%) were found to have non-severe CDI. Full multivariate regression and reduced model of potential predictors for severe CDI showed no association with opioids prescribed. Conclusion: Opioid exposure (predominantly in modest range) does not appear to be a risk factor for severe healthcare-associated CDI.

The morbidity and mortality of cryptococcal meningoencephalitis (CM) in previously healthy, HIV-negative individuals is increasingly recognized. We administered a healthcare associated quality of life (QOL) survey to the largest longitudinally followed cohort of these patients in the United States. We identified moderate or severe self-reported impairment in at least one QOL domain in 61% of subjects at least one year following diagnosis. Self-reported cognitive impairment was noted in 52% and sleep disturbance was noted in 55%. This is the first comprehensive study of cross-sectional long-term QOL in previously healthy patients following cryptococcal infection.

Background: Non-sterile latex disposable gloves (NSLDGs) can prevent infections, but may also cause them if improperly used. Aim: To study NSLDGs bacterial contamination and the effect of hand hygiene reminder notices. Methods: A controlled interventional study was conducted through a quantitative bacterial sampling of NSLDGs (n = 160 gloves) obtained from boxes immediately after they were opened (baseline contamination) and 48 hours afterwards (per-intervention), and after hand hygiene reminder notices were placed (post-intervention). Bacteria were isolated and identified by 16S rRNA gene sequencing and antibiotic sensitivity testing. Findings:Pre-intervention contamination was found to be 90% and 65% for skin commensals and pathogens, respectively. Post-intervention contamination by skin commensals and pathogens declined to 70% and 15%, respectively, representing a significant reduction in the prevalence of pathogens (p = 0.0006244). The average number of colony-forming units per glove pair was also reduced, from 57.05 to 4.95 (p = 1.5 × 10-5) and from 16.1 to 0.65 (p = 0.003374), for skin commensals and pathogenic bacteria, respectively. Discussion: NSLDGs are potential pathogen transmission vehicles. Hand hygiene reminder notices placed on glove boxes can lead to reductions in bacterial contamination levels.

Aim: Candida infections develop especially in intensive care unit (ICU) patients and increase the mortality rates. So, early and accurate diagnosis of Candida infections and determination of risk factors are very important. We aimed to retrospectively investigate Candida infections in terms of species and risk factors for candidemia caused by fungi. Methods: Candida infections in critically ill patients hospitalized in the ICU between January 2014 and December 2018 at Bolu Abant Izzet Baysal University Training and Research Hospital were retrospectively analyzed. The isolated Candida species were evaluated according to the sample types. The cases were investigated in terms of mortality due to candidiasis, previously used antibiotics and isolated Candida species. Results: 34 Candida species isolated from fungal cultures in ICUs were included in the study. Candida albicans (73.5%) was the most prevalent species isolated (NAC 26.5%). Patients with Candida isolated in their urine samples (76%) had a higher mortality rate than patients with Candida from other regions. Conclusion: The results of our study suggest that the highest rate of candidiasis (88%) is in patients who received beta-lactam antibiotic treatment. In addition, we think that when Candida species are detected in the urine samples of critically ill patients in the ICU, care should be taken in terms of candidiasis.

Introduction: Healthcare-associated ventriculitis and meningitis occur after neurosurgical procedures, is associated with an adverse outcome in the majority of patients and represent a diagnostic c...

Background:There is controversy regarding whether the addition of cover gowns offers a substantial benefit over gloves alone in reducing personnel contamination and preventing pathogen transmission.Design:Simulated patient care interactions.Objective:To evaluate the efficacy of different types of barrier precautions and to identify routes of transmission.Methods:In randomly ordered sequence, 30 personnel each performed 3 standardized examinations of mannequins contaminated with pathogen surrogate markers (cauliflower mosaic virus DNA, bacteriophage MS2, nontoxigenic Clostridioides difficile spores, and fluorescent tracer) while wearing no barriers, gloves, or gloves plus gowns followed by examination of a noncontaminated mannequin. We compared the frequency and routes of transfer of the surrogate markers to the second mannequin or the environment.Results:For a composite of all surrogate markers, transfer by hands occurred at significantly lower rates in the gloves-alone group (OR, 0.02; P < .001) and the gloves-plus-gown group (OR, 0.06; P = .002). Transfer by stethoscope diaphragms was common in all groups and was reduced by wiping the stethoscope between simulations (OR, 0.06; P < .001). Compared to the no-barriers group, wearing a cover gown and gloves resulted in reduced contamination of clothing (OR, 0.15; P < .001), but wearing gloves alone did not.Conclusions:Wearing gloves alone or gloves plus gowns reduces hand transfer of pathogens but may not address transfer by devices such as stethoscopes. Cover gowns reduce the risk of contaminating the clothing of personnel.

