Tag: infection control

Categories : Diseases, Syndromes and ConditionsTags :

Healthcare Workers among Those Who Conceal their Infectious Illness

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A startling number of people – including healthcare workers – conceal an infectious illness to avoid missing work, travel, or social events, new research at the University of Michigan suggests. The findings however, reported in Psychological Science, exclude being ill with COVID.

Across a series of studies involving healthy and sick adults, 75% of the 4110 participants said they had either hidden an infectious illness from others at least once or might do so in the future.

Many participants reported boarding planes, going on dates, and engaging in other social interactions while secretly sick.

More than 61% of healthcare workers participating in the study also said they had concealed an infectious illness.

Interestingly, the researchers found a difference between how people believe they would act when ill and how they actually behave, said Wilson N. Merrell, a doctoral candidate and lead author on the study.

More than 61% of healthcare workers participating in the study also said they had concealed an infectious illness.

Interestingly, the researchers found a difference between how people believe they would act when ill and how they actually behave, said Wilson N. Merrell, a doctoral candidate and lead author on the study.

“Healthy people forecasted that they would be unlikely to hide harmful illnesses – those that spread easily and have severe symptoms – but actively sick people reported high levels of concealment regardless of how harmful their illness was to others,” Merrell said.

In the first study, Merrell and his colleagues, psychology professor Joshua M. Ackerman and PhD student Soyeon Choi, recruited 399 university healthcare employees and 505 students.

The participants reported the number of days they felt symptoms of an infectious illness, starting in March 2020, when the COVID pandemic began.

They then rated how often they actively covered up symptoms from others, came to campus or work without telling others they were feeling ill, or falsified mandatory symptom screeners that the university had required for anyone using campus facilities.

More than 70% of the participants reported covering up their symptoms.

Many said they hid their illness because it would conflict with social plans, while a small percentage of participants cited pressure from institutional policies (eg, lack of paid time off). Only five participants reported hiding a COVID infection.

In a second study, the researchers recruited 946 participants online and randomly assigned them to one of nine conditions in which they imagined being either moderately or severely sick while in a social situation.

In each condition, the risk of spreading the illness was designated as low, medium, or high.

(To control for the special stigma associated with COVID at the time, the researchers asked participants not to imagine being sick with that disease.) Participants were most likely to envision themselves hiding their sickness when symptom severity was low, and least likely to conceal when symptoms were severe and highly communicable.

Source: Association for Psychological Science

Categories : Medical Research & TechnologyTags :

Infection-preventing Air Treatment Systems may All Just be Hot Air

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Air filtration systems do not reduce the risk of picking up viral infections, according to new research from the University of East Anglia. A new study published in Preventive Medicine reveals that technologies designed to make social interactions safer in indoor spaces are not effective in the real world. The team studied technologies including air filtration, germicidal lights and ionisers.

They looked at all the available evidence but found little to support hopes that these technologies can make air safe from respiratory or gastrointestinal infections.

Prof Paul Hunter said: “Air cleaners are designed to filter pollutants or contaminants out of the air that passes through them.

“When the Covid pandemic hit, many large companies and governments – including the NHS, the British military, and New York City and regional German governments – investigated installing this type of technology in a bid to reduce airborne virus particles in buildings and small spaces.

“But air treatment technologies can be expensive. So it’s reasonable to weigh up the benefits against costs, and to understand the current capabilities of such technologies.” 

The research team studied evidence about whether air cleaning technologies make people safe from catching airborne respiratory or gastrointestinal infections. They analysed evidence about microbial infections or symptoms in people exposed or not to air treatment technologies in 32 studies, all conducted in real world settings like schools or care homes. So far none of the studies of air treatment started during the Covid era have been published.

‘Disappointing’ findings

Lead researcher Dr Julii Brainard said: “The kinds of technologies that we considered included filtration, germicidal lights, ionisers and any other way of safely removing viruses or deactivating them in breathable air.

“In short, we found no strong evidence that air treatment technologies are likely to protect people in real world settings.

