Severe cellulitis from methicillin-resistant Staphylococcus aureus (MRSA) in a couple of preterm twins: a case report.

BACKGROUND: Preterms are at risk of systemic infections as the barrier function of their immature skin is insufficient. The long period of hospitalization and the huge number of invasive procedures represent a risk factor for complications. Among the nosocomial infections of the skin, methicillin-resistant Staphylococcus aureus (MRSA) is associated with significant morbidity and mortality. We report a clinical case of cellulitis and abscess in two preterm twins caused by MRSA in a tertiary level Neonatal Intensive Care Unit (NICU). CASE PRESENTATION: Two preterm female babies developed cellulitis from MRSA within the first month of extrauterine life. The first one (BW 990 g) showed signs of clinical instability 4 days before the detection of a hyperaemic and painful mass on the thorax. The second one (BW 1240 g) showed signs of clinical instability contextually to the detection of an erythematous, oedematous and painful area in the right submandibular space. In both cases the diagnosis of cellulitis was confirmed by ultrasound. A broad spectrum, multidrug antimicrobial therapy was administered till complete resolution. CONCLUSIONS: Due to the characteristic antibiotic resistance of MRSA and the potential complications of those infections in such delicate patients, basic prevention measures still represent the key to avoid the spreading of neonatal MRSA infections in NICUs, which include hand hygiene and strict precautions, as well as screening of patients for MRSA on admission and during hospital stay, routine prophylactic topical antibiotic of patients, enhanced environmental cleaning, cohorting and isolation of positive patients, barrier precautions, avoidance of ward crowding, and, in some units, surveillance, education and decolonization of healthcare workers and visiting parents.

Exploring variations in IPC competencies: a cross-sectional study among healthcare professionals in Northwest China.

BACKGROUND: This cross-sectional study investigates infection prevention and control (IPC) competencies among healthcare professionals in northwest China, examining the influence of demographic factors, job titles, education, work experience, and hospital levels. METHODS: Data from 874 respondents across 47 hospitals were collected through surveys assessing 16 major IPC domains. Statistical analyses, including Mann-Whitney tests, were employed to compare competencies across variables. RESULTS: Significant differences were identified based on gender, job titles, education, work experience, and hospital levels. Females demonstrated higher IPC competencies, while senior positions exhibited superior performance. Higher educational attainment and prolonged work experience positively correlated with enhanced competencies. Variances across hospital levels underscored context-specific competencies. CONCLUSION: Demographic factors and professional variables significantly shape IPC competencies. Tailored training, considering gender differences and job roles, is crucial. Higher education and prolonged work experience positively impact proficiency. Context-specific interventions are essential for diverse hospital settings, informing strategies to enhance IPC skills and mitigate healthcare-associated infections effectively.

Infection Prevention and Control in Correctional Settings.

Correctional facilities house millions of residents in communities throughout the United States. Such congregate settings are critical for national infection prevention and control (IPC) efforts. Carceral settings can be sites where infectious diseases are detected in patient populations who may not otherwise have access to health care services, and as highlighted by the COVID-19 pandemic, where outbreaks of infectious diseases may result in spread to residents, correctional staff, and the community at large. Correctional IPC, while sharing commonalities with IPC in other settings, is unique programmatically and operationally. In this article, we identify common challenges with correctional IPC program implementation and recommend action steps for advancing correctional IPC as a national public health priority.

A quanta-independent approach for the assessment of strategies to reduce the risk of airborne infection.

