Did safety-engineered device implementation contribute to reducing the risk of needlestick and sharps injuries? Retrospective investigation of 20 years of observation in a specialist tertiary referral hospital.

OBJECTIVES: In Poland, there are numerous cases of injuries caused by sharp instruments annually, still significantly more than in other European Union countries. The aim of this study was to analyze work-related injuries among healthcare workers in a selected hospital before and after the implementation of safety-engineered devices (SED). MATERIAL AND METHODS: Retrospective analysis of medical documentation regarding occupational needlestick and sharps injuries (NSSI) in a tertiary referral surgical hospital in 1998-2018. The study group consisted of nurses and doctors who had been injured and reported the incident. The frequency of injury reports, injury rate, and characterization of circumstances surrounding NSSI are presented. RESULTS: Over the period of 20 years, a total of 257 NSSI incidents were reported. The average injury rate was statistically significant for nurses (p = 0.004) and was higher before the introduction of SED. Moreover, the number of injuries among nurses showed a downward trend during the study period. However, for doctors, there was no statistically significant difference in the median puncture rate (p = 0.099), and the number of injuries showed an increasing trend. CONCLUSIONS: In this study, the authors' have demonstrated not only the occurrence of injuries and punctures in the daily work of medical personnel but also the potential for their reduction through the use of safety equipment at every workstation where healthcare services are provided using sharp medical instruments. Int J Occup Med Environ Health. 2024;37(2):234-43.

Polish infection control nurses' job satisfaction and cooperation with their colleagues reflect how the value of infection control is appreciated by other health care workers: findings from surveys conducted before and during the COVID-19 pandemic.

BACKGROUND: Infection prevention and control (IPC) is based on the activity of specialized, trained and highly qualified personnel, especially infection control nurses (ICNs). Effective implementation of IPC procedures demands close cooperation between IPC teams (IPCTs) and hospital personnel. Based on disturbing results on the epidemiology of health care-associated infections (HAIs) and compliance with preventive procedures, we suspect that cooperation between ICNs and different groups of hospital staff is poor. The aim of this study was to assess the perceptions of ICNs working in Polish hospitals with regard to difficulties in working with various professional groups in the hospital, their organizational conditions, and their job satisfaction before and after the COVID-19 pandemic. METHODS: The study was conducted twice, in 2014 and 2021, among ICNs working in Polish hospitals. The survey used an anonymous questionnaire designed by the authors. RESULTS: In 2014, 183 ICNs participated in the study, and 175 ICNs participated in 2021. The respondents' average age and seniority (duration of work as an ICN) were higher in 2021. Depending on the ward specialty, approximately 30-48.8% of the ICNs had difficulty cooperating with physicians. However, the ICNs declared better cooperation with nurses in various hospital wards and with other professionals. For some groups of hospital staff, there was a negative correlation between poor cooperation and ICNs' job satisfaction. The job satisfaction data were disturbing; for example, more than half of the respondents considered changing jobs, and the lack of a sense of purpose in their work was declared by 29.7% of ICNs in 2014 and by 54.3% of ICNs in 2021. CONCLUSIONS: Our results suggest that infection prevention and control is not highly appreciated by health care workers and hospital management. Our study reveals difficulties in ICNs' cooperation with hospital staff and managers in both 2021 and 2014, moderate job satisfaction, a high level of willingness to change jobs, and insufficient training in interpersonal skills and the implementation of changes. These findings clearly indicate an urgent need to introduce modern competence development systems in infection control beyond the scope of traditional training.

Investigation of Acinetobacter baumannii Activity in Vascular Surgery Units through Epidemiological Management Based on the Analysis of Antimicrobial Resistance, Biofilm Formation and Genotyping.

