COVID-19 Personal Protective Equipment in the Home: Navigating the Complexity of Donning and Doffing.

PURPOSE: The safety of care professionals and patients is paramount while caring for people with infectious diseases, including those with confirmed or suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronavirus disease 2019 (COVID-19). Existing policies and protocols for donning and doffing personal protective equipment (PPE) are primarily for institutional settings such as hospitals, not for home visits for patient care. We describe a protocol for donning and doffing PPE in home settings. METHODS: We used an iterative, rapid-prototyping approach to develop the protocol. A small workgroup created preliminary drafts, drawing on hospital-based protocols and modifying them, while undertaking simulations. Wider input was solicited via 2 webinars; 1 regional (Hamilton, Ontario) with palliative clinicians, and 1 national (Canada) with varying professions. We also consulted a group of infectious disease experts. A "how-to" video accompanies the protocol. RESULTS: Twelve versions of the protocol were produced, with major changes occurring within the first 6 versions. A national webinar mid-development provided further validation and minor modifications. Subsequent versions involved minor changes. The protocol has 4 phases: (1) Preparing, (2) Entering the Home, (3) Leaving the Home, and (4) After the Visit and Reprocessing. In addition to PPE-related equipment, the protocol requires additional materials including 2 pails for transporting supplies, plastic bags, hand sanitizer, disinfectant wipes, and printed easy-to-use checklists. CONCLUSIONS: This protocol addresses gaps in COVID-19-related guidelines, specifically the process of donning and doffing PPE during home visits while supplementing jurisdictional PPE guidelines and protocols.Appeared as Annals "Online First" article.

Correlating incidence densities and point-prevalence for the surveillance of catheter-associated urinary tract infections.

We aimed to validate the use of point-prevalence to identify catheter-associated urinary tract infections against the gold standard of incidence densities. We did not find a significant association, and hence our findings do not support the common practice of using point-prevalence as a less resource intensive method for catheter-associated urinary tract infections surveillance.

Hand hygiene knowledge, attitudes, and practices among hospital inpatients: A descriptive study.

BACKGROUND: Pathogens may be transmitted in hospitals via patients' own hands, but little is known about the facilitators and barriers of hand hygiene among inpatients. This study aimed to assess the hand hygiene knowledge, attitudes, and practices of adult inpatients at 5 hospitals. METHODS: The study consisted of a cross-sectional survey distributed followed by structured interviews with randomly selected inpatients. Qualitative data were analyzed independently by 2 researchers using the Theoretical Domains Framework. RESULTS: A total of 268 surveys were completed, with 66.4% of patients reporting always performing hand hygiene after toileting and 49.2% before eating. The majority of patients (74.6%) stated that they did not want to receive more information about hand hygiene while in the hospital. Key themes identified from 23 interviews include knowledge; environmental context and resources; memory, attention, and decision processes; and social influences. CONCLUSIONS: Self-reported patient hand hygiene rates are suboptimal and there are knowledge gaps among patients as to when to perform hand hygiene, but patients are not receptive to receiving traditional educational interventions. Future interventions to improve patient hand hygiene should focus on other behavior change domains, including environmental context and resources (eg, access to hand sanitizer at the bedside), memory, attention, and decision processes (eg, posters or other reminders), and social influences (eg, role modeling).

Vancomycin-resistant enterococcus (VRE) transmission and risk factors in contacts of VRE carriers.

During a 2-year period, the vancomycin-resistant enterococcus (VRE) acquisition rate was 10.9% (40/368) in patients who had shared a room with a newly detected VRE carrier. Exposure to vancomycin and to anti-anaerobic antibiotics were identified as independent risk factors for VRE acquisition. Sensitivity of the first rectal VRE screening was less than 50%.

Algorithm to reduce unnecessary isolation days in patients with a history of colonization by antimicrobial-resistant organisms.

To determine the need of isolation precautions upon admission, we created and tested an algorithm based on a total of 474 patients with a history of carriage of an antibiotic-resistant organism. Using the algorithm upon patient admission reduced unnecessary isolations by almost 60% while maintaining a high sensitivity to predict persisting antibiotic-resistant organism colonization.

Quality control is indispensable for automated dilution systems with accelerated hydrogen peroxide.

BACKGROUND: Hamilton Health Sciences (HHS) is a large teaching hospital with over 1000 beds consisting of three acute care sites, one regional cancer center and two rehabilitation/complex chronic care facilities. The use of chemical dilution control systems to dilute concentrated accelerated hydrogen peroxide (AHP) disinfectant to an ideal strength for effective environmental decontamination is a growing trend in healthcare. These systems, compared to manual dilution methods, are economical, efficient and promote a safer workplace. However, quality control (QC) and preventative maintenance standards to ensure performance are lacking in the environmental and healthcare cleaning industries. The automated systems used to dilute concentrated AHP products for disinfection cleaning were assessed for reliability at HHS-Henderson acute care site. METHOD: The control systems used on three clinical units to dilute concentrated AHP products, 7% Percept at 1:16 dilution (0.5%) and 3% PerDiem at 1:256 dilution (0.01%), were evaluated daily for reliability over 30 days. Virox AHP indicator test strips were used once a day to check use-dilution of Percept at 5000 parts per million (ppm) AHP and PerDiem at 100 ppm AHP.QC was repeated if the initial test was outside the acceptable range. Vendor service was arranged for the dilution system when repeat QC failed. Ready-to-use AHP product was employed until the system was functional. RESULTS: Overall, nine QC failures were detected on all systems during a 30-day testing period, specifically, five failures on one system, three on the second and one on the third. Seven failures involved Percept with results at < or =500 ppm, well below the acceptable 5000 ppm concentration, and two involved PerDiem at 500 ppm, well above the required concentration. CONCLUSION: Disinfectants must be used in the dilution specified by the manufacturer for optimal decontamination. Although there are benefits with using automated dilution systems in healthcare settings, findings show that attention must be given to quality control and preventative maintenance to ensure optimum results.

Use of a fluorescent chemical as a quality indicator for a hospital cleaning program.

BACKGROUND: Hamilton Health Sciences is a large teaching hospital with over 1,000 beds and consists of three acute care sites, one Regional Cancer Center and two Rehabilitation/Chronic Care facilities. An environmental cleaning pilot project was initiated at the acute care Henderson site, following an outbreak of vancomycin-resistant Enterococcus (VRE). Healthcare-associated infections (HAI) due to antibiotic-resistant organisms are increasing in Southern Ontario. Environmental cleaning plays a key role in eradicating resistant organisms that live in hospital environments, thereby helping to reduce HAIs. The environmental cleaning practices on the Orthopaedic Unit were identified as a contributing factor to the VRE outbreak after visual assessments were completed using a Brevis GlitterBug product, a chemical that fluoresces under an ultraviolet (UV) lamp. These findings led to a hospital-wide cleaning improvement initiative on all units except critical care areas. The GlitterBug potion was employed by Infection Control and Customer Support Services (CSS) as a tool to evaluate the daily cleaning of patient washrooms as well as discharge cleaning of contact precaution isolation rooms. METHOD: Over a four-week period, the GlitterBug potion was applied to seven frequently touched standard targets in randomly selected patient bathrooms on each unit and 14 frequently touched targets prior to cleaning in the rooms used for isolation. The targets were then evaluated using the UV lamp to detect objects that were not cleaned and the results were recorded on a standardized form. The rate of targets cleaned versus the targets missed was calculated. RESULTS: The overall rate for daily cleaning of bathrooms and cleaning of isolation rooms was poor with only 23% of the targets cleaned. Based on these findings, several interventions were implemented. This resulted in a significant improvement in cleaning practices during the pilot project. Greater than 80% of the targets were cleaned compared to the baseline findings of 23%. Subsequently, nosocomial cases of VRE have declined despite the increased prevalence of VRE in the Hamilton and surrounding regions. CONCLUSION: The GlitterBug product is an effective tool to evaluate environmental cleaning and adherence to policies and procedures and this method was superior to previous visual inspection methods. The use of GlitterBug potion improved physical cleaning and enhanced staff contribution. The Brevis GlitterBug product was incorporated into the CSS environmental cleaning program at Hamilton Health Sciences as a quality indicator to monitor environmental cleaning practices.