Search Results (176)

Microbiological contamination of healthcare workers’ gowns represents a critical risk for the transmission of healthcare-associated infections (HAIs). Despite their use as protective equipment, gowns can act as reservoirs of antibiotic-resistant bacteria, favouring the spread of pathogens between healthcare workers and patients. The presence of these resistant bacteria on healthcare workers’ gowns highlights the urgent need to address this risk as part of infection control strategies. The aim of this work was to assess the microbiological risks associated with the contamination of healthcare staff gowns with Gram-negative bacteria, including the ESKAPE group, and their relationship with antimicrobial resistance. An observational, cross-sectional, prospective study was conducted in 321 hospital workers. The imprinting technique was used to quantify the bacterial load on the gowns, followed by bacterial identification by MALDI-TOF mass spectrometry. In addition, antimicrobial resistance profiles were analysed, and tests for carbapenemases and BLEE production were performed. The ERIC-PCR technique was also used for molecular analysis of Pantoea eucrina clones. Several Gram-negative bacteria were identified, including bacteria of the ESKAPE group. The rate of microbiological contamination of the gowns was 61.05% with no association with the sex of the healthcare personnel. It was observed that critical areas of the hospital, such as intensive care units and operating theatres, showed contamination by medically important bacteria. In addition, some strains of P. eucrina showed resistance to carbapenemics and cephalosporins. ERIC-PCR analysis of P. eucrina isolates showed genetic heterogeneity, indicating absence of clonal dissemination. Healthcare personnel gowns are a significant reservoir of pathogenic bacteria, especially in critical areas of Hospital Juárez de México. It is essential to implement infection control strategies that include improving the cleaning and laundering of gowns and ideally eliminating them from clothing to reduce the risk of transmission of nosocomial infections. Full article

Healthcare-associated infections (HAIs), also referred to as nosocomial or hospital-acquired infections, are a significant cause of death worldwide, with hand hygiene being the most powerful means to tackle them. The present study had a twofold aim: first, to assess the level of knowledge and the degree of compliance with hand hygiene practices based on healthcare workers’ self-reports; second, to evaluate whether behavioral economics techniques, specifically a poster combining an image and an informational message, designed according to the published literature, can increase the level of healthcare workers’ compliance with hand hygiene. Factors that potentially affect compliance were also examined. This study involved distributing a questionnaire to healthcare workers in Greek public hospitals, from which 314 completed responses were collected during the last quarter of 2023. Participants were randomly and evenly assigned to an intervention group that received a nudging poster or to a control group, which did not. Self-reported compliance with hand hygiene practices was high, based on two latent variables derived through exploratory factor analysis, although knowledge of germ transmission was moderate, as reflected in the relevant knowledge question scores. However, nudging had no statistically significant effect on hand hygiene behavior. Compliance was associated with several factors, including gender, age, work experience, profession, perceived adequacy of available hygiene-related resources, and perceived consequences of nosocomial infections on patient outcomes. Full article

Background: Reusable tourniquets are commonly used to aid venipuncture and blood collection. However, inadequate disinfection may lead to bacterial contamination and increase the risk of healthcare-associated infections (HAIs). Tourniquets can function as fomites, facilitating the spread of pathogenic bacteria. This study assessed microbial contamination of reusable tourniquets in the emergency department and operating theatre, focusing on clinically relevant HAI-associated pathogens. Methods: Tourniquets from four hospital departments (emergency: adult observation and resuscitation; surgical theatres: pediatric and adult general surgery) were sampled at three time points (n = 12). DNA was extracted and analyzed via 16S rRNA sequencing using NGS technology to identify microbial contamination and taxonomic composition. Results: Sequencing revealed 131 bacterial species across the 12 tourniquets, including clinically important pathogens. Among the top ten HAI-associated groups, Klebsiella spp. were detected in 5/12 samples, Enterococcus spp. in 9/12, Staphylococcus aureus in 1/12, Pseudomonas aeruginosa in 9/12, and Acinetobacter spp. in 10/12. No Escherichia coli, Clostridium difficile, coagulase-negative staphylococci, Proteus spp., or Enterobacter spp. were found. Emergency department tourniquets showed higher bacterial loads; operating theatres had greater species diversity. Conclusions: Reusable tourniquets harbor significant bacterial contamination. Considering disinfection challenges and the lack of guidelines, single-use tourniquets should be considered to reduce HAI risk. Full article

