Healthcare Library Current Awareness Bulletin - Infection Prevention and Control April and May 2015

Surveillance of healthcare-associated infections is central to healthcare epidemiology and infection control programmes and a critical factor in the prevention of these infections. By definition, the term 'infection prevention' implies that healthcare-associated infections may be preventable. The purpose of surveillance is to provide quality data that can be used in an effective monitoring and alert system and to reduce the incidence of preventable healthcare-associated infections. This article examines the purpose of surveillance, explains key epidemiological terms, provides an overview of approaches to surveillance and discusses the importance of validation. [Continuing Professional Development, NS779] [PUBLICATION] 36 references Source: BNI 15.Title: Protecting the frontline: Designing an infection prevention platform for preventing emerging respiratory viral illnesses in healthcare personnel Citation: Infection Control and Hospital Epidemiology, March 2015, vol./is. 36/3(336-345), 0899-823X (01 Mar 2015) Author(s): Branch-Elliman W., Price C.S., McGeer A., Perl T.M. Language: English Abstract: Healthcare personnel often find themselves on the frontlines of any epidemic, and may be at particularly high risk of acquiring respiratory viral illnesses when compared to the general population. Many aspects dictate how respiratory viruses spread both inside the hospital and out: Elements to consider include the specific type of virus being targeted for prevention, as well as environmental conditions and host factors, such as age and immune status. Due to the diverse nature of these agents, multiple modes of transmission, including contact, droplet, aerosol, and transocular, must be considered when designing an effective infection prevention program. In this review, we examine the data behind current theories of respiratory virus transmission and key elements of any respiratory illness prevention program. We also highlight other influences that may come into play, such as the costeffectiveness of choosing one respiratory protection strategy over another. Publication type: Journal: Article Source: EMBASE 16.Title: Response to the Ebola crisis in Sierra Leone Citation: Nursing Standard, Feb 2015, vol. 29, no. 26, p. 37-41, 0029-6570 (February 25, 2015) Author(s): Davies, Beauty Chiedza, Bowley, Douglas, Roper, Katrina Abstract: The Ebola outbreak in 2014 marked the first time that an epidemic of this viral haemorrhagic fever had occurred in West Africa. From its origin in Guinea, the outbreak rapidly increased to become a humanitarian crisis affecting all aspects of life in the three countries worst affected: Guinea, Sierra Leone and Liberia. Improving understanding of Ebola virus disease among the general population and instigating the behavioural changes required to help break the epidemic were central to the public health response. This article explores some of the misconceptions about Ebola as it spread into Sierra Leonean communities, and the social mobilisation response of the government of Sierra Leone. It is a reflective account of conversations with Sierra Leonean nationals during a military deployment at the International Security Advisory Team headquarters medical treatment facility in Freetown. [PUBLICATION] 24 references Source: BNI 17.Title: Risk factors for periprosthetic joint infection after total joint arthroplasty: A systematic review and metaanalysis Citation: Journal of Hospital Infection, February 2015, vol./is. 89/2(82-89), 0195-6701;1532-2939 (01 Feb 2015) Author(s): Zhu Y., Zhang F., Chen W., Liu S., Zhang Q., Zhang Y. Language: English Abstract: Many of the mooted risk factors associated with periprosthetic joint infection (PJI) after total joint arthroplasty (TJA) remain controversial and are not well characterized. Online and manual searches were performed using Medline, Embase, Chinese National Knowledge Infrastructure and the Cochrane Central Database from January 1980 to March 2014). For inclusion, studies had to meet the quality assessment criteria of the CONSORT statement, and be concerned with evaluation of risk factors for PJI after TJA. Two reviewers extracted the relevant data independently and any disagreements were resolved by consensus. Fourteen studies were included in this metaanalysis. The following significant risk factors for PJI were identified: body mass index (both continuous and dichotomous variables); diabetes mellitus; corticosteroid therapy; hypoalbuminaemia; history of rheumatoid arthritis; blood transfusion; presence of a wound drain; wound dehiscence; superficial surgical site infection; coagulopathy; malignancy, immunodepression; National Nosocomial Infections Surveillance