bluuebunny/crossref_metadata_2025_split huggingface dataset:
Experience of Treating Candida auris Cases at a General Hospital in Qatar
Authors: Shaukat Adila , Visan Feah , Al Ansari Naser , Al Wali Walid , Hamed Manal , Elmadhoun Ihab , Mitwally Hassan , Karic Edin 
Published: November 2021

Background: So far, there have been no studies on Candida auris in Qatar. We describe the clinical spectrum and outcome of C. auris infection in patients admitted to a general hospital in Qatar. Methods: We conducted this descriptive observational study in a general hospital in Qatar. We have included all patients with C. auris infection and colonization admitted to a general hospital from December 2018 to August 2019. Results: We identified 13 patients with confirmed C. auris infection or colonization, of whom 5 cases represented an actual C. auris infection, while the remaining 8 cases were considered colonization. The mean age of the patients with infection was 76.6 years (SD, ±8.4), while the mean age of the patients with colonization was 66.4 years (SD, ±24.7). Among the individuals clinically infected with C. auris, 2 had urinary tract infections, 1 had candidemia, 1 acquired a soft-tissue infection, and 1 had a lower respiratory tract infection. All strains of C. auris were susceptible to echinocandins, flucytosine, and posaconazole while resistant to fluconazole and amphotericin B. Of the patients with C. auris infection who received systemic antifungal therapy, 3 (60%) died during antifungal therapy. Conclusions: Our study showed that C. auris can cause a wide variety of invasive infections, including bloodstream infection, urinary tract infection, skin infection, and lower respiratory tract infections, especially in critically ill patients. In addition, our isolates showed resistance to the most common antifungal agents such as fluconazole and amphotericin B.Funding: NoDisclosures: None
Damaged Hospital Mattresses and Bed Frames Are Common in Acute-Care Hospitals
Authors: Hooker Edmond 
Published: November 2021

Background: Hospital beds are now high-tech, reprocessable, medical devices. The surface of the mattress (cover) is manufactured using polyurethane-coated fabric to ensure moisture-vapor transmission to prevent pressure ulcers. In recent years, due to multidrug-resistant organisms, healthcare organizations have used increasingly harsh chemicals to clean these mattresses. None of these chemicals are approved for use on polyurethane-coated fabric. Previous research has shown that many mattresses in hospitals are damaged. The US Food and Drug Administration, Centers for Disease Control and Prevention, ECRI, and manufacturers recommend routine mattress inspection and replacement of mattresses with any visible signs of stains, wear, or damage. Damaged mattresses have been linked to fluid leakage, resulting in patient exposure and outbreaks of healthcare-acquired infections. Methods: Four hospitals of a midwestern hospital system had all of their mattresses inspected for damage and staining to the mattress. After external examination, each mattress was opened, and the mattress core was evaluated for damage. The cover of each mattress was examined using the naked eye and then using an LED light to demonstrate smaller holes. Each bed frame was examined for evidence of rust, and the amount of rust was recorded. If available, the age of the mattress was determined based on a label on the mattress. Results: In total, 727 beds and mattresses were inspected. Of these mattresses, 523 (72%) were damaged. Also, 340 (47%) required replacement of the mattress cover, and 183 (25%) required replacement of the entire mattress (cover and core). For the 209 damaged mattresses (40%) with the date of manufacture label, 156 (75%) were <4 years old. Damage to the mattress included 428 (59%) with holes in the cover: 113 (16%) were visible to the naked eye and 315 (43%) small holes only detected by using an LED light. Also 173 mattresses (24%) had stains on the exterior cover, 215 (30%) had stains on the interior of the top cover, and 192 (26%) had stains on the interior of the bottom cover. Bed-frame rust was identified on 175 (24%) beds, of which 65 (9%) had widespread rust. Conclusions: These findings confirm previous reports that damaged mattresses are common in hospitals and potentially place patients at risk. Most of these failed mattresses are <4 years old, which is much less than the expected life of a mattress and bed deck.Funding: NoDisclosures: None
Antibiotic Stewardship Implementation at Hospitals Without On-Site Infectious Disease Specialists: A Mixed-Methods Study
Authors: Livorsi Daniel , Perencevich Eli , Stewart Steffensmeier Kenda , Goetz Matthew , Reisinger Heather 
Published: November 2021