BACKGROUND/OBJECTIVES: The genus Acinetobacter demonstrates resistance to antibiotics and has been shown to spread in the hospital environment causing epidemic outbreaks among hospitalized patients. The objectives of the present study was to investigate the antibiotic resistance, biofilm formation, and clonality among Acinetobacter baumannii strains. MATERIALS AND METHODS: The study involved 6 (I Outbreak) and 3 (II Outbreak) A. baumannii strains isolated from patients hospitalized in vascular surgery unit. RESULTS: All tested A. baumannii strains were extensively drug resistant (XDR) and all the isolates were carbapenem-resistant and among them, all carried the blaOXA-51 gene, the blaOXA-24 gene, as well as the blaOXA-23 gene. All of the investigated strains had the ability to form a biofilm, but all of them produced less biofilm than the reference strain. Multi-locus sequence typing (MLST) showed that all strains belonged to the ST2 clone. Pulsed-field gel electrophoresis (PFGE) divided the tested outbreak strains into two clones (A and B). CONCLUSION: This study shows a nosocomial spread of XDR A. baumannii ST2 having the blaOXA-51 gene, the blaOXA-24 gene, as well as the blaOXA-23 gene, low biofilm formers, that was prevalent in the vascular surgery unit. To identify the current situation of vascular surgery departments targeted epidemiological investigation was needed. Effective implementation of infection control prevented the spread of the epidemic outbreaks.

Interest in Working as an Infection Prevention and Control Nurse and Perception of This Position by Nursing Students-Results of a Pilot Study.

Background: The results of several studies in the area of infection control in Poland are disturbing. The situation may be shaped by many factors. However, the key factor for effective infection prevention and control is dedicated personnel, especially infection prevention and control nurses (IPCN). Nevertheless, based on the available published data and the authors' experience, in many Polish hospitals infection control is not sufficiently appreciated by managers, it is consequently underfunded, and treated by medical staff as a nuisance. This may influence the nurses willingness to work as IPCN. The aim of the study was to assess the nursing students' perception of the work of IPCN and their interest in employment in this position, as well as the potential reasons for choosing this particular specialization. Materials and methods: The study was conducted using the authors' anonymous questionnaire conducted among nursing students of three Polish universities. The questionnaire was prepared by a panel of experts working in the field of infection control, including nurses working both as academic teachers and infection control nurses in hospitals. The design of the questionnaire was based on the authors' own experience, knowledge, and exchanging information with the practitioners in infection control in Poland. The reliability of the questionnaire was confirmed by the Cronbach alpha test. The raw alpha values and 95% CI for two main questions concerning opinion were: 0.76 (0.72-0.81) and 0.69 (0.63-0.75). Results: The study was conducted among 253 students, mostly women (98%) of full-time (31.4%) and extramural (68.6%) studies. The age range of the respondents was 20-58 years, median = 26 years, IQR = 19 years. To the key item in the questionnaire, i.e., "Would you like to work as an IPCN?", 84.6% (214 respondents; first group) of the respondents answered "no" and 15.4% (39 respondents, second group) answered "yes". The results revealed no significant differences between the two groups concerning the position responsibilities and appreciation by other medical staff. Additionally, for respondents willing to work as ICPN the most important issues were the influence on patient safety, expected salary, and possibility of professional development; for the respondents from the other group the most important issue was lack of contact with patients. The results concerning the students' opinion on the perception of IPCN by medical personnel proved to be peculiar. About 80% of the respondents confirmed the IPCNs' key role in ensuring patient and personnel safety, while only 31.6% declared their high standing in the hospital hierarchy. Conclusions: The obtained results indicate the necessity of thorough studies on the organization and structure of infection control in Polish hospitals, with a particular emphasis on building a positive perception of IPCNs by medical staff, as well as implementing an education campaign on infection control in the hospital environment.

Injuries as exposure events in providing medical services by nursing staff

INTRODUCTION: Among medical staff, nurses are particularly vulnerable to occupational exposure since they provide direct patient care and perform medical activities which often involve using sharps. AIM: The objective of the study was to examine the frequency of injuries and their causes in nursing. METHODS: A diagnostic survey was employed using an original questionnaire. The study was carried out from 3rd March to 2nd April 2017. The study group comprised part-time nursing students. 107 respondents participating in the study worked in out-patient (28%) and in-patient (72%) healthcare. Most of the respondents were aged 41­50 (34.6%). RESULTS: 61.7% of the respondents were injured at work. The injury reporting rate was: 19.7% always, 22.7% often, 30.3% rarely, and 27.3% never. The most commonly mentioned types of injuries included: prick (51.5%), cut (28.8%), scratch (10.6%), prick and cut (9.1%). The incidence of injuries varied. 48.5% of the studied people declared fewer than 5 incidents, 31.8% quoted 5­10 injuries, 6.1% recalled 11­20, 13.6% did not remember such a situation. For nurses with longer seniority, there is a significant increase in injuries (p=0.029). Sources of injuries were most often: injection needle (35.9%), ampoule with medicine (23.3%), pen (7.8%). CONCLUSIONS: Not all occupational exposure cases are reported by nurses. Seniority determines injury incidence among nurses. The longer the seniority, the more common the injuries. The needle causes injuries most frequently.

Polish infection control nurses - Self-assessment of their duties and professional autonomy in different types of hospitals.

BACKGROUND: The objective of the study is self-assessment of Polish infection control nurses (ICNs) in terms of the structure of professional tasks and autonomy of decision-making. MATERIAL AND METHODS: A questionnaire survey was filled out by 208 ICNs (around 21% of all Polish ICNs) in 15 provinces located in Poland. The research encompassed ICNs surveillance healthcare-associated infections (HAIs) in 2014. RESULTS: The work time that ICNs devote to professional tasks and decision autonomy on the scale of 1-100% was as follows: 34% (67% of decision autonomy) was dedicated to detecting and registering HAIs, 12% (71%) - internal control, 10% (58%) - devising and implementing infection prevention practices, 10% (68%) - staff trainings, 8% (65%) - identification and study of outbreaks, 7% (58%) - promoting hand hygiene, 6% (51%) - consults with infected patients, 4% (57%) - consults on decontamination, 4% (54%) - consults on maintaining cleanliness, 3% (51%) - isolation and application of personal protective measures, 2% - other tasks. Infection prevention and control nurses estimated, on average, that their autonomy of decisions concerning the professional tasks performed amounted to 60%. CONCLUSIONS: Infection control nurses in Poland have difficulty in achieving balance between tasks they perform and the authority they exercise. The ICN professional task structure is dominated by duties associated with monitoring hospital infections, however, the greatest decision autonomy is visible regarding internal control. Decision-making concentrated on internal control may hinder building a positive image of an ICN. We should strive to firmly establish professional tasks and rights of ICNs in legislation concerning performing the duties of a nurse and midwife. Med Pr 2018;69(6):605-612.

Typing of Enterococcus spp. strains in 4 hospitals in the Malopolska region in Poland.

BACKGROUND: In the Malopolska province, the first case of vancomycin resistant enterococci (VRE) occurrence was an outbreak in 2001 caused by strains of the genus E. faecium carrying the vanA operon. OBJECTIVES: The aim of this study is to determine the antimicrobial resistance and the occurrence of virulence determinants among Enterococcus spp. in patients hospitalized in the Malopolska region in 2015. MATERIAL AND METHODS: Antimicrobial susceptibility was determined by disc diffusion and the E test. The presence of aminoglycoside and glycopeptide resistance genes and virulence genes (asa1, gelE, cylA, esp, hyl) was investigated using multiplex polymerase chain reaction (PCR). Also, the presence of IS16 was investigated. The activity of gelatinase, cytolysin (hemolysin), and DNase was tested. RESULTS: All E. faecalis were susceptible to ampicillin, vancomycin, teicoplanin, linezolid and tigecycline. All E. faecium strains were susceptible to quinupristin-dalfopristin. Resistance to ampicillin and vancomycin was detected among all E. faecium isolates from hospitals C and D. 87.32% of E. faecium presented high-level aminoglycoside-resistant (HLAR) phenotype, including 78.33% of strains from hospital C and 100% from hospital D. In hospital C (98.3%) and D (96%), resistance to ciprofloxacin, levofloxacin and norfloxacin was observed. Gene esp was detected in all E. faecium isolates and the majority of E. faecium isolates carried hyl (97%). In E. faecalis, different combinations of virulence genes were detected. All analyzed E. faecium strains showed the presence of IS16 insertion element. CONCLUSIONS: E. faecalis isolates were more susceptible to antimicrobials than E. faecium, which were largely multidrug-resistant. E. faecalis strains have diverse virulence factors. E. faecium showed a high percentage of hyl and esp genes and the presence of IS16.

