Cross-site collaboration on infection prevention and control research—room for improvement? A 7-year comparative study in five European countries

Background: The spread of SARS-CoV-2, multidrug-resistant organisms and other healthcare-associated pathogens represents supra-regional challenges for infection prevention and control (IPC) specialists in every European country. To tackle these problems, cross-site research collaboration of IPC specialists is very important. This study assesses the extent and quality of national research collaborations of IPC departments of university hospitals located in Austria, England, France, Germany, and the Netherlands, identifies network gaps, and provides potential solutions. Methods: Joint publications of IPC heads of all university hospitals of the included countries between 1st of June 2013 until 31st of May 2020 were collected by Pubmed/Medline search. Further, two factors, the journal impact factor and the type/position of authorship, were used to calculate the Scientific Collaboration Impact (SCI) for all included sites; nationwide network analysis was performed. Results: In five European countries, 95 sites and 125 responsible leaders for IPC who had been in charge during the study period were identified. Some countries such as Austria have only limited national research cooperations, while the Netherlands has established a gapless network. Most effective collaborating university site of each country were Lille with an SCI of 1146, Rotterdam (408), Berlin (268), Sussex (204), and Vienna/Innsbruck (18). Discussion: The present study indicates major differences and room for improvement in IPC research collaborations within each country and underlines the potential and importance of collaborating in IPC

Cross-site collaboration on infection prevention and control research—room for improvement? A 7-year comparative study in five European countries

Background: The spread of SARS-CoV-2, multidrug-resistant organisms and other healthcare-associated pathogens represents supra-regional challenges for infection prevention and control (IPC) specialists in every European country. To tackle these problems, cross-site research collaboration of IPC specialists is very important. This study assesses the extent and quality of national research collaborations of IPC departments of university hospitals located in Austria, England, France, Germany, and the Netherlands, identifies network gaps, and provides potential solutions. Methods: Joint publications of IPC heads of all university hospitals of the included countries between 1st of June 2013 until 31st of May 2020 were collected by Pubmed/Medline search. Further, two factors, the journal impact factor and the type/position of authorship, were used to calculate the Scientific Collaboration Impact (SCI) for all included sites; nationwide network analysis was performed. Results: In five European countries, 95 sites and 125 responsible leaders for IPC who had been in charge during the study period were identified. Some countries such as Austria have only limited national research cooperations, while the Netherlands has established a gapless network. Most effective collaborating university site of each country were Lille with an SCI of 1146, Rotterdam (408), Berlin (268), Sussex (204), and Vienna/Innsbruck (18). Discussion: The present study indicates major differences and room for improvement in IPC research collaborations within each country and underlines the potential and importance of collaborating in IPC.Projekt DEA

Organization and training at national level of antimicrobial stewardship and infection control activities in Europe: an ESCMID cross-sectional survey

Antimicrobial stewardship (AMS) and Infection prevention and control (IPC) are two key complementary strategies that combat development and spread of antimicrobial resistance. The ESGAP (ESCMID Study Group for AMS), EUCIC (European Committee on Infection Control) and TAE (Trainee Association of ESCMID) investigated how AMS and IPC activities and training are organized, if present, at national level in Europe. From February 2018 to May 2018, an internet-based cross-sectional survey was conducted through a 36-item questionnaire, involving up to three selected respondents per country, from 38 European countries in total (including Israel), belonging to the ESGAP/EUCIC/TAE networks. All 38 countries participated with at least one respondent, and a total of 81 respondents. Education and involvement in AMS programmes were mandatory during the postgraduate training of clinical microbiology and infectious diseases specialists in up to one-third of countries. IPC was acknowledged as a specialty in 32% of countries. Only 32% of countries had both guidance and national requirements regarding AMS programmes, in contrast to 61% for IPC. Formal national staffing standards for AMS and IPC hospital-based activities were present in 24% and 63% of countries, respectively. The backgrounds of professionals responsible for AMS and IPC programmes varied tremendously between countries. The organization and training of AMS and IPC in Europe are heterogeneous and national requirements for activities are frequently lacking

Bedeutung von Octenidol®, Glandomed® und Chlorhexidin-Mundspüllösung in der Prävention von Mukositis und der Reduktion der oropharyngealen Flora: Ergebnisse einer doppelt-verblindeten randomisiert-kontrollierten Studie

Aim: The oropharyngeal flora is of importance for the development of oral mucositis, which is a frequent complication in oncologic practice. It also plays a role in the pathogenesis of ventilator-associated pneumonia. Mucositis is associated with significantly worse clinical and economic outcomes. The aim of our study was to assess the efficacy of Octenidol®, Glandomed® and chlorhexidine mouthwash in the prevention of mucositis and reduction of the oropharyngeal flora.Methods: A prospective, double-blinded RCT including two strata was conducted between October 2008 and November 2010. Stratum i consisted of ventilated cardiothoracic surgical patients. Stratum ii consisted of medical patients with haemato-oncological malignancies requiring stem cell transplantation. The primary outcome measures were development of mucositis regarding to OMAS/WHO score and reduction of the oropharyngeal flora. Results: Both strata showed low OMAS/WHO scores which did not differ significantly between the groups. The overall mean reduction of colony forming units was significantly higher in the Octenidol® group compared to the chlorhexidine and the Glandomed® groups.Conclusions: No significant differences in the development of mucositis were found, thus all solutions proved successful in the prevention of mucositis. However, Octenidol® was superior in the reduction of the oropharyngeal flora. Hence, the preventive effect on nosocomial infections might be higher in patients using Octenidol® rather than chlorhexidine or Glandomed®.Ziel: Die oropharyngeale Flora ist in der Pathogenese der oralen Mukositis und der Beatmungs-assoziierten Pneumonie von großer Wichtigkeit. Die Mukositis als häufige Komplikation bei hämato-onkologischen Patienten, ist assoziiert mit signifikant verschlechtertem klinischen und ökonomischen Outcome. Das Ziel unserer Studie war die Überprüfung der Wirksamkeit von Octenidol®, Glandomed® und Chlorhexidin-Mundspüllösung in Bezug auf die Prävention von Mukositis und die Reduktion der oropharyngealen Flora.Methoden: Eine prospektive, doppelt-verblindete randomisierte Studie von Oktober 2008 bis November 2010 mit zwei Studienarmen. Arm i bestand aus beatmeten kardiochirurgischen Patienten. Arm ii bestand aus hämato-onkologischen Patienten, die eine Stammzelltransplantation erhielten. Primäre Endpunkte waren die Entwicklung von Mukositis nach dem OMAD/WHO Score sowie die Reduktion der oropharyngealen Flora.Ergebnisse: Beide Studienarme zeigten niedrige OMAS/WHO Werte, die sich nicht signifikant unterschieden. Die gemittelte Gesamtreduktion von koloniebildenden Einheiten war signifikant größer in der Octenidol®-Gruppe im Vergleich zur Chlorhexidin- und Glandomed®-Gruppe.Fazit: Es zeigten sich keine signifikanten Unterschiede in Bezug auf die Entwicklung von Mukositis in beiden Studienarmen. Alle Lösungen stellten eine erfolgreiche Präventionsmaßnahme in Bezug auf die Pathogenese von Mukositis dar. Octenidol® zeigte im Vergleich zu Chlorhexidin oder Glandomed® eine stärkere Reduktion der oropharyngealen Flora und könnte sich daher als effektiver in der Prävention nosokomialer Infektionen erweisen

Zusammenhang von subjektiver Wahrnehmung und psychologischen Auswirkungen von Patienten in räumlicher Isolierung

