Background:Acute respiratory infection (ARI) outbreaks in care homes remain a significant burden, especially during influenza season. Prompt public health responses and timely antiviral administration are crucial for mitigating transmission and minimising the impacts of outbreaks. This study aimed to assess the timeliness and appropriateness of the public health response to notifications of ARI in care homes during flu season, across the South East England region. Methods:This was a cross-sectional study analysing ARI in care home notifications during 2024/25 Chief Medical Officer (CMO)-declared flu season. A combination of quota and random sampling was used for detailed analysis. Descriptive and inferential statistical analyses were used to evaluate timeliness of public health response and antiviral prescribing patterns. Results:During the study period, 340 ARI incidents were notified among 2737 care homes, and 103 care homes were included in the detailed analysis. The median time from first symptom onset to public health notification was 4 days (IQR 3-7 days), whereas the median time from most recent reported symptom onset to public health assessment was 1 day (IQR 0-1 day), indicating a prompt public health response following outbreak notification. The median time interval from risk assessment to antiviral recommendation was the same day. Prior to public health assessment, 66/82 (80.5%) care homes reviewed by a GP had residents commenced on antibiotics, 4/82 (4.9%) on antivirals, and 7/82 (8.5%) on both antibiotics and antivirals. Conclusion:Our findings suggest that public health response following notification of ARI outbreaks in care homes was generally prompt. However, delays in outbreak recognition and notification, barriers to timely antiviral prescribing, and frequent antibiotic prescribing despite influenza-like illness criteria being met highlight the need to streamline antiviral prescribing pathways and strengthen antimicrobial stewardship in this setting.
Aims:Documentable evidence of previous receipt of 2-dose of measles-containing vaccine (MCV) is often sufficient as proof of measles immunity in healthcare workers (HCWs). The usefulness of this policy was assessed by estimating the global prevalences of different MCV-receipt statuses in measles infected HCWs. Methods:Eligible publications since 1974 were searched in PubMed, Embase, and Scopus databases. Pooled prevalences were estimated by prevalence meta-analysis and meta-regressed using durations since MCV inclusion in the national immunization schedule (NIS) of respective study countries to measles outbreak years as a moderator. Results:Of the 7571 citations retrieved, 27 studies reporting on 1319 measles-infected HCWs aged 18-60 years (outbreak years: 1985-2019) were reviewed. Prevalences of measles-infected HCWs were- a. by MCV-receipt statuses: ≥1-dose: 41.0% (95% CI: 28.0, 55.0); ≥2-dose: 28.0% (95% CI: 11.0, 46.0); unvaccinated: 31.0% (95% CI: 17.0, 46.0); unknown: 21.0%; b. by gender: females: 65.0% (95% CI: 57.0, 72.0); males: 35.0% (95% CI: 28.0, 43.0); c. by birth year: born after MCV inclusion in NIS: 77.0% (95% CI: 66.0, 87.0) and in born before: 6.0% (95% CI: 0.0, 17.0); d. by health profession: nurses: 31.0% (95% CI: 24.0, 39.0); doctors: 27.0% (95% CI: 19.0, 36.0); students 5.0% (95% CI: 1.0, 12.0). The measles risk in ≥2-dose of MCV recipient HCWs increased with duration since MCV inclusion in NIS to outbreak occurrences (p < .05). Conclusion:In measles infected HCWs, as the rates of being ≥2-dose MCV recipient or unvaccinated were substantial and comparable, the role of documented 2-dose of MCV receipt alone as a proof of measles immunity remains uncertain.