Background:The hands of healthcare personnel are the most important source for transmission of healthcare-associated pathogens. The role of contaminated fomites such as portable equipment, stethoscopes, and clothing of personnel in pathogen transmission is unclear.Objective:To study routes of transmission of cauliflower mosaic virus DNA markers from 31 source patients and from environmental surfaces in their rooms.Design:A 3-month observational cohort study.Setting:A Veterans’ Affairs hospital.Methods:After providing care for source patients, healthcare personnel were observed during interactions with subsequent patients. Putative routes of transmission were identified based on recovery of DNA markers from sites of contact with the patient or environment. To assess plausibility of fomite-mediated transmission, we assessed the frequency of transfer of methicillin-resistant Staphylococcus aureus (MRSA) from the skin of 25 colonized patients via gloved hands versus fomites.Results:Of 145 interactions involving contact with patients and/or the environment, 41 (28.3%) resulted in transfer of 1 or both DNA markers to the patient and/or the environment. The DNA marker applied to patients’ skin and clothing was transferred most frequently by stethoscopes, hands, and portable equipment, whereas the marker applied to environmental surfaces was transferred only by hands and clothing. The percentages of MRSA transfer from the skin of colonized patients via gloved hands, stethoscope diaphragms, and clothing were 52%, 40%, and 48%, respectively.Conclusions:Fomites such as stethoscopes, clothing, and portable equipment may be underappreciated sources of pathogen transmission. Simple interventions such as decontamination of fomites between patients could reduce the risk for transmission.

Objectives Nursing and healthcare-associated pneumonia (NHCAP) was proposed by the Japanese Respiratory Society to refer to healthcare-associated pneumonia. This study aimed to investigate whether antipseudomonal antibiotic therapy improved the prognosis of NHCAP patients at high risk for antimicrobial-resistant pathogens. Methods Consecutive hospitalised NHCAP patients in Kurashiki Central Hospital between October 2010 and December 2016 were prospectively enrolled. NHCAP patients who were at high risk for antimicrobial resistance were defined as those who received antimicrobials in the preceding 90 days and/or were on tube feeding. The patients who received antipseudomonal antibiotics were defined as the guideline-concordant (GC) therapy group, and the others were defined as the guideline-discordant (GD) therapy group. The primary outcome was 30-day mortality. Inverse probability of treatment weighting (IPTW) analysis was used to reduce biases. Results There were 277 patients with NHCAP; a majority (78.0%) were discharged from a hospital in the preceding 90 days. There were 52 patients in the GC group and 225 patients in the GD group. The 30-day mortality rate was significantly higher in the GC group than in the GD group (17.3%, 9/52 vs. 7.1%, 16/225; P = 0.03). After IPTW analysis, the GC therapy, compared with GD therapy, did not improve the 30-day mortality (OR 1.71, 95% CI 0.65–4.47; P = 0.28). Conclusions Not all NHCAP patients, even those at high risk for antimicrobial resistance, need antipseudomonal antimicrobial treatment. The treatment strategy for NHCAP patients should be individualised, according to the pneumonia severity, risk for antimicrobial-resistant pathogens, and antibiogram in each hospital.

