Impact of intensified prevention measures on rates of hospital-acquired bloodstream infection in medical-surgical intensive care units, Israel, 2011 to 2019.

BackgroundCentral line-associated bloodstream infection (CLABSI) is among the most common preventable infectious complications in patients in intensive care units (ICU). In 2011, the Israel National Center for Infection Control initiated a nationwide CLABSI prevention programme.AimTo evaluate the impact of different components of the programme on CLABSI and non-CLABSI rates in medical-surgical ICUs.MethodsWe included data collected from all 29 medical-surgical ICUs in Israel from November 2011 to December 2019. The study period was divided into three phases: I (baseline, initial CLABSI prevention guidelines introduced, initial feedback on rates provided), II (initial guidelines widely implemented, surveillance undertaken, feedback continued) and III (after implementation of additional prevention measures). Interrupted time series analysis was used to compare CLABSI and non-CLABSI rates during the three phases.ResultsThe pooled mean (SD) incidence of CLABSI per 1,000 central line-days dropped from 7.4 (0.38) in phase I to 2.1 (0.13) in phase III (p < 0.001). The incidence rate ratio (IRR) was 0.63 (95% CI: 0.51-0.79) between phases I and II, and 0.78 (95% CI: 0.59-1.02) between phases II and III. The pooled mean (SD) incidence of non-CLABSI per 1,000 patient-days declined from 5.3 (0.24) in phase I to 3.4 (0.13) in phase III (p < 0.001).ConclusionNational CLABSI prevention guidelines, surveillance and feedback resulted in significant reductions in CLABSI and non-CLABSI rates. In the wake of further interventions, significant reduction was achieved in ICUs reporting improvement in the uptake of additional prevention measures.

Dental team member compliance with personal protective equipment and aerosol-generating procedure recommendations during the COVID-19 pandemic in Israel: An observational study.

INTRODUCTION: Coronaviruses which have been responsible for numerous epidemics worldwide, share common transmission modalities and pose a risk within dental clinics. Updated, COVID-19-specific infection control and personal protective equipment (PPE) guidelines for dental settings, including minimizing aerosol-generating procedures (AGPs), were issued by the Israeli Ministry of Health (MoH) in spring 2020. This study investigated dental team members (dentists, dental assistants and hygienists) compliance with MoH recommendations exposed to asymptomatic COVID-19 positive patients. METHODS: The MoH analysed exposure reports from dental clinics to asymptomatic SARS-CoV-2 positive patients following their reopening (April 2020). Exposure reports were verified against a COVID-19 national database. A cumulative transmission rate was calculated and compared to the rate in the population. RESULTS: One thousand three hundred twenty-third exposure reports were received (May 1-December 31, 2020) regarding dental team members who treated asymptomatic SARS-CoV-2 positive patients: 525 (39.7%) were dentists, 656 (49.6%) dental assistants and 126 (9.5%) hygienists. Practitioner type was not reported in 16 (1.2%) cases. Most dental team members reported full PPE use and performance of short/non-aerosol-generating procedures. Dentists and hygienists reported higher compliance compared with dental assistants. 8 (0.6%) dental team members (four dentists, four dental assistants) were positive post-exposure, with an average of 5.4 days (median 5 days, SD = 4.8) from dental treatment to a positive COVID-19 test. PRINCIPAL CONCLUSIONS: Most dental team members complied fully with the MoH recommendations. Differences were found between the dental team members (hygienists being most adherent). Further efforts are required to encourage full compliance.

Pandora's box in the dental clinic.

