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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.

Master of Public Health - MPH / Hospital acquired infections are a huge public health concern, contributing to increased hospitalisation and death in developing countries. Infection prevention and control (IPC) is a discipline which relies on practical evidence-based approaches to preventing both patients and health workers from hospital avoidable infections. However, most of these infections, in many developing countries including Zimbabwe can be attributed to lack of compliance with infection prevention and control measures by health care workers. / 2023

Health care-associated and hospital-acquired infections are two entities associated with increased morbidity and mortality. They are highly costly and constitute a great burden to the health care system. Vitamin D deficiency (< 20 ng/ml) is prevalent and may be a key contributor to both acute and chronic ill health. Vitamin D deficiency is associated with decreased innate immunity and increased risk for infections. Vitamin D can positively influence a wide variety of microbial infections. Herein we discuss hospital-acquired infections, such as pneumonia, bacteremias, urinary tract and surgical site infections, and the potential role vitamin D may play in ameliorating them. We also discuss how vitamin D might positively influence these infections and help contain health care costs. Pending further studies, we think it is prudent to check vitamin D status at hospital admission and to take immediate steps to address existing insufficient 25-hydroxyvitamin D levels.

Research Abstract Purpose: to explain how there is a direct correlation between nursing staff ratios and patient results regarding mortality, infection, poor patient safety, and other sentinel events. Aims: how is patient care compromised by nursing staff shortage? Methods: observational studies from public information records such as Medicare patient claims, AHA, and surveys from RNs working at acute care hospitals. Results: certain groups are more susceptible to sentinel events. Patients with chronic diseases, elderly, patients needing intensive care, or overall unstable patients are examples of patients who fall under this category. Studies show that patients are at higher risk for receiving detrimental care due to poor nurse to patient ratio. Conclusions: adding to a nurse’s workload increases patient mortality in length of stay in hospitals due to hospital administration only needing to meet the minimum staffing requirements. The minimum staffing required for operations still does not meet the recommendations provided by the Safe Staffing Act. Key Words: nurse shortages, patient safety, patient outcomes, healthcare quality, workload, hospital acquired infections, staffing, CAUTI, VAP, CABI

Yes / It is estimated that 5-10% of hospitalised patients in developed countries contract hospital acquired infections (HAI). Increasing levels of antimicrobial resistance manifested by many HAI-causing pathogens such as Acinetobacter spp in the intensive care unit (ICU) setting present a significant challenge to those managing these infections. Consequently, much attention has been focused on the prevention of HAIs. Particular emphasis has been placed on interventions intended to interrupt patient-to-patient transmission of pathogens, such as enhanced hand hygiene and identification of patients colonised with methicillin-resistant Staphylococcus aureus (MRSA) using rapid DNA-based screening techniques. However, comparatively little attention has been given to the hospital environment, including water supplies, as a source of nosocomial pathogens of importance for patients on the critical care unit. This article reviews the role of hospital water sources in the epidemiology of HAI and new technologies which can be employed in the prevention and control of such infections.

More than 13,000 deaths and $340 million in health care costs are the result of catheter-associated urinary tract infections (CAUTIs) annually in the United States. CAUTIs can also result in acute patient discomfort and potentially preventable exposure to antibiotics. The hospital for which this quality improvement project was developed was above the National Healthcare Safety Network CAUTI bench mark. Framed within the Iowa model of evidence-based practice, a multidisciplinary team of 8 hospital stakeholders guided the project (n=8). The purpose of the project was to develop an indwelling urinary catheter maintenance checklist using evidence-based practice guidelines related to preexisting inappropriate risk factors for catheterization and appropriate indications for catheterization, as well as evidence-based maintenance practices for care of the indwelling catheter. Each piece of evidence to be included in the checklist was evaluated by 4 content experts using a 10 item 5 point Likert scale ranging from 'strongly disagree' to 'strongly agree'. Descriptive analysis showed an average of 4.8/5 for all items with 'agree' being voiced in two of the items rather than 'strongly agree'. The checklist was completed and presented to hospital senior leadership who recommended that the checklist be incorporated into the hospital CAUTI prevention plan. All project team members (n=8) completed an 8 item 5 point Likert scale summative evaluation of the purpose, goal, objectives, and my leadership which averaged as 5 or 'strongly agree' supporting the development of the project. Implications for social change include improved patient outcomes, mindful stewardship of healthcare dollars, and increased patient and family satisfaction.