Background/Objectives: Healthcare-associated infections (HAIs) are a major global public health concern, significantly impacting patient safety and healthcare quality. These infections are associated with high morbidity and mortality rates, prolonged hospital stays, and increased healthcare costs. Nurses play a critical role in infection prevention, implementing evidence-based interventions to reduce infection risks. This systematic review aims to identify and synthesize the most effective nursing interventions to prevent HAIs in hospitalized adults, analyzing their variability across different clinical settings and populations. Methods: This systematic review follows the Joanna Briggs Institute (JBI) methodology for systematic reviews of effectiveness and is reported according to PRISMA guidelines. The protocol is registered in the PROSPERO database (CRD42024582820). This review includes randomized controlled trials, quasi-experimental studies, and observational studies (cohort, case-control, and cross-sectional) assessing the effectiveness of nursing interventions in reducing HAIs. A comprehensive search is conducted in the PubMed, CINAHL, Scopus, Web of Science, and Cochrane databases. Study selection, data extraction, and quality assessment are performed by two independent reviewers, with disagreements resolved by a third reviewer. Results: The primary outcomes include reductions in HAI incidence rate, increased adherence to preventive interventions, decreased hospital length of stay, reduced readmission rates due to infections, and overall patient safety improvements. A meta-analysis is conducted when feasible; otherwise, results are synthesized narratively. Conclusions: The findings of this review contribute to the standardization of evidence-based nursing practices for HAI prevention, promoting safer healthcare environments. By identifying the most effective interventions, this study aims to support healthcare professionals and policymakers in implementing targeted infection control strategies. Full article

Background and Objectives: Healthcare-associated infections (HAIs) are on the rise worldwide because the range of etiologic agents involved is very diverse and their antimicrobial resistance poses a threat to population health in the third millennium. Materials and Methods: We conducted a retrospective, longitudinal, descriptive clinical–epidemiological study in a hospital with a neurosurgical profile in northeastern Romania (“Prof. Dr. N. Oblu” Clinical Emergency Hospital in Iasi), during 2020–2024. The study is centered on the involvement of Acinetobacter spp. in the occurrence and evolution of HAIs. Results: The highest incidence of Acinetobacter spp. HAIs was recorded in the intensive care unit (ICU)—82.78% compared to neurosurgical wards (15.38%), with predominance in males (69.23%) and rural residence patients (55.67%). Most HAIs were represented by ventilator-associated pneumonia (42.13%) and lower respiratory tract infections (23.08%). Strains with high virulence and pathogenicity (CR-MDR, ESBL-MDR) were found, with the highest proportion of CR-MDR strains (88.27%). Conclusions: Our study provides useful data for surveillance of the antimicrobial resistance of pathogens involved in HAIs at the hospital level and for guiding antibiotic therapy in hospital-acquired infections. Full article

Background: Healthcare-associated infections (HAIs) significantly increase morbidity, mortality, and healthcare costs. Among HAIs, catheter-associated infections are particularly prevalent due to the susceptibility of catheters to microbial contamination and biofilm formation, especially with prolonged use. Biofilms act as infection reservoirs, complicating treatment and often requiring catheter removal, thus extending hospital stays and increasing costs. Recent technological advances in catheter design have focused on integrating antifouling and antimicrobial coatings to mitigate or prevent biofilm formation. Methods: We developed COPESIL^®, a novel silicone rubber embedded with PEGylated copper nanoparticles designed to reduce microbial contamination on catheter surfaces. We conducted in vitro assays to evaluate the antimicrobial and antibiofilm efficacy of COPESIL^® against pathogens commonly implicated in catheter-associated urinary tract infections. Additionally, the safety profile of the material was assessed through cytotoxicity evaluations using HepG2 cells. Results: COPESIL^® demonstrated substantial antimicrobial activity, reducing contamination with Escherichia coli and Klebsiella pneumoniae by >99.9% and between 93.2% and 99.8%, respectively. Biofilm formation was reduced by 5.2- to 7.9-fold for E. coli and 2.7- to 2.8-fold for K. pneumoniae compared to controls. Cytotoxicity assays suggest the material is non-toxic, with cell viability remaining above 95% after 24 h of exposure. Conclusions: The integration of PEGylated copper nanoparticles into a silicone matrix in COPESIL^® represents a promising strategy to enhance the antimicrobial properties of catheters. Future studies should rigorously evaluate the long-term antimicrobial efficacy and clinical safety of COPESIL^®-coated catheters, with a focus on their impact on patient outcomes and infection rates in clinical settings. Full article