BACKGROUND: In June 2018, the Ministry of Health received notification from 2 hospitals about 2 patients who presented with overwhelming Enterobacter kobei sepsis that developed within 24 hours after a dental procedure. We describe the investigation of this outbreak. METHODS: The epidemiologic investigation included site visits in 2 dental clinics and interviews with all involved healthcare workers. Chart reviews were conducted for case and control subjects. Samples were taken from medications and antiseptics, environmental surfaces, dental water systems, and from the involved healthcare professionals. Isolate similarity was assessed using repetitive element sequence-based polymerase chain reaction (REP-PCR). RESULTS: The 2 procedures were conducted in different dental clinics by different surgeons and dental technicians. A single anesthesiologist administered the systemic anesthetic in both cases. Cultures from medications, fluids and healthcare workers' hands were negative, but E. kobei was detected from the anesthesiologist's portable medication cart. The 2 human isolates and the environmental isolate shared the same REP-PCR fingerprinting profile. None of the 21 patients treated by the anesthesiologist in a general hospital during the same period, using the hospital's medications, developed infection following surgery. CONCLUSIONS: An outbreak of post-dental-procedure sepsis was linked to a contaminated medication cart, emphasizing the importance of medication storage standards and strict aseptic technique when preparing intravenous drugs during anesthesia. Immediate reporting of sepsis following these outpatient procedures enabled early identification and termination of the outbreak.

Effect of a national policy of universal masking and uniform criteria for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) exposure on hospital staff infection and quarantine.

OBJECTIVE: To determine the effect of 2 regulations issued by the Israel Ministry of Health on coronavirus disease 2019 (COVID-19) infections and quarantine among healthcare workers (HCWs) in general hospitals. DESIGN: Before-and-after intervention study without a control group (interrupted time-series analysis). SETTING: All 29 Israeli general hospitals. PARTICIPANTS: All HCWs. INTERVENTIONS: Two national regulations were issued on March 25, 2020: one required universal masking of HCWs, patients, and visitors in general hospitals and the second defined what constitutes HCW exposure to severe acute respiratory coronavirus virus 2 (SARS-CoV-2) and when quarantine is required. RESULTS: Overall, 283 HCWs were infected at work or from an unknown source. Before the intervention, the number of HCWs infected at work increased by 0.5 per day (95% confidence interval [CI], 0.2-0.7; P < .001), peaking at 16. After the intervention, new infections declined by 0.2 per day (95% CI, -0.3 to -0.1; P < .001). Before the intervention, the number of HCWs in quarantine or isolation increased by 97 per day (95% CI, 90-104; P < .001), peaking at 2,444. After the intervention, prevalence decreased by 59 per day (95% CI, -72 to -46; P < .001). Epidemiological investigations determined that the most common source of HCW infection (58%) was a coworker. CONCLUSIONS: Universal masking in general hospitals reduced the risk of hospital-acquired COVID-19 among HCWs. Universal masking combined with uniform definitions of HCW exposure and criteria for quarantine limited the absence of HCWs from the workforce.

The association between implementation of second-tier prevention practices and CLABSI incidence: A national survey.

BACKGROUND: Prevention of central-line-associated bloodstream infection (CLABSI) represents a complex challenge for the teams involved in device insertion and maintenance. First-tier practices for CLABSI prevention are well established. OBJECTIVE: We describe second-tier prevention practices in Israeli medical-surgical ICUs and assess their association with CLABSI rates. METHODS: In June 2017, an online survey assessing infection prevention practices in general ICUs was sent to all Israeli acute-care hospitals. The survey comprised 14 prevention measures supplementary to the established measures that are standard of care for CLABSI prevention. These measures fall into 2 domains: technology and implementation. The association between the number of prevention measures and CLABSI rate during the first 6 months of 2017 was assessed using Spearman's correlation. We used negative binomial regression to calculate the incidence rate ratio (IRR) associated with the overall number of prevention measures and with each measure individually. RESULTS: The CLABSI rates in 24 general ICUs varied between 0.0 and 17.0 per 1,000 central-line days. Greater use of preventive measures was associated with lower CLABSI rates (ρ, -0.70; P < .001). For each additional measure, the incidence of CLABSI decreased by 19% (IRR, 0.81; 95% CI, 0.73-0.89). Specific measures associated with lower rates were involvement of ward champions (IRR, 0.47; 95% CI, 0.31-0.71), auditing of insertions by infection control staff (IRR, 0.35; 95% CI, 0.19-0.64), and simulation-based training (IRR, 0.38; 95% CI, 0.22-0.64). CONCLUSION: Implementation of second-tier preventive practices was protective against CLABSI. Use of more practices was correlated with lower rates.