Regional infection control assessment of antibiotic resistance knowledge and practice.

OBJECTIVE Multidrug-resistant organisms (MDROs) are an increasing burden among healthcare facilities. We assessed facility-level perceived importance of and responses to various MDROs. DESIGN A pilot survey to assess staffing, knowledge, and the perceived importance of and response to various multidrug resistant organisms (MDROs)

SETTING Acute care and long-term healthcare facilities

METHODS In 2012, a survey was distributed to infection preventionists at ~300 healthcare facilities. Pathogens assessed were Clostridium difficile, carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Acinetobacter, methicillinresistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus, multidrug-resistant (defined as bacterial resistance to ≥3 antibiotic classes) Pseudomonas, and extended-spectrum β-lactamaseproducing Escherichia coli.

RESULTS A total of 74 unique facilities responded, including 44 skilled nursing facilities (SNFs) and 30 acute care facilities (ACFs). While ACFs consistently isolated patients with active infections or colonization due to these MDROs, SNFs had more variable responses. SNFs had more multi-occupancy rooms and reported less specialized training in infection control and prevention than did ACFs. Of all facilities with multi-occupancy rooms, 86% employed a cohorting practice for patients, compared with 50% of those without multioccupancy rooms; 20% of ACFs and 7% of SNFs cohorted staff while caring for patients with the same MDRO. MRSA and C. difficile were identified as important pathogens in ACFs and SNFs, while CRE importance was unknown or was considered important in <50% of SNFs.

CONCLUSION We identified stark differences in human resources, knowledge, policy, and practice between ACFs and SNFs. For regional control of emerging MDROs like CRE, there is an opportunity for public health officials to provide targeted education and interventions. Education campaigns must account for differences in audience resources and baseline knowledge.

ReferenceRegional infection control assessment of antibiotic resistance knowledge and practice. Black SR, Weaver KN, Weinstein RA, Hayden MK, Lin MY, Lavin MA, Gerber SI. Infect Control Hosp Epidemiol. 2015 Apr, vol 36, no 4, p381-6.

Motivation and environmental perceptions influence hand hygiene

Motivation and perceptions of the working environment influence the extent to which healthcare workers comply with hand hygiene guidelines. Interventions to educate, change behaviour and empower staff may be useful. Reviewers from Ireland examined qualitative literature about healthcare workers’ compliance with hand hygiene guidelines. Factors that workers said contributed to the level of compliance included motivational factors and perceptions of the work environment. Motivational factors could be influenced by behaviour change interventions. The way in which staff perceive their work environment may be influenced by empowerment and culture change.

Reference: Smiddy MP, O’Connell R, Creedon SA. Systematic qualitative literature review of health care workers’ compliance with hand hygiene guidelines. American Journal of Infection Control. 2015 Mar;43(3):269-274

Wearing two sets of gloves reduces contamination in surgery

A simple intervention such as wearing double gloves and removing the outer layer after touching the patient during surgery can reduce contamination. This study tested, in a simulated environment, whether anaesthetists wearing two pairs of gloves reduced contamination in surgery. The outer set of gloves was removed immediately after placing a tube into the airway. In half of the 22 simulation sessions personnel wore a single pair of gloves and in the other half they wore two sets of gloves. Before the simulation, the lips and inside of the mouth of the mannequin were coated with a fluorescent gel to represent a pathogen. After the simulation, an observer examined 40 different sites to determine whether the ‘pathogen’ was transferred to the patient or the patient’s environment. There was a significant reduction in the rate of contamination with double gloves. Single gloves were associated with an average of 20 contaminated sites compared to five with double gloves.

Reference: Birnbach DJ, Rosen LF, Fitzpatrick M, Carling P, Arheart KL, Munoz-Price LS. Double gloves: a randomized trial to evaluate a simple strategy to reduce contamination in the operating room. Anesthesia and Analgesia. 2015 Mar;120(4):848-852