Background: This study examines the role of the built environment in mitigating risk in healthcare facilities, with a particular focus on how the design of hospital infrastructures can influence and improve the safety of patients, staff, and visitors. Methods: A two-phase mixed-methods approach was adopted. First, a scoping literature review was conducted to identify design-based strategies targeting five categories of risk: healthcare-associated infections (HAIs), indoor air quality (IAQ), safety, falls, and emergency resilience. Based on this review, a structured questionnaire was developed and administered to a sample of hospital facilities in Northern Italy to assess the implementation of the strategies emerged. Results: The literature review identifies recurring specific design solutions and strategies that have proven effective in mitigating risks in healthcare infrastructures in the following dimensions: infection mitigation, indoor air quality, falls reduction, safety, emergency preparedness. At the same time, survey data from (n = 9) hospitals indicate a significant implementation gap. Key shortcomings included a lack of spatial flexibility, limited environmental monitoring (especially for IAQ and acoustic conditions), and underutilization of antibacterial surfaces. Antibacterial flooring and wall finishes were absent in (n = 4/9) and (n = 6/9) of the facilities, respectively. IAQ monitoring was mostly confined to surgical areas, with (n = 0/9) facility reporting comprehensive building-wide monitoring. Only two (n = 2) facilities reported adaptable spaces suitable for emergency conversion and accessible green areas. Conclusions: This study provides a comprehensive overview of risk mitigation strategies in hospital design. The results reveal critical gaps in implementation, particularly in spatial flexibility, environmental monitoring, and antimicrobial surfaces. Future research should focus on developing adaptable design models that are context-sensitive, scalable, and capable of enhancing healthcare resilience in response to emerging global health threats. Full article

In small animal practice, blood cultures (BCs) are essential for diagnosing bacterial bloodstream infections (BSIs) and guiding targeted antimicrobial therapy, particularly in relation to the rise of multidrug-resistant (MDR) pathogens. This study analyzed 96 positive BCs from dogs and cats at the Veterinary University Hospital (VUH) of Bologna (2020–2024), assessing bacterial prevalence, antimicrobial resistance, and associated risk factors. Escherichia coli was the most common isolate (29/96), followed by Streptococcus canis (11/96). MDR percentage was 29.2% (28/96), with Gram-negatives associated with higher rates (p = 0.040). Nearly half of the cases (46.9%, 45/96) were suspected healthcare-associated infections (HAIs) significantly associated with the number of invasive devices used (p = 0.008) and with the absence of co-positive samples (p = 0.012). Empirical antibiotic therapy was administered in 94.8% (91/96) of cases, with ampicillin–sulbactam and marbofloxacin as the most used drugs. In vitro empirical therapy appropriateness was 76.9% (70/91). MDR was associated with inappropriate empirical therapy (p < 0.001). Mortality within 30 days was 36.5% (35/96), significantly linked to antibiotic escalation (p = 0.006). The findings highlight the need for systematic BC surveillance in veterinary settings to optimize treatment strategies (especially in countries with restrictions on antibiotic use in animals) to mitigate MDR spread and to protect public health. Full article

Background: Current research on healthcare-associated infection (HAI) surveillance in traditional Korean medicine (TKM) institutions is limited. Methods: We utilized the Delphi method to evaluate the validity and feasibility of implementing an HAI surveillance system in TKM hospitals. This involved conducting a systematic literature review and focus group interviews with three infection control experts and five TKM doctors experienced in infection control within TKM hospitals. Based on these findings, we developed a Delphi questionnaire. The survey included a total of fifteen participants: ten TKM doctors and TKM-related policy researchers with infection control expertise, two infection control nurses, and three infectious disease doctors. Results: The survey results indicated strong consensus on the necessity of introducing an HAI surveillance system tailored to TKM hospitals, as well as their integration into the Korean National Healthcare-associated Infections Surveillance (KONIS) system. Since infectious diseases do not differentiate between acute care hospitals and TKM hospitals, it is reasonable for TKM hospitals to participate in infection surveillance systems. However, the feasibility of implementing HAI surveillance in TKM hospitals remains low due to a lack of awareness regarding infection surveillance, insufficient surveillance personnel, inadequate diagnostic and surveillance infrastructure, and limited policy support for infection control. Therefore, this study proposes a phased approach in which hand hygiene surveillance and safe injection practice monitoring, which received relatively higher consensus on feasibility, should be prioritized to establish the necessary surveillance infrastructure. Subsequently, a stepwise implementation of HAI surveillance can be introduced. Conclusions: Although TKM hospitals generally have a lower risk of HAIs compared to acute care facilities, they lack robust infection control systems and support. To address this gap, TKM hospitals should join the KONIS system. Appointing and training dedicated infection control personnel will enable their participation and enhance overall infection management. Full article