Score >2; other nosocomial infection; prolonged operative time; and previous surgery. Factors that were not significantly associated with PJI were: cirrhosis; hypothyroidism; urinary tract infection; illicit drug abuse; alcohol abuse; hypercholesterolaemia; hypertension, ischaemic heart disease; peptic ulcer disease; hemiplegia or paraplegia; dementia; and operation performed by a staff surgeon (vs a trainee). Strategies to prevent PJI after TJA should focus, in particular, on those patients at greatest risk of infection according to their individual risk factors. Publication type: Journal: Review Source: EMBASE 18.Title: Root cause analysis to support infection control in healthcare premises. Citation: Journal of Hospital Infection, 01 April 2015, vol./is. 89/4(331-334), 01956701 Author(s): Venier, A-G Language: English Abstract: Infection control teams (ICTs) seek to prevent healthcare-associated infections (HCAIs). They undertake surveillance and prevention, promote safety and quality of care, and evaluate and manage risk. Root cause analysis (RCA) can support this work but is not widely used by ICTs. This paper describes how ICTs can use RCA to enhance their day-to-day work. Many different tools and methods exist for RCA. Its primary aim is to identify the factors that have led to HCAI, but RCA can also be used for near-misses. A team effort and multidisciplinary work are usually required. Published accounts and personal experience in the field indicate that an ICT that correctly uses RCA implements more effective prevention measures, improves practice and collaborative working, enhances teamwork, and reduces the risk of HCAI. RCA should be promoted among ICTs because it adds value to their work and helps to develop a hospital culture that anticipates and pre-empts problems. Publication type: journal article Source: CINAHL 19.Title: Screening and isolation to control meticillin-resistant Staphylococcus aureus: Sense, nonsense, and evidence Citation: The Lancet, March 2015, vol./is. 385/9973(1146-1149), 0140-6736;1474-547X (21 Mar 2015) Author(s): Fatkenheuer G., Hirschel B., Harbarth S. Language: English Publication type: Journal: Review Source: EMBASE Full text: Available Lancet at Lancet, The 20.Title: Sharp truth: health care workers remain at risk of bloodborne infection. Citation: Occupational medicine (Oxford, England), Apr 2015, vol. 65, no. 3, p. 210-214 (April 2015) Author(s): Rice, B D, Tomkins, S E, Ncube, F M Abstract: In 2013, new regulations for the prevention of sharps injuries were introduced in the UK. All health care employers are required to provide the safest possible working environment by preventing or controlling the risk of sharps injuries. To analyse data on significant occupational sharps injuries among health care workers in England, Wales and Northern Ireland before the introduction of the 2013 regulations and to assess bloodborne virus seroconversions among health care workers sustaining a blood or body fluid exposure. Analysis of 10 years of information on percutaneous and mucocutaneous exposures to blood or other body fluids from source patients infected with a bloodborne virus, collected in England, Wales and Northern Ireland through routine surveillance of health care workers reported for the period 2002-11. A total of 2947 sharps injuries involving a source patient infected with a bloodborne virus were reported by health care workers. Significant sharps injuries were 67% higher in 2011 compared with 2002. Sharps injuries involving an HIV-, hepatitis B virusor hepatitis C virus (HCV)-infected source patient increased by 107, 69 and 60%, respectively, between 2002 and 2011. During the study period, 14 health care workers acquired HCV following a sharps injury. Our data show that during a 10-year period prior to the introduction of new regulations in 2013, health care workers were at risk of occupationally acquired bloodborne virus infection. To prevent sharps injuries, health care service employers should adopt safety-engineered devices, institute safe systems of work and promote adherence to standard infection control procedures. © The Author 2015. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: [email protected]. Source: Medline 21.Title: Sharps injuries in a teaching hospital: changes over a decade. Citation: Occupational medicine (Oxford, England), Mar 2015, vol. 65, no. 2, p. 135-138 (March 2015) Author(s): Kevitt, F, Hayes, B Abstract: Sharps injuries create a high volume of occupational health (OH) workload in the health care setting. The deadline for implementation of the European Sharps Directive was 11 May 2013. To compare the epidemiology of sharps injuries reported in a large Irish teaching hospital in 2008-10 with those reported between 1998 and 2000. We compared data from electronic and paper OH records of sharps injuries reported between 1 January 2008 and 31 December 2010 with those from a previous study of sharps injuries reported between 1 January 1998 and 31 December 2000. A total of 325 sharps injuries were reported in 2008-10, compared with 332 in 1998-2000 (P = 0.568). Hepatitis B immunity in sharps injury recipients in 2008-10 was 87% compared to 86% in 1998-2000 (P = 0.32). Glove use was reported in 80% of reported injuries in 2008-10 compared with 74% in 1998-2000 (P = 0.32). In 2008-10, 49% of injuries occurred during disposal or following improper disposal of sharps, compared with 42% in 1998-2000. There was no significant change in the epidemiology of sharps injuries reported between 2008 and 2010 compared with 1998-2000. Further education in standard precautions, safe disposal of sharps, the use of safetyengineered devices and the benefits of hepatitis B immunization is needed. © The Author 2014. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved. For Permissions, please email: [email protected]. Source: Medline 22.Title: Systematic qualitative literature review of health care workers' compliance with hand hygiene guidelines Citation: American Journal of Infection Control, Mar 2015, vol. 43, no. 3, p. 269-274, 0196-6553 (March 2015) Author(s): Smiddy, Maura P, Connell, Rhona O, Creedon, Sile A Abstract: Acquisition of a health care-associated infection is a substantial risk to patient safety. When health care workers comply with hand hygiene guidelines, it reduces this risk. Despite a growing body of qualitative research in this area, a review of the qualitative literature has not been published. A systematic review of the qualitative literature. The results were themed by the factors that health care workers identified as contributing to their compliance with hand hygiene guidelines. Contributing factors were conceptualized using a theoretical background. This review of the qualitative literature enabled the researchers to take an inductive approach allowing for all factors affecting the phenomenon of interest to be explored. Two core concepts seem to influence health care workers' compliance with hand hygiene guidelines. These are motivational factors and perceptions of the work environment. Motivational factors are grounded in behaviorism, and the way in which employees perceive their work environment relates to structural empowerment. Noncompliance with hand hygiene guidelines remains a collective challenge that requires researchers to adopt a consistent and standardized approach. Theoretical models should be used intentionally to better explain the complexities of hand hygiene. [Publication] 72 references Source: BNI 23.Title: Systematic review of the effectiveness of strategies to encourage patients to remind healthcare professionals about their hand hygiene Citation: Journal of Hospital Infection, Mar 2015, vol. 89, no. 3, p. 141-162, 0195-6701 (March 2015) Author(s): Davis, R., Parand, A., Pinto, A., Buetow, S. Abstract: Background:Patients could help to improve the hand hygiene (HH) compliance of healthcare professionals (HCPs) by reminding them to sanitize their hands. Aim: To review the effectiveness of strategies aimed at increasing patient involvement in reminding HCPs about their HH. Methods: A systematic review was conducted across Medline, EMBASE and PsycINFO between 1980 and 2013. Findings: Twenty-eight out of a possible 1956 articles were included. Of these, 23 articles evaluated the effectiveness of developed patient-focused strategies and five articles examined patients' attitudes towards hypothetical strategies. Sixteen articles evaluated single-component strategies (e.g. videos) and 12 articles evaluated multi-modal approaches (e.g. combination of video and leaflet). Overall, the strategies showed promise in helping to increase patients' intentions and/or involvement in reminding HCPs about their HH. HCP encouragement appeared to be the most effective strategy. However, the methodological quality of the articles in relation to addressing the specific aims of this review was generally weak. Conclusion: A number of strategies are available to encourage patients to question HCPs about their HH. Better controlled studies with more robust outcome measures will enhance understanding about which strategies may be most successful and why. [PUBLICATION] 111 references Source: BNI 24.Title: Time for action-Improving the design and reporting of behaviour change interventions for antimicrobial stewardship in hospitals: Early findings from a systematic review. Citation: International journal of antimicrobial agents, Mar 2015, vol. 45, no. 3, p. 203-212 (March 2015) Author(s): Davey, Peter, Peden, Claire, Charani, Esmita, Marwick, Charis, Michie, Susan