Virulence and antimicrobial resistance of Staphylococcus aureus isolated from bloodstream infections and pneumonia in Southern Poland.

OBJECTIVES: Staphylococcus aureus remains the most important cause of infections in hospitals and long-term care facilities. The aim of this study was to analyse the resistance, virulence, and epidemiological and genetic relationships of S. aureus from bloodstream infections (BSIs) and pneumonia from patients in Southern Poland. METHODS: All strains were tested for antimicrobial susceptibility using the disk diffusion method. Etest was also performed for vancomycin, teicoplanin, tigecycline, oxacillin, cefoxitin and penicillin. PCR amplification was used to detect selected virulence genes. The genetic similarity of methicillin-resistant S. aureus (MRSA) isolates was determined by spa typing and pulsed-field gel electrophoresis (PFGE). Using the BURP algorithm and the Ridom SpaServer database, spa types were clustered into different clonal complexes (spa-CCs). RESULTS AND CONCLUSIONS: MRSA strains were observed at a prevalence of 26.7%, but 88.6% of hospital-acquired infections were MRSA, with no difference between BSIs and pneumonia. The highest resistance was observed to erythromycin and tobramycin. None of the strains were resistant to linezolid, glycopeptides or tigecycline. The strains had no significant virulence factors and the number of virulence genes present did not correlate with the degree of drug resistance. PFGE typing showed relatively high diversity of strains. The majority of isolates belonged to spa type t003 (CC5).

Longevity and gender as the risk factors of methicillin-resistant Staphylococcus aureus infections in southern Poland.

BACKGROUND: The proportion of older people among the general population has risen. Staphylococcus aureus (SA) constitutes a significant problem. Underlying disease and functional debility, predispose the older adult to staphylococcal carriage and infection, specially bloodstream infection and pneumonia. METHODS: This is a retrospective cohort study of older patients with SA infections. We analyzed a database containing the results of laboratory cultures from patients treated in 2013 for SA infections and selected 613 hospitalized and non-hospitalized people aged ≥60 years. RESULTS: The prevalence of Methicillin-resistant SA (MRSA) were significantly different in categories of patients: from 14.1% in young old, 19.5% in old old and 26.7 in longevity. MRSA was significantly more frequently reported in cases of pneumonia, 40.4% of SA strains (p < 0.0001, OR 0.3, 95%CI 0.14-0.49). The nosocomial MRSA infections were more common in ICU departments: prevalence 36.8%, than in non-ICU departments: prevalence 17.3% (OR 2.8, 95%CI 1.06-7.34, p = 0.014). Bloodstream infections, which accounted for 6% of all infections, were more frequent in males (p = 0.0231, OR 2.25, 95%CI 1.098-4.604). The greatest increase in antibiotic resistance was related to trimethoprim/sulfamethoxazole (TMP/SXT), which increased to over 80% in the older study groups. All age groups demonstrated increased MIC90 values for glycopeptide and tigecycline. Although strains isolated from patients in all age groups remained sensitive to vancomycin, strains isolated from patients in the old-old and longevity groups demonstrated resistance to teicoplanin. The MIC90 for tigecycline was the highest in the group aged >90 years. CONCLUSIONS: MRSA constitutes a significant epidemiological problem in cases of hospital-treated pneumonia. The findings were similar for long-term-care facilities, where MRSA appears to affect male residents in particular, although there were fewer male residents than female residents. The low sensitivity to TMP/SXT of SA strains isolated from the oldest patients indicates potentially serious challenges pertaining to efficacious treatment of SA infections.

[Molecular characterization of Staphylococcus aureus strains isolated from surgical site infections of patients in southern Poland].