Background/Objectives: Healthcare-associated infections (HAIs), including sepsis, represent a major challenge in clinical practice owing to their impact on patient outcomes and healthcare systems. Large language models (LLMs) offer a potential solution by analyzing clinical documentation and providing guideline-based recommendations for infection management. This study aimed to evaluate the performance of LLMs in extracting and assessing clinical data for appropriateness in infection prevention and management practices of patients admitted to an infectious disease ward. Methods: This retrospective proof-of-concept study analyzed the clinical documentation of seven patients diagnosed with sepsis and admitted to the Infectious Disease Unit of San Bortolo Hospital, ULSS 8, in the Veneto region (Italy). The following five domains were assessed: antibiotic therapy, isolation measures, urinary catheter management, infusion line management, and pressure ulcer care. The records, written in Italian, were anonymized and paired with international guidelines to evaluate the ability of LLMs (ChatGPT-4o) to extract relevant data and determine appropriateness. Results: The model demonstrated strengths in antibiotic therapy, urinary catheter management, the accurate identification of indications, de-escalation timing, and removal protocols. However, errors occurred in isolation measures, with incorrect recommendations for contact precautions, and in pressure ulcer management, where non-existent lesions were identified. Conclusions: The findings underscore the potential of LLMs not merely as computational tools but also as valuable allies in advancing evidence-based practice and supporting healthcare professionals in delivering high-quality care. Full article

Vancomycin-resistant enterococci (VRE) are a major cause of healthcare-associated infections (HAIs). However, the clinical significance of VRE colonization and the subsequent risk of VRE infection in hospitalized patients are not fully established. Prolonged hospital stays have been observed in neonates colonized by VRE. The mortality rate in pediatric patients with VRE infections ranges from 0% to 42% in both endemic and outbreak settings, often occurring in VRE-colonized neonates. Host and bacterial factors associated with a worse outcome are not fully understood yet. We describe an outbreak of VRE colonization in 21 newborns admitted to our neonatal intensive care unit in January 2024. Microbiological analyses on rectal swabs were performed using molecular testing and culture. Results: In January, VRE was first detected in the urine culture of a 3-week-old patient, followed by a subsequent positive rectal swab result. In accordance with our infection control policy, all the NICU patients were tested, leading to the identification of another 12 colonized patients. The implementation of molecular testing led to rapid VRE identification and the subsequent isolation of colonized neonates, which promptly contained the outbreak. The median time from NICU admission to colonization was 34 (6–37) days. Only one patient developed a CVC-related bloodstream infection, which was successfully treated with linezolid and CVC removal. No VRE-related deaths occurred, even among three patients who underwent abdominal surgery (one gastroschisis, one incarcerated abdominal hernia, and one umbilical hernia) and one patient with necrotizing enterocolitis. Our data show a low infection rate (4%) among VRE-colonized patients (4%) during a NICU outbreak. The rapid identification of multidrug-resistant genes by molecular testing may be implemented in specific settings to enable timely patient identification, adopt infection control measures, and administer appropriate antimicrobial therapy. Full article

Outpatient healthcare facilities represent potential sources of healthcare-associated infections (HAIs). The purpose of this study was to survey high-contact surfaces in an outpatient physical therapy clinic, characterize the microbiome of those surfaces, and investigate the effects of a microbiome-specific cleaning and hygiene plan. Hand sanitizer containing a fluorescent probe used by patients and staff identified surface contact. High-contact surfaces were analyzed for bacterial DNA and SARS-CoV-2. A microbiome-specific cleaning and hygiene plan was developed based on initial analysis. After the implementation of the revised cleaning regimen, microbial community diversity and predicted metagenome content (PICRUSt) were employed for differential analysis. Patients had greater surface contact than staff. Ralstonia pickettii was the dominant species pre-cleaning, comprising 49.76% of the total, and observed on 79.5% of surfaces. The cleaning and hygiene plan significantly increased Shannon diversity, and R. pickettii decreased to 4.05% of total bacteria. SARS-CoV-2 was not observed on any surfaces. This study found ecological dominance by a single species in this outpatient clinic, suggesting a potential source of HAIs. However, a microbiome-specific cleaning strategy was successful in diversifying the microbiome and reducing ecological dominance. Additional research is needed to confirm these findings. Full article

