"Beyond the guidelines" - Deviations in adherence to infection control measures in Tyrolean hospitals, Austria.

BACKGROUND: Hospital-acquired infections represent increasing problems in health-care facilities worldwide. Adequate infection control measures are key elements in preventing those infections. Expert societies have published recommendations that help to reduce Hospital-acquired infections. METHODS: In November 2019, a questionnaire-based point-prevalence survey, eliciting the adherence of 14 Tyrolean hospitals to the recommendations of the Centers of Disease Control and Prevention (CDC) was performed. Additionally, standard infection control measures performed by different medical (clinical and infection control specialists) disciplines as well as the performed infection control measures of nurses and physicians were compared. RESULTS: The survey revealed varying adherence to CDC-recommendations of different medical disciplines, with highest congruence by the infection control specialists and lower congruencies by all surveyed clinical disciplines. Concordance rate between nurses and physicians was high. DISCUSSION: Explanations for the varying congruencies of clinical disciplines on the one hand and the infection control specialists on the other hand may be versatile. Possible lacks of knowledge about the required hygiene measures should be taken into account. CONCLUSIONS: The present survey showed moderate adherence of Tyrolean hospitals to the recommendations provided by CDC, however with noticeable differences between different medical disciplines. Nurses and doctors in most cases reported identically.

High percentage of microbial colonization of osteosynthesis material in clinically unremarkable patients.

Stabilization of fractures with internal fixation devices is a common procedure and implant-associated infections are a dreaded complication. The exact pathomechanism is not completely understood; however, microbial colonization of osteosynthesis material is considered a trigger for infection. This study aimed to determine the colonization rate of osteosynthesis implants in patients with no clinical or laboratory signs of infection, using two methods, conventional culture and polymerase chain reaction (PCR) of sonication fluid. Fifty-seven patients aged between 18 and 79 years without signs of infection who underwent routine removal of osteosynthesis devices between March 2015 and May 2017 were included in this study. Osteosynthesis material was investigated by sonication followed by cultivation of the sonication fluid in blood culture bottles and PCR analysis, simultaneously. Additionally, electron scanning microscopy was performed in nine representative implants to evaluate biofilm production. Thirty-two (56.1%) implants showed a positive result either by culture or PCR with coagulase-negative staphylococci being the most commonly identified microorganism (68.1%). Furthermore, the detection rate of the culture (50.9%) was significantly higher compared to PCR (21.1%). The scanning electron microscopy imaging demonstrated biofilm-like structures in four of six culture and/or PCR-positive samples. This study is the first, to the best of our knowledge, to demonstrate bacterial colonization of osteosynthesis implants in healthy patients with no clinical or laboratory signs of infection. Colonization rate was unexpectedly high and conventional culture was superior to PCR in microbial detection. The common understanding that colonization is a trigger for infection underlines the need for strategies to prevent colonization of implant material like antibiotic-loaded coating or intraoperative gel application.