1,721,062 research outputs found
Personalized infection prevention and control: a concept whose time has arrived
No full text: Personalized medicine has been progressively implemented in several diagnostic and therapeutic patients' algorithms, based on the common assumption that tailoring interventions, practices, and/or therapies to individual patients' clinical, biological, epidemiological, and genetic characteristics would optimize their effectiveness and reduce adverse effects. The potential benefit of the precision medicine approach has been recently considered for possible implementation in the field of infection prevention and control. The commentary explores available evidence and assesses possible future scenarios where, through advanced modeling approaches, we would be able to provide personalized prediction algorithms identifying at-risk patients who deserve the implementation of tailored preventive measures
Risk perception of the antimicrobial resistance by infection control specialists in Europe: a case-vignette study
Full text linkUsing case-vignettes, we assessed the perception of European infection control (IC) specialists regarding the individual and collective risk associated with antimicrobial resistance (AMR) among inpatients
Infection Risk in Sterile Operative Procedures
No full textThe main objective of hospital hygiene and infection prevention is to protect patients from preventable nosocomial infections. It was recently stated that the proper goal should be for zero infection rates in sterile surgical procedures. In this article, we attempt to determine whether this demand is supported by the available literature
Ethanol is indispensable for virucidal hand antisepsis: memorandum from the alcohol-based hand rub (ABHR) Task Force, WHO Collaborating Centre on Patient Safety, and the Commission for Hospital Hygiene and Infection Prevention (KRINKO), Robert Koch Institute, Berlin, Germany
Full text linkBackground: The approval of ethanol by the Biocidal Products Regulation has been under evaluation since 2007. This follows concern over alcohol uptake from ethanol-based hand rubs (EBHR). If ethanol is classified as carcinogenic, mutagenic, or reprotoxic by the European Chemicals Agency (ECHA), then this would affect infection prevention and control practices. Aim: A review was performed to prove that ethanol is toxicological uncritical and indispensable for hand antisepsis because of its unique activity against non-enveloped viruses and thus the resulting lack of alternatives. Therefore, the following main points are analyzed: The effectiveness of ethanol in hand hygiene, the evidence of ethanol at blood/tissue levels through hand hygiene in healthcare, and the evidence of toxicity of different blood/tissue ethanol levels and the non-comparability with alcoholic consumption and industrial exposure. Results: EBHR are essential for preventing infections caused by non-enveloped viruses, especially in healthcare, nursing homes, food industry and other areas. Propanols are effective against enveloped viruses as opposed to non-enveloped viruses but there are no other alternatives for virucidal hand antisepsis. Long-term ingestion of ethanol in the form of alcoholic beverages can cause tumours. However, lifetime exposure to ethanol from occupational exposure < 500 ppm does not significantly contribute to the cancer risk. Mutagenic effects were observed only at doses within the toxic range in animal studies. While reprotoxicity is linked with abuse of alcoholic beverages, there is no epidemiological evidence for this from EBHR use in healthcare facilities or from products containing ethanol in non-healthcare settings. Conclusion: The body of evidence shows EBHRs have strong efficacy in killing non-enveloped viruses, whereas 1-propanol and 2-propanol do not kill non-enveloped viruses, that pose significant risk of infection. Ethanol absorbed through the skin during hand hygiene is similar to consumption of beverages with hidden ethanol content (< 0.5% v/v), such as apple juice or kefir. There is no risk of carcinogenicity, mutagenicity or reprotoxicity from repeated use of EBHR. Hence, the WHO Task Force strongly recommend retaining ethanol as an essential constituent in hand rubs for healthcare
Contact Precautions for Preventing Nosocomial Transmission of Extended-Spectrum β Lactamase-Producing Escherichia coli: A Point/Counterpoint Review
No full textContact precautions have been recommended for hospitalized patients colonized or infected with extended-spectrum β-lactamase-producing Escherichia coli (ESBL-EC). Despite such recommendations, a steady, worldwide increase of ESBL-EC has been reported. We discuss arguments in favor of and against contact precautions for ESBL-EC carriers. Healthcare settings with high ESBL-EC colonization pressure, extended hospital stay, and close contact between patients may serve as amplification platforms, further accelerating transmission. However, the evidence base for justifying the implementation of contact precautions for all ESBL-EC carriers remains weak. Until more high-level evidence is available, we support the attitude that hospitals and countries should carefully evaluate their decision on whether to implement contact precautions for ESBL-EC carriers. It is likely that a majority of patients and wards do not need to rely on contact precautions for preventing nosocomial ESBL-EC transmission in nonepidemic settings, without harming patient safety, providing sufficient compliance with standard precautions and ongoing surveillance
Use of evidence-based recommendations in an antibiotic care bundle for the intensive care unit
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Der Einfluss der SARS-CoV-2-Pandemie und behördlichen Maßnahmen auf Angstsymptome und depressive Symptome bei psychiatrischen Erkrankungen
Full text linkEine Stichprobe von 115 erwachsenen Proband*innen wurde prospektiv über drei Zeiträume im ersten Jahr der SARS-CoV-2-Pandemie untersucht. Mithilfe etablierter Skalen wurde der Einfluss der medial kommunizierten Pandemie und behördlicher nicht-pharmakologischer Maßnahmen auf Depressions- und Angstsymptome erfasst. Untersucht wurden eine Patient*innengruppe, die nach PTBS-Screening-Status weiter unterteilt wurde, und eine Kontrollgruppe.
