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Hospital-acquired infections, including central line associated bloodstream infections (CLABSI), are an ongoing source of cost, morbidity, and mortality worldwide. This article presents a summary of the impact of the recent SARS-CoV-2 pandemic on CLABSI incidence, an overview of current standard-of-care practices for reduction of CLABSI, and a look toward future changes in bacteremia metrics and challenges in prevention.

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Background: The independent effects of extranasal-only carriage, carriage at multiple bodily sites, or the bacterial load of colonizing Staphylococcus aureus (SA) on the risk of developing SA surgical site infections and postoperative bloodstream infections (SA SSI/BSIs) are unclear. We aimed to quantify these effects in this large prospective cohort study. Methods: Surgical patients aged 18 years or older were screened for SA carriage in the nose, throat, or perineum within 30 days before surgery. SA carriers and noncarriers were enrolled in a prospective cohort study in a 2:1 ratio. Weighted multivariable Cox proportional hazard models were used to assess the independent associations between different measures of SA carriage and occurrence of SA SSI/BSI within 90 days after surgery. Results: We enrolled 5004 patients in the study cohort; 3369 (67.3%) were SA carriers. 100 SA SSI/BSI events occurred during follow-up, and 86 (86%) of these events occurred in SA carriers. The number of colonized bodily sites (adjusted hazard ratio [aHR], 3.5-8.5) and an increasing SA bacterial load in the nose (aHR, 1.8-3.4) were associated with increased SA SSI/BSI risk. However, extranasal-only carriage was not independently associated with SA SSI/BSI (aHR, 1.5; 95% CI, 0.9-2.5). Conclusions: Nasal SA carriage was associated with an increased risk of SA SSI/BSI and accounted for the majority of SA infections. Higher bacterial load, as well as SA colonization at multiple bodily sites, further increased this risk.

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AIMS: To investigate the genetic profile and characterize antimicrobial resistance, including the main ß-lactam antibiotic resistance genes, in Acinetobacterbaumannii isolates from a tertiary hospital in Recife-PE, Brazil, in the post-COVID-19 pandemic period. METHODS AND RESULTS: Acinetobacter baumannii isolates were collected between 2023 and 2024 from diverse clinical samples. Antimicrobial resistance testing followed standardized protocols, with ß-lactamase-encoding genes detected via PCR and sequencing. Investigation into ISAba1 upstream of blaOXA-carbapenemase and blaADC genes was also conducted. Genetic diversity was assessed through ERIC-PCR. Among the 78 A. baumannii, widespread resistance to multiple antimicrobials was evident. Various acquired ß-lactamase-encoding genes (blaOXA-23,-24,-58,-143, blaVIM, and blaNDM) were detected. Furthermore, this is the first report of blaVIM-2 in A. baumannii isolates harboring either the blaOXA-23-like or the blaOXA-143 gene in Brazil. Molecular typing revealed a high genetic heterogeneity among the isolates, and multi-clonal dissemination. CONCLUSION: The accumulation of genetic resistance determinants underscores the necessity for stringent infection control measures and robust antimicrobial stewardship programs to curb multidrug-resistant strains.

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BACKGROUND: Health care-associated infections (HAIs) are a major threat to patient safety and quality care. However, they are avoidable by implementing evidence-based infection prevention and control (IPC) measures. This review evaluated the evidence of the effectiveness of IPC interventions in reducing rates of HAIs in health care settings in Africa. METHODS: We searched several databases: CENTRAL, EMBASE, PUBMED, CINAHL, WHO IRIS, and AJOL for primary studies reporting rates of the 4 most frequent HAIs: surgical site infections, central line--associated bloodstream infections, catheter-associated urinary tract infections, ventilator-associated pneumoniae, and increase in hand hygiene compliance. Two reviewers appraised the studies and PRISMA guidelines were followed. RESULTS: Out of 4,624 studies identified from databases and additional sources, 15 studies were finally included in the review. The majority of studies were of pre- and post-test study design. All the studies implemented a combination of interventions and not as stand-alone components. Across all included studies, an improvement was reported in at least 1 primary outcome. CONCLUSIONS: Our review highlights the potential of IPC interventions in reducing HAIs and improving compliance with hand hygiene in health care facilities in Africa. For future research, we recommend more pragmatic study designs with improved methodological rigor.

