Background: In the United States, it is estimated that 1 in 20 patients become infected with a healthcare acquired infection (HAI). Some of the complications of HAIs include increased morbidity and mortality, and drug-resistant infections. Clostridium difficile has replaced methicillin-resistant Staphylococcus aureus (MRSA) as the most important HAI in the United States by doubling its prevalence during the last decade. Significance of the study: This study is grounded on the subdiscipline of macroergonomics and highly detailed simulation. The Macroergonomic Analysis and Design (MEAD) model is utilized to identify and correct deficiencies in work systems. The MEAD process was applied to develop possible sociotechnical interventions that can be used against HAIs. Highly detailed simulation can evaluate infection exposure, interventions, and individual behavior change for populations in large populations. These two methods provide the healthcare system stakeholders with the ability to test interventions that would otherwise be impossible to evaluate. Objective/Purpose: The purpose of this study is to identify the factors that reduce HAI infections in healthcare facility populations, and provide evidence-based best practices for these facilities. The central research question is: What type of interventions can help reduce Clostridium difficile infections? Methods: We collected one year of patient archival information to include activities, locations and contacts through electronic patient records from two Virginia regional hospitals. Healthcare worker activities were obtained through direct observation (shadowing) at the two Virginia regional hospitals. Experiments were designed to test the different types of interventions using EpiSimdemics, a highly-resolved simulation software. A Clostridium difficile disease model was developed to evaluate interventions. Results: We observed a significant drop in infection cases at a regional Hospital. There is significant evidence to link this drop in HAI infections to a sociotechnical intervention. However, there is not enough information to pinpoint the specific action that caused the drop. We additionally conducted simulation experiments with two hospital simulations. Simulated sociotechnical interventions such as hand washing, room cleaning, and isolation caused significant reductions in the infection rates. Conclusions: The combined use of macroergonomics and simulation can be beneficial in developing and evaluating interventions against HAIs. The use of statistical control charts as an epidemiology tool can help hospitals detect outbreaks or evaluate the use of interventions. Use of systemic interventions in an in-silico environment can help determine cheaper, more flexible, and more effective actions against HAIs. / Ph. D.

No

Hospital-acquired infections are to date a major challenge in the patient safety. The proliferation of pathogens such as Staphylococcus aureus, Escherichia coli and Klebsiella pneumoniae is often reported in connection with textiles, which represent a significant source of transmission. This leads most often to the contamination and cross-contamination of the hospitalized patient and the hospital staff. A promising approach and the immediate objective of this research is the application of probiotics to a textile fabric. They provide preliminary evidence in being able to inhibit pathogenic bacteria growth through their competitive mechanism. During this study, screen-printing was used as a method to apply probiotics on a polyester fabric. The viability of probiotics on the fabric was evaluated in the agar plate test method. Samples that exhibited a growth of grown out colonies were further tested regarding their efficacy towards the abovementioned pathogens. This was determined in a competition test, that included the individually inoculation of the samples with the different bacteria strains. Contact-angle measurements and abrasion resistance as well as the durability were tested in order to investigate the applicability of the fabric and scanning electron microscope images were taken to detect probiotics and to evaluate the quality of the print on the fabric. Major findings included that probiotics were able to survive on the polyester fabric and that these viable probiotics are further successful in the growth inhibition of pathogenic bacteria. Thereby their efficacy against pathogens is related to the viability the probiotics. As neither the probiotics used in this study, nor the other ingredients are considered as hazardous, this process is environment-friendly. This work increases the understanding of probiotics mechanism and their survival and competition behaviour on a textile material. It opens a way in the reduction of hospital-acquired infections through the beneficial effects of probiotics.

Transmissions based precautions are measures implemented in various clinical health care settings as a means to prevent the transmission of infectious diseases and decrease instances of healthcare acquired infections (HAI). HAI’s result in increased cost to hospitals, longer hospitalization for patients, increased patient suffering, and fatal patient outcomes. While staff member adherence to transmissions based precautions are mandated through various organizations and hospital policies, a review of literature indicates little research has been conducted regarding visitor compliance with transmission-based precautions. The potential implications in healthcare from visitor non-adherence acquired infections are unknown; revealing a gap in literature and supporting the need for further research to describe the phenomenon. Through utilization of a descriptive online survey instrument, the purpose of this descriptive study is to gain insight into why nurses believe visitors may or may not be compliant with transmission-based precautions. To collect the data, an online descriptive survey instrument was developed and distributed via email to all graduate students’ enrolled East Tennessee State University’s College of Nursing. Only ten participants met the eligibility requirements to participate in this study. Data was analyzed though a predictive analytics software and grouping responses into themes. Responses suggest that nurses feel visitors are not complying with transmission-based precautions because of a lack in education, not perceiving the infection as a threat, prior exposure to loved one at home, and inconvenience.

Clostridium difficile (C. difficile) is a gram positive, anaerobic, spore forming bacterium. C. difficile infections are triggered by dysbiosis of the intestinal microbiome linked to age, immune status, and medication; particularly use of antibiotics and proton pump inhibitors (PPI). The spore forming nature of the bacteria gives it the ability to persist in the environment for long periods of time and makes it impervious to many commonly-used hospital cleaning and disinfection products. C. difficile, along with Methicillin-resistant Staphylococcus aureus (MRSA) and Vancomycin-resistant Enterococcus (VRE) are some of the leading multi-drug resistant hospital acquired infections in the United States. Environmental contamination and patient susceptibility are hypothesized as major contributors to infection transmission in a healthcare setting. We conducted a cross-sectional pilot study aimed at determining the bioaerosol concentration of C. difficile present in the toilet plume of C. difficile infected patients’ rooms. Patient rooms within the University of Iowa Hospital and Clinics (UIHC) were sampled using a customized bioaerosol air impactor device. Environmental samples were collected before and after flushing the toilet to determine the pre-flush and post-flush levels of aerosolized bacteria. Particle density was collected during both pre and post-flush sampling. Activity levels in the rooms were recorded as a potential confounding variable. A total of 144 environmental samples were collected in 24 rooms. Clostridium difficile was detected in two of the twenty-four rooms (8%). There was a 12% (9/72) positive culture rate pre-flush compared to 23% (19/72) post-flush. Wilcoxon rank sum tests revealed a significant increase in particle concentration at the 5.0µm and 10.0µm size between rooms that produced a bacterial culture compared to rooms that did not (p-values 0.0095 and 0.0082 respectively). There was no significant association between the amount of activity in the room and detectable bioaerosol production (p-value=0.605). Next, we performed a randomized control trial of hospital privacy curtains with antimicrobial properties to determine their ability to resist pathogenic bacterial contamination in an intensive care unit setting. Rooms within the surgical and neurological intensive care unit at UIHC were randomized to receive impregnated curtains, impregnated curtains plus Fuzion hypochlorite spray, or standard control curtains. MRSA, VRE, Pseudomonas spp. and Acinetobacter spp. were the four most frequently cultured pathogenic species. Time to event (contamination) analysis identified a significant difference in time to pathogenic contamination between the control curtains and the impregnated curtains post spray (p-value<0.001). The impregnated curtains post Fuzion spray also grew significantly less colonies of bacteria compared to the control curtains (p-value<0.001). After evaluating environmental risk factors that contribute to Clostridium difficile infection, patient related risk factors for infection were evaluated. Proton pump inhibitors are a class of gastric acid reducers that work by reducing the amount of hydrogen ions produced in the stomach. Recent evidence suggests that prolonged use could negatively affect the intestinal microbiome making it more susceptible to enteric pathogens. A nested case control study was done to determine the association between PPI medication duration and C. difficile infection. Fecal microbiome diversity was analyzed via logistic regression in relation to the development of Clostridium difficile infection. A co-morbidity score was created to adjust for other microbiome altering conditions. PPI duration remained a significant predictor of infection after adjusting for the microbiome influence (p-value=0.0123). Environmental contamination remains a significant risk factor for the transmission of hospital acquired infections including C. difficile. Toilets flushing has been shown to produce pathogenic bioaerosols in the healthcare setting. Hospital privacy curtains have been shown to routinely be contaminated with pathogenic bacteria including other gastrointestinal bacteria that could increase susceptibility to C. difficile infection. PPI medication, which is frequently prescribed in the hospital, has been shown to increase the risk of C. difficile infection, although specific microbiome changes could not be identified.