Purpose of review The aim of this article is to review the epidemiology, cause, diagnostic evaluation, and management of healthcare-associated diarrhea (HCAD) with particular attention to current epidemiology and recent developments in diagnostics. Recent findings Multiplex polymerase chain reaction gastrointestinal panels allow rapid detection of a wide array of potential enteropathogens but the role, yield, and utility of these tests have not been systematically assessed in patients with HCAD. Recent epidemiologic studies reaffirm that HCAD is predominantly a noninfectious condition most often caused by medications or underlying medical conditions, sometimes Clostridioides difficile, and occasionally viruses. Other infections are rare. Summary Clinical assessment remains fundamental to the evaluation of HCAD and targeted testing for C. difficile is sufficient in most patients. Multiplex gastrointestinal panels may have a role in immunocompromised patients but more study is needed. Medication-induced diarrhea is common and underappreciated and not limited to antibiotics, laxatives, and enemas.

Objective:To examine the global burden, associated point sources, and successful prevention and control measures for documented outbreaks of Burkholderia cepacia healthcare-associated infections (HAIs).Design:Integrative review.Methods:A review of all outbreaks of Burkholderia cepacia HAIs published in the peer-reviewed literature between January 1970 and October 2019 was conducted to identify the global burden, associated point sources, and successful prevention and control measures using the Guidelines for Outbreak Reports and Intervention Studies of Nosocomial Infections (ORION).Results:In total, we reviewed 125 documented outbreaks of Burkholderia cepacia–related HAIs worldwide. The reported B. cepacia HAIs for this period involved 3,287 patients. The point sources were identified in most outbreaks of B. cepacia HAIs (n = 93; 74.4%); they included medication vials, disinfectants, and antiseptics. Moreover, 95 of the outbreak reports (76%) described effective prevention and control measures, but only 33 reports indicated the use of a combination of environment-, patient- and staff-related measures. None of the outbreak reports used the ORION guidelines.Conclusions:Outbreaks of Burkholderia cepacia HAIs are an ongoing challenge. They are often associated with immunocompromised patients who acquire the infection from exposure to contaminated medications, products, and equipment. These outbreaks are not infrequent, and a range of infection prevention and control measures have been effective in arresting spread. The use of ORION guidelines for outbreak reporting would improve the quality of information and data to generate evidence for translation into practice.

Background Escherichia coli is the most common cause of bacteremia in high-income countries. To enable the development and implementation of effective prevention strategies, a better understanding of the current epidemiology of invasive E. coli infections is needed. Methods A systematic review of literature published between 1 January 2007 and 31 March 2018 on the burden and epidemiology of E. coli bacteremia in populations that include adults in high-income countries was conducted. Meta-analysis was performed for descriptive purposes. Results During the studied time interval, the estimated incidence rate of E. coli bacteremia was 48 per 100 000 person-years, but this increased considerably with age: rates per 100 000 person-years were >100 in 55-to-75-year-olds and >300 in 75-to-85-year-olds. Overall, E. coli accounted for 27% of documented bacteremia episodes: 18% if hospital acquired, 32% if community-onset healthcare associated, and 33% if community acquired. The estimated case fatality rate was 12%. Approximately 44% of episodes were community acquired, 27% community-onset healthcare associated, and 27% hospital acquired. Urinary tract infection (UTI) was the primary source for 53% of episodes. Conclusions This systematic review confirms the substantial burden of E. coli bacteremia in older adults and justifies the implementation of community-level programs to prevent E. coli bacteremia and ideally UTI in this age group.

Background:Cohorting of patients and staff is a control strategy often used to prevent the spread of infection in healthcare institutions. However, a comprehensive evaluation of cohorting as a prevention approach is lacking.Methods:We performed a systematic review of studies that used cohorting as part of an infection control strategy to reduce hospital-acquired infections. We included studies published between 1966 and November 30, 2019, on adult populations hospitalized in acute-care hospitals.Results:In total, 87 studies met inclusion criteria. Study types were quasi-experimental “before and after” (n = 35), retrospective (n = 49), and prospective (n = 3). Case-control analysis was performed in 7 studies. Cohorting was performed with other infection control strategies in the setting of methicillin-resistantStaphylococcus aureus(MRSA, n = 22),Clostridioides difficileinfection (CDI, n = 6), vancomycin-resistantEnterococcus(VRE, n = 17), carbapenem-resistant Enterobacteriaceae infections (CRE, n = 22),A. baumannii(n = 15), and other gram-negative infections (n = 5). Cohorting was performed either simultaneously (56 of 87, 64.4%) or in phases (31 of 87, 35.6%) to help contain transmission. In 60 studies, both patients and staff were cohorted. Most studies (77 of 87, 88.5%) showed a decline in infection or colonization rates after a multifaceted approach that included cohorting as part of the intervention bundle. Hand hygiene compliance improved in approximately half of the studies (8 of 15) during the respective intervention.Conclusion:Cohorting of staff, patients, or both is a frequently used and reasonable component of an enhanced infection control strategy. However, determining the effectiveness of cohorting as a strategy to reduce transmission of MDRO andC. difficileinfections is difficult, particularly in endemic situations.

