bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of Environmental Decontamination of Surfaces Using Continuous Application of Low-Level Hydrogen Peroxide
Authors: Garcia Robert 
Published: November 2020

Background: Pathogens that remain on healthcare surfaces after standard cleaning have been reported to cause 10%–30% of all healthcare-associated infections among admitted patients. The study reported here evaluated the effect of a continuous application of low-level gaseous hydrogen peroxide (H2O2) on microbial surface contamination in a pulmonary specialty unit (PSU) of a large magnet-designated urban hospital. Methods: A baseline surface contamination level was measured by obtaining cultures of 5 high-touch points in 8 patient rooms, a nurse’s station, and a nurse’s charting room to determine the bacterial and fungal microbial burden levels (period 1). No revisions to cleaning practices were made during any period. Also, 8 continuous decontamination devices were installed in the HVAC near the area to be treated. The devices convert humidified air into predominately H2O2, which then exited the ducts, covering all surfaces. Environmental sampling was conducted every 4 weeks for 4 months after activation to measure the effects on the intrinsic microbial burden on surfaces as well as the incidence of MRSA and VRE (periods 2–5). In addition, the unit manager tracked the level of absenteeism of employees in the PCU during the trial to compare results to the same 4-month period from the prior year. Results: In concert with regular cleaning and disinfecting practices, the average bacterial microbial burden levels found on 52 locations prior to the activation of the devices were 6,446 CFU/1002. Incidence of MRSA and VRE were 31% and 10%, respectively. During the intervention, the levels of both bacterial and fungal microbial burden on surfaces were significantly lower, as was the incidence of MRSA and VRE. The continuous application of low-levels of oxidizing molecules exerted a significant 78% and 97% reduction in the average bacterial and fungal microbial burden found on PSU surfaces (1,415 CFU/100 2 and 328 CFU/1002 for bacteria and fungi, respectively). The incidences of MRSA and VRE on surfaces were reduced by 63% and 70%, respectively. In addition, the unit manager reported a significant decline in absenteeism, with a reduction of 550 hours (1,313 vs 752) during the 4-month trial versus the same 4-month period the previous year. Conclusions: The introduction of continuous low-level gaseous H2O2 on all surfaces throughout a PSU reduced the overall bacterial and fungal microbial burden as well as lowered the incidence of both MRSA and VRE on surfaces, and it reduced employee absenteeism, providing a potentially safer environment for patients, staff, and visitors.Funding: NoneDisclosures: None
Evaluation of Sampling Methods for Detection of Pathogens from Steel Surfaces; Contact Plates, Foam Swabs, and Flocked Swabs
Authors: West Rolieria , Rose Laura , Noble-Wang Judith 
Published: November 2020

Background: Contaminated healthcare surfaces can serve as reservoirs for the transmission of pathogens. Sensitive sampling methods are needed to investigate sources of pathogens for implementing effective disinfection strategies and thereby preventing environmental transmission. Conventional approaches employ swabs to sample environmental surfaces. Contact plates represent an alternative approach for sampling healthcare surfaces that does not require lab processing, though little is known about their performance. A contact plate is an agar plate that is overfilled with selective or nonselective media. It can be gently applied to the surface, then simply incubated at a temperature optimal for target organism (s), thus saving time and resources. Methods: In this study, contact plates containing trypticase soy agar with 5% sheep blood (TSAII), foam swabs, and flocked swabs were evaluated for their ability to recover 4 pathogens that persist on healthcare surfaces. Stainless-steel coupons (4 in2) were inoculated with the following pathogens (102 CFU): Acinetobacter baumannii (AB, strain type 12), carbapenemase-producing KPC+ Klebsiella pneumoniae (KP; ATCC BAA-1705); methicillin-resistant Staphylococcus aureus (MRSA; ATCC 43300); and vancomycin-resistant Enterococcus faecalis (VRE; Van A + 256). The plates were allowed to dry 1 hour. Sampling with CPs was performed in 2 ways; (1) a single contact plate was used to sample 1 stainless-steel surface and (2) a composite was collected by 3 sequential contact-plate samplings of the same stainless-steel surface. The contact plates were then incubated at 351C. Foam and flocked swabs were premoistened with phosphate-buffered saline + 0.02% polysorbate 80 (PBST) and were used to sample the stainless-steel coupons. Swabs were held for 1 hour and processed by sonication and vortexing in 5 mL of PBST, then the eluent was cultured and CFU counted. Mean percentage recoveries (%R) relative to the inoculum were calculated and compared. Results: When the %R for all 4 pathogens were pooled, the composite contact-plate sampling method yielded the highest, (P < .05) (66.0%; SD, 0.22), followed by the single contact plate method (39.7%; SD, 0.12), foam swab (32.9%; SD, 0.18), and flocked swab (20.3%; SD, 0.20). The composite contact plate method yielded the highest %R for VRE (102.1 %; SD, 0.17), and the lowest %R was observed when using flocked swabs to recover KP (6.3%; SD, 0.05). Conclusions: The contact-plate composite method may provide investigators with minimal environmental microbiology capacity an alternative method for environmental sampling and detection of organisms from surface areas (4 in 2) with low bioburden.Funding: NoneDisclosures: None
Evolution of Healthcare-Associated Infections and Antibiotic Resistance Programs in US Health Departments, 2009–2018
Authors: Ashley Michael , Gumbis Stephanie , Hunter Jennifer C. , Perz Joseph 
Published: November 2020

Background: Domestically, the integration of public health into healthcare-associated infection (HAI) and antibiotic resistance (AR) prevention activities represents a major development. We describe CDC Funding: of public health HAI/AR programs through the Epidemiology and Laboratory Capacity (ELC) cooperative agreement to improve local capacity to prevent HAIs and detect and contain the spread of AR threats. Methods: We reviewed ELC budget reports and program documents to summarize the evolution of funded activities and programs from 2009 to 2018. Results: In 2009, 51 programs (49 states, 2 cities and territories) received US$35.8 million through the American Recovery and Reinvestment Act for an initial 28-month period. These funds supported each jurisdiction to establish an HAI coordinator and a multidisciplinary HAI advisory group, coordinate and report HAI prevention efforts, conduct surveillance and report HAI data, and maintain an HAI plan; ~27 programs were also funded to coordinate multicenter HAI prevention collaboratives among acute-care hospitals. Through 2011, 188 state or local HAI/AR program positions were at least partially funded by the CDC. From 2011 to 2015, investments from the Affordable Care Act (~US$10–11 million annually) were used to maintain the HAI/AR programs, with some expansion of program goals related to non–acute-care settings and antibiotic stewardship. In 2015, following the Ebola outbreak in West Africa, supplemental ELC funds were awarded to 61 programs (50 states, 11 cities and territories) totaling US$85 million over 36 months. These awards marked an expansion of HAI/AR program activities to develop healthcare provider inventories, to conduct data-driven education and training, and to perform onsite infection control assessments in healthcare facilities. In 2016, through its AR Solutions Initiative, CDC invested US$57.3 million in Funding: to 57 programs (50 states, 7 cities and territories), expanding laboratory capacities for AR threat detection (via the AR Laboratory Network) and epidemiologic activities to rapidly contain novel and targeted multidrug-resistant organisms. As of 2018, >500 state or local HAI/AR program positions were at least partially funded by the CDC. Conclusions: State and local HAI/AR programs have grown substantially over the 10 years of their existence, as reflected in major increases in funding, staffing, scope, and partnerships. CDC investments and guidance have supported the development of HAI/AR epidemiology prevention and response capacity.Funding: NoneDisclosures: None
Finding The Source Of Bacterial Sepsis And Its Impact On Sepsis Related Outcome, The Bundle That Fumble
Authors: Garg Rahul , shaw Tushar , K.E Vandana , Mukhopadhyay Chiranjay 
Published: November 2020

Background: Sepsis is currently one of the important global health issues due to its complexity from pathophysiologic, clinical, and therapeutic viewpoints. Most sepsis-related studies are from the West, where all the patients were grouped together failing to identify specific patient populations that may actually benefit from a particular intervention. We investigated the characteristics and impact of the source of infection on sepsis-related ICU outcomes among critically ill adult patients Methods: A prospective ICU based observational study was conducted over 15 months in a tertiary-care hospital in southern India. Our study included all critically ill patients (18 years old) who were admitted either with existing a new episode of sepsis with suspected or documented bacterial infections within 24 hours of ICU admission with SOFA score 2. Basic demographics, the clinical presentation with the anatomical site of infection and outcome were noted. Categorical variables were compared using the 2 test, and continuous variables were compared using 1-way analysis of variance (ANOVA). Cox regression was used to determine the effect of sepsis source on 28-day mortality. Results: Among the 4,548 patients screened during the study period, 400 were recruited, with a mean age of 55.716 years, among whom 276 (61%) were men. The mean SOFA score at admission was 9.92.7. Bacteremia was observed among 99 cases (24.8%), predominantly gram-negative sepsis (65 of 99, 65.6%). The source for blood culture positivity was determined in 48 of 99 cases (48.4%). Successful isolation of the bacteria was achieved from other anatomical sites in 115 patients (37.8%) where blood culture remained negative. The most common source of sepsis was lung (67 of 400, 16.7%) followed by skin and soft-tissue infection (56 of 400, 14%). Patients treated with steroids were more prone to develop a respiratory infection (P = .001), whereas renal impairment was correlated with urinary tract infection (P = .001). Patients with respiratory infections had a longer ICU stay (P < .001). The overall in-hospital mortality was 37.2%. Multivariable Cox regression showed patients with genitourinary infection (HR, 2.23; P = .04) and implantable devices (HR, 11.30; P = .17) were at higher risk of death. Conclusions: Site-specific infection was a significant predictor of mortality in our study. These factors should be taken into consideration and warrant further evaluation to understand their specific roles in adverse outcomes among a cohort of patients diagnosed with sepsis.Funding: NoneDisclosures: None
Hand Hygiene In and Out: Compliance and Sustainability Are Possible: 90/90 Program in a Mexican Tertiary-Care Center
Authors: González Roxana Trejo , Salcido Miguel Ángel García , Antunez Diana Palami , Handal Reyna Yacaman 
Published: November 2020

Background: The American British Cowdray Medical Center I.A.P., also known as ABC Medical Center, is a highly specialized hospital and private assistance institution located in Mexico City. The ABC Medical Center implemented hand hygiene policies since around 2009, when Mexico committed to patient security. However, hand hygiene compliance remained low. Methods: The objective of the Hand Hygiene 90/90 program was to increase hand hygiene compliance through an integral strategy including a multidisciplinary team with leaders from different areas (nursing, physicians, human resources, quality, and educators). It was named 90/90 because it aimed to accomplish a 90% hand hygiene compliance among all health providers and hospital staff in 90 days (October 1–December 29) upon entering and exiting patient rooms (ie, In & Out). The Hand Hygiene 90/90 program led by the epidemiology area consisted of 5 specific components: management, supplies, education, monitoring, and social marketing (Fig. 1). For a period of 90 days, several permanent actions were implemented; they had a positive influence on the expected outcome (Fig. 2). Results: The starting point at the ABC Medical Center upon launching the program was 70% compliance. With the Hand Hygiene 90/90 program, the first steady change was observed at the end of November 2012 (ie, the sixth measurement point). An 88% compliance was achieved, all compliance was >50% from this point on. The highest compliance was achieved among health providers (doctors and nurses), followed by administrative staff. At the end of December 2012, 91% compliance was achieved by all health providers and hospital staff. Sustainability has been possible over the years through ongoing hand hygiene campaigns. In the 5 years following the implementation of the program, hand hygiene compliance remained mostly below the 90% standard (Fig. 3). Conclusions: An intervention for continuous improvement and hand hygiene compliance using the WHO 5 Moments was implemented throughout 2018, (in addition to the In & Out program). This intervention also incorporated elements of the WHO Multimodal Strategy 1 to develop a comprehensive hand hygiene program together with new indicators. The ABC Medical Center, with the support and leadership of the Ministry of Health, aims to become an example of institutions that achieve national and international benchmarks in the implementation of patient safety programs that are not only successful but also sustainable.Funding: NoneDisclosures: None
Hand Hygiene in Acute Care Hospitals—Evaluation of 12 Years National Hand Hygiene Campaign in Germany
Authors: Kramer Tobias , Bunte Karin , Walter Janine , Schroeder Christin , Behnke Michael , Gastmeier Petra 
Published: November 2020

Background: Hand hygiene is one of the most effective measures to prevent healthcare-associated infections and transmission of multidrug-resistant organisms in healthcare settings. The WHO proposes a multimodal intervention strategy to improve hand hygiene in healthcare settings. In 2008, a voluntary national campaign for hand hygiene was implemented in the German healthcare system. The objective of this study was to evaluate participation, practices, and performance of hand hygiene in German acute-care hospitals. Methods: In 2008 a national hand hygiene campaign began in Germany. Based on voluntary participation, the campaign’s goal was to implement the WHO 5 Moments model, to establish a national surveillance system for compliance to hand hygiene, to improve availability of alcohol-based hand-rub (ABHR) dispensers at points of care, and to implement interdisciplinary executive boards at each hospital to ensure sustainable implementation. Annual data on ABHR consumption and patient days (PD) were collected within the national surveillance system (HAND-KISS) on the individual ward level and were validated. Direct observation of compliance was performed according the recommendations of the WHO. Results: Overall, 1,047 of 1,942 acute-care hospitals in Germany participated in the national hand hygiene campaign in 2018, covering 81,571,917 patient days. Moreover, 9,360 regular wards (RWs), 338 intermediate care units (IMCs) and 1,342 intensive care units (ICUs) provided data on ABHR consumption. Between 2007 and 2018 in the ICU, ABHR consumption increased continuously from 70 mL/PD (IQR, 52–98) to 129 mL/PD (IQR, 102–162). In intermediate care units, ABHR consumption increased from 40 mL/PD (IQR, 15–54) to 67 mL/PD (IQR, 46–95), and on regular wards, ABHR consumption increased from 14 mL/PD (IQR, 10–21) to 29 mL/PD (IQR, 22–39). These increases were especially pronounced in wards that continuously provided annual data for ABHR consumption over the past 12 years. In 2014, electronic documentation for direct observation of compliance to hand hygiene was established. From 2014 until 2018, 1,598,209 opportunities were observed on 1,907 wards of 422 hospitals. The median directly observed compliance in 2018 was 76% (IQR, 66%–84%). Median compliance to the 5 Moments was 71% (IQR, 57%–82%) before touching a patient, 68% (IQR, 51%–85%) before clean or aseptic procedures, 83% (IQR, 72%–92%) after body fluid exposure or risk, 84% (IQR, 75%–90%) after touching a patient, and 74% (IQR, 61%–84%) after touching patient surroundings. Conclusions: The WHO multimodal intervention strategy has been successfully established in German acute-care hospitals. A surveillance system for ABHR consumption and direct observation of compliance to hand hygiene are widely used by hospitals in Germany. Hand hygiene practices have significantly improved in the German healthcare system.Funding: NoneDisclosures: None
Health Department Authorities to Assist Healthcare Facilities with Outbreaks or High HAI Rates—Preliminary Assessment, 2018
Authors: Shrivastwa Nijika , Perz Joseph , Hunter Jennifer C. 
Published: November 2020

Background: Health departments have been increasingly called upon to monitor healthcare associated-infections (HAIs) at the hospital- or facility-level and provide targeted assistance when high rates are identified. Health department capacity to effectively respond to these types of signals depends not only on technical expertise but also the legal and regulatory authority to intervene. Methods: We reviewed annual reports describing HAI and antibiotic resistance (HAI/AR) activities from CDC-funded HAI/AR programs for August 2017 through July 2018. We performed a qualitative data analysis on all 50 state health department responses to a question about their regulatory and legal authority to intervene or assist facilities without invitation when outbreaks are suspected (as determined by the health department) or high HAI rates have been identified (eg, based on NHSN data). Results: When an outbreak is identified, 31 health departments (62%) indicated that they have the authority to intervene without invitation from a facility and 8 (16%) did not specify. Among the 11 health departments (22%) that indicated that they do not have this authority, 5 (45%) states noted that they operate under decentralized systems in which the local health department can intervene in outbreak situations and the state health department is available to assist. When a health department identifies high HAI rates, 14 health departments (28%) indicated that they have the authority to intervene without invitation, 22 (44%) indicated that they do not, and 14 (28%) did not specify. Among those in the latter categories, 3 stated they can work through their local health departments, which do have this authority and 8 described working through partners (eg, State Hospital Association, n = 3 or State Healthcare Licensing Agency, n = 5). Discussion: Assistance from state health departments (eg, HAI/AR programs) in the context of outbreaks and high HAI rates has value that is usually well recognized and welcomed by healthcare facilities. Nonetheless, there are occasions when a health department might need to exert its authority to intervene. The preliminary analysis described here indicated that this authority was more commonly self-reported in the context of outbreaks than when high HAI rates are identified. These 2 situations are connected, as high rates might be indicative of unrecognized or unreported outbreak activity, and these issues may benefit from further analysis.Funding: NoneDisclosures: None
How to Convince People and Get Adherence to Hand Hygiene Practices? The Success of Ozires, the Humanoid Robot!
Authors: Couto Braulio , Machado Amanda , Barbosa Ana Clara , Mendes Bruna , Nogueira Maria da Glória , Peixoto Maria Luiza , Alvim André , Romaniello Jeruza , Alves Adriana , Batista Bruno , Covello Luciana , Starling Carlos 
Published: November 2020

Background: Our team has been fighting nosocomial infections since 1991. During our journey, we often ask why people do not wash their hands! Semmelweiss discovered in the 1840s that handwashing prevented deaths from puerperal sepsis, but we still need to convince healthcare workers about hand hygiene. One answer is that washing hands is an unsophisticated gesture, without any technology, so people just do not do it. How can we improve compliance with hand hygiene? We imagined a robot in our team to remind people to wash their hands. Then, in 2016 we met Meccanoid, a US$200 toy robot: a 4-foot-tall programmable humanoid robot with voice recognition capabilities. We made adaptions in the robot (mini-projector + audio amplifier + alcohol dispenser + spy camera), and we gave him a name (Ozires) and a purpose: He became a professor who teaches healthcare workers how, when, and why wash their hands! Here, we describe the multimodal strategy centered around Ozires. Methods: The multimodal strategy consists of 7 key elements: (1) the robot, accompanied by a infection control practitioner, performs audio and video lectures about hand hygiene techniques, motivational videos, data feedback; (2) the robot’s wood copies with sound alert with motion detector for hand hygiene are spread out in the whole hospital; (3) fridge magnet with robot prints (gifts for patients and healthcare professionals); (4) app for hand hygiene monitoring (Hands Clean); (5) adherence rates by professional category and individual feedback; (6) patient empowerment for hand hygiene; and (7) sound alert for hand hygiene in the patient room’s door. Results: After the insertion of Ozires in 3 ICUs of hospital A (pilot study), the hand hygiene (HH) rate increased from ~36%, between January and July 2016, to ~68% between August 2016 and October 2019. At hospital B, Ozires started his lectures in May 2018, throughout the hospital. Hand hygiene adherence increased from 23% between July and December 2017 to 60% between June 2018 and October 2019. In the 3 months before this multimodal strategy was implemented in hospital C (June–August 2019), and the mean rate of hand hygiene was 65%. With the robot, the hand hygiene rate increased to 94% (September–October 2019). Conclusions: The multimodal strategy centered around the robot Ozires works! Hand hygiene compliance increased significantly after the interventions. People listen the robot much more attentively than to their human colleagues, and healthcare worker behavior changed! We need to go further improve the program, but it is sustainable. Finally, we succeeded in convincing people to improve their hand hygiene practices.Funding: NoneDisclosures: None