Workload for infection prevention and control teams in preventing nosocomial tuberculosis: an underestimated burden

Tuberculosis (TB) remains a leading cause of mortality with an estimated 1.5 million deaths globally in 2020.The control and prevention of TB in hospitals is achieved by administrative approaches (early investigations and diagnosis), engineering measures (isolation rooms) and personal respiratory protection. A hospital infection prevention and control (IPC) plan is crucial to ensure prompt detection and isolation of patients with suspected and confirmed TB to prevent cross-infection.</p

Personal protective equipment training & lived experience for healthcare staff during COVID-19

Objectives: To describe the lived experience of healthcare staff during the Coronavirus Disease 2019 (COVID-19) pandemic relating to the use of personal protective equipment (PPE) and investigate risks associated with PPE use, error mitigation and acceptability of mindfulness incorporation into PPE practice.Methods: A qualitative human factors' study at two Irish hospitals occurred in late 2020. Data was collected by semi-structured interview and included role description, pre-COVID-19 PPE experience, the impact of COVID-19 on lived experience, risks associated with PPE use, contributory factors to errors, error mitigation strategies and acceptability of incorporating mindfulness into PPE practice.Results: Of 45 participants, 23 of whom were nursing staff (51%), 34 (76%) had previously worn PPE and 25 (56%) used a buddy system. COVID-19 lived experience impacted most on social life/home-work interface (n=36, 80%). Nineteen staff (42%) described mental health impacts. The most cited risk concerned 'knowledge of procedures' (n=18, 40%). Contributory factors to PPE errors included time (n=15, 43%) and staffing pressures (n=10, 29%). Mitigation interventions included training/education (n=12, 40%). The majority (n=35, 78%) supported mindfulness integration into PPE practice.Conclusions: PPE training should address healthcare staff lived experiences and consider incorporation of mindfulness and key organisational factors contributing to safety.</div

Mupirocin-resistant methicillin-resistant Staphylococcus aureus (MRSA) and vascular surgery

Aim  An outbreak of mupirocin and methicillin resistant Staphylococcus aureus (MR-MRSA) occurred in a tertiary hospital, causing considerable disruption in a vascular unit. We investigated factors that might explain this large outbreak and areas for intervention to prevent a recurrence.  Methods  Cases of MRSA strain, spa type t127 or t922, were identified through databases, and healthcare records to describe affected patients in time, place and person. The adjusted matched odds ratio (amOR) for selected exposures in a matched case control study among hospital in-patients was calculated, using multivariable conditional logistic regression.  Results  Forty-one cases occurred over 18 months. Males predominated (78%), with a median age of 73 years. The specialty with the largest number of patients was vascular surgery with 18 cases (44%). Male sex (amOR=21; 95%CI 0.99-454), vascular surgery consultation (amOR=5.1; 95%CI 0.89-29), urinary catheterisation (amOR=12; 95%CI 0.98-154), occupational therapy (amOR=9.9; 95%CI 1.6-61) and length-of-stay (amOR=1.1; 95%CI 1.0-1.1 per additional overnight stay) were independently associated with an outbreak case. Control measures included; enhanced contact precautions, patient isolation/cohorting, ward closure, enhanced environmental decontamination and staff screening.  Conclusion  Vascular patients and those with underlying high dependency, i.e. urinary catheterisation and a requirement for occupational therapy had a higher risk of colonisation with MR-MRSA. Recording patient dependency prospectively, avoiding excessive bed occupancy, and a formal hospital policy on staff MRSA screening, are recommended to prevent/control future outbreaks in vascular units and elsewhere in hospitals.</p