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BACKGROUND: Health care-associated infections due to multidrug-resistant organisms (MDROs), such as methicillin-resistant Staphylococcus aureus (MRSA) and Clostridioides difficile (CDI), place a significant burden on our health care infrastructure. OBJECTIVE: Screening for MDROs is an important mechanism for preventing spread but is resource intensive. The objective of this study was to develop automated tools that can predict colonization or infection risk using electronic health record (EHR) data, provide useful information to aid infection control, and guide empiric antibiotic coverage. METHODS: We retrospectively developed a machine learning model to detect MRSA colonization and infection in undifferentiated patients at the time of sample collection from hospitalized patients at the University of Virginia Hospital. We used clinical and nonclinical features derived from on-admission and throughout-stay information from the patient's EHR data to build the model. In addition, we used a class of features derived from contact networks in EHR data; these network features can capture patients' contacts with providers and other patients, improving model interpretability and accuracy for predicting the outcome of surveillance tests for MRSA. Finally, we explored heterogeneous models for different patient subpopulations, for example, those admitted to an intensive care unit or emergency department or those with specific testing histories, which perform better. RESULTS: We found that the penalized logistic regression performs better than other methods, and this model's performance measured in terms of its receiver operating characteristics-area under the curve score improves by nearly 11% when we use polynomial (second-degree) transformation of the features. Some significant features in predicting MDRO risk include antibiotic use, surgery, use of devices, dialysis, patient's comorbidity conditions, and network features. Among these, network features add the most value and improve the model's performance by at least 15%. The penalized logistic regression model with the same transformation of features also performs better than other models for specific patient subpopulations. CONCLUSIONS: Our study shows that MRSA risk prediction can be conducted quite effectively by machine learning methods using clinical and nonclinical features derived from EHR data. Network features are the most predictive and provide significant improvement over prior methods. Furthermore, heterogeneous prediction models for different patient subpopulations enhance the model's performance.

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Background: The coronavirus disease 2019 (COVID-19) pandemic has brought about drastic hygienic measures, one upside of which might be the mitigated occurrence of surgical site infection (SSI). This study investigated the association of the pandemic with SSI occurrence after cardiac surgeries. Patients and Methods: From 2014 to 2022, patients undergoing cardiac surgery were included and categorized into pre-pandemic and during-pandemic groups. Surgical site infections were classified into harvest-site, superficial sternal, and complex sternal infection. Multiple logistic regression and inverse probability weighting assessed the association of the pandemic with SSI. Results: Among a total of 26,143 patients, 793 SSIs occurred. The during-pandemic patients were younger (61.87 ± 10.58 vs. 65.64 ± 11.82) with a higher male proportion (70.1% vs. 67.4%) and a higher prevalence of all studied comorbidities/risk factors (expect cigarette smoking). Total SSI rate decreased substantially from 3.3% before COVID-19 to 1.8% afterward (p < 0.001). Inverse probability weights analyses evinced an independent association of the pandemic with a reduced risk of total (adjusted odds ratio [OR]; 0.59; 95% confidence interval [CI], 0.45-0.78), harvest-site (adjusted OR, 0.36; 95% CI, 0.19-0.70), and superficial sternal infection (adjusted OR, 0.60; 95% CI, 0.43-0.81). No significant association was observed with complex sternal site infection (adjusted OR, 1.05; 95% CI, 0.55-2.01). Multivariable regression recapitulated these findings. Conclusions: The COVID-19 pandemic independently pertained to more than a 40% reduction in SSI occurrence, particularly affecting harvest-site and superficial sternal infections. However, there remains the possibility of the implications of other known and unknown confounders on the observed association. To some extent, the decrease in SSIs after the pandemic can be justified by reinforced hygienic precautions, emphasizing the necessity of extending the adherence to these measurements into the post-COVID-19 era to maintain the status quo.