Gram-negative infection has been linked to hospital water although few studies have examined whether water systems are reservoirs of nosocomial pathogens. This study investigated longitudinal recovery of the opportunistic pathogens Pseudomonas aeruginosa, Stenotrophomonas maltophilia and Acinetobacter baumannii from water outlets of a haematology unit and evaluated Point-Of-Use Filtration (POU-F) as a control measure. In a two-year double cross-over trial, water samples and swabs were taken weekly from 39 showers/taps on the unit. Four study phases alternated between non-filtered (Phases 1 &amp; 3), and filtered outlets (Phases 2 &amp; 4) using Pall AquasafeTM 14-day filters. In Phases 1 &amp; 3; 99% of 1396 samples yielded bacterial growth, with colonies generally too numerous to count. Target species were isolated from 22% of water samples (P. aeruginosa 14%; S. maltophilia 10%) and 10% of swabs. P. aeruginosa was particularly associated with handwash stations and S. maltophilia with showers. A. baumannii was not isolated. With POU-F; 22% of 1242 samples yielded bacterial growth (mean CFU/100ml ,4.6). S. maltophilia was isolated only once from water but never from outlet swabs. PCR typing identified clusters of isolates colonizing different outlets over time but no clear association between water and patient isolates was identified. The incidence of Gram negative infections remained low throughout the study. Without POU-F, water from taps/showers represented a source of bacteria including the target species. POU-F substantially reduced the frequency and number of target species from every outlet, and merits further investigation as an intervention to protect immunocompromised patients from opportunistic pathogens.

Methicillin-resistant staphylococcus aureus (MRSA) has become resistant to antibiotics. The purpose of this quantitative, retrospective cohort study was to examine the relationship between length of hospitalization and invasive MRSA infection rates among different racial and ethnic groups in the 8 service planning areas (SPAs) of Los Angeles County. Cane, O'Connor, and Michie's theoretical domain framework was used. Secondary data from the Healthcare-Associated (HA) Infections Program of the California Department of Public Health were analyzed. For the first research question, a Pearson correlation analysis was conducted to assess the relationships between length of hospitalization and invasive HA-MRSA infection rates and counts. Length of hospital stay was not correlatedwith HA-MRSA infection rates; however, it was strongly and positively correlated with HA-MRSA infection counts. For the second research question, a one-way ANOVA was conducted on the infection count rate data, with SPA as the between-subjects factor. The results were statistically significant, indicating that HA-MRSA infection counts varied among the 8 SPAs. The findings might help medical professionals better understand the risk factors associated with MRSA infections. In doing so, findings may relieve some of the burden on the U.S. health care system and improve the overall quality of life of the patients involved.

Bakgrund: Centrala venkatetrar förekommer idag inte bara på intensivvårdsavdelningar utan har även blivit en vanlig företeelse på vårdavdelningar där allmänsjuksköterskan arbetar. Med CVK följer risker för infektioner, både lokala och systemiska. Vårdrelaterade infektioner, specifikt kateterrelaterade sådana, är ett stort problem inom sjukvården och medför såväl ökade vårdtider som ökade kostnader. Allmänsjuksköterskan ansvarar för handhavande och skötsel av CVK och har därmed en nyckelroll i att förebygga infektioner. Syfte: Att sammanställa vetenskaplig litteratur rörande hur allmänsjuksköterskan kan förebygga infektioner hos patienter med CVK inneliggande på vårdavdelning.Metod: Den valda undersökningsmetoden var en litteraturstudie. Databassökningar utfördes i Cinahl, PubMed och Cochrane Library. Efter kvalitetsgranskning inkluderades tio vetenskapliga artiklar med kvantitativ metod. Resultat: Åtgärder för förebyggande av infektion sorterades in under fyra rubriker: desinfektion, utbildning, omläggning och teknik vid byte av koppling. Åtgärderna inom dessa grupper visades minska förekomsten av kateterrelaterad infektion.Konklusion: Klorhexidinlösningar, desinfektionsproppar, utbildning samt semipermeabla förband kan leda till minskad förekomst av kateterrelaterade infektioner hos patienter med CVK. Eventuellt kan ”non-touch”-teknik vara ett alternativ vid byte av kopplingar. Mer forskning krävs gällande sjuksköterskans förebyggande åtgärder utanför IVA samt en mer enhetlig forskning för att skapa tydligare riktlinjer. / Background: Central venous catheters today are not only common in intensive care units but have become a regular phenomenon in wards where non-specialised nurses work. With CVCs comes a risk for infections, both local and systemic. Hospital acquired infections, in particular catheter-related infections, are a major problem in health care and cause prolonged length of hospital stay as well as increased costs. The general nurse is responsible for the handling and care of CVCs, and therefore has a key part in preventing infections. Aim: To compile scientific literature regarding how the general nurse can prevent infections in patients with CVCs on general wards. Method: The chosen method of investigation was a literature review. A literature search was undertaken using Cinahl, PubMed and Cochrane Library. Following a quality assessment, ten scientific papers with a quantitative method were included. Results: Measures to prevent infection were sorted under four headlines: disinfection, education, dressing care, and technique for line changes. The measures within these groups were shown to reduce prevalence of catheter-related infections.Conclusion: Chlorhexidine solutions, disinfection caps, education and semipermeable dressings can lead to reduced prevalence of catheter-related infections in patients with CVCs. A “non-touch” technique may be a possible alternative when changing lines. More research is needed regarding preventive nursing measures outside the intensive care units, as well as more unified research to create clear guidelines.