Background:Inappropriate glove use can undermine hand hygiene, increase cross-transmission risk, and contribute to healthcare waste. Objectives:To evaluate a trust-wide quality improvement campaign aimed at reducing unnecessary non-sterile glove use and improving appropriateness of glove use. Methods:A multimodal intervention was implemented across an acute NHS Trust (February 2023-April 2026), including education, policy refinement, visual prompts, and audit feedback. Evaluation used a triangulated design: staff survey, statistical process control (SPC) analysis, and procurement/environmental trend data. The Capability, Opportunity, Motivation and Behaviour (COM-B) model informed interpretation. Descriptive statistics and SPC methods were applied. Results:A total of 123 staff responded. Mean knowledge score was 89%, with 76% scoring ≥80%; 72% reported receiving education and 75% exposure to campaign materials. Confidence was high (95.1%), but fewer (65.9%) felt comfortable challenging inappropriate practice. SPC analysis showed common-cause variation with no sustained improvement in glove use audit data. Procurement data suggested an initial reduction followed by plateau: glove use decreased from 57.24 to 49.52 per occupied bed day (difference 7.71). Waste and carbon metrics showed similar proportional reductions (∼13.5%). Due to mixed reporting periods, findings are interpreted as trend data. Discussion:The campaign achieved high knowledge and early system-level reductions but did not produce sustained behavioural change. Significance and impact:Findings suggest a ceiling effect, with residual behaviour driven by social and contextual factors. Future efforts should prioritise targeted, behaviour-focused interventions over repeated trust-wide awareness campaigns.
Background:Nursing homes were affected by COVID-19, and limited testing capacity during the first wave highlighted the value of complementary surveillance approaches. Objective:To characterize clinical presentations, virological findings, and mortality identified through syndromic and virological surveillance during two COVID-19 waves. Materials and methods:A retrospective study was conducted in 16 nursing homes in Northeastern France, including 1,493 residents monitored from February 2020 to February 2021. Residents were classified into four clinical sign patterns: combined general and respiratory signs (G and R), R only, G only, and asymptomatic positive SARS-CoV-2 tests (T+ only). Outbreaks were defined by at least three residents presenting G and R or T+ only within four consecutive days. Wave 2 analyses were conducted separately before and during immunization. Results:Outbreak frequency and duration remained high during both epidemic waves, although smaller facilities were less likely to experience outbreaks. The proportion of residents presenting G and R declined from 62.9% during wave 1 to 53.0% and 38.9% during the pre-immunization and immunization periods, respectively (p < 0.001), whereas G only presentations increased. Virological testing coverage among CSPs increased from 41.0% to 84.8% and 79.2%, respectively. Estimated 8-week mortality decreased from 25.4% to 20.5% and 12.8% (p = 0.002). In multivariable analysis, clinical sign patterns (highest risk among G and R), older age, male sex, and not being tested were independently associated with mortality, while epidemic period was not. Discussion:These findings highlight the complementary value of syndromic and virological surveillance for characterizing COVID-19 outbreaks in nursing homes.
Background:Healthcare workers in critical care settings are at increased risk of acquiring respiratory infections, particularly during aerosol-generating procedures (AGPs). Portable negative-pressure isolation devices have been proposed to fix airborne infection in isolation rooms. Objective:To evaluate whether an isolated negative-pressure device reduces bacterial and fungal aerosol dispersion under controlled laboratory conditions. Methods:This laboratory-based controlled experimental observational study assessed aerosol containment across three techniques: (1) no cover, (2) plastic sheet canopy barrier, and (3) a portable negative-pressure isolation system. Standardized 5 mL suspensions of Staphylococcus epidermidis and Aspergillus flavus were nebulized on three separate days for each technique. Nutrient agar plates were placed and colony-forming units (CFU) were manually counted. The primary outcome was the mean CFU per technique per day. One-way ANOVA with post-hoc Welch's t-tests (Bonferroni-corrected) was used for statistical comparison. Results:A total of 36 bacterial and fungal plates were analysed. For bacterial aerosols, mean CFU was highest with no cover (535.6 ± 5.38), lower with plastic sheet canopy barrier (429.5 ± 5.41), and lowest with the negative-pressure system (217.5 ± 17.5). Differences were statistically significant (ANOVA p = 9.8 × 10-8; η2 = 0.995). Fungal CFU demonstrated a similar pattern with significantly lower CFU for Technique 3 compared with both other techniques (p < .001). Conclusion:The negative-pressure isolation device significantly reduced airborne dispersion of bacterial and fungal aerosols compared with plastic sheet canopy barrier methods. These findings support the use of portable negative-pressure systems to enhance aerosol containment during AGPs. Further clinical validation is recommended.