The Wells-Riley model is extensively used for retrospective and prospective modelling of the risk of airborne transmission of infection in indoor spaces. It is also used when examining the efficacy of various removal and deactivation methods for airborne infectious aerosols in the indoor environment, which is crucial when selecting the most effective infection control technologies. The problem is that the large variation in viral load between individuals makes the Wells-Riley model output very sensitive to the input parameters and may yield a flawed prediction of risk. The absolute infection risk estimated with this model can range from nearly 0 % to 100 % depending on the viral load, even when all other factors, such as removal mechanisms and room geometry, remain unchanged. We therefore propose a novel method that removes this sensitivity to viral load. We define a quanta-independent maximum absolute before-after difference in infection risk that is independent of quanta factors like viral load, physical activity, or the dose-response relationships. The input data needed for a non-steady-state calculation are just the removal rates, room volume, and occupancy duration. Under steady-state conditions the approach provides an elegant solution that is only dependent on removal mechanisms before and after applying infection control measures. We applied this method to compare the impact of relative humidity, ventilation rate and its effectiveness, filtering efficiency, and the use of ultraviolet germicidal irradiation on the infection risk. The results demonstrate that the method provides a comprehensive understanding of the impact of infection control strategies on the risk of airborne infection, enabling rational decisions to be made regarding the most effective strategies in a specific context. The proposed method thus provides a practical tool for mitigation of airborne infection risk.

Assessing the impact of a cleaning programme on environmental hygiene in labour and neonatal wards: an exploratory study in The Gambia.

BACKGROUND: Effective surface cleaning in hospitals is crucial to prevent the transmission of pathogens. However, hospitals in low- and middle-income countries face cleaning challenges due to limited resources and inadequate training. METHODS: We assessed the effectiveness of a modified TEACH CLEAN programme for trainers in reducing surface microbiological contamination in the newborn unit of a tertiary referral hospital in The Gambia. We utilised a quasi-experimental design and compared data against those from the labour ward. Direct observations of cleaning practices and key informant interviews were also conducted to clarify the programme's impact. RESULTS: Between July and September 2021 (pre-intervention) and October and December 2021 (post-intervention), weekly surface sampling was performed in the newborn unit and labour ward. The training package was delivered in October 2021, after which their surface microbiological contamination deteriorated in both clinical settings. While some cleaning standards improved, critical aspects such as using fresh cleaning cloths and the one-swipe method did not. Interviews with senior departmental and hospital management staff revealed ongoing challenges in the health system that hindered the ability to improve cleaning practices, including COVID-19, understaffing, disruptions to water supply and shortages of cleaning materials. CONCLUSIONS: Keeping a hospital clean is fundamental to good care, but training hospital cleaning staff in this low-income country neonatal unit failed to reduce surface contamination levels. Further qualitative investigation revealed multiple external factors that challenged any possible impact of the cleaning programme. Further work is needed to address barriers to hospital cleaning in low-income hospitals.

Analysis of sterilizer allocation and related factors in dental health-care settings in Yunnan Province, China: a cross-sectional study.

OBJECTIVE: To investigate the status and related factors of sterilizers in dental health-care settings in Yunnan Province, with the aim of providing a theoretical basis for the health administrative department to formulate regional quality control programs and systems, proposing reasonable suggestions for optimizing the allocation of sterilizer resources in Yunnan's dental health-care settings, thereby improving resource utilization efficiency. METHODS: This cross-sectional survey was conducted in 2600 dental health-care settings in Yunnan Province in March 2020. Uni-variable linear regression, multi-variable linear regression, curve fitting and threshold effect analysis were used to understand the relationship between dental units and sterilizers. RESULTS: A total of 2600 dental health-care settings were included. The disinfection and sterilization work were mainly completed by the dental department in 1510(58.1%) institutions. 44(1.7%) institutions were not allocated sterilization equipment, and 1632 (62.8%) had only one sterilizer. The median allocation of sterilizers was 1.0. Uni-variable linear regression showed significant differences in covariates such as dental unit, dental handpiece, disinfection equipment, dentist, and dental assistant, which were more sensitive (p < 0.001) and statistically significant. The adjusted model was more stable in the multi-variable linear regression, and the differences in covariates between different settings were statistically significant. Curve fitting revealed an S-shaped curvilinear relationship between the number of dental units and sterilizers in oral healthcare settings. CONCLUSION: The disinfection and sterilization work was mainly completed by the dental department in dental health-care settings in Yunnan Province. Sterilizer allocation increases with the number of dental units, but some institutions have insufficient allocation of sterilizer and manpower resources, resulting in certain risks of infection control. Thus, it is necessary to strengthen supervision, inspection and regional quality control work in infection control of dentistry.

Public Health Response to SARS-CoV-2 in Assisted Living Facilities in New York State: March 2020-December 2022.

CONTEXT: Assisted living facility (ALF) residents are especially vulnerable to SARS-CoV-2 infection due to the age and comorbidities of the resident population and the social nature of these facilities. OBJECTIVE: To collate all New York State Department of Health guidance and regulations to control transmission of SARS-CoV-2 infection within ALFs from March 2020 through December 2022 and to include US Food and Drug Administration COVID-19 testing and vaccine authorizations. DESIGN: A narrative chronological review of all New York State Department of Health guidance. RESULTS: Documents and associated guidance and regulations are divided into 4 sections: (1) lockdown until COVID-19 vaccine emergency use authorization; (2) COVID-19 vaccine authorization until phased reopening; (3) phased reopening, vaccination requirements, and booster vaccination; (4) the period of the bivalent booster. CONCLUSION: Controlling the spread of SARS-CoV-2 within ALFs required a multifactorial approach that included stringent infection control measures, testing, and vaccination and careful attention to the social structure and support systems within ALFs. The SARS-CoV-2 pandemic highlighted the complexity of controlling spread of an easily transmissible respiratory pathogen in assisted living communities and the need to structure infection control programs within the diverse ALFs that provide care for our aging population.

Outbreak of invasive Group A streptococcus disease in a nursing home in Ireland in February 2023 caused by emm type 18.

An out-of-season increase in cases of invasive Group A streptococcus (iGAS) was observed in Ireland between October 2022 and August 2023. We describe the management of an iGAS outbreak involving three nursing home residents in Ireland in early 2023. A regional Department of Public Health was notified of an iGAS case in a nursing home resident in January 2023. When two further cases among residents were notified 7 days later, an outbreak was declared. Surveillance for GAS/iGAS infection in residents and staff was undertaken. The site was visited to provide infection prevention and control (IPC) support. Isolates were emm typed. A total of 38 residents and 29 staff in contact with resident cases were provided with antibiotic chemoprophylaxis. Seven additional staff with no direct resident contact also received chemoprophylaxis after finding one probable localised GAS infection among them. No more iGAS cases subsequently occurred.Site visit recommendations included advice on terminal cleaning and cleaning of shared equipment, as well as strengthening staff education on hand hygiene and masking. All isolates were of emm subtype 18.12, a subtype not previously detected in Ireland. Key outbreak control measures were rapid delivery of IPC support and chemoprophylaxis. Emm18 is infrequently associated with GAS infections.

A guide to removing surgical staples.

This article provides a comprehensive overview of the wound healing process, emphasising the critical role of surgical staples in primary intention healing. It outlines the four distinct phases of wound healing including haemostasis, inflammation, proliferation, and maturation - and discusses the mechanisms by which surgical staples enhance this natural biological process. Special focus is given to the aseptic non-touch technique (ANTT), which is crucial in preventing infections during the staple removal procedure. The article further explores the procedural steps involved in the removal of surgical staples and highlights the holistic aspects of patient care that need to be considered. This includes strategies for effective pain management, ensuring informed consent, and maintaining a sterile environment. By integrating clinical skills with a thorough understanding of wound care, this article aims to improve nursing practices in surgical settings, promoting better patient outcomes and recovery.

Prevención de infecciones asociadas a cuidados de la salud en pacientes quemados / Prevention of healthcare-associated Infections in burn patients

Las infecciones asociadas a cuidados de la salud (IACS) son una de las complicaciones más importantes que presentan los pacientes gran quemados. Aumentan su morbimortalidad, la duración de su estadía, el consumo de antimicrobianos y los costos hospitalarios. Las tasas reportadas de IACS son muy variables entre los distintos países y centros de atención.El ánimo de esta publicación es brindar el material necesa-rio y actualizado de las medidas de control de infecciones que se deben implementar en la atención de los quemados ya que no es fácil disponer de información sobre este tema.En la presente revisión se analizaron estudios de distin-tas poblaciones, adultos y niños, con diferentes tipos que-maduras y diversos lugares de atención. Se utilizó como material de referencia las recomendaciones vigentes de la Sociedad Internacional de injurias por Quemaduras (ISBI, por su sigla inglés) y se adicionaron publicaciones y expe-riencias de grupos de trabajo local e internacional referen-tes en el tema.Se describen cinco tipos de medidas de control y preven-ción de IACS: medidas generales, medidas de higiene am-biental, prevención de la infección de los lechos de las que-maduras, profilaxis antibiótica y medidas de prevención de neumonía, infecciones asociadas a catéteres vasculares y vesicales en quemados. Es esencial implementar un enfoque proactivo y multidisci-plinario del control de infecciones en la atención de estos pacientes, generando recomendaciones adaptadas a la realidad de cada centro de salud, destinadas a disminuir las transmisión cruzada de microorganismos, utilizar los antimicrobianos tópicos y sistémicos en forma adecuada, disminuir la multirresistencia, reducir las IACS y su mor-talidad

Healthcare-associated infections (HAIs) are one of the most important complications of severe burn patients. They increase their morbidity and mortality, length of stay, antimicrobial consumption, and hospital costs. Re-ported rates of IACS vary widely across countries and care settings.The purpose of this publication is to provide the nec-essary and up-to-date material on the infection control measures that should be implemented in the care of burn patients, since it is not easy to have information on this subject.In this review, we analysed studies of different popula-tions, adults and children, with different types of burns and different places of care. The current recommenda-tions of the International Society of Burn Injuries (ISBI) were used as reference material, and publications and experiences of local and international working groups on the subject were added. Five types of IACS control and prevention measures are described: General mea-sures, Environmental hygiene measures, Prevention of infection of burn injuries, Antibiotic prophylaxis and pre-vention measures for pneumonia, infections associated with vascular and bladder catheters in burn patients.Conclusion: It is essential to implement a proactive and multidisciplinary approach to infection control in the care of these patients, generating recommendations adapted to the reality of each health center, aimed at reducing cross-transmission of microorganisms, using typical and systemic antimicrobials appropriately, reduc-ing multiresistance, reducing HAIs and their mortality

Expert consensus on irrigation and intracanal medication in root canal therapy.

Chemical cleaning and disinfection are crucial steps for eliminating infection in root canal treatment. However, irrigant selection or irrigation procedures are far from clear. The vapor lock effect in the apical region has yet to be solved, impeding irrigation efficacy and resulting in residual infections and compromised treatment outcomes. Additionally, ambiguous clinical indications for root canal medication and non-standardized dressing protocols must be clarified. Inappropriate intracanal medication may present side effects and jeopardize the therapeutic outcomes. Indeed, clinicians have been aware of these concerns for years. Based on the current evidence of studies, this article reviews the properties of various irrigants and intracanal medicaments and elucidates their effectiveness and interactions. The evolution of different kinetic irrigation methods, their effects, limitations, the paradigm shift, current indications, and effective operational procedures regarding intracanal medication are also discussed. This expert consensus aims to establish the clinical operation guidelines for root canal irrigation and a position statement on intracanal medication, thus facilitating a better understanding of infection control, standardizing clinical practice, and ultimately improving the success of endodontic therapy.

Availability of basic infection control items and personal protection equipment in 7948 health facilities in eight low- and middle-income countries: Evidence from national health system surveys.

Background: Hundreds of millions of people become infected globally every year while seeking care in health facilities that lack basic needs like infection control measures and personal protective equipment (PPE). We aimed to evaluate the availability of infection control items and PPE in eight low- and middle-income countries and identify disparities in the availability of those items. Methods: In this study, we combined publicly available nationally representative cross-sectional health system surveys (Service Provision Assessments by the Demographic and Health Survey Programme) conducted in eight countries between 2013 and 2018: Afghanistan, Bangladesh, the Democratic Republic of the Congo, Haiti, Malawi, Nepal, Senegal, and Tanzania. The availability of infection control items was evaluated using a list of six items (a waste receptacle, a sharps container, disinfectant, single-use disposable or auto-disposable syringes, soap and running water, or an alcohol-based hand rub, and guidelines for standard precautions). PPE includes four items: gloves, medical masks, gowns, and eye protection. We considered these items available in a facility if they were observed in general outpatient areas or any service-specific area (i.e. delivery room). Results: We analysed data from 7948 health facilities (694 hospitals and 7254 health centres/clinics). Overall, among the infection control items and PPE, most surveyed facilities had high availability of single-use disposable or auto-disposable syringes (91.40%) and latex gloves (92.56%). Of infection control measures, guidelines for infection control were the least available during the survey, with the lowest (6.15%) in Nepal and the highest (68.18%) in Malawi. Of the PPE items, eye protection was the least available during the survey, with the lowest (5.4% in Senegal) and the highest (28.17%) in Haiti. Only 1567 (19.71%) facilities looked to have all the basic infection control materials, and 1023 (12.87%) of the analysed facilities possessed all of the PPE. Within the same country, the availability of items varied more between hospitals and health centres/clinics than between them. Conclusions: All eight of our study countries experience shortages of the most fundamental standard precaution items to avert infection. Steps must be taken in each of these countries to reduce inadequacies and disparities and enhance efficiency in the conversion of health-system inputs into the facility's availability of standard precaution items for infection control - to curb the risk of infectious disease transmission.

Evolution of Burn Care: Past, Present, and Future.

Burn care evolved slowly from primitive treatments depicted in cave drawings 3500 years ago to a vibrant medical specialty which has made remarkable progress over the past 200 years. This evolution involved all areas of burn care including superficial dressings, wound assessment, fluid resuscitation, infection control, pathophysiology, nutritional support, burn surgery, and inhalation injury. Major advances that contributed to current standards of care and improved outcomes are highlighted in this article. New innovations are making possible a future where severe burn injuries will require less morbid interventions for acute care and outcomes will restore patients more closely to their pre-injury condition.

A retrospective cohort study of the impact of COVID-19 infection control measures on surgical site infections in an academic hospital setting.

Previous studies show that both the frequency of surgeries and incidence of surgical site infections (SSIs) have been lower during the coronavirus disease 2019 (COVID-19) pandemic. This study's purpose is to analyse the possible association of the COVID-19 epidemic-related increased health measures, such as protective equipment and products, increased hand hygiene and restrictions imposed, on the incidence of SSIs in an academic medical centre. We designed a single-centre, retrospective cohort study and collected data on the frequency of surgeries and the incidence of SSIs, among patients who had surgeries pre- and post-COVID-19 pandemic. Besides the intervention and outcome variable, we sought information on patient gender, surgery type, body mass index (BMI), smoking, and type II diabetes mellitus. We used Wald 95% confidence interval (95% CI) and the p values of the odds ratio (OR) to report results. Of the N = 24 098 surgeries performed in this hospital, there were 269 patients who reported post-surgical SSIs in this hospital between March 2019 and March 2021. The OR of developing a post-surgical SSI was 0.40 (95% CI: 0.33-0.57, p < 0.05; adjusted for confounders 0.39 [95% CI: 0.30-0.52, p < 0.05]) among patients who had surgery under post-pandemic infection control measures, as compared to patients who had surgery under pre-pandemic usual care infection control measures. Our significant results conclude that an association may exist between the enhanced infection control measures used during the COVID-19 pandemic and lower incidence of SSIs we observed during this period.

Compliance with infection prevention and control standard precautions and factors associated with noncompliance among healthcare workers working in public hospitals in Addis Ababa, Ethiopia.

BACKGROUND: Standard Precautions (SPs) are the minimal infection prevention and control (IPC) measures that apply to all patient care activities at all times, regardless of whether the patient has a suspected or proven disease, in any place where healthcare service is provided. These evidence-based practices protect healthcare workers (HCWs) from infection while preventing the spread of infectious agents among patients, visitors, and the environment. OBJECTIVES: Assessed compliance of HCWs working in public hospitals in Addis Ababa to infection prevention and control SPs, and factors associated with noncompliance. METHODS: In a hospital-based cross-sectional study, 422 HCWs were recruited from nine public hospitals in Addis Ababa using a stratified random sampling technique. Data were collected using self-administered questionnaires, entered into a computer using Epi data, and analyzed using SPSS version 25. The association between the independent and the outcome variables was investigated using logistic regression. Odd ratios with corresponding 95% confidence intervals (CI) were used as measures of the strength of the association between the outcome and the explanatory variables. A p-value below 5% was considered an indicator of statistical significance. RESULTS: The level of knowledge of HCWs about IPC and SPs was 51.9% and 36.49% of the respondents were compliant with SPs. Receiving IPC Training [Adjusted Odds Ratio (AOR) = 1.81, 95% CI 1.06, 3.09], knowing SPs [AOR = 3.46, 95% CI = 1.83, 6.54], presence of a mechanism in the hospital to enforce the IPC practices [AOR = 1.71 95% CI = 1.01, 2.89], and availability of cleaning and disinfection chemicals in the hospital [AOR = 2.18, 95%CI = 1.15, 4.13] were significantly associated with the HCWs' compliance with SPs. CONCLUSION: Compliance with IPC standard precautions of HCWs in public hospitals of Addis Ababa is suboptimal. Working in medical units, less work experience, lack of training, poor knowledge, absence of a mechanism to enforce adherence, and inadequate resources are independent predictors for non-compliance of the HCWs.

Telodendrimer functionalized hydrogel platform for sustained antibiotics release in infection control.

Wound infection commonly causes delayed healing, especially in the setting of chronic wounds. Local release of antibiotics is considered a viable approach to treat chronic wounds. We have developed a versatile telodendrimer (TD) platform for efficient loading of charged antibiotic molecules via a combination of multivalent and synergistic charge and hydrophobic interactions. The conjugation of TD in biocompatible hydrogel allows for topical application to provide sustained antibiotic release. Notably, a drug loading capacity as high as 20 % of the drug-to-resin dry weight ratio can be achieved. The payload content (PC) and release profile of the various antibiotics can be optimized by fine-tuning TD density and valency in hydrogel based on the charge and hydrophobic features of the drug, e.g., polymyxin B (PMB), gentamycin (GM), and daptomycin (Dap), for effective infection control. We have shown that hydrogel with moderately reduced TD density demonstrates a more favorable release profile than hydrogel with higher TD density. Antibiotics loaded in TD hydrogel have comparable antimicrobial potency and reduced cytotoxicity compared to the free antibiotics due to a prolonged, controlled drug release profile. In a mouse model of skin and soft tissue infection, the subcutaneous administration of PMB-loaded TD hydrogel effectively eliminated the bacterial burden. Overall, these results suggest that engineerable TD hydrogels have great potential as a topical treatment to control infection for wound healing. STATEMENT OF SIGNIFICANCE: Wound infection causes a significant delay in the wound healing process, which results in a significant financial and resource burden to the healthcare system. PEGA-telodendrimer (TD) resin hydrogel is an innovative and versatile platform that can be fine-tuned to efficiently encapsulate different antibiotics by altering charged and hydrophobic structural moieties. Additionally, this platform is advantageous as the TD density in the resin can also be fine-tuned to provide the desired antibiotic payload release profile. Sustained antibiotics release through optimization of TD density provides a prolonged therapeutic window and reduces burst release-induced cytotoxicity compared to conventional antibiotics application. Studies in a preclinical mouse model of bacteria-induced skin and soft tissue infection demonstrated promising therapeutic efficacy as evidenced by effective infection control and prolonged antibacterial efficacy of antibiotics-loaded PEGA-TD resin. In conclusion, the PEGA-TD resin platform provides a highly customizable approach for effective antibiotics release with significant potential for topical application to treat various bacterial wound infections to promote wound healing.