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The World Health Organization's (WHO) World Hand Hygiene Day continues to "bring people together and accelerate hand hygiene action at the point of care in health care to contribute to a reduction in health care-associated infections and the achievement of safer, quality health care for all."

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BACKGROUND: Hand hygiene (HH) is an important strategy for preventing health-care-associated infections (HAIs). Few programs focus on HH for family members and primary caregivers but fewer for patients. This study aimed to estimate the frequency with which hospitalized pediatric patients have hand contact with hospital surfaces. METHODS: We conducted a cross-sectional descriptive observational study consisting of three phases: the first was the creation of an observation and data collection tool, the second was the training of the monitors, and the third was the observational study of hand contact and HH opportunities in hospitalized pediatric patients. RESULTS: Over 3600 minutes of observation, 2032 HH opportunities were detected, averaging 33.8/h (SD 4.7) as determined by hand contact with hospital surfaces of hospitalized pediatric patients. In our study, infants and preschool children had the highest frequency of hand contact. CONCLUSION: The high frequency of hand contact of hospital surfaces by children suggests that hourly hand disinfection of patients and caregivers, objects and surfaces around the patients may be prevention measures that could be incorporated to reduce HAIs in pediatric hospitals.

INTRODUCCIÓN: La higiene de manos es una estrategia importante para la prevención de infecciones asociadas a la atención sanitaria. Existen pocos programas centrados en la higiene de manos para los familiares y cuidadores primarios, y aún menos para el paciente. El objetivo de este estudio fue cuantificar la frecuencia con la que los pacientes pediátricos hospitalizados tienen contacto manual con superficies hospitalarias. MÉTODOS: Se llevó a cabo un estudio observacional descriptivo transversal que constó de tres fases: la primera fue la creación de una herramienta de observación y registro de datos; la segunda fue la capacitación de los monitores y la tercera fue el estudio observacional del contacto manual y de las oportunidades de higiene de manos en pacientes pediátricos hospitalizados. RESULTADOS: Durante los 3600 minutos de observación, se detectaron 2032 oportunidades, con una media de 33.8 (DE 4.7) por hora de oportunidades de higiene de manos establecidas por contacto manual con superficies de pacientes pediátricos hospitalizados. Los lactantes y los niños en edad preescolar presentaron la mayor frecuencia de contacto manual. CONCLUSIONES: La alta frecuencia de contacto manual por parte del niño indica que medidas como la desinfección de las manos cada hora del paciente y del cuidador, así como de los objetos y superficies alrededor del paciente, podrían ser medidas útiles que deberían incluirse para prevenir las infecciones asociadas a la atención de la salud en los hospitales pediátricos.

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BACKGROUND: Catheter-Associated Urinary Tract Infections (CAUTIs) frequently occur in the intensive care unit (ICU) and are correlated with a significant burden. METHODS: We implemented a strategy involving a 9-element bundle, education, surveillance of CAUTI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CAUTI rates and performance feedback. This was executed in 299 ICUs across 32 low- and middle-income countries. The dependent variable was CAUTI per 1,000 UC days, assessed at baseline and throughout the intervention, in the second month, third month, 4 to 15 months, 16 to 27 months, and 28 to 39 months. Comparisons were made using a 2-sample t test, and the exposure-outcome relationship was explored using a generalized linear mixed model with a Poisson distribution. RESULTS: Over the course of 978,364 patient days, 150,258 patients utilized 652,053 UC-days. The rates of CAUTI per 1,000 UC days were measured. The rates decreased from 14.89 during the baseline period to 5.51 in the second month (risk ratio [RR] = 0.37; 95% confidence interval [CI] = 0.34-0.39; P < .001), 3.79 in the third month (RR = 0.25; 95% CI = 0.23-0.28; P < .001), 2.98 in the 4 to 15 months (RR = 0.21; 95% CI = 0.18-0.22; P < .001), 1.86 in the 16 to 27 months (RR = 0.12; 95% CI = 0.11-0.14; P < .001), and 1.71 in the 28 to 39 months (RR = 0.11; 95% CI = 0.09-0.13; P < .001). CONCLUSIONS: Our intervention, without substantial costs or additional staffing, achieved an 89% reduction in CAUTI incidence in ICUs across 32 countries, demonstrating feasibility in ICUs of low- and middle-income countries.