Objective: The neonatal mortality rate remains a serious problem in most countries in sub-Saharan Africa such as Burkina Faso, where, in 2010 this mortality rate was 28 per 1000 live births [1] [2]. Its reduction is possible and passes first by the strict prevention of infections in birth rooms. The objective of this study was to describe the practices of infection prevention in the birth rooms of seven referral hospitals in Ouagadougou from April 1 to July 31, 2016. Materials and Methods: This was a cross-sectional study on the knowledge, attitudes and practices of the rules of prevention and control of healthcare associated infections (PCHAI) among 123 consenting health workers who provided birth room care in 7 hospitals in Ouagadougou. Data were collected through individual interviews and direct observations. The study was authorized by the Institutional Ethics Committee in 2015 under the number 32. The data analysis was done with the Epi Info software version 2000. Results: The “five clean in the birth room” were known by 26.83%. Regarding the equipment used for PCHAI, sterile gloves were mentioned by 75.61% of the agents, the source of clean water by 62.60% and soap by 57.11%; in practice, 17.07% of the respondents had not washed their hands and 42 providers (34%) had not performed with complete mastery the wearing of sterile gloves before giving birth, and 55.28% had not cleaned the perineum. Conclusion: Deficiencies in the prevention and control of healthcare-associated infections have been identified. Training on infection prevention in the neonatal period is needed for the benefit of hospital providers.

Although the overall use of healthcare services fell by about a third during the covid-19 pandemic, with greater reductions among people with less severe diseases, the issue of overdiagnosis and overtreatment adding to increased healthcare associated carbon emissions persisted.123 Repeated and unnecessary testing of patients with covid-19 using RT-PCR, blood tests, and radiological investigations was pervasive. Rampant …

Chryseobacterium species are recognized as an emerging opportunistic bacterial pathogen in nosocomial settings especially in debilitated or immunosuppressed patients and neonates. The ubiquitous distribution in nature, ability to form biofilms with inherent resistance to broad-spectrum antimicrobials, and lack of clinical studies pose a further diagnostic and therapeutic challenge. This case report describes an elderly male with relapsed diffuse large B-cell lymphoma (DLBCL) status post-chemotherapy and radiation who acquired healthcare-associated pneumonia with sputum isolates showing Chryseobacterium gleum and Stenotrophomonas maltophila. It also includes a review of literature compiling all the previously reported cases with antibiotic susceptibilities, clinical picture, and treatment outcomes.

Background Epidemiological data on secondary bacteremia associated with nosocomial urinary tract infections generally include adult patients with urinary catheters. Aim To evaluate the frequency and outcome of secondary bacteremia complicating healthcare-associated urinary tract infections. Material and methods This study was conducted between May 2013 and December 2017 at the Dr. Behcet Uz Children's Hospital and included symptomatic nosocomial urinary tract infections. A total of 117 patients with positive blood cultures were enrolled in the study. Results Six patients had bacteremia associated with nosocomial urinary tract infections yielding an incidence of 5.1%. The pathogens responsible for secondary bacteremia were: Klebsiella pneumonia in two patients, Enterococcus faecium in two patients, Klebsiella oxytoca in one patient, and Pseudomonas aeruginosa in one patient. Conclusion The incidence of bacteremia associated with nosocomial urinary tract infections was not different from bacteremia associated with community-acquired urinary tract infections, and was approximately 5%.

Summary Background Healthcare-associated norovirus outbreaks place a large burden on healthcare staff. Environmental service workers (ESWs), however, remain understudied despite high contact with potentially contaminated surfaces. Understanding the magnitude of the risk of norovirus infection in healthcare ESWs can protect workers and improve infection control. Aim This study simulated the risk of norovirus infection for unprotected ESWs after a single fomite contact, assuming no disinfection or protective equipment, in norovirus-positive patient rooms. In addition, the risk of secondary surface transmission from norovirus-exposed ESWs was simulated. Methods A quantitative microbial risk assessment employing two-dimensional Monte Carlo simulation with parameters extracted from the literature was used to estimate norovirus infection from multiple fomite contact scenarios defined by: norovirus source (patient vomit/diarrhoea), location (bathroom/patient room) and target outcome (ESW/secondary illness). Findings Unprotected ESWs have a maximum estimated risk of norovirus infection of 33% (1:3) for a single fomite contact in a room where a norovirus-positive patient had a diarrhoeal event. Patient vomit events lead to fomite contact risk estimates that are four orders of magnitude lower than those for diarrhoeal events. The estimated risk of secondary illness from touching a common surface is as high as 25% (1:4) after single fomite exposure following a diarrhoeal event. Conclusions A single fomite contact may lead to sizable risk of norovirus infection in ESWs if personal protective equipment and disinfection are not used appropriately. ESWs can also transfer virus to secondary surfaces, initiating further infections. Interventions are needed to reduce fomite transfer of norovirus, and protect patients and staff from nosocomial infections.

This paper describes the elimination of healthcare-associated Acinetobacter baumannii infections in a highly endemic region. A prospective, observational study was performed between October 2012 and October 2017. Acinetobacter baumannii were isolated from 59 patients, and >95% similarity was demonstrated among isolates of seven patients (DiversiLab™, BioMérieux). Carbapenemase activity was detected in 15 of 17 (88%) isolates, and all were OXA-23 type. The control of Acinetobacter baumannii outbreaks can be achieved by close follow-up supported by molecular techniques, strict application of infection control measures, and isolation of transferred patients., NA

Objectives : Nosocomial transmission was an important aspect of SARS-CoV-1 and MERS-CoV outbreaks. Healthcare-associated SARS-CoV-2 infection has been reported in single and multi-site hospital-based studies in England, but not nationally. Methods : Admission records for all hospitals in England were linked to SARS-CoV-2 national test data for the period 01/03/2020 to 31/08/2020. Case definitions were: community-onset community-acquired, first positive test

Background. The incidence of healthcare-associated respiratory tract infections in non-ventilated patients (NVA-HARTI) in neurosurgical intensive care units (ICU) is unknown. The impact of NVA-HARTI on patient outcomes and differences between NVA-HARTI and ventilator-associated healthcare-associated respiratory tract infections (VA-HARTI) are poorly understood. Our objectives were to report the incidence, hospital length of stay (LOS), ICU LOS, and mortality in neurosurgical ICU and compare these characteristics between NVA- and VA-HARTI.Methods. This prospective cohort study was conducted in a neurosurgical ICU in Moscow from 2011 to 2020. All patients with ICU LOS >48h were included. Time trends were analyzed for all outcomes. A competing risk model was used for survival and risk analysis.Results. A total of 3,937 ICU admissions were analyzed. NVA-HARTI vs VA-HARTI results were: cumulative incidence 7.2 (6.4-8.0) vs 15.4 (14.2-16.5) per 100 ICU admissions, incidence rate 4.2±2.0 vs 9.5±3.0 per 1000 patient-days in the ICU, median LOS 32 [21; 48.5] vs 46 [28; 76.5] days, median ICU LOS 15 [10; 28.75] vs 26 [17; 43] days, and mortality rates 12.3% (7.9-16.8) vs 16.7% (13.6-19.7). The incidence of VA-HARTI decreased in ten years while NVA-HARTI incidence did not change. VA-HARTI was found to be an independent risk factor of death, odds ratio 1.54 (1.11-2.14), p-value=0.009 while NVA-HARTI was not.Conclusion. Our findings suggest that NVA-HARTI in neurosurgical ICU patients represents a significant healthcare burden with relatively high incidence and associated poor outcomes. NVA-HARTI appeared to be different from VA-HARTI and persisted despite preventive measures; therefore, extrapolating VA-HARTI research findings to NVA-HARTI should be avoided.

