Frequency of hand contact with hospital surfaces in hospitalized pediatric patients / Frecuencia de contacto de manos de pacientes pediátricos hospitalizados

Abstract Background: Hand hygiene (HH) is an important strategy for preventing health-care-associated infections (HAIs). Few programs focus on HH for family members and primary caregivers but fewer for patients. This study aimed to estimate the frequency with which hospitalized pediatric patients have hand contact with hospital surfaces. Methods: We conducted a cross-sectional descriptive observational study consisting of three phases: the first was the creation of an observation and data collection tool, the second was the training of the monitors, and the third was the observational study of hand contact and HH opportunities in hospitalized pediatric patients. Results: Over 3600 minutes of observation, 2032 HH opportunities were detected, averaging 33.8/h (SD 4.7) as determined by hand contact with hospital surfaces of hospitalized pediatric patients. In our study, infants and preschool children had the highest frequency of hand contact. Conclusion: The high frequency of hand contact of hospital surfaces by children suggests that hourly hand disinfection of patients and caregivers, objects and surfaces around the patients may be prevention measures that could be incorporated to reduce HAIs in pediatric hospitals.

Resumen Introducción: La higiene de manos es una estrategia importante para la prevención de infecciones asociadas a la atención sanitaria. Existen pocos programas centrados en la higiene de manos para los familiares y cuidadores primarios, y aún menos para el paciente. El objetivo de este estudio fue cuantificar la frecuencia con la que los pacientes pediátricos hospitalizados tienen contacto manual con superficies hospitalarias. Métodos: Se llevó a cabo un estudio observacional descriptivo transversal que constó de tres fases: la primera fue la creación de una herramienta de observación y registro de datos; la segunda fue la capacitación de los monitores y la tercera fue el estudio observacional del contacto manual y de las oportunidades de higiene de manos en pacientes pediátricos hospitalizados. Resultados: Durante los 3600 minutos de observación, se detectaron 2032 oportunidades, con una media de 33.8 (DE 4.7) por hora de oportunidades de higiene de manos establecidas por contacto manual con superficies de pacientes pediátricos hospitalizados. Los lactantes y los niños en edad preescolar presentaron la mayor frecuencia de contacto manual. Conclusiones: La alta frecuencia de contacto manual por parte del niño indica que medidas como la desinfección de las manos cada hora del paciente y del cuidador, así como de los objetos y superficies alrededor del paciente, podrían ser medidas útiles que deberían incluirse para prevenir las infecciones asociadas a la atención de la salud en los hospitales pediátricos.

High level of infection prevention and control in surveyed hospitals in Colombia, 2021 / Nivel avanzado de prevención y control de infecciones en hospitales de Colombia en el 2021 / Alto nível de prevenção e controle de infecções em hospitais da Colômbia, 2021

ABSTRACT Objective. This study aimed to determine the performance of infection prevention and control (IPC) programs in eight core components in level 2 and level 3 hospitals across all provinces in Colombia. Methods. This cross-sectional study used self-assessed IPC performance data voluntarily reported by hospitals to the Ministry of Health and Social Protection during 2021. Each of the eight core components of the World Health Organization's checklist in the Infection Prevention and Control Assessment Framework contributes a maximum score of 100, and the overall IPC performance score is the sum of these component scores. IPC performance is graded according to the overall score as inadequate (0-200), basic (201-400), intermediate (401-600) or advanced (601-800). Results. Of the 441 level 2 and level 3 hospitals, 267 (61%) reported their IPC performance. The median (interquartile range [IQR]) overall IPC score was 672 (IQR: 578-715). Of the 267 hospitals reporting, 187 (70%) achieved an advanced level of IPC. The median overall IPC score was significantly higher in private hospitals (690, IQR: 598-725) than in public hospitals (629, IQR: 538-683) (P < 0.001). Among the core components, scores were highest for the category assessing IPC guidelines (median score: 97.5) and lowest for the category assessing workload, staffing and bed occupancy (median score: 70). Median overall IPC scores varied across the provinces (P < 0.001). Conclusions. This countrywide assessment showed that 70% of surveyed hospitals achieved a self-reported advanced level of IPC performance, which reflects progress in building health system resilience. Since only 61% of eligible hospitals participated, an important next step is to ensure the participation of all hospitals in future assessments.