“There is a lot of existing evidence that environmental and surface contamination can be reduced by several air treatment strategies, especially germicidal lights and high efficiency particulate air filtration (HEPA).  But the combined evidence was that these technologies don’t stop or reduce illness.

“There was some weak evidence that the air treatment methods reduced likelihood of infection, but this evidence seems biased and imbalanced. We strongly suspect that there were some relevant studies with very minor or no effect but these were never published.

“Our findings are disappointing – but it is vital that public health decision makers have a full picture. Hopefully those studies that have been done during Covid will be published soon and we can make a more informed judgement about what the value of air treatment may have been during the pandemic.”

Source: University of East Anglia

Categories : Diseases, Syndromes and Conditions HospitalsTags :

Chlorine Disinfectant no Better than Water at Eliminating C. Diff

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Clostridioides difficile. Credit: CDC

One of the primary chlorine disinfectants currently used for hospital infection control does not kill off spores of the notorious cause of hospital-acquired infection Clostridioides difficile, according to a new study published in the journal Microbiology.

Research by the University of Plymouth has shown that C. Diff spores are completely unaffected despite being treated with high concentrations of bleach used in many hospitals.

In fact, the chlorine chemicals are no more effective at damaging the spores when used as a surface disinfectant – than using water with no additives.

The study’s authors say susceptible people working and being treated in clinical settings might be unknowingly placed at risk of contracting the superbug.

As a result, and with incidence of biocide overuse only serving to fuel rises in antimicrobial resistance (AMR) worldwide, they have called for urgent research to find alternative strategies to disinfect C. diff spores in order to break the chain of transmission in clinical environments.

Dr Tina Joshi, Associate Professor in Molecular Microbiology at the University of Plymouth, carried out the study with Humaira Ahmed, a fourth year Medicine student from the University’s Peninsula Medical School.

Dr Joshi, said: “With incidence of anti-microbial resistance on the rise, the threat posed by superbugs to human health is increasing. But far from demonstrating that our clinical environments are clean and safe for staff and patients, this study highlights the ability of C. diff spores to tolerate disinfection at in-use and recommended active chlorine concentrations. It shows we need disinfectants, and guidelines, that are fit for purpose and work in line with bacterial evolution, and the research should have significant impact on current disinfection protocols in the medical field globally.”

C. diff causes diarrhoea, colitis and other bowel complications, causing around 29 000 deaths per year in the USA, and almost 8500 in Europe, with the most recent data showing that, in the UK, incidence of C. diff infection was increasing prior to the start of the COVID pandemic.

Previously, Dr Joshi and colleagues had demonstrated the ability of C. diff spores to survive exposure to recommended concentrations of sodium dichloroisocyanurate in liquid form and within personal protective fabrics such as surgical gowns.

The new study examined spore response of three different strains of C. diff to three clinical in-use concentrations of sodium hypochlorite. The spores were then spiked onto surgical scrubs and patient gowns, examined using scanning electron microscopes to establish if there were any morphological changes to the outer spore coat.

Dr Joshi, who is on the Microbiology Society Council and Co-Chairs their Impact & Influence Committee, added: “Understanding how these spores and disinfectants interact is integral to practical management of C. diff infection and reducing the burden of infection in healthcare settings. However, there are still unanswered questions regarding the extent of biocide tolerance within C. diff and whether it is affected by antibiotic co-tolerance. With AMR increasing globally, the need to find those answers – both for C. diff and other superbugs – has never been more pressing.”

Source: University of Plymouth

Categories : Diseases, Syndromes and Conditions HospitalsTags :

The Greater Clostridioides Difficile Threat may Come from Within

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Clostridioides difficile. Credit: CDC

Despite strenuous control efforts, hospital-acquired infections still occur – the most common of which is caused by the bacterium Clostridioides difficile, which creates lingering spores and resists alcohol-based hand sanitisers. Surprising findings from a new study in Nature Medicine suggest that the burden of C. diff infection may be less a matter of hospital transmission and more a result of characteristics associated with the patients themselves.

The study team, led by Evan Snitkin, PhD; Vincent Young, MD, PhD; and Mary Hayden, MD, leveraged ongoing epidemiological studies focused on hospital-acquired infections that enabled them to analyse daily faecal samples from every patient within the intensive care unit at Rush University Medical Center over a nine-month period.

Arianna Miles-Jay, a postdoctoral fellow in Dr Snitkin’s lab, analysed 1141 eligible patients, and found that a little over 9% were colonised with C. diff. Using whole genome sequencing at U-M of 425 C. difficile strains isolated from nearly 4000 faecal specimens, she compared the strains to each other to analyse spread. But she found that, based on the genomics, there was very little transmission.

Essentially, there was very little evidence that the strains of C. diff from one patient to the next were the same, which would imply in-hospital acquisition. In fact, there were only six genomically supported transmissions over the study period. Instead, people who were already colonised were at greater risk of transitioning to infection.

“Something happened to these patients that we still don’t understand to trigger the transition from C. diff hanging out in the gut to the organism causing diarrhoea and the other complications resulting from infection,” said Snitkin.

Hayden notes this doesn’t mean hospital infection prevention measures are not needed. In fact, the measures in place in the Rush ICU at the time of the study – high rates of compliance with hand hygiene among healthcare personnel, routine environmental disinfection with an agent active against C. diff, and single patient rooms were likely responsible for the low transmission rate. The current study highlights, though that more steps are needed to identify patients who are colonised and try to prevent infection in them.

Where did the C. diff come from? “They are sort of all around us,” said Young. “C. diff creates spores, which are quite resistant to environmental stresses including exposure to oxygen and dehydration…for example, they are impervious to alcohol-based hand sanitiser.”

However, only about 5% of the population outside of a healthcare setting has C. diff in their gut – where it typically causes no issues.

“We need to figure out ways to prevent patients from developing an infection when we give them tube feedings, antibiotics, proton pump inhibitors – all things which predispose people to getting an actual infection with C. diff that causes damage to the intestines or worse,” said Young.

The team next hopes to build on work on AI prediction for patients at risk of C. diff infection to identify patients more likely to be colonised and who could benefit from more focused intervention.

Said Snitkin, “A lot of resources are put into gaining further improvements in preventing the spread of infections, when there is increasing support to redirect some of these resources to optimise the use of antibiotics and identify other triggers that lead patients harbouring C. diff and other healthcare pathogens to develop serious infections.”

Source: Michigan Medicine – University of Michigan

Categories : Diseases, Syndromes and ConditionsTags :

RSV Easier to Inactivate than Many Other Viruses

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Every year, respiratory syncytial viruses (RSV) cause countless respiratory infections worldwide. For infants, young children and people with pre-existing conditions, the virus can be life-threatening and so clinicians are always on the look-out for ways to reduce infections. New research published in the Journal of Hospital Infection shows that, when used correctly, alcohol-based hand sanitisers and commercially available surface disinfectants provide good protection against transmission of the virus via surfaces.

Some viruses are known to remain infectious for a long time on surfaces. To determine this period for RSV, the Ruhr-University Bochum virology team examined how long the virus persists on stainless steel plates at room temperature. “Even though the amount of infectious virus decreased over time, we still detected infectious viral particles after seven days,” says Dr Toni Luise Meister. “In hospitals and medical practices in particular, it is therefore essential to disinfect surfaces on a regular basis.” Five surface disinfectants containing alcohol, aldehyde and hydrogen peroxide were tested and found to effectively inactivate the virus on surfaces.

RSV is easier to inactivate than some other viruses

Hand sanitisers recommended by the WHO also showed the desired effect. “An alcohol content of 30 percent was sufficient: we no longer detected any infectious virus after hand disinfection,” said Toni Luise Meister. RSV is thus easier to render harmless than some other viruses, such as mpox (formerly monkeypox) virus or hepatitis B virus.

Still, most infections with RSV are transmitted from one person to another, via airborne droplets. The risk of contracting the virus from an infected person decreases if that person rinses their mouth for 30 seconds with a commercial mouthwash. The lab tests showed that three mouthwashes for adults and three of four mouthwashes designed specifically for children reduced the amount of virus in the sample to below detectable levels.