Background: Hospitals are required to have antibiotic stewardship programs (ASPs), but there are few models for implementing ASPs without the support of an infectious disease (ID) specialist, defined as an ID physician and/or ID pharmacist. In this study, we sought to understand ASP implementation at hospitals within the Veterans’ Health Administration (VHA) that lack on-site ID support. Methods: Using a mandatory 2016 VHA survey, we identified acute-care hospitals that lacked an on-site ID specialist. For each hospital, antibiotic use (2018–2019) was quantified as days of therapy (DOT) per 1,000 days present, based on NHSN methodology for tracking all antibacterial agents. From July 2019 through April 2020, we conducted semistructured interviews with personnel involved in or affected by ASP activities at 7 qualifying hospitals. All interview transcripts were analyzed using thematic content analysis. Results: Of the 7 acute-care hospitals, 6 (86%) had a long-term care unit; 3 (43%) had an intensive care unit; and 2 (29%) had full-time employment equivalents dedicated to stewardship. Sites averaged 1,075 (SD, ±654) and 148 (SD, ±96) admissions per year in acute-care and long-term care, respectively. At the site-level, mean antibiotic use was 486 DOT (SD, ±98) per 1,000 days-present in acute-care and 207 DOT (SD, ±74) per 1,000 days present in long-term care. We interviewed 42 personnel across the 7 sites. Although sites reported using similar interventions to promote antibiotic stewardship, the shape of these interventions varied. The following 4 common themes were identified: (1) The primary responsibility for ASPs fell on the pharmacist champions, who were typically assigned multiple other non-ASP responsibilities. (2) The pharmacist champions were more successful at gaining buy-in for stewardship initiatives when they had established rapport with clinicians, but at some sites, the use of contract physicians and frequent staff turnover were potential barriers. (3) Some sites felt that having access to an off-site ID specialist was important for overcoming institutional barriers to stewardship and improving the acceptance of their stewardship interventions. (4) In general, stewardship champions struggled to mobilize institutional resources, which made it difficult to advance their programmatic goals. Conclusions: In this study of 7 hospitals without local ID support, we found that ASPs are largely a pharmacy-driven process. Remote ID support, if available, was seen as helpful for implementing stewardship interventions. These findings may inform the future implementation of ASPs in settings lacking local ID expertise.Funding: NoDisclosures: None
Gamifying the Infection Control Curriculum: The Impact on Nursing Students’ Knowledge, Exam Performance, and Course Perception
Authors: Mestrovic Tomislav , Talapko Jasminka , Cikac Tina , Neuberg Marijana 
Published: November 2021

Background: Unlike passive didactic teaching, the introduction of innovative active-learning approaches to university nursing curricula aims to address the educational content in an interactive learning environment, improving in turn the learning process and problem-solving skills indispensable for future infection control professionals. One such strategy is the use of educational games, which can motivate students and enhance the degree of their engagement. We appraised the effectiveness of introducing an interactive game based on a popular television quiz show “Who Wants to be a Millionaire?” for educational attainment, exam performance, and course perception in nursing students. Methods: A whole generation of second-year undergraduate nursing students (126 female and 27 male participants; age range, 19–41 years) from a public university in Croatia (University Centre Varazdin, University North) were divided into 2 groups by cluster randomization; one group had received additional hours of game play after core training curriculum in a “Hygiene and Epidemiology” course, while the other had not. Game play was accomplished by employing ‘edutaining’ interactive multimedia approach, and covered primarily hand hygiene, cough etiquette, the use of personal protective equipment, sterilization and disinfection, and safe injection practices. Quantitative results of multiple-choice exams were used to evaluate any differences in the knowledge level of respective groups. A satisfaction opinion survey was used to gauge attitudes of students attending the course. Statistical significance was defined as P < .05 (2-tailed). Results: The mean baseline examination score was 28.30±5.79 points for the game group and 24.65±5.94 points for the control group, demonstrating improved knowledge retention when the interactive game was introduced into the curriculum. The statistically significant improvement in knowledge was observed in the domains of personal protective equipment and safe injection practices. There was no statistically significant difference in the overall scores between male and female students. Students who were subjected to game play expressed more agreement on a Likert scale regarding course enjoyment and innovativeness, albeit they did not differ from control group when assessing the educational merit of the course. Conclusions: Introducing interactive games to university courses that cover infection control may boost student enjoyment and enhance long-term retention of information, as confirmed by this study. Nonetheless, extra care should be taken when specific games that have not been assessed objectively are implemented. Further research in this field will elucidate how this increased knowledge retention in infection control principles translates to quotidian practice, for the benefit of students and (ultimately) patients.Funding: NoDisclosures: None
Experience with Bloodborne Pathogen Exposures Among Operation Room Nurses in Korea: A Qualitative Study
Authors: Kang JaHyun , Lee Hyunsook 
Published: November 2021