Abstract: There is strong evidence that self-monitoring and feedback are effective behaviour change techniques (BCTs) across a range of healthcare interventions and that their effectiveness is enhanced by goal setting and action planning. Here we report a summary of the update of a systematic review assessing the application of these BCTs to improving hospital antibiotic prescribing. This paper includes studies with valid prescribing outcomes published before the end of December 2012. We used a structured method for reporting these BCTs in terms of specific characteristics and contacted study authors to request additional intervention information. We identified 116 studies reporting 123 interventions. Reporting of BCTs was poor, with little detail of BCT characteristics. Feedback was only reported for 17 (13.8%) of the interventions, and self-monitoring was used in only 1 intervention. Goals were reported for all interventions but were poorly specified, with only three of the nine characteristics reported for ≥50% of interventions. A goal threshold and timescale were specified for just 1 of the 123 interventions. Only 29 authors (25.0%) responded to the request for additional information. In conclusion, both the content and reporting of interventions for antimicrobial stewardship fell short of scientific principles and practices. There is a strong evidence base regarding BCTs in other contexts that should be applied to antimicrobial stewardship now if we are to further our understanding of what works, for whom, why and in what contexts. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved. Source: Medline 25.Title: Turning the tide or riding the waves? Impacts of antibiotic stewardship and infection control on MRSA strain dynamics in a Scottish region over 16 years: Non-linear time series analysis Citation: BMJ Open, 2015, vol./is. 5/3, 2044-6055 (2015) Author(s): Lawes T., Lopez-Lozano J.-M., Nebot C., Macartney G., Subbarao-Sharma R., Dare C.R.J., Edwards G.F.S., Gould I.M. Language: English Abstract: Objectives: To explore temporal associations between planned antibiotic stewardship and infection control interventions and the molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA). Design: Retrospective ecological study and time-series analysis integrating typing data from the Scottish MRSA reference laboratory. Setting: Regional hospital and primary care in a Scottish Health Board. Participants: General adult (N=1 051 993) or intensive care (18 235) admissions and primary care registrations (460 000 inhabitants) between January 1997 and December 2012. Interventions: Hand-hygiene campaign; MRSA admission screening; antibiotic stewardship limiting use of macrolides and '4Cs' (cephalosporins, coamoxiclav, clindamycin and fluoroquinolones). Outcome measures: Prevalence density of MRSA clonal complexes CC22, CC30 and CC5/Other in hospital (isolates/1000 occupied bed days, OBDs) and community (isolates/10 000 inhabitant-days). Results: 67% of all clinical MRSA isolates (10 707/15 947) were typed. Regional MRSA population structure was dominated by hospital epidemic strains CC30, CC22 and CC45. Following declines in overall MRSA prevalence density, CC5 and other strains of community origin became increasingly important. Reductions in use of '4Cs' and macrolides anticipated declines in sublineages with higher levels of associated resistances. In multivariate time-series models (R2=0.63-0.94) introduction of the hand-hygiene campaign, reductions in mean length of stay (when >4 days) and bed occupancy (when >74 to 78%) predicted declines in CC22 and CC30, but not CC5/other strains. Lower importation pressures, expanded MRSA admission screening, and reductions in macrolide and third generation cephalosporin use (thresholds for association: 135-141, and 48-81 defined daily doses/1000 OBDs, respectively) were followed by declines in all clonal complexes. Strain-specific associations with fluoroquinolones and clindamycin reflected resistance phenotypes of clonal complexes. Conclusions: Infection control measures and changes in population antibiotic use were important predictors of MRSA strain dynamics in our region. Strategies to control MRSA should consider thresholds for effects and strain-specific impacts. Publication type: Journal: Article Source: EMBASE Full text: Available Highwire Press at BMJ Open 26.Title: Understanding the current state of infection prevention to prevent Clostridium difficile infection: a human factors and systems engineering approach Citation: American Journal of Infection Control, Mar 2015, vol. 43, no. 3, p. 241-247, 0196-6553 (March 2015) Author(s): Yanke, Eric, Zellmer, Caroline, Van Hoof, Sarah, Moriarty, Helene, Carayon, Pascale, Safdar, Nasia Abstract: Achieving and sustaining high levels of health care worker (HCW) compliance with contact isolation precautions is challenging. The aim of this study was to determine HCW work system barriers to and facilitators of adherence to contact isolation for patients with suspected or confirmed Clostridium difficile infection (CDI) using a human factors and systems engineering approach. This prospective cohort study took place between September 2013 and November 2013 at a large academic medical center (hospital A) and an affiliated Veterans Administration hospital (hospital B). A human factors engineering (HFE) model for patient safety, the Systems Engineering Initiative for Patient Safety model, was used to guide work system analysis and direct observation data collection. There were 288 observations conducted. HCWs and visitors were assessed for compliance with all components of contact isolation precautions (hand hygiene, gowning, and gloving) before and after patient contact. Time required to complete contact isolation precautions was measured, and adequacy of contact isolation supplies was assessed. Full compliance with contact isolation precautions was low at both hospitals A (7%) and B (22%). Lack of appropriate hand hygiene prior to room entry (compliance for hospital A: 18%; compliance for hospital B: 29%) was the most common reason for lack of full compliance. More time was required for full compliance compared with compliance with no components of contact isolation precautions before patient room entry, inside patient room, and after patient room exit (59.9 vs 3.2 seconds, P .001; 507.3 vs 149.7 seconds, P = .006; 15.2 vs 1.3 seconds, P .001, respectively). Compliance was lower when contact isolation supplies were inadequate (4% vs 16%, P = .005). Adherence to contact isolation precautions for CDI is a complex, time-consuming process. HFE analysis indicates that multiple work system components serve as barriers and facilitators to full compliance with contact isolation precautions and should be addressed further to prevent CDI. [Publication] 23 references Source: BNI 27.Title: Ventilator-associated infection: the role for inhaled antibiotics. Citation: Current Opinion in Pulmonary Medicine, 01 May 2015, vol./is. 21/3(239-249), 10705287 Author(s): Palmer, Lucy B Language: English Abstract: PURPOSE OF REVIEW: Despite multiple protocols for the prevention of ventilator-associated pneumonia (VAP), respiratory infections have not been eliminated in the ICU. The profound disruption in both airway integrity and mucociliary clearance caused by the endotracheal tube makes it unlikely there will ever be a zero rate of respiratory infection in critically ill ventilated patients or a 100% cure rate when infection is present. In fact, options for treatment are diminishing as bacteria resistant to most, or in some hospitals all, systemic antibiotics increase in prevalence from our liberal use of systemic antibiotics. Inhaled therapy with proper delivery will result in the high concentrations of antibiotics needed in the treatment of increasingly resistant organisms. RECENT FINDINGS: Data from many recent investigations have focused on inhaled antibiotics as: adjunctive therapy to systemic antibiotic for VAP, monotherapy for VAP, and as monotherapy for ventilator-associated tracheobronchitis. The clinical outcomes of these studies will be reviewed as well as their effect on multidrug-resistant organisms. SUMMARY: The present review will focus on the rationale for inhaled therapy, the current studies examining the delivery and clinical efficacy of inhaled antibiotics, and the potential role for this mode of delivery actually decreasing antibiotic resistance in the respiratory tract. Publication type: journal article Source: CINAHL 28.Title: Washing uniforms at home: adherence to hospital policy Citation: Nursing Standard, Feb 2015, vol. 29, no. 25, p. 37-43, 0029-6570 (February 18, 2015) Author(s): Riley, Kate, Laird, Katie, Williams, John Abstract: Infection control is a priority for all hospitals to reduce the spread of healthcare-associated infections (HCAIs). Textiles especially uniforms, are a possible route of HCAI transmission. There are protocols to ensure hospital laundry services meet accepted standards, however healthcare uniforms are laundered by staff at home and variations in practice occur. A questionnaire was used to conduct a service evaluation at four hospitals in different NHS trusts to determine how closely healthcare staff followed hospital guidelines on laundering and aftercare of uniforms at home. Responses showed that not all staff followed these guidelines; 44% of staff washed their uniforms below the recommended temperature of 60°C, which presents a potential route for cross-contamination and infection. [PUBLICATION] 22 references Source: BNI