“If we assume that these results from the lab can be transferred to everyday life, we are not at the mercy of seasonal flu and common cold, but can actively prevent infection,” concludes Toni Luise Meister. “In addition to disinfection, people should wash their hands regularly, maintain a proper sneezing and coughing etiquette, and keep their distance from others when they’re experiencing any symptoms.”

Source: Ruhr-University Bochum

Categories : COVID Diseases, Syndromes and ConditionsTags :

Wristbands a Breeding Ground for Bacteria, Including E. Coli

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The COVID pandemic took disinfecting to new heights. Now, a new study has uncovered a niche for bacteria to colonise: despite being worn daily, routine cleaning of wristbands is generally overlooked or simply ignored. Researchers from Florida Atlantic University tested wristbands of various materials to determine their risk for harbouring potentially harmful pathogenic bacteria, and found that plastic and rubber bands had a particularly high load, especially if worn at the gym.

For the study, researchers tested plastic, rubber, cloth, leather and metal (gold and silver) wristbands to see if there is a correlation between wristband material and the prevalence of bacteria. They investigated the hygienic state of these various types of wristbands worn by active individuals and identified the best protocols to properly disinfect them.

Using standard microbiological assays, researchers looked at bacterial counts, type of bacteria and their distribution on the wristband surfaces. They also conducted a bacteria susceptibility assay study screening the effectiveness of three different disinfectant solutions: Lysol™ Disinfectant Spray; 70% ethanol, commonly used in hospitals and alcohol wipes; and a more natural solution, apple cider vinegar.

Results of the study, published in the journal Advances in Infectious Diseases, suggest you stick with the ‘gold standard’ or at least silver the next time you purchase a wristband. Nearly all wristbands (95%) were contaminated. However, rubber and plastic wristbands had higher bacterial counts, while metal ones, especially gold and silver, had little to no bacteria.

“Plastic and rubber wristbands may provide a more appropriate environment for bacterial growth as porous and static surfaces tend to attract and be colonissd by bacteria,” said Nwadiuto Esiobu, PhD, senior author and a professor of biological sciences in the Charles E. Schmidt College of Science.

The most important predictor of wristband bacteria load was the texture of wristband material and activity (hygiene) of the subject at sampling time. There were no significant differences between males and females in the occurrence or distribution of the bacteria groups.

Intestinal organisms of the genera Escherichia, specifically E. coli. Staphylococcus spp was prevalent on 85% of the wristbands; researchers found Pseudomonas spp on 30% of the wristbands; and they found E. coli bacteria on 60% of the wristbands, which most commonly begins infection through faecal-oral transmission.

The gym-goer showed the highest staphylococcal counts, which emphasises the necessity of sanitising wristbands after engaging in rigorous activity at the gym or at home.

“The quantity and taxonomy of bacteria we found on the wristbands show that there is a need for regular sanitation of these surfaces,” said Esiobu. “Even at relatively low numbers these pathogens are of public health significance. Importantly, the ability of many of these bacteria to significantly affect the health of immunocompromised hosts indicates a special need for health care workers and others in hospital environments to regularly sanitize these surfaces.”

Findings from the study showed that Lysol™ Disinfectant Spray and 70% ethanol were highly effective regardless of the wristband material with 99.99% kill rate within 30 seconds. Apple cider vinegar was not as potent and required a full two-minute exposure to reduce bacterial counts. While these common household disinfectants all proved at least somewhat effective on all materials (rubber, plastic, cloth and metal), antibacterial efficacy was significantly increased at two minutes compared to thirty seconds.

Different disinfectants, depending on their active ingredients, kill bacteria in different ways, such as by disrupting cell membrane integrity, altering or removing proteins or interfering with metabolic activities.

“Other potential forms of bacterial transmission and facilitation of infection, such as earbuds or cell phones, should be similarly studied,” said Esiobu.

Source: Florida Atlantic University

Categories : UncategorizedTags :

Monkeypox Virus can Linger for up to a Month on Surfaces

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Monkeypox virus. Source: NIH

According to a study published in the Journal of Infectious Diseases, the monkeypox virus remains infectious on steel surfaces for up to 30 days, especially in cold conditions, but can be effectively inactivated by alcohol-based disinfectants.