INTRODUCTION: The aim of the study was a molecular characterization of Staphylococcus aureus strains isolated from surgical site infections (SSIs) from patients in southern Poland, undergoing different surgical procedures, together with evaluation of the prevalence of antimicrobial resistance and the presence of virulence factors. MATERIALS AND METHODS: In this laboratory-based, multicenter study, non-repetitive 162 samples from SSI were collected from hospitalized patients (12 hospitals, n=139) or outpatients (n=23) in southern Poland between January 1 and December 31, 2013. In all S. aureus isolates, we investigated antimicrobial susceptibility, the presence of selected virulence genes (lukE, pvl, tsst-l and eta), and also conducted spa typing. RESULTS: Patients with SSI had a median age of 61 years; 54.9% were male. Prevalence of MRSA (29 strains, 17.9%) SSI per surgery type was 8.7% in orthopaedic, 17.7% in general and 42.9% in vascular surgery. Over 20% of strains were resistant for erythromycin (27.2%), clindamycin (23.5%). No resistance was found for linezolid, glycopeptides or tigecycline. Gene of Leukocidin (lukE) was the most frequently found gene. Spa typing identified 10 spa types; the two dominant types were t003 (41.4%) and t138(17.2%). CONCLUSIONS: The results show that after vascular surgery, there was an unexpectedly high prevalence of MRSA in SSIs in southern Poland. Conversely, the prevalence of MRSA was unexpectedly low following orthopaedics procedures. The surprisingly observation was the low virulence of the S. aureus strains among older patients.

Virulence Potential of Staphylococcus aureus Strains Isolated from Diabetic Foot Ulcers Among Patients from Southern Poland.

The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) was investigated among infected diabetic foot ulcers in hospitalized and nonhospitalized patients in southern Poland to assess the virulence patterns and antimicrobial resistance among these strains. MRSA was detected in 10.3% of all studied isolates, from the hospitalized patients only. The rest of the isolates was methicillin susceptible. The minimal inhibitory concentration that inhibits 50% of bacterial isolates (MIC50) for vancomycin was 1.0 mg/mL. The mupA gene was detected in six (8.8%) isolates, in one MRSA strain and five methicillin-sensitive S. aureus (MSSA) strains. Among the mupA-positive strains, two were resistant to mupirocin (1 MRSA and 1 MSSA). Such results raise serious concern about the usage of mupirocin in MRSA decolonization. The pvl gene was not detected among the study isolates. The majority of isolates (70.6%) possessed the lukE gene, with no significant difference in prevalence between MRSA and MSSA isolates. An interesting finding was the presence of enterotoxin genes among the study isolates. Diabetic foot may therefore be a reservoir of bacteria, containing genes localized on mobile genetic elements that could be easily transferred to other non-pathogenic strains. The prevalence of MRSA was alarmingly high (as also suggested by others), as evaluated by the presence of the mup gene among strains, highlighting the importance of appropriate clinical management of MRSA infections in patients with diabetic foot ulcers. In this group of patients, screening of ulcer samples before antimicrobial therapy would enable informed choices regarding the selection of antimicrobial agents (e.g. octenidine, authorized for the treatment of chronic wounds) maximizing the chances of positive therapy.

Nursing care for patients infected or colonized with vancomycin-resistant enterococci (VRE).

Advances in medicine enable many patients to regain their health. But, at the same time, they become susceptible to hospital-acquired infections. The occurrence of vancomycin-resistant enterococci is a considerable problem in the modern health system. In order to limit the risk of VRE infection, proper patient care is vital, which is focused on compliance with relevant procedures (isolation, decontamination, education). Mutual cooperation between charge nurses and the ward sister and epidemiological nurse plays a major role in nursing surveillance of patients with VRE.

Healthcare workers' occupational exposure to bloodborne pathogens: a 5-year observation in selected hospitals of the Malopolska province.