Background: Operation room (OR) nurses are at a high risk for bloodborne pathogen (BBP) exposures because they are constantly in contact with blood and body fluid (BBF) through surgical sites, and they frequently use sharp surgical instruments and sutures during surgeries. We explored occupational experiences with BBP exposures among OR nurses in South Korea. Methods: With an institutional review board’s approval, this qualitative research was performed with 12 OR nurses who had worked for >3 months and had experienced BBP exposures. Based on the main research question “How is the experience of BBP exposure among OR nurses?” the semistructured questions for in-depth interview were prepared. Narrative data were collected through 1-hour individual interviews from June to September 2020 and were analyzed using a thematical analysis method. Results: The average age of the participants was 34.4 years with an average 9.75 years of clinical experience. The main theme extracted was “The nurses are alerted to their safety after experiencing the aftereffects and emotional trauma from BBP exposures,” with 4 subthemes and 14 concepts. The first subtheme, “OR nurses risking exposure to BBF,” included (1) hurried doctors and hasty nurses; (2) sharp surgical instruments everywhere; (3) deprioritized self-protection due to ongoing surgery; (4) inattentive to BBF risk; and (5) uncomfortable, foggy goggles and receded safety devices. The second subtheme, “BBP exposures occurred in a flash,” included (1) sharp injury occurred in a split second; (2) temporarily treat sharp wounds while hiding frightened feelings; and (3) OR nurses concentrated on surgery by suppressing anxiety and sharp wounds. The third subtheme, “Burdened time that could be overwhelmed alone,” included (1) BBP exposures moments that I wish to reverse; (2) anger over dangerous environments and the turmoil of anxiety; (3) exhausted body and facial discoloration due to taking postexposure prophylaxis; and (4) exposure to BBP that I want to hide from family and friends. The fourth subtheme, “Voice for everyone’s safety,” included (1) establishing a safety culture, which requires everyone’s efforts, and (2) necessity of practical resources for decreasing BBP exposures. Conclusions: The participating OR nurses felt that they were working with a high risk to BBF exposures and called for institutional interventions to reduce the risks, including surgeons’ attentive collaboration. Korean hospitals should make greater efforts to establish safety culture in ORs and to provide repeated, tailored education to prevent BBF exposures. They should also supply high-quality protective equipment and safety-engineered devices for OR nurses.Funding: NoDisclosures: None
Zero Healthcare-Associated COVID-19
Authors: Lin Ling Moi , How Molly , Yuen Tan Kwee , Wee Elaine , Poh Choo Phoon , Chee Lee Lai 
Published: November 2021

Background: The ongoing COVID-19 pandemic tests the healthcare system in many ways. The scarcity of resources poses challenges to infection prevention (IP) practices. We describe our experience in managing such scarcity in our care of COVID-19 patients in the hospital as well as community settings. Methods: The hospital pandemic plan traditionally included only plans for healthcare delivery management within the hospital. However, on March 25, 2020, a decision was made by the Ministry of Health to set up swab isolation (SIFs) and community care facilities (CCFs) to meet the growing demand for isolation beds for migrant workers infected by COVID-19. The CCFs were located in convention halls and resort centers and the SIFs were located in facilities previously functioning as hotels. Mobile medical teams were activated to run clinics at the dormitories housing 200,000 migrant workers. The IP team of an acute- and tertiary-care hospital in Singapore was activated to oversee IP measures at facilities managed by medical teams from the hospital, with the goal of zero healthcare-associated COVID-19 cases among staff. Two IP leaders were set up to oversee the IP program at 8 dormitories, 4 SIFs, and 2 CCFs. In total, 12 IP staff and 15 infection prevention liaison officers (IPLOs) were deployed from 2 acute-care hospitals and 3 specialty centers to conduct training in hand hygiene and the use of personal protective equipment, and to conduct daily audits of compliance to practice guidelines. Education on personal hygiene was also given to patients in these facilities in at least 7 languages. In the SIFs and dormitories, IPLOs were recruited to perform daily audits and feedback to the IP team on issues related to IP at the sites. Results: Since our first COVID-19 patient on January 23, 2020, there has been no report of healthcare-associated COVID-19 within the hospital nor among the medical, administrative, and support service staff working in the external operation facilities. Daily audits showed an average of 99.4% compliance to IP guidelines. Conclusions: IPLOs or IP champions play a significant role in ensuring compliance to IP guidelines. This compliance allows the IP professional to focus on the evaluation of the IP program, managing IP consultations, and planning and implementation of the IP program in nontraditional healthcare settings. The key success factors of the program included the ability to contextualize the planning and implementation of IP programs in various settings, strong leadership support, cohesive teamwork, and effective communication at various levels.Funding: NoDisclosures: None
How Do Safety Climate Ratings Relate to Attitudes Towards and Knowledge About Surgical Site Infection Prevention Measures?
Authors: Pfeiffer Yvonne , Atkinson Andrew , Maag Judith , Lane Michael , Schwappach David , Marschall Jonas 
Published: November 2021