Background: Spatial isolation is a common infection control measure, but negative psychological effects are often neglected. We investigated which factors influence the perception of single room isolated patients.Methods: In the present correlative cross-sectional study, 32 isolated patients have been interviewed within three departments of the Heidelberg University Hospital, one of Germany's largest hospitals. The following questionnaires were used: 10-Item Big Five Inventory (BFI-10), Positive and Negative Affect Schedule (PANAS), Hospital Anxiety and Depression Scale (HADS) and a self-developed questionnaire to evaluate the individual experience of isolation. Data were analysed using correlation and regression analysis.Results: A significant positive correlation was found between the isolation period and anxiety (r=.42, p<.05). Interestingly, a significant positive correlation was demonstrated between the duration of contact to nursing staff and negative daydreaming (r=.89, p<.01). The activity watching television was associated with higher levels of anxiety (r=.38, p<.05). Surfing the internet had a positive relationship with thinking about beautiful things (r=.41, p<.05). Conclusions: Our study results have implications how to improve the psychological situation of patients during spatial isolation. Contact between nursing staff and patients is crucial, since this contact significantly associated with negative daydreaming, probably due to increased neediness of emotional and physical care in some patients. The duration of the isolation has an influence on the experience of anxiety. Activities to cope with the isolation, however, not always have positive effects on the well-being of the patient.Hintergrund: Die räumliche Isolierung ist eine häufig angewendete krankenhaushygienische Maßnahme. Negative psychologische Effekte werden jedoch oftmals ausgeblendet. Die vorliegende Studie untersucht, welche Faktoren die individuelle Wahrnehmung der Isolierung im Einzelzimmer beeinflussen.Methoden: Im Rahmen einer korrelativen Querschnittsuntersuchung wurden bei 32 isolierten Patienten des Heidelberger Universitätsklinikums die Fragebögen 10-Item Big Five Inventory (BFI-10), Positive and Negative Affect Schedule (PANAS), Hospital Anxiety and Depression Scale (HADS) sowie ein selbsterstellter Fragebogen zum Erleben der Isolierung erhoben. Die Daten wurden mittels Korrelations- und Regressionsanalyse ausgewertet.Ergebnisse: Es gab zwischen der Isolierungsdauer und Angst einen signifikanten positiven Zusammenhang (r=.42, p<.05). Auch ließ sich zwischen der Dauer des Kontakts zum Pflegepersonal und negativen Tagträumen ein signifikant positiver Zusammenhang nachweisen (r=.89, p<.01). Die Tätigkeit Fernsehen stand im Zusammenhang mit höheren Angstwerten (r=.38, p<.05). Internet surfen hatte eine positive Korrelation zu Nachdenken über schöne Dinge (r=.41, p<.05).Fazit: Aus den Ergebnissen lässt sich ableiten, wie die psychologische Situation der Patienten während des Krankenhausaufenthalts verbessert werden kann. Der Kontakt zwischen Pflegepersonal und Patient spielt dabei eine bedeutende Rolle, da dieser Kontakt signifikant mit negativen Tagträumen in Zusammenhang steht. Dieser Zusammenhang erklärt sich wahrscheinlich durch die emotionale und physische Bedürftigkeit bei einigen Patienten. Ebenso hat die Dauer der Isolierung einen Einfluss auf das Angsterleben. Auch die Tätigkeiten während der Isolierung, wie Fernsehen und im Internet surfen, wirken auf das Befinden der Patienten ein, jedoch nicht immer positiv

Compliance mit Hygienerichtlinien in der zahnmedizinischen Praxis eines Universitätskrankenhauses

Aim: Compliance with infection control practices is the key to quality care and excellence in dentistry. Infection control remains one of the most cost-beneficial interventions available. However, implementing control procedures requires full compliance of the whole dental team. The aim of our study was to measure the compliance in daily clinical practice.Methods: The compliance with infection control practices in dentistry by dental health care personnel (DHCP) in a German university dental clinic was observed during clinical work. In addition, a survey was conducted to assess the individual knowledge about infection control procedures. Contamination of the workplace during invasive dental procedures was tested, as well.Results: A total of 58 invasive dental treatments implying close contacts between HCWs and patients were scrutinized. All HCWs (100%) wore gloves during dental work, but in some cases (female dentists: 14.3%; dental assistants: 28.6%) gloves were neither changed nor hands were disinfected between different activities or patient contacts (female dentists: 68.6%; male dentists: 60.9%; dental assistants: 93%). Only 31.4% of female and 39.1% of male dentists carried out adequate hygienic hand disinfection after removing gloves. Male dentists wore significantly more often (100%) protective eyewear compared to 77.1% of female dentists (p<0.05). In addition, most of female dentists (62.9%) and dental assistants (80.7%) wore jewelry during dental procedures. Conclusion: Despite the knowledge of distinct hygiene procedures only a small percentage of dental staff performs hygiene practices according to recommended guidelines. Strict audit is clearly needed in the dental setting to ensure compliance with infection control guidelines to prevent transmission of pathogens. Our results provide insights for the development of a targeted education and training strategy to enhance compliance of dental staff especially of dental assistants with infection control procedures.Ziel: Die Einhaltung von Hygienerichtlinien ist der Schlüssel zur Gewährleistung einer hohen Qualität und exzellenten Patientenversorgung in der Zahnheilkunde. Infektionskontrolle bleibt eine der kosteneffektivsten Interventionen die zur Verfügung stehen. Allerdings erfordert die erfolgreiche Implementierung von Hygienerichtlinien die vollständige Compliance des gesamten Praxisteams. Das Ziel unserer Studie war es, diese Compliance im täglichen klinischen Alltag zu messen.Methoden: Die Compliance mit Hygienerichtlinien in der Zahnmedizin durch das zahnmedizinische Personal (ZP) in einer deutschen Universitätszahnklinik wurde während der klinischen Arbeit beobachtet. Zusätzlich wurde eine Umfrage durchgeführt, um das individuelle Wissen über Maßnahmen zur Infektionskontrolle zu erfassen. Des Weiteren wurde die mikrobiologische Umgebungskontamination des Arbeitsplatzes während der Durchführung von invasiven zahnärztlichen Eingriffen getestet.Ergebnisse: Insgesamt wurden 58 invasive zahnärztliche Behandlungen, welche engen Kontakt zwischen ZP und Patienten erfordern, ausgewertet. Alle des ZP (100%) trugen Handschuhe während der zahnärztlichen Arbeit, aber in einigen Fällen (Zahnärztinnen: 14,3%; Zahnarzthelferinnen: 28,6%) wurden die Handschuhe weder gewechselt, noch die Hände zwischen den verschiedenen Tätigkeiten oder Patientenkontakten desinfiziert (Zahnärztinnen: 68,6%; Zahnärzte: 60,9%; Zahnarzthelferinnen: 93%). Nur 31,4% der weiblichen und 39,1% der männlichen Zahnärzte führten eine korrekte hygienische Händedesinfektion nach dem Ausziehen der Handschuhe durch. Männliche Zahnärzte trugen signifikant häufiger (100%) Schutzbrillen im Vergleich zu 77,1% der weiblichen Zahnärzte (p<0,05). Zudem trugen die meisten der weiblichen Zahnärzte (62,9%) und der Zahnarzthelferinnen (80,7%) Schmuck.Fazit: Trotz Kenntnis von Hygienerichtlinien befolgt nur ein kleiner Prozentsatz des ZP die empfohlenen Richtlinien. Eine strenge Auditierung und fachliche Weiterbildung des ZP ist notwendig, um die Einhaltung von Hygienerichtlinien in der Zahnheilkunde zu gewährleisten und um die Übertragung von Krankheitserregern sicher zu verhindern. Unsere Ergebnisse liefern Erkenntnisse zur Entwicklung einer gezielten Fortbildungsstrategie, um die Compliance des ZP mit Hygienerichtlinien, vor allem von Zahnarzthelferinnen, zu verbessern

Detection of a cfr(B) variant in German Enterococcus faecium clinical isolates and the impact on Linezolid resistance in Enterococcus spp

The National Reference Centre for Staphylococci and Enterococci in Germany has received an increasing number of clinical linezolid-resistant E. faecium isolates in recent years. Five isolates harbored a cfr(B) variant gene locus the product of which is capable of conferring linezolid resistance. The cfr(B)-like methyltransferase gene was also detected in Clostridium difficile. Antimicrobial susceptibility was determined for cfr(B)-positive and linezolid-resistant E. faecium isolates and two isogenic C. difficile strains. All strains were subjected to whole genome sequencing and analyzed with respect to mutations in the 23S rDNA, rplC, rplD and rplV genes and integration sites of the cfr(B) variant locus. To evaluate methyltransferase function, the cfr(B) variant of Enterococcus and Clostridium was expressed in both E. coli and Enterococcus spp. Ribosomal target site mutations were detected in E. faecium strains but absent in clostridia. Sequencing revealed 99.9% identity between cfr(B) of Enterococcus and cfr of Clostridium. The methyltransferase gene is encoded by transposon Tn6218 which was present in C. difficile Ox3196, truncated in some E. faecium and absent in C. difficile Ox3206. The latter finding explains the lack of linezolid and chloramphenicol resistance in C. difficile Ox3206 and demonstrates for the first time a direct correlation of elevated linezolid MICs in C. difficile upon cfr acquisition. Tn6218 insertion sites revealed novel target loci for integration, both within the bacterial chromosome and as an integral part of plasmids. Importantly, the very first plasmid-association of a cfr(B) variant was observed. Although we failed to measure cfr(B)-mediated resistance in transformed laboratory strains the occurrence of the multidrug resistance gene cfr on putatively highly mobile and/or extrachromosomal DNA in clinical isolates is worrisome with respect to dissemination of antibiotic resistances