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Abstract Background: Hand hygiene (HH) is an important strategy for preventing health-care-associated infections (HAIs). Few programs focus on HH for family members and primary caregivers but fewer for patients. This study aimed to estimate the frequency with which hospitalized pediatric patients have hand contact with hospital surfaces. Methods: We conducted a cross-sectional descriptive observational study consisting of three phases: the first was the creation of an observation and data collection tool, the second was the training of the monitors, and the third was the observational study of hand contact and HH opportunities in hospitalized pediatric patients. Results: Over 3600 minutes of observation, 2032 HH opportunities were detected, averaging 33.8/h (SD 4.7) as determined by hand contact with hospital surfaces of hospitalized pediatric patients. In our study, infants and preschool children had the highest frequency of hand contact. Conclusion: The high frequency of hand contact of hospital surfaces by children suggests that hourly hand disinfection of patients and caregivers, objects and surfaces around the patients may be prevention measures that could be incorporated to reduce HAIs in pediatric hospitals.

Resumen Introducción: La higiene de manos es una estrategia importante para la prevención de infecciones asociadas a la atención sanitaria. Existen pocos programas centrados en la higiene de manos para los familiares y cuidadores primarios, y aún menos para el paciente. El objetivo de este estudio fue cuantificar la frecuencia con la que los pacientes pediátricos hospitalizados tienen contacto manual con superficies hospitalarias. Métodos: Se llevó a cabo un estudio observacional descriptivo transversal que constó de tres fases: la primera fue la creación de una herramienta de observación y registro de datos; la segunda fue la capacitación de los monitores y la tercera fue el estudio observacional del contacto manual y de las oportunidades de higiene de manos en pacientes pediátricos hospitalizados. Resultados: Durante los 3600 minutos de observación, se detectaron 2032 oportunidades, con una media de 33.8 (DE 4.7) por hora de oportunidades de higiene de manos establecidas por contacto manual con superficies de pacientes pediátricos hospitalizados. Los lactantes y los niños en edad preescolar presentaron la mayor frecuencia de contacto manual. Conclusiones: La alta frecuencia de contacto manual por parte del niño indica que medidas como la desinfección de las manos cada hora del paciente y del cuidador, así como de los objetos y superficies alrededor del paciente, podrían ser medidas útiles que deberían incluirse para prevenir las infecciones asociadas a la atención de la salud en los hospitales pediátricos.

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An increase in hospital-onset Clostridioides difficile prompted an interprofessional team to implement enhanced environmental service cleaning practices and adopt a routine cleaning program undertaken by clinical staff. These interventions resulted in a reduction of hospital-onset Clostridioides difficile from 7.27 cases per 10,000 patient days to 1.54 cases per 10,000 patient days.

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BACKGROUND: The COVID-19 pandemic has generated numerous hospital outbreaks. This study aimed to identify factors related to the extent of nosocomial COVID-19 outbreaks in the largest French public health institution. METHODS: An observational study was conducted from July 2020 to September 2021. Outbreaks were defined as at least 2 cases, patients and/or health care workers (HCWs), linked by time and geographic location. Logistic regression was performed to identify risk factors for large outbreaks among nine variables: variant, medical ward, COVID-19 vaccination rate and incidence among HCWs and Paris population, number of weekly COVID-19 tests among HCWs and the positivity rate, epidemic waves. RESULTS: Within 14 months, 799 outbreaks were identified: 450 small ones (≤6 cases) and 349 large ones (≥7 cases), involving 3,260 patients and 3,850 HCWs. In univariate analysis, large outbreaks were positively correlated to geriatrics wards, COVID-19 incidence, and rate of weekly positive tests among HCWs; and negatively correlated to intensive care units, variant Delta, fourth wave, vaccination rates of the Paris region's population and that of the HCWs. In multivariate analysis, factors that remained significant were the type of medical ward and the vaccination rate among HCWs. CONCLUSIONS: Intensive care unit and high vaccination rates among HCWs were associated with a lower risk of large COVID-19 outbreaks, as opposed to geriatric wards, which are associated with a higher risk.