Group Name: Watussi Study GroupBackground: A positive safety climate is an important precursor of safe care outcomes. However, only limited evidence supports the association of low surgical-site infection (SSI) rates and positive safety climate. We investigated the role that perceptions of SSI prevention measures play for both safety climate level and strength as a subjective norm, that is, the social pressure perceived to perform the prevention measures, commitment to observe SSI prevention measures despite other situational pressures, and the level of knowledge about the prevention measures. Methods: The safety climate scale of the Safety Attitudes Questionnaire and 3 scales assessing subjective norm, commitment, and knowledge were used. All items were translated and retranslated from German to French and to Italian. All translated scales were pretested for understandability. Operating room (OR) personnel in 54 Swiss acute-care hospitals were surveyed, resulting in 2,769 analyzed responses with data aggregated on the hospital level. Two regression analyses were conducted: one using the percentage of positive responses per hospital as a safety climate level indicator, and another using the standard deviation of the safety climate ratings per hospital as a safety climate strength indicator. As independent variables, the hospital means of subjective norm, commitment, and knowledge were investigated and appropriately adjusted for number of respondents and sample composition. Results: The sample consisted of 1,495 nurses (54%) and 1,101 physicians (40%). Commitment and subjective norm were significant predictors (p < 0.001 and p < .05, respectively) of safety climate level, in the expected positive direction, but KNOW was not (R2, adjusted: 0.48); for safety climate strength, only COM was significant p < 0.001 (R2, adjusted: 0.27). Conclusions: The extent to which OR personnel were committed to perform the measures, such as timely administration of antibiotics, was associated with their safety climate rating level and strength. Thus, the rather general safety climate assessments are related to more specific safety behaviors necessary to achieve good outcomes such as low infection rates. Subjective norm was related to safety climate level only, indicating that in work environments with a good safety climate, the perceived social pressure to adhere to infection prevention measures may be higher. Knowledge about SSI prevention had no significant impact on safety climate, pointing to future research regarding the role of education in implementing prevention measures. Investigating how attitudes and knowledge about measures to prevent specific patient safety outcomes furthers our understanding of the role of safety climate in patient safety improvement.Funding: NoDisclosures: None
Healthcare-Associated Viral Respiratory Infections in a Pediatric Intensive Care Unit and Cardiovascular Intensive Care Unit
Authors: Feldman Kelly , Singh Jasjit , Gornick Wendi 
Published: November 2021

Background: Healthcare-associated infections (HAIs) affect patient health and are tracked closely by infection prevention. Patients in a pediatric intensive care unit (PICU) acquired viral respiratory infections had longer use of respiratory support. We sought to determine the types of viral respiratory HAIs (VR-HAIs) acquired in the PICU and the characteristics of those affected. Methods: CHOC Children’s Hospital is a 334-bed tertiary-care center. Charts were reviewed on patients with VR-HAIs from fiscal years (FY) 2005–2020. High-risk VR-HAI (HR-VR-HAI) were influenza A and B, respiratory syncytial virus (RSV), adenovirus, parainfluenza, and human metapneumovirus (hMPV, added in FY 2014). Patients in the PICU, cardiovascular ICU (CVICU), and oncology ICU (OICU) with HR-VR-HAIs were reviewed. Patients were categorized according to underlying pathology, immunosuppression, and isolation prior to HR-VR-HAI. Increased respiratory support was defined as any increase from a patient’s baseline support ±24 hours of viral diagnosis: increase in oxygen flow or transition from nasal cannula to high-flow nasal cannula or ventilator support. Antibiotic escalation, defined as initiation of antibiotic therapy for ≥2 days ±24 hours of viral diagnosis or broadening the spectrum of antimicrobials for ≥2 days ±24 hours of viral diagnosis. Results: During FY 2005–2020, there were 204 VR-HAIs: 143 HR-VR-HAIs (70%), of which 39 (27.2%) occurred in ICUs (Figure 1). Most of the HR-VR-HAIs were RSV, parainfluenza, and hMPV (Figure 2). Of 39 patients, 10 (25.6%) had underlying oncologic conditions, 9 of whom were immunosuppressed. Of 39 patients, 16 (41%) had structural cardiac disease, 4 (10.3%) had pulmonary disease, 5 (12.8%) had neurologic disease, and the remaining 4 (10.3%) had other comorbidities. Of 39 patients, 12 (31%) required an increase in respiratory support and 13 (33%) had escalation of antibiotics. Of 39 HR-VR-HAI patients, 2 died within 2 weeks of acquisition. Conclusions: HR-VR-HAIs are uncommon in ICUs. RSV, parainfluenza, and hMPV are the most common, and 1 of 3 of patients required escalation in respiratory support and/or escalation in antibiotics. All patients had underlying comorbidities. In our series, there were 2 deaths within 2 weeks of infection.Funding: NoDisclosures: None