Methicillin resistant Staphylococcus aureus (MRSA) remains a major cause of both community and healthcare-associated infections. This study was designed to determine the prevalence and antibiogram of healthcare-associated MRSA (HA-MRSA) in Ebonyi State, Nigeria. A total of 315 clinical samples were obtained from government-owned and private-owned healthcare facilities (HCFs) in Ebonyi State. S. aureus were characterized and identified based on standard microbiological procedures. MRSA isolates were detected using Kirby-Bauer disc diffusion technique with oxacillin (1µg) and cefoxitin (30µg) antibiotic discs. HA-MRSA prevalence frequency of 41.5% was recorded in the HCFs in Ebonyi State. Frequency of HA-MRSA isolation was highest in urine samples (51.1 %). Furthermore, a higher HA-MRSA isolation rate (63.6%) was observed in clinical samples from private HCFs than the government HCFs (28.4%). HA-MRSA were highly resistant to penicillin (99.4 %), ceftazidime (96.4 %), and erythromycin (90.6%), but highly susceptible to ciprofloxacin and gentamycin. A mean MARI index of 0.71 was observed in this study with 96.5 % > 0.2. In conclusion, prevalence of HA-MRSA was quite alarming in our study area. Therefore, more proactive measures must be taken to curb this public health menace before it escalates beyond control. The use of therapeutics such as ciprofloxacin and gentamycin is strongly recommended for the treatment of MRSA infections in our study area.

Immunocompromised patients are at risk for infections due to above-ceiling activities in hospitals. Mobile dust-containment carts are available as environmental controls, but no published data support their efficacy. Using microbial air sampling and particle counts, we provide evidence of reduced risk of fungal exposure during open ceiling activities.

Background:Staphylococcus aureus has long been an important cause of healthcare-associated infections (HAIs) and remains the second most common HAI pathogen in the United States. Often resistant to several antibiotics, S. aureus infections are difficult to treat and can leave patients at risk for serious complications such as pneumonia and sepsis. HAI pathogens and their antimicrobial susceptibility testing (AST) results have been reported to NHSN since its inception in 2005. Previous NHSN surveillance reports have presented national annual benchmarks for antimicrobial resistance phenotypes, such as methicillin-resistant S. aureus (MRSA). Whether there have been any significant changes over time in the prevalence of methicillin resistance among S. aureus infections reported to NHSN has not been previously assessed. Methods:S. aureus AST data from central-line–associated bloodstream infections, catheter-associated urinary tract infections, and inpatient surgical site infections reported from acute-care hospitals between 2009 and 2018 were analyzed. S. aureus was defined as MRSA if it was reported as resistant to oxacillin, cefoxitin, or methicillin. A national percentage resistant (%R) was calculated for each year as the number of resistant pathogens divided by the number of pathogens tested for susceptibility multiplied by 100. A generalized linear mixed model with logistic function was created to evaluate annual changes in the percentage resistant. Several patient-level and hospital-level characteristics were assessed as potential covariates. To account for differential baseline %R values between individual hospitals, specification of random intercept and slope were used during model creation. Differences in the trend of %R between HAI types were assessed using interaction terms. Data were analyzed using SAS v 9.3 software, and P < .05 was considered significant. Results: Overall, 3,317 hospitals reported at least 1 S. aureus pathogen tested for susceptibility between 2009 and 2018. The national unadjusted %R decreased from 49.2% (2009) to 41.2% (2018), with similar decreases seen in each HAI type (Table 1). After adjusting for significant covariates, a statistically significant annual 3% decrease in the prevalence of resistance was observed (Fig. 1). Significant differences between HAI types did not exist. Conclusions: The percentage of healthcare-associated S. aureus resistant to oxacillin, cefoxitin, or methicillin has declined consistently over the past 10 years. Continued efforts in infection prevention and antimicrobial stewardship are vital to sustaining this decline.Funding: NoneDisclosures: None