Nosocomial infections are acquired in health care settings and they can lead to catastrophic health care consequences for patients. These infections can also pose significant financial burdens on society and health care systems. Educating nurses on hand hygiene is essential to reducing infection rates. The research question for the study examined the effectiveness of hand hygiene among nurses in reduction of nosocomial infections and how can health care organizations develop educational strategies to reduce nosocomial infections to improve public confidence in health care systems. The purpose of this study was to educate nurses on how to reduce the incidence of nosocomial infections. The evidence-based practice model for this project was Florence Nightingale's environmental theory. The health belief model was used to identify the reasons for health care culture and how they inspire change. In this study, 2 licensed practical nurses and 2 registered nurses were educated on how to reduce nosocomial infections in acute care settings. Participants then completed a questionnaire to assess their knowledge of hand hygiene as a means of reducing nosocomial infections when caring for patients. All participants agreed that hand hygiene; reduces the risk of contracting a nosocomial infection, suggesting that the incidence of nosocomial infections within acute care settings maybe reduced through this education. This project has potential positive social change by educating first and second year nursing students on the importance of hand hygiene in reduction of nosocomial infections and preventing patients from sustaining further injuries while admitted in acute care settings.

Background Hospital-acquired infections are significant cause of morbidity and mortality among hospitalized patients worldwide. Healthcare workers during job are exposed to blood borne pathogens through contact with infected body parts, blood and body fluids. World health organization (WHO) estimated that globally about 2.5% of HIV and 40% of hepatitis viral infected cases are among health workers due to exposures. The most important mechanism of spread of these pathogens is through contaminated hands of the healthcare workers. Standard precautions measures are essential to prevent and control healthcare associated infection among healthcare workers and patients. In developing countries despite the development of detailed guideline for infection control the knowledge of standard precautions is low and not properly applied. The aim of this study is to assess the knowledge and practice of health care workers regarding standard precautions and hand hygiene to infectious disease control.  Aim The aim of this study was to assess the knowledge and practice of health care workers regarding hand wash and standard precautions to control infectious diseases in BMCH. In addition create awareness among participants and encourage them to practice regularly hand hygiene and standard precautions to control or reduce nosocomial infections in health care facilities Methods The study design is cross-sectional evaluation of healthcare worker knowledge and practices about standard precautions and hand hygiene for infectious disease control. A questionnaire administered to health care workers (doctors and nurses). The questionnaire was divided in two parts and the first part concerns demographic information, asking knowledge and practice. The second part asked opinions about risk and prevention of HAIs. The questionnaire was developed with consultation of other studies of the same kind. It has been pre tested and is finalized for survey. The ethical approval was given by hospital superintendent and informs consent from all study participants. Statistic analysis was done on Excel and statistical software SPSS version 20. Data was described in numbers, percentages and Chi Square test done for association among categorical variables, significant level was considered P= &lt;0.05. Results Two hundred questionnaires were distributed to HCWs in BMCH and 169 completely fill questionnaire were returned. The male gender respondents were 42% and female respondents were 58%. The basic questions about knowledge of hand hygiene and standard precautions were answered well in both categories; about 73% were with sufficient knowledge. The practice of hand hygiene and standard precautions was not satisfactory among both categories; about 47% found with good practice. Differences found in sub groups, young age none trained doctors and nurses answered wrong and shown lack of knowledge. This study found an association of age, profession and job experience with knowledge and practice regarding hand hygiene and standard precautions. Open handed questions described well the major issue regarding HAIs and participants emphasized on risk and prevention methods.  Conclusions The respondents were HCWs (doctors and nurses) of both sex and this study found that majority of HCWs have good knowledge and practice about control of HAIs but difference were found in age groups, sex and profession. Above half of the HCWs were not trained for infection control in health facilities, thus getting training of infection control is important but more important is implementation of it during practice.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2007. / Härtill 5 uppsatser.

- / -

Microbial pathogens commonly transmitted through the aerosol route to surfaces, equipment, and hands in the clinical setting leads to costly and life threatening hospital-acquired infections (HAIs). Even with improved hand hygiene and surface disinfection, HAIs continue to persist in healthcare environments, warranting consideration of novel interventions to reduce the transmission risk of HAIs. This study quantitated the efficacy of ion generating passive air treatment (PAT) against viruses (MS2), bacteria (Escherichia coli), and bacterial spores (Bacillus thuringiensis) in a controlled environmental setting. Microorganisms were seeded into a 2.72 m3 chamber using a positive pressure nebulizing device to generate aerosolized droplets. The PAT unit was then turned on and seeded organisms were collected at various time points using impingers to concentrate the organisms into sterile aqueous solution. The microorganisms were enumerated using approved standard protocols developed in the Environment, Exposure Science, and Risk Assessment Center's laboratory at The University of Arizona. Three experiments were conducted to challenge the PAT unit. Experiment one evaluated the efficacy of the PAT unit over a single 10-minute period on microbial inactivation from the airborne environment following a single seeding; additionally, experiment one aimed to determine the efficacy of the PAT unit against viruses, bacteria, and bacterial spores on environmental surfaces; experiment two evaluated the efficacy of the PAT unit running continuously over a period of 6 hours following a single seeding; and experiment three evaluated the efficacy of the PAT unit running two continuously over a period of 5.25 hours following two seeding events. Bacterial spores from pre- and post-treatment with the PAT unit were collected and analyzed by scanning electron microscopy to assess structural differences. After a single seeding and 10 minutes of continuous treatment of the PAT unit, normalized average microbial log10 reductions of post-treatment compared to pre-treatment air concentrations were 1.67, 0.59, and 1.04 for MS2, B. thuringiensis spores, and E. coli, respectively. Differences in average log10 reductions between the control unit and the PAT unit were statistically significant for MS2 (p=0.009) and B. thuringiensis (p=0.0455), but not for E. coli (p=0.0565). The geometric mean log10 surface concentrations of MS2, B. thuringiensis, and E. coli after a single seeding and 10 minutes of continuous treatment of the PAT unit were 7.30 PFU/100 cm2, 5.90 CFU/100 cm2, and 2.74 CFU/100 cm2, respectively, compared to exposure of the control unit, 8.59 PFU/100 cm2, 6.03 CFU/100 cm2, and 4.96 CFU/100 cm2, respectively. There was a statistically significant difference between the mean log10 surface concentrations following 10 minutes of treatment with the control unit compared to the PAT unit for E. coli (p=0.002), but not for MS2 (p=0.3358) or B. thuringiensis (p=0.0866). After a single seeding and 6-hours of continuous treatment of the PAT unit, normalized average microbial log10 reductions of MS2 and B. thuringiensis were 1.43 and 1.32, respectively. The difference in average log10 reduction of all post-treatment samples between the control unit and the PAT unit was statistically significant for B. thuringiensis (p=0.0008) but not for MS2 (p=0.2568). After two seedings and 5.25 hours of continuous treatment of the PAT unit, normalized average microbial log10 reductions of MS2 and B. thuringiensis were 1.59 and 1.26, respectively. There was a statistically significant difference in the average log10 reductions between the control unit and the PAT unit for MS2 (p=0.002) and B. thuringiensis (p=0.0003). Scanning electron microscopy analysis identified visual modification to B. thuringiensis spores following treatment with the PAT unit. In this study, the tested ion generating PAT unit was effectively able to reduce airborne microbial concentrations between 1-2 log10 in a controlled chamber environment within 10 minutes and up to 6 hours of treatment. The implications of this study suggest that ion producing PAT systems may represent a beneficial supplement to cleaning and disinfection practices in the reduction of pathogen contamination from the airborne and fomite-airborne routes.