Smallpox viruses are notorious for their ability to remain infectious in the environment for a very long time. A study conducted by the Department of Molecular and Medical Virology at Ruhr University Bochum, Germany, has shown that temperature is a major factor in this process: at room temperature, a monkeypox virus that is capable of replicating can survive on a stainless steel surface for up to 11 days, and at 4°C for up to a month. Consequently, it’s very important to disinfect surfaces. According to the study, alcohol-based disinfectants are very effective against monkeypox viruses, whereas hydrogen peroxide-based disinfectants have proved inadequate.

Weeks of monitoring

Since 2022, the monkeypox virus has been transmitted more and more frequently from one human host to another. Although infections primarily result from direct physical contact, it’s also possible to contract the virus through contaminated surfaces, for example in the household or in hospital rooms. “Smallpox viruses are notorious for their ability to remain infectious in the environment for a very long time,” explains Dr Toni Meister from the Department for Molecular and Medical Virology at Ruhr University Bochum. “For monkeypox, however, we didn’t know the exact time frames until now.”

The researchers therefore studied them by applying the virus to sanitised stainless steel plates and storing them at different temperatures: at 4°C, at 22°C, which roughly corresponds to room temperature, and at 37°C. They determined the amount of infectious virus after different periods of time, ranging from 15 minutes to several days to weeks.

Viruses remain infectious for a long time

Regardless of the temperature, there was little change in the amount of infectious virus during the first few days. At 22 and 37°C, the virus concentration dropped significantly only after five days. At 37°C, no virus capable of reproducing was detected after six to seven days, at 22°C it took 10–11 days until infection was no longer possible. At 4°C, the amount of virus only dropped sharply after 20 days, and after 30 days there was no longer any danger of infection. “This is consistent with our experience that people can still contract monkeypox from surfaces in the household after almost two weeks,” points out Professor Eike Steinmann, Head of the Department for Molecular and Medical Virology.

In order to reduce the risk of infection in the event of an outbreak, it is therefore extremely important to disinfect surfaces. This is why the researchers tested the effectiveness of five common disinfectants. They found that alcohol-based or aldehyde-based disinfectants reliably reduced the risk of infection. A hydrogen peroxide-based disinfectant, however, didn’t inactivate the virus effectively enough in the study. “Our results support the WHO’s recommendation to use alcohol-based surface disinfectants,” concludes Toni Meister.

Source: Ruhr-University Bochum

Categories : Diseases, Syndromes and Conditions HospitalsTags :

Toss Out Hospital Sinks Colonised by MDRO, Evidence Suggests

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Methicillin-resistant Staphylococcus aureus (MRSA) bacteria. Credit: CDC

An outbreak of a pandrug-resistant nosocomial pathogen was interrupted by not using hospital sinks during COVID, according to Basma Mnif, Professor of Microbiology at Habib Bourguiba University Hospital of Sfax, Tunisia. In her presentation at the 14th SAFHE Southern African Healthcare Conference, she said that infection control methods to eradicate the pathogen failed and that other research indicated it was necessary to replace the sinks entirely.

Multidrug-resistant organisms (MDRO) are a growing threat in hospitals, especially to critically ill patients.

Over 2017 to 2021, 90 critically ICU patients in a Tunisian hospital were infected with pandrug-resistant Proteus mirabilis strains. This is the first known long-term outbreak by pandrug-resistant P. mirabilis strains.

P. mirabilis is an uncommon nosocomial pathogen causing opportunistic infections. P. mirabilis survives well in the natural environment and is increasingly implicated in nosocomial outbreaks worldwide.

The all-cause mortality rate in the infected was 47%, with patients ranging in age from 16 to 78 years. The average length of stay before infection was 23.56 days.

An outbreak was recognised in April 2017, and IDC measures were taken to contain it. The outbreak was suppressed but reoccurred in July and December. Analysis revealed overlapping ICU stays of infected patients, suggesting horizontal, intra-ICU transmission. Lab analysis of phenotypes revealed two clones, A and B, both with drug resistance genes, to which a third clone was added in 2018. This Clone C proved to have resistance to all known antibiotics.

During the COVID pandemic in 2020, hospital sinks were not used and enhanced infection prevention interventions were deployed. This period coincided with a complete absence of P. mirabilis infections. The outbreak resumed in 2021, with the same three clones causing infections in patients.

“The outbreak intermission during COVID could be related to the enhanced protection measures implemented during this period,” Prof Mnif noted, “but we think that the sinks are in fact the reservoirs of these MDRO, and must in fact be removed and replaced, and the chemical disinfection that we had performed was not sufficient to control the outbreak.”

The outbreak highlighted the need for proper infection control protocols. Hospital wastewater is a major source of outbreaks, Prof Mnif pointed out. A study found that “over the past 20 years, there have been 32 reports of carbapenem-resistant organisms in the hospital water environment.”

She said when it came to replacing the sinks, hospitals should “respect FGI guidelines, especially in having sufficient depths of the sink, deep enough to prevent splashing.” Having sufficient pressure and splash reduction measures such as splash guards are also important, Prof Mnif added.

Although there are CDC guidelines to help prevent colonisation, there is no clear strategy for eradication for when a sink is colonised. There is likely genetic interchange between organisms in biofilms, something which needs to be investigated further, as well as means of eradication.

Categories : Expert Opinion HospitalsTags :

Proper Handwash Basin Design and Use is Critical to Controlling AMR

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Some 10 million people annually are projected to die annually from antimicrobial resistance AMR in 2050, says Briëtte Du Toit, Programme Manager and Training Coordinator at Infection Control Africa Network (ICAN). While efforts to develop new antibiotics and conserve current ones are under way, it is vitally important to limit hospital-acquired infections as this is where many resistant strains spread. One of the key ways of controlling this is through the proper use of handwash basins, which necessitates a collaboration between the medical and engineering disciplines.

Presenting at the 14th SAFHE Southern African Healthcare, Du Toit stressed the importance of proper handwashing protocol and the critical importance of handwash basin design and placement to control the spread of hospital-acquired infections amid rising antimicrobial resistance.

The simple protocol of hand washing is perhaps one of the most important in modern medicine. In the past, clinicians might perform and autopsy and then deliver a child, all without washing their hands. It was only until the mid 1800s when Hungarian doctor Ignaz Semmelweis discovered the importance of hand washing, causing infection rates to plummet after the introduction of this most simple of protocols.

In modern hospitals, handwash basin design and placement, along with inadequate water supply and inadequate knowledge on the part of staff, contributes to inadequate hand washing and therefore high infection rates, Du Toit pointed out.

The design of handwash basins may seem straightforward, but there are many factors to consider. Water may drop onto other surfaces, or splash onto HCWs’ clothes. If medical supplies are stored nearby, then stray water droplets may also land on them.

A study of handwash basins showed that only 23% of basins were used for handwashing, while the remainder were used for a variety of activities including waste disposal. Of the basins used for waste disposal, 55% were contaminated. Another study showed that, in the ICU setting, washbasins were used for handwashing a mere 4% of the time. A sluice is also needed in close proximity to patients, otherwise staff will use handwash basins for incorrect disposal of body fluids.

Having the outlet directly beneath the tap as in a traditional domestic basin increases contamination. A bowl depth less than 19cm also contributed to contamination. Without a bowl cover, 9% of gowns and 6% of hands were found to be contaminated with gram-negative bacili (GNB), versus 2% of gowns and 0% of hands when a cover was present.

Significant improvements were also seen in ‘water-free’ protocols at the point of care, which involved the extensive use of disposable wipes, bottled water and practices such as using electric shaving. The implementation of water-free protocols at one hospital saw a drop in GNB colonisations from 26.3 to 21.6 / 1 000 ICU admission days. An even greater effect was seen for long-term ICU stays, with a 3.6 fold-reduction for stay exceeding 14 days.

Du Toit concluded by stressing the importance of collaboration between the medical and engineering fields, sharing data. Engineers should also be on IPC committees. Likewise, medical personnel should be part of the project team during building and renovations.