OBJECTIVES: The study presents data concerning occupational exposures among the staff of 5 hospitals in the Malopolska province in 2008-2012, taking into account the frequency and circumstances of exposure formation, occupational groups of hospital workers, as well as diversification of the reported rates in subsequent years between the hospitals and in each of them. An additional objective of the analysis was to assess the practical usefulness of the reported data for planning and evaluation of the effectiveness of procedures serving to minimize the risk of healthcare workers' exposure to pathogens transmitted through blood. MATERIAL AND METHODS: Data were derived from occupational exposure registries kept by 5 hospitals of varying sizes and operational profiles from the Malopolska province from the years 2008-2012. RESULTS: Seven hundred and seventy-five cases of exposure were found in a group of 3165 potentially exposed workers in the analyzed period. Most cases were observed in nurses (68%) and these were mainly various types of needlestick injuries (78%). Exposure rates with respect to all workers ranged from 2.6% to 8.3% in individual hospitals, but the differences in their values registered in the hospitals in subsequent years did not bear any statistical significance, in a way similar to the rates calculated separately for each occupational group. CONCLUSIONS: There was no upward or downward trend in the number of reported cases of exposure to bloodborne pathogens in the studied period in any of the hospitals. Statistically significant differences in the percentages of exposures were reported between individual hospitals in some years of the analyzed period, which confirms the need for registries in individual units in order to plan and evaluate the effectiveness of preventative measures.

[Analysis of occupational exposure of healthcare workers in the years 1998-2013 for bloodborne pathogens on the example of the hospital of the surgical profile]. / Analiza ekspozycji zawodowej pracowników medycznych w latach 1998-2013 na patogeny przenoszone droga krwi na przykldzie szpitala o profilu zabiegowym.

BACKGROUND: To analyze occupational exposures to blood-borne pathogens among workers of a 130-bed hospital of surgical profile in the Malopolska province. MATERIAL AND METHODS: All cases of occupational exposure recorded in the hospital in the years 1998-2013 were analyzed, taking into account exposure rates (no. of incidents / no. of exposed workers x100%) and the frequency, circumstances, professional groups, hospital staff, the place of rendered services and type of exposure. RESULTS: Average rates of exposure for all workers, regardless of the wards, ranged in different years from 4.3% (2006) to 12.6% (2013), and the average value in the whole period was 7.3% (±2.39).The majority of exposure cases were reported among nurses - 67.8%, followed by physicians - 29.7%, the lowest number of cases was found among other employees - 1.5%.TIhe proportion of injuries in the years 1998-2013 did not show a significant decreasing trend (p = 0.356). Among physicians there was a significant trend of an exponential character (p = 0.002). Among other workers no significant change was observed in the period under consideration. Over the analyzed period the distribution of exposure showed a downward trend for nurses (p = 0.001) and upward trend for physicians (p < 0.001). There was a significant downward trend in the percentage of needle-sticks, and an upward trend in exposures during surgery. CONCLUSIONS: The reported trends were linked with the recent introduction of safe equipment and the increased number of surgeons' reports on exposure incidents. Due to differences between health care units there is a necessity to keep reliable records of exposure by individual units.

[Surgical site infections following vascular surgery]. / Zakazenia miejsca operowanego po zabiegach w chirurgii naczyniowej.

OBJECTIVE: The aim of this paper was to perform epidemiological and microbiological analyses of surgical site infections diagnosed in patients after vascular surgery in two highly specialist centers in the year 2005. METHODS: The study was conducted in two highly specialist wards in 2005 and covered totally 413 procedures. SSI's detection was based on definitions developed according to CDC guidelines. Post-discharge detection was included in the study. Collected data enabled evaluation of incidence rates and, additionally, in one hospital, assessing detailed rates included standardized SSI risk index. MAIN OBSERVATIONS: Patients underwent analyzed procedures was mainly male (80%), aged 60 and more. In hospital I SSI incidence rate reached 2,6% and in the other (hospital II)--5,6%. Among the etiological factors isolated from patients with SSI staphylococci were the most common (45,5%) and it was mainly Staphylococcus aureus. CONCLUSIONS: The study which was performed showed the incidence of SSIs in patients undergoing vascular surgery at the level of 2.6 and 5.6%. It was shown that it is possible to introduce an effective post-discharge surveillance, which encompassed 50-66% diagnosed cases of SSI.