Background: The increasing use of telemedicine in surgical care has shown promise in improving patient outcomes and optimizing healthcare resources. Surgical site infections (SSIs) are a major cause of healthcare-associated infections (HAIs), leading to significant economic and health burdens. A pilot study already demonstrated that RedScar© achieved 100% sensitivity and 83.13% specificity in detecting SSIs. Patients reported high satisfaction regarding comfort, cost-effectiveness, and reduced absenteeism. Methods: This multicenter prospective study will include 168 patients undergoing abdominal surgery. RedScar© utilizes smartphone-based automated infection risk assessments without clinician input. App-based detection will be compared with in-person evaluations. Sensitivity and specificity will be analyzed using receiver operating characteristic (ROC) analysis, while secondary objectives include assessing patient satisfaction and standardizing telematic follow-up. Results: This study aims to evaluate the efficacy of the RedScar© app, sensitivity, specificity in detecting SSIs. Satisfaction regarding comfort, cost-effectiveness, and absenteeism due to telematic detection and the monitoring of SSIs will be recorded too. Conclusions: This study seeks to validate RedScar© as a reliable and scalable tool for postoperative monitoring. By improving early SSI detection, it has the potential to enhance surgical recovery, reduce healthcare costs, and optimize resource utilization. Full article

Background/Objectives: Data about the relationship between COVID-19 and healthcare-associated Clostridioides difficile infection (HA-CDI) occurrence are still controversial. This study examines antibiotics associated with CDI in patients with and without COVID-19 infection. Methods: A prospective cohort study was conducted at the University Clinical Center Belgrade, Serbia, from January 2019 to December 2021. Patients with the first episode of HA-CDI without and with COVID-19 were included. Results of bacteriology analyses, demographic and clinical data, and data on antibiotic usage and daily defined doses (DDD) were collected by the hospital Infection Control Team. Results: Out of 547 HA-CDI cases, 341 (62.3%) had COVID-19 infection. HA-CDI patients with COVID-19 were significantly younger (p = 0.017) with fewer comorbidities (<0.001). Two or more antibiotics in therapy were more frequently used by those patients (p = 0.03). COVID-19 patients were treated significantly more by third- and fourth-generation cephalosporins, fluoroquinolones (p < 0.001) and macrolides (p = 0.01). Ceftriaxone had a higher median DDD in COVID-19 patients (6.00, range 1.00–20.00) compared to non-COVID-19 patients (4.00, range 1.00–14.00), (p = 0.007). Conversely, meropenem showed a lower median DDD in COVID-19 patients. Multivariate analysis identified the use of fourth-generation cephalosporins and fluoroquinolones as independent risk factors for HA-CDI in COVID-19 patients. Conclusions: Patients with HA-CDI and COVID-19 more frequently received two or more antibiotics before the onset of HAI-CDI. The third and fourth generations of cephalosporins, fluoroquinolones and macrolides were administered significantly more often in these patients. More frequent administration of ceftriaxone was observed, but the lower DDD associated with meropenem needed additional analysis. Full article

To analyze nursing interventions for preventing healthcare-associated infections (HAIs), major complications in acute care impacting length of stay, costs, morbidity, and mortality, an umbrella review was conducted between 1 February and 26 February 2024, following the Joanna Briggs Institute methodology and PRISMA reporting guidelines, resulting in the inclusion of 22 articles. The 22 final articles obtained addressed the following Centers for Disease Control and Prevention (CDC) categories: surgical site infections (e.g., skin antisepsis, antibiotic prophylaxis), catheter-related bloodstream infections (e.g., taurolidine lock solutions), ventilator-associated pneumonia (e.g., oral hygiene, semi-recumbent positioning), and catheter-associated urinary tract infections (e.g., catheter duration management). Using Neuman’s holistic framework, the review emphasized patient–environment interactions. Further primary research is needed to refine these interventions and enhance interprofessional care. The protocol was registered in PROSPERO (CRD42024506801). Full article