Die Symptome für Depression und Angst waren zu Beginn der Pandemie in allen Gruppen am höchsten. Im Studienverlauf sanken Angst- und Depressionswerte besonders stark bei Patient*innen ohne PTBS, gefolgt von jenen mit PTBS. Die Kontrollgruppe zeigte hingegen nur minimale Veränderungen. Patient*innen unterlagen damit stärkeren Schwankungen als die Kontrollgruppe.
Über das gesamte Proband*innenkollektiv hinweg zeigte sich, dass eine Reduktion nicht-pharmakologischer Maßnahmen mit einer signifikanten Abnahme der Depressionssymptome einherging. Dies legt nahe, dass strengere Maßnahmen zu Beginn der Pandemie höhere Depressionswerte begünstigten. Im Gegensatz dazu wurde für die Entwicklung der Angstsymptome kein vergleichbarer Einfluss festgestellt. Ebenso erwies sich die medial kommunizierte 7-Tage-Inzidenz in keiner Gruppe als signifikanter Faktor für die Entwicklung von Angst- oder Depressionssymptomen.
Die Ergebnisse deuten darauf hin, dass Menschen mit psychiatrischen Vorerkrankungen in NRW im ersten Pandemiejahr hinsichtlich Angst- und Depressionssymptomen vulnerabler waren als gesunde Personen. Zudem scheint ein direkter Zusammenhang zwischen Maßnahmenintensität und depressiven Symptomen zu bestehen, was bei zukünftigen Krisen berücksichtigt werden sollte.
Obwohl im gegebenen Kontext die Publikation weiterer aussagekräftiger Meta-Analysen wünschenswert wäre, sind zusätzliche empirische Studien aufgrund der Einzigartigkeit der SARS-CoV-2-Pandemiesituation nicht mehr umsetzbar. Umso wichtiger ist es, ggf. vorhandene Daten, auch in Bezug auf eine vorbestehende PTBS als besonderen Vulnerabilitätsfaktor, möglichst vollständig zu analysieren und zu veröffentlichen
The role of routine SARS-CoV-2 screening of healthcare-workers in acute care hospitals in 2020: a systematic review and meta-analysis
No full textAbstract
Background
Healthcare workers (HCW) are at increased risk of infection with SARS-CoV-2. Vulnerable patient populations in particular must be protected, and clinics should not become transmission hotspots to avoid delaying medical treatments independent of COVID. Because asymptomatic transmission has been described, routine screening of asymptomatic HCW would potentially be able to interrupt chains of infection through early detection.
Methods
A systematic search was conducted in the Cochrane COVID-19 Study Register, Web of Science and WHO COVID‐19 Global literature on coronavirus with regard to non-incident related testing of healthcare workers using polymerase chain reaction on May 4th 2021. Studies since January 2020 were included. An assessment of risk of bias and representativeness was performed.
Results
The search identified 39 studies with heterogeneous designs. Data collection of the included studies took place from January to August 2020. The studies were conducted worldwide and the sample size of the included HCW ranged from 70 to 9449 participants. In total, 1000 of 51,700 (1.9%) asymptomatic HCW were tested positive for SARS-CoV-2 using PCR testing. The proportion of positive test results ranged between 0 and 14.3%. No study reported on HCW-screening related reductions in infected person-days.
Discussion and conclusions
The heterogeneous proportions might be explained by different regional incidences, lock-downs, and pre-analytical pitfalls that reduce the sensitivity of the nasopharyngeal swab. The very high prevalence in some studies indicates that screening HCW for SARS-CoV-2 may be important particularly in geographical regions and pandemic periods with a high-incidence. With low numbers and an increasing rate of vaccinated HCW, a strict cost–benefit consideration must be made, especially in times of low incidences. Since we found no studies that reported on HCW-screening related reductions in infected person-days, re-evaluation should be done when these are available.Bundesministerium für Bildung und Forschung http://dx.doi.org/10.13039/501100002347Universitätsklinikum Bon
ESCMID/EUCIC clinical practice guidelines on perioperative antibiotic prophylaxis in patients colonized by multidrug-resistant Gram-negative bacteria before surgery
No full textInfection control strategies for patients and accompanying persons during the COVID-19 pandemic in German hospitals – Results from a cross-sectional study in March-April 2021
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