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BACKGROUND: Central line-associated bloodstream infections (CLABSIs) increased nationally during the COVID-19 pandemic. We described CLABSIs at our institution during 2019 to 2022. METHODS: This retrospective observational study examined CLABSIs among adult inpatients at an 866-bed teaching hospital in the Midwest. CLABSI incidence was trended over time and compared to monthly COVID-19 admissions. Manual chart review was performed to obtain patient demographics, catheter-associated variables, pathogens, and clinical outcomes. RESULTS: We identified 178 CLABSIs. The CLABSI incidence (cases per 1,000 line days) tripled in October 2020 as COVID-19 admissions increased. CLABSIs in 2020 were more frequently caused by coagulase-negative staphylococci and more frequently occurred in the intensive care units 7+ days after central line insertion. The CLABSI incidence normalized in early 2021 and did not increase during subsequent COVID-19 surges. Throughout 2019 to 2022, about half of the nontunneled central venous catheters involved in CLABSI were placed emergently. One-quarter of CLABSIs involved multiple central lines. Chlorhexidine skin treatment adherence was limited by patient refusal. CONCLUSIONS: The increase in CLABSIs in late 2020 during a surge in COVID-19 admissions was likely related to central line maintenance but has resolved. Characterizing CLABSI cases can provide insight into adherence to guideline-recommended prevention practices and identify areas for improvement at individual institutions.

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A systematic approach to contact investigations has long been a cornerstone of interrupting the transmission of tuberculosis in community settings. This paper describes the implementation of a systematic 10-step contact investigation within an acute care setting during a multistate outbreak of healthcare-associated tuberculosis. A systematic approach to contact investigations might have applicability to the prevention of other communicable infections within healthcare settings.

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BACKGROUND: The study objective was to quantify infection rate trends for central line-associated bloodstream infections (CLABSIs) and catheter-associated urinary tract infections (CAUTIs) in 89 Alabama hospitals from 2015 to 2021 to analyze how the COVID-19 pandemic impacted health care delivery. METHODS: Retrospective analysis of CLABSI and CAUTI rates, from 89 Alabama hospitals via data from the Alabama Department of Public Health from 2015 to 2021. RESULTS: Based on our modeling strategies, there was a statistically significant decrease in rates of CAUTIs from 2015 to 2019 at an estimated rate of 7% per year (P = 0.0167) and CLABSIs from 2015 to 2018 at an estimated rate of 13% per year (P < .001) in these hospitals. In 2020, the CAUTI and CLABSI rates began increasing at a modeled rate of 29% per year (P = .001) and 35% per year (P < .001) respectively. DISCUSSION: A review of potential causes for the elevated rate of health care-associated infections illustrated that certain practices may have contributed to increased CAUTI and CLABSI rates. Utilizing staff from noncritical care areas with less experience in health care-associated infection prevention, batching of tasks to conserve personal protective equipment, and a nationwide mental health crisis could have affected infection prevention bundle compliance. CONCLUSIONS: An increase in CAUTIs and CLABSIs was observed during the pandemic, likely due to the large volume of patients requiring advanced medical care and subsequent depleted resources.

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BACKGROUND: Central line (CL)-associated bloodstream infections (CLABSIs) occurring in the intensive care unit (ICU) are common and associated with a high burden. METHODS: We implemented a multidimensional approach, incorporating an 11-element bundle, education, surveillance of CLABSI rates and clinical outcomes, monitoring compliance with bundle components, feedback of CLABSI rates and clinical outcomes, and performance feedback in 316 ICUs across 30 low- and middle-income countries. Our dependent variables were CLABSI per 1,000-CL-days and in-ICU all-cause mortality rates. These variables were measured at baseline and during the intervention, specifically during the second month, third month, 4 to 16 months, and 17 to 29 months. Comparisons were conducted using a two-sample t test. To explore the exposure-outcome relationship, we used a generalized linear mixed model with a Poisson distribution to model the number of CLABSIs. RESULTS: During 1,837,750 patient-days, 283,087 patients, used 1,218,882 CL-days. CLABSI per 1,000 CL-days rates decreased from 15.34 at the baseline period to 7.97 in the 2nd month (relative risk (RR) = 0.52; 95% confidence interval [CI] = 0.48-0.56; P < .001), 5.34 in the 3rd month (RR = 0.35; 95% CI = 0.32-0.38; P < .001), and 2.23 in the 17 to 29 months (RR = 0.15; 95% CI = 0.13-0.17; P < .001). In-ICU all-cause mortality rate decreased from 16.17% at baseline to 13.68% (RR = 0.84; P = .0013) at 17 to 29 months. CONCLUSIONS: The implemented approach was effective, and a similar intervention could be applied in other ICUs of low- and middle-income countries to reduce CLABSI and in-ICU all-cause mortality rates.

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BACKGROUND: Following a 200% increase in the central line-associated bloodstream infection (CLABSI) standardized infection ratio in a private teaching hospital between 2019 and 2020, a program with the utilization of a CLABSI Prevention Registered Nurse was implemented to reduce CLABSIs through a variety of focused prevention efforts and education. METHODS: The CLABSI P-RN project consisted of a dedicated team of RNs that performed interventions that included an audit of all central lines daily, real-time education and remediation, bi-weekly educational handouts, and assistance with 2-person dressing changes. Audit data were utilized to identify trends in gaps in compliance with the CLABSI bundle (ie, daily bathing, dressing integrity). The CLABSI rate/1,000 central line days were tracked in preintervention, intervention, and postintervention time periods. RESULTS: During the intervention, the CLABSI rate decreased from 1.4 during the preintervention time period, to 0.4 during the intervention time period (P-value .04). Additionally, daily bathing compliance improved from 84.3% during the preintervention time period, to 90.8% during the intervention time period (P-value .004). DISCUSSION: The implementation of the CLABSI P-RN was beneficial in reducing CLABSIs. CONCLUSIONS: An expert-trained role dedicated to central line management reduces CLABSI occurrences, reduces health care costs, and improves patient outcomes.

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Surgical site infections (SSIs) are common health care-associated infections. SSIs after kidney transplantation (K-Tx) can endanger patient and allograft survival. Multicenter studies on this early posttransplant complication are scarce. We analyzed consecutive adult K-Tx recipients enrolled in the Swiss Transplant Cohort Study who received a K-Tx between May 2008 and September 2020. All data were prospectively collected with the exception of the categorization of SSI which was performed retrospectively according to the Centers for Disease Control and Prevention criteria. A total of 58 out of 3059 (1.9%) K-Tx recipients were affected by SSIs. Deep incisional (15, 25.9%) and organ/space infections (34, 58.6%) predominated. In the majority of SSIs (52, 89.6%), bacteria were detected, most frequently Escherichia coli (15, 28.9%), Enterococcus spp. (14, 26.9%), and coagulase-negative staphylococci (13, 25.0%). A BMI ≥25 kg/m2 (multivariable OR 2.16, 95% CI 1.07-4.34, P = .023) and delayed graft function (multivariable OR 2.88, 95% CI 1.56-5.34, P = .001) were independent risk factors for SSI. In Cox proportional hazard models, SSI was independently associated with graft loss (multivariable HR 3.75, 95% CI 1.35-10.38, P = .011). In conclusion, SSI was a rare complication after K-Tx. BMI ≥25 kg/m2 and delayed graft function were independent risk factors. SSIs were independently associated with graft loss.

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Hospitals are always looking to improve the quality of patient care and avoid hospital-acquired conditions such as ventilator-associated pneumonia (VAP). Currently, there are no set standards regarding interventions to prevent VAP, and there is not a single element that has a direct impact on VAP prevention. By creating an interprofessional team to work together, the quality improvement project was able to evaluate current practice compared with evidence-based practice in the literature to develop a critical care VAP bundle practice, which demonstrated improvement in compliance.

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