RESUMEN Objetivo. El objetivo de este estudio es determinar el desempeño de los programas de prevención y control de infecciones (PCI) en relación con ocho componentes básicos en hospitales de nivel 2 y 3 de todas las provincias de Colombia. Métodos. En este estudio transversal se emplearon datos de autoevaluación del desempeño de los programas de PCI informados voluntariamente al Ministerio de Salud y Protección Social por parte de los hospitales durante el 2021. Cada uno de los ocho componentes básicos de la lista de verificación de la Organización Mundial de la Salud incluidos en el Marco de evaluación de prevención y control de infecciones al nivel de establecimientos de atención de salud recibe una puntuación máxima de 100, y la puntuación general del desempeño del programa es la suma de las puntuaciones de estos componentes. Este desempeño se califica según la puntuación general como inadecuado (0-200), básico (201-400), intermedio (401-600) o avanzado (601-800). Resultados. De los 441 hospitales de nivel 2 y nivel 3, 267 (61%) informaron datos sobre su desempeño. La mediana (rango intercuartil [IQR]) de la puntuación general fue de 672 (IQR: 578-715). De los 267 hospitales que proporcionaron información, 187 (70%) alcanzaron el nivel avanzado. La mediana de la puntuación general fue significativamente mayor en los hospitales privados (690, IQR: 598-725) que en los hospitales públicos (629, IQR: 538-683) (p < 0,001). En el caso de los componentes básicos, las puntuaciones más altas fueron para la categoría que evalúa las directrices de PCI (puntuación mediana: 97,5) y más bajas para la categoría que evalúa la carga de trabajo, la dotación de personal y la ocupación de camas (puntuación mediana: 70). La mediana de las puntuaciones generales de PCI varió entre las provincias (p < 0,001). Conclusiones. Esta evaluación a nivel nacional mostró que el 70% de los hospitales encuestados lograron un nivel avanzado autoinformado del desempeño en cuanto a la PCI, lo que refleja el progreso en fortalecimiento de la resiliencia del sistema de salud. Dado que solo participó el 61% de los hospitales que reunían las condiciones, el siguiente paso importante es garantizar la participación de todos los hospitales en futuras evaluaciones.

RESUMO Objetivo. Este estudo teve o objetivo de determinar o desempenho de programas de prevenção e controle de infecções (PCI) quanto a oito componentes centrais em hospitais secundários e terciários de todas as províncias da Colômbia. Métodos. Este estudo transversal utilizou dados de desempenho autoavaliado de PCI enviados voluntariamente pelos hospitais ao Ministério da Saúde e Proteção Social em 2021. Cada um dos oito componentes centrais da lista de verificação na Estrutura de Avaliação de Prevenção e Controle de Infecções da Organização Mundial da Saúde contribui com uma pontuação máxima de 100. A pontuação total de desempenho de PCI é a soma das pontuações nesses componentes. De acordo com a pontuação total, o desempenho de PCI é classificado nas seguintes categorias: inadequado (0-200), básico (201-400), intermediário (401-600) ou avançado (601-800). Resultados. Dos 441 hospitais secundários e terciários, 267 (61%) informaram o desempenho de PCI. A mediana (intervalo interquartil [IIQ]) da pontuação total de PCI foi 672 (IIQ: 578-715). Dos 267 hospitais que disponibilizaram informações, 187 (70%) alcançaram um nível de PCI avançado. A mediana da pontuação total de PCI foi significativamente maior nos hospitais privados (690, IIQ: 598-725) do que nos públicos (629, IIQ: 538-683) (p < 0,001). Entre os componentes centrais, as pontuações mais altas foram observadas na categoria de avaliação das diretrizes de PCI (pontuação mediana: 97,5), ao passo que as mais baixas ocorreram na categoria de avaliação da carga de trabalho, dotação de pessoal e taxa de ocupação de leitos (pontuação mediana: 70). As medianas das pontuações totais de PCI variaram entre províncias (p < 0,001). Conclusões. Esta avaliação nacional mostrou que 70% dos hospitais pesquisados alcançaram um nível avançado de desempenho autorrelatado de PCI, o que demonstra progresso no desenvolvimento de resiliência no sistema de saúde. Como apenas 61% dos hospitais elegíveis participaram, um próximo passo importante é assegurar a participação de todos os hospitais em futuras avaliações.

Principales factores relacionados con las infecciones asociadas a la atención en salud en población neonatal entre 2014 a 2020. Revisión sistemática / Main factors related with the acquisition of health care associated infections in the neonatal population between 2014 to 2020. Systematic review

Introducción. Las infecciones asociadas a la atención en salud son un efecto adverso frecuente. Los neonatos son un grupo poblacional afectado debido a su inmadurez inmunitaria. La Organización Mundial de la Salud estima que estas infecciones varían entre 5% a 25% en función del nivel de ingresos de cada país. En Colombia se evidencia un subregistro para estas infecciones, particularmente en los neonatos. Este estudio buscó identificar los factores de riesgo, microorganismos más comunes, y las vías de transmisión y colonización relacionadas a las infecciones asociadas a la atención en salud en neonatos, según lo reportado en la literatura mundial. Metodología. Se realizó una búsqueda sistemática por duplicado, que incluyó pesquisa de artículos, primera lectura y exclusión de duplicados, conciliación entre autores y evaluación de la calidad, en la base de datos PubMed, con artículos publicados entre los años 2014 a 2019. Resultados. El nivel de evidencia y el grado de recomendación fue bueno en general (niveles 1 y 2, recomendación A y B). Los factores de riesgo más comunes fueron la prematuridad y el bajo peso al nacer, el uso de catéter venoso central, ventilación mecánica, estancia hospitalaria prolongada y el uso de antibióticos por largo tiempo. Se reportaron microorganismos de importancia como Staphylococcus coagulasa negativos y Serratia marcenscens, y vías de transmisión y colonización comunes como el torrente sanguíneo, la vía respiratoria, la gastrointestinal y la piel. Conclusión. Las infecciones asociadas a la atención en salud son más frecuentes de lo estimado y se pueden prevenir con la adopción de políticas sanitarias, como son un correcto lavado de manos, la desinfección del ambiente y equipos médicos, un adecuado cuidado de la piel del neonato y protocolos de aislamiento para pacientes con estas infecciones

Introduction. Health care-associated infections are a frequent adverse effect. Neonates are an affected population group due to their immune immaturity. The World Health Organization estimates that these infections vary between 5% to 25% depending on the income level of each country. In Colombia these infections are underreported, particularly in neonates. The aim of this review was to identify the risk factors, the most common microorganisms, and the routes of transmission for these type of infections in neonates, as reported in the world literature. Methodology. A systematic duplicate search was carried out in PubMed, with articles published between 2014 to 2019, which included a search for articles, reading and exclusion of duplicates, reconciliation between authors, and quality assessment. Results. The level of evidence and the grade of recommendation was optimal in general (levels 1 and 2, recommendation A and B). The most common risk factors were prematurity and low birth weight, the use of central venous catheter, mechanical ventilation, prolonged hospital stay, and long-term use of antibiotics. Microorganisms such as coagulase negative Staphylococcus and Serratia marcenscens were reported, and common routes of transmission such as the bloodstream, respiratory tract, gastrointestinal tract, and skin were described. Conclusion. Health care-associated infections are more frequent than estimated, and can be prevented with the adoption of health policies, such as proper hand washing, disinfection of environmental surfaces and medical equipment, an adequate skin care of the neonate, and isolation protocols for patients with these infections

Knowledge, Perceptions, and Self-reported Performance of Hand Hygiene Among Registered Nurses at Community-based Hospitals in the Republic of Korea: A Cross-sectional Multi-center Study / 예방의학회지

OBJECTIVES: To assess the nurses' hand hygiene (HH) knowledge, perception, attitude, and self-reported performance in small- and medium-sized hospitals after Middle East Respiratory Syndrome outbreak. METHODS: The structured questionnaire was adapted from the World Health Organization's survey. Data were collected between June 26 and July 14, 2017. RESULTS: Nurses showed scores on knowledge (17.6±2.5), perception (69.3±0.8), self-reported HH performance of non-self (86.0±11.0), self-reported performance of self (88.2±11.0), and attitude (50.5±5.5). HH performance rate of non-self was Y1 =36.678+ 0.555X1 (HH performance rate of self) (adjusted R2=0.280, p < 0.001). The regression model for performance was Y 4=18.302+0.247X 41 (peception)+0.232X 42 (attitude)+0.875X 42 (role model); coefficients were significant statistically except attitude, and this model significant statistically (adjusted R2=0.191, p < 0.001). CONCLUSIONS: Advanced HH education program would be developed and operated continuously. Perception, attitude, role model was found to be a significant predictors of HH performance of self. So these findings could be used in future HH promotion strategies for nurses.

Public health emergency preparedness and response in Korea

Infectious disease control and prevention in Korea are handled based on laws such as the Framework Act on the Management of Disasters and Safety and the Infectious Disease Control and Prevention Act. To fill the gaps in the national public health system that were identified during the 2015 Middle East respiratory syndrome outbreak in Korea, Korea has strengthened its capacity to prepare for and respond to public health emergency. The objectives are to prevent, promptly detect, and rapidly respond to imported infectious diseases; to fully mobilize public health and medical resources; to revise governance enhancing the role of the centralized decision-making structures; and to improve health care facilities to prevent health care-associated infections.

Effect of wound protector on preventing incisional wound infection following class Ⅲ-Ⅳincision abdominal operation / 中国感染控制杂志

Objective To evaluate the effect of wound protector on preventing incisional wound infection following class Ⅲ-Ⅳincision abdominal operation.Methods Patients who had undergone class Ⅲ-Ⅳincision abdominal opera-tion from January 2013 to December 2014 were divided into trial group and control group according to whether they had used wound protector ,incidence of postoperative incisional wound infection between two groups were com-pared.Results A total of 310 patients were monitored,150 cases in trial group,and 160 cases in control group. Incidence of incisional wound infection in trial group was significantly lower than control group (4.00% [n=6]vs 11 .88%[n=19],χ2 =6.48,P <0.05).The average operation time and length of hospital stay in trial group were both shorter than control group ([42.10±3.30]min vs [58.30±4.10]min,P <0.05;[7.00±2.20]d vs [10.00 ±3.50]d ,P <0.05),score of pain assessment of incision in trial group was lower than control group([2.00 ± 1 .70]vs [3.00±1 .80],P <0.05).Conclusion Wound protector can effectively reduce the incidence of incisional wound infection following class Ⅲ-Ⅳincision abdominal operation.

Selective decontamination of digestive tract for preventing ventilator-associated pneumonia:a Meta-analysis / 中国感染控制杂志

Objective To evaluate the effect of selective decontamination of digestive tract(SDD)on preventing ventilator-associated pneumonia by Meta-analysis based on theory and method of evidence-based medicine.Methods Six medical databases (PubMed,Excerpta Medica Database [EMBASE],China Biology Medicine disc[CBMdi-sc],China National Knowledge Infrastructure[CNKI],VIP database,from 1995 to 2014,and Cochrane Library of issue 12,2014 )were searched,literatures were selected,data were extracted,Meta-analysis was performed by using RevMan 5.3 software.Results 13 literatures were included (2 676 patients were involved),Meta-analysis revealed that the incidence of VAP in treatment and control group was 20.68% and 35.99% respectively (OR and 95%CI ,0.40 [0.28,0.56],P <0.001 ),the mortality rate of patients with mechanical ventilation in treatment group and control group were 20.60% and 20.03% respectively (OR and 95%CI ,0.99 [0.81 ,1 .20],P =0.91 ). Conclusion SDD can reduce the incidence of VAP in patients with mechanical ventilation,but can’t reduce mortali-ty rate.

Distribution and antimicrobial resistance of Pseudomonas aeruginosa in a county-level hospital / 中国感染控制杂志

Objective To analyze the distribution and antimicrobial resistance of Pseudomonasaeruginosa(P. aeruginosa)in a county-level hospital,provide reference for rational antimicrobial use,and promote the control and prevention of healthcare-associated infection (HAI).Methods Data of P.aeruginosaisolated from patients in a hospital between 2010 and 2012 were analyzed statistically.Results A total of 369 P.aeruginosaisolates were iso-lated,strains were mainly from specimens of sputum(n= 234,63.41% ),urine(n= 41,11.11% )and wound(n= 28, 7.59% );most strains were from intensive care unit(n= 146,39.56% ),respiratory diseases department(n= 51, 13.82% )and neurosurgical department(n= 37,10.03% ).P.aeruginosastrains were not resistant to polymyxin B;the resistance rates to imipenem,meropenem,cefoperazone/sulbactam,piperacillin/tazobactam and amikacin were all low(6.81% -22.73% );from 2010 to 2012,resistance rates to antimicrobial agents (except polymyxin B) increased with varying degrees,some antimicrobial agents showed statistical difference(P<0.05).Conclusion P. aeruginosais mainly isolated from respiratory specimens,mainly distributed in departments with serious patients;and resistance to most antimicrobial agents is high,resistance tendency is increasing,surveillance should be intensi-fied.

Hand hygiene intervention to reduce healthcare-associated infection rate in an intensive care unit / 中国感染控制杂志

Objective To investigate the influence of health care workers’(HCWs)hand hygiene intervention in healthcare-associated infection(HAI)in an intensive care unit(ICU).Methods Intervention measures of hand hygiene were adopted,effective supervision and management systems were established,hand hygiene compliance and HAI rate be-fore intervention(January-December 2012)and after intervention (the first stage:January-June 2013;the second stage:Ju-ly-December 2013)were compared.Results A total of 4 066 patients were surveyed,HCWs’hand hygiene compliance rate before intervention was 50.03%,the first and second stage after intervention was 61.80% and 64.57% respectively,there was increasing trend (rs=1.00,P<0.001).HAI before intervention was 5.48%,the first and second stage after inter-vention was 3.86% and 3.30% respectively,there was decreasing trend (rs=-1.00,P<0.001).Significant decreasing trends were found in rates of catheter-related bloodstream infection(CRBSI),catheter-associated urinary tract infection (CAUTI)and ventilator-associated pneumonia(VAP)(rs=-1.00,P<0.001).There were negative correlations between hand hygiene compliance rate and the infection rate of ICU,infection rate of CRBSI,CAUTI and VAP (P<0.05 ). Conclusion The improvement of hand hygiene compliance can effectively reduce the incidence of HAI in ICU ward.

Prevention and control of health care-associated infections through improved hand hygiene.

Determined actions are required to address the burden due to health care-associated infections worldwide and improve patient safety. Improving hand hygiene among health care workers is an essential intervention to achieve these goals. The World Health Organization (WHO) First Global Patient Safety Challenge, Clean Care is Safer Care, pledged to tackle the problem of health care-associated infection at its launch in 2005 and has elaborated a comprehensive set of guidelines for use in both developed and developing countries worldwide. The final version of the WHO Guidelines on Hand Hygiene in Health Care was issued in March 2009 and includes recommendations on indications, techniques, and products for hand hygiene. In this review, we discuss the role of hands in the transmission of health care-associated infection, the benefits of improved compliance with hand hygiene, and the recommendations, implementation strategies and tools recommended by WHO. We also stress the need for action to increase the pace with which these recommendations are implemented in facilities across India.