Background:Pathogen transmission-based precautions are essential to safe inpatient care, yet loneliness and loss of social connection carry clinical consequences. Objective:To synthesize evidence on the association between hospital isolation and patient-reported loneliness or social connectedness, and to identify interventions and routine processes that mitigate these effects. Method:We conducted a systematic review under a prespecified methodological plan and reported it according to PRISMA 2020. We searched MEDLINE, Scopus, Web of Science, CENTRAL, Europe PMC, WHO Global Index Medicus, CINAHL and PsycINFO without design limits. Eligible designs were randomised/quasi-experimental, observational, qualitative, mixed methods and implementation. Outcomes were loneliness/connectedness and proximate processes (family presence, communication channel/cadence). We screened 717 records, assessed 18 full texts and included 16 studies. Results:Across acute wards, adult intensive care, rehabilitation and paediatrics, isolation was associated with higher loneliness and perceived social avoidance on general wards. In intensive care and paediatrics, restricted presence disrupted connectedness, parental role and peer ties. Barrier precautions thinned spontaneous staff-patient contact and displaced key conversations to telephone/video. Interventions clustered in three families-brief education/coping supports, organized tele-visiting with scheduled video/phone, and age-appropriate digital/VR supports-with good feasibility/acceptability and improvements in patient-reported outcomes and anxiety/stress in several studies. Conclusions:Isolation carries consistent social costs. Simple, proportionate countermeasures-shared, consistent explanations of purpose and predictable, resourced contact routines-are actionable now. Future work should test defined bundles using shared patient-reported and process outcomes in pragmatic designs.
Background:The COVID-19 pandemic highlighted the need for robust Infection Prevention and Control (IPC) policies and for the workforce of long-term residential care facilities (LTRCFs) to be educated and trained in IPC with support from specialists with IPC knowledge and advice. IPC champions are often put in place within LTRCFs to provide education and guidance. The aim of this study was to explore how the impact of trained IPC champions (or leads) was perceived by staff in the long-term residential care settings. Methods:Purposive sampling was conducted to recruit participants from three LTRCFs located in the East of Ireland. Semi-structured interviews were conducted amongst six participants which were then transcribed and analysed using thematic analysis. Results:Four themes were identified via codes and sub-themes: (1) IPC Core Knowledge and Skills, (2) Point of Care Coaching and Support, (3) Practical Enablers of IPC and (4) Audit and Quality Improvement in IPC. Conclusion:The results indicate that IPC champions make a positive impact on IPC practices and procedures in Irish LTRCFs. The identified themes and sub-themes indicate that IPC champions' roles are multi-faceted, and that they utilise several skills to ensure best IPC practices are carried out in their workplace.
Background:Peripheral venous catheters (PVCs) are widely used vascular access devices and can cause significant adverse events, including bloodstream infections (BSIs). Aim/Objectives:To map the scientific literature on PVC-BSI. Methods:A scoping review including 67 studies, from MEDLINE/PubMed, SciELO, EMBASE, and LILACS/BIREME, was conducted, synthesizing data on incidence rates, microbiology, risk factors, preventive strategies, and economic burden. Findings/Results:PVC-BSI incidence shows marked geographic and clinical variation, with rates ranging from 0.1 to 0.5 cases per 1,000 catheter-days in high-income countries, contrasting with significantly higher averages in developing regions such as Latin America (2.06) and the Middle East (2.32). Effective preventive strategies included staff education, bundle implementation, active surveillance, multimodal interventions, chlorhexidine-alcohol skin antisepsis, and use of innovative devices. Staphylococcus spp. accounted for 20% to 70.7% of infections, but the proportion of Gram-negative bacilli might be increasing. Identified risk factors included the insertion site (hand punctures were protective), parenteral nutrition, catheter gauge (larger than 16G), and material contamination. Only one study addressed costs, estimating an additional expenditure exceeding €5,000 per infected patient. Discussion:Although less frequent than central venous catheter infections, PVC-related bloodstream infections represent an important public health concern due to their widespread use. Incidence is likely underestimated because of limited reporting and variable diagnostic criteria. Standardized definitions, systematic surveillance, continued professional training, and more research-especially in low- and middle-income settings-are needed to improve prevention and management.
This commentary discusses the scoping review by da Silva et al. on care bundles to prevent infiltration in short peripheral intravenous catheters in hospitalized children. While the review addresses an important paediatric patient safety issue, its conclusions should be interpreted cautiously. The evidence base comprised only four heterogeneous studies, mainly quality improvement or pre-post designs, which is sufficient for mapping bundle elements but not for determining which components are truly effective. Recurrent elements such as site assessment, securement, review of catheter need, and timely removal may indicate a preventive core. Further prospective multicenter studies are needed to define components.
Background Preoperative skin preparation (PSP) is a critical step of surgery to reduce bacteria on the skin that can cause infections. It is commonly believed that the reusable equipment method of PSP reduces environmental emissions relative to single-use options. However, no research comparing entire-life cycle environmental emissions associated with the two approaches exists. Methods A Life Cycle Assessment (LCA) was conducted comparing PSP in a European hospital using a single-use applicator versus a reusable equipment method. Results Findings highlight the superior environmental performance of a single-use antiseptic applicator method, resulting in 49% less CO 2 -eq emissions than the reusable method. Similar trends were observed across all categories: climate change, cumulative energy demand, water scarcity, resources, ecosystems, and human health. The single-use applicator had lower energy demand and higher resource efficiency. In addition, the single-use applicator was less sensitive to hospital and staff practice variability. Discussion The study challenges the assumption that reusable systems always result in lower environmental impacts. This LCA revealed that efficient manufacturing processes, optimized use of antiseptic during procedure, and reduced energy consumption throughout the single-use method life cycle can decrease the carbon footprint. This highlights the need to scrutinize the life cycle when making comparisons as part of surgical sustainability.
Background:Healthcare-associated infections (HAIs) are a major public health concern. Although interprofessional education (IPE) is recognized as a promising strategy, there is limited robust evidence demonstrating its effectiveness in reducing infection rates in healthcare settings. Aim/objective:To identify studies on interprofessional simulation for healthcare teams focused on infection prevention and control (IPC). Methods:This scoping review followed the PRISMA-ScR checklist and was registered on the OSF platform (https://osf.io/bj6uc/). Six databases (MEDLINE, Embase, Web of Science, CINAHL, ERIC, Scopus) were searched, yielding 632 citations. After screening and applying exclusion criteria, 11 studies were included. Finding/results:Among the selected studies, four (36.4%) originated from the United States. Five studies (45.5%) employed simulation practices based on evidence or expert consensus. Seven studies (63.6%) involved teams comprising three or more professional categories. All studies addressed infectious diseases requiring rapid response, mainly COVID-19 (55%) and Ebola (45%). Most (81.8%) used patient simulators. The most frequently addressed IPE competencies were teamwork (90.9%), roles and responsibilities (81.8%), and interprofessional communication (72.7%). Discussion:Findings indicate a reliance on expert-driven simulation practices and a concentration on emergency contexts. There is a lack of studies evaluating interprofessional simulation in routine care environments, such as primary health care and long-term care. Additionally, the absence of medium- and long-term outcome assessments limits our understanding of the sustained impact of interprofessional simulation on IPC. Further research is needed to support evidence-based implementation in diverse healthcare settings.
Background:Nurses' infection control practices are crucial for managing infectious diseases like coronavirus disease 2019 (COVID-19). While various factors influence these practices, they may be mediated by nurses' intention to provide care. Research on intention-based factors remains limited. This study aimed to identify factors influencing infection control practices based on nurses' intention to care for COVID-19 patients. Methods:This cross-sectional study surveyed 240 nurses from three general hospitals in Korea in March 2021 regarding individual and environmental factors. Multiple regression analyzed predictors of infection control practices based on care intention levels. Results:The findings revealed distinct influencing factors based on nurses' intention levels. Among nurses with high care intention, individual factors were predominant: COVID-19-related infection control awareness (β = .449, p < .001) and psychosocial stress (β = -.271, p = .012) were significantly associated with their practices. In contrast, for nurses with moderate intention, both individual and environmental factors were significant: infection control awareness (β = .362, p < .001) and the availability of negative pressure rooms (β = .224, p = .042) played key roles. Conclusion:Factors influencing infection control practices vary depending on nurses' care intention. