Fluid retention in endoscopes: A real-world study on drying effectiveness.

BACKGROUND: Outbreaks linked to inadequate endoscope drying have infected numerous patients, and current standards and guidelines recommend at least 10 minutes of forced air for drying channels. This study evaluated a new forced-air drying system (FADS) for endoscopes. METHODS: Drying was assessed using droplet detection cards; visual inspection of air/water connectors, suction connectors, and distal ends; and borescope examinations of endoscope interiors. Assessments were performed after automated endoscope reprocessor (AER) alcohol flush and air purge cycles and after 10-minute FADS cycles. RESULTS: Researchers evaluated drying during encounters with 22 gastroscopes and 20 colonoscopes. After default AER alcohol and air purge cycles, 100% (42/42) of endoscopes were still wet. Substantial fluid emerged from distal ends during the first 15 seconds of the FADS cycle, and droplets also emerged from air/water and suction connectors. Following FADS cycle completion, 100% (42/42) were dry, with no retained fluid detected by any of the assessment methods. CONCLUSIONS: Multiple endoscope ports and channels remained wet after AER cycles intended to aid in drying but were dry after the FADS cycle. This study reinforced the need to evaluate the effectiveness of current drying practices and illustrated the use of practical tools in a real-world setting.

Effect of an initial specimen diversion device on blood-culture contamination rates and vancomycin usage: A quasi-experimental study.

Initial specimen diversion devices (ISDDs) are a potential solution for reducing blood-culture contamination rates. We report the implementation of an ISDD associated with a sustained reduction in blood-culture contamination rates for >18 months after implementation. We did not observe a clinically significant reduction in inpatient vancomycin usage.

Impacts of the COVID-19 pandemic on the infection prevention and control field: Findings from focus groups conducted with association for professionals in infection control & epidemiology (APIC) members in fall 2021.

INTRODUCTION: Emergence of the Delta variant in 2021 changed the pandemic landscape and led to healthcare surges across the US, despite availability of COVID-19 vaccine. Anecdotal information indicated that the infection prevention and control (IPC) field was changing, but formal assessment was needed. METHODS: Focus groups (6) were conducted with APIC members in November and December, 2021 to elicit infection preventionists' (IP) opinions changes to the IPC field due to the pandemic. Focus groups were audio recorded via Zoom and transcribed. Content analysis was used to identify major themes. RESULTS: Ninety IPs participated. IPs described multiple changes to the IPC field during the pandemic, including being more involved in policy development, the challenge of transitioning back to routine IPC while still responding to COVID-19, increased need for IPs across practice settings, difficulties in recruiting and retaining IPs, presenteeism in healthcare, and extensive burnout. Participants suggested approaches to improve IPs' wellbeing. CONCLUSIONS: The ongoing pandemic has brought significant changes to the IPC field, including a shortage of IPs just as the field is expanding rapidly. The continued overwhelming workload and stress due to the pandemic has resulted in burnout among IPs and the need for initiatives to improve their wellbeing.

Infection preventionists' experiences during the second year of the COVID-19 pandemic: Findings from focus groups conducted with association for professionals in infection control & epidemiology (APIC) members.

INTRODUCTION: COVID-19 epidemiology changed dramatically in spring 2021 when vaccine became widely available and the Delta variant emerged. There was a need to identify current infection prevention challenges due to changing pandemic epidemiology. METHODS: Six focus groups were conducted via Zoom with APIC members in November and December, 2021 to elicit infection preventionists' (IP) experiences with the COVID-19 pandemic after the Delta variant had emerged. Each focus group was audio recorded then transcribed verbatim. Content analysis was used to identify major themes. RESULTS: In total, 90 IPs participated (average of 15 IPs per focus group). Participating IPs described multiple issues they have faced during the second year of the COVID-19 pandemic after the Delta variant emerged, including continuing challenges with personal protective equipment, changes in pandemic restrictions that caused confusion and pushback, the hope when vaccine first became available and then despair when there was more vaccine breakthrough than anticipated, staffing and medical supply shortages, overwhelming workloads, and anger towards health care personnel and IPs. However, IPs felt more valued by leadership, and reported greater internal collaboration and external coordination of care. CONCLUSIONS: The second year of the pandemic brought ongoing and new challenges for IPs, but also better coordination of care. Strategic initiatives are needed to address the identified challenges, such as how to prioritize tasks when IPs are overwhelmed.

Availability and crisis standards of care for personal protective equipment during fall 2020 of the COVID-19 pandemic: A national study by the APIC COVID-19 task force.

BACKGROUND: The COVID-19 pandemic resulted in personal protective equipment (PPE) shortages in spring 2020, necessitating crisis protocols. METHODS: An online survey was administered to all Association for Professionals in Infection Control and Epidemiology members in October, 2020 to assess PPE availability and crisis standards utilized in fall, 2020. RESULTS: In total, 1,081 infection preventionists participated. A quarter lacked sufficient disinfection supplies, N95s, isolation gowns, and gloves; 10%-20% lacked eye protection and hand hygiene supplies. Significantly more were reusing respirators than masks (65.6% vs 46.8%, respectively; P < .001); a third (32.0%, n = 735) were reusing isolation gowns. About half (45.9%, n = 496) were decontaminating respirators. Determinants of believing current PPE reuse protocols were safe and evidence-based included the infection preventionists being involved in developing COVID-19 protocols (both), having respirator reuse protocols that involve ≤ 5 reuses (both), using reusable respiratory protection (both), decontaminating respirators (perceived safe), and not reusing masks (perceived safe; P < .05 for all). CONCLUSIONS: Although most health care facilities had adequate PPE in fall 2020, PPE supply chains were still disrupted, resulting in the need to reuse or decontaminate PPE. Ongoing gaps in PPE access need to be addressed in order to minimize health care associated infections and occupational illness.

Availability of personal protective equipment and infection prevention supplies during the first month of the COVID-19 pandemic: A national study by the APIC COVID-19 task force.

BACKGROUND: SARS-CoV-2, the virus that causes COVID-19 disease was first discovered in China in December, 2019. The disease quickly spread globally, with the first US case identified in January, 2020; it was declared a pandemic on March 11, 2020. Soon after, anecdotal reports indicated that many US hospitals and healthcare facilities were running low on personal protective equipment (PPE) and supplies. METHODS: An online survey was administered to all Association for Professionals in Infection Control and Epidemiology members in March, 2020 to assess access to PPE, hand hygiene products, and disinfection supplies. RESULTS: In all, 1,201 infection preventionists participated. Participants reported running a bit low to almost being out of all PPE types. More had sufficient gloves (63.4%) compared to all other PPE types (P < .001 for all). Face shields and N95 respirators were the least available (13.6% and 18.2% had sufficient supplies, respectively; p < .001 for all). Many (66.9%) had sufficient hand soap, but far fewer had sufficient hand sanitizer (29.5%, X2 = 211.1, P < .001). Less than half (45.4%, n = 545) had sufficient disinfection supplies. CONCLUSIONS: Many US healthcare facilities had very low amounts of PPE, hand hygiene products, and disinfection supplies early on during the pandemic. A lack of these supplies can lead to occupational exposures and illness as well as healthcare-associated transmission of COVID-19 and other diseases.

Operating room traffic in total joint arthroplasty: Identifying patterns and training the team to keep the door shut.

BACKGROUND: Surgical site infections after joint arthroplasty are devastating complications and are influenced by patient, surgical, and operating room environmental factors. METHODS: In an effort to reduce the incidence of door openings (DOs) during total joint arthroplasty cases, this prospective observational study consisted of 3 phases. Phase 1 determined the baseline incidence of DOs, followed by installation of a mechanical door counter (phase 2). Finally, an educational seminar was presented to all personnel (phase 3) regarding the implications frequent DOs have on patient and surgical outcomes. RESULTS: The average openings per case (OPC) for each of the 3 phases were 33.5, 34.2, and 27.7, respectively. There was a 17% reduction in OPC between phases 1 and 3 (P= .02). There were no significant differences between knee and hip arthroplasty cases during the 3 phases (P= .21, P= .46, and P= .81, respectively). There was a strong correlation between length of surgery and OPC, with a Pearson coefficient of r = 0.87 during phase 3. To account for differences in average operative time between phases, data were normalized for the length of surgery with the ratio of door openings per minute determined (0.36, 0.34, and 0.32 for each phase, respectively). CONCLUSIONS: We were able to show that simply monitoring door openings during joint arthroplasty was not effective in reducing the occurrences. However, after a novel educational seminar given to all personnel, we were able to significantly reduce the incidence of operating room door openings, reducing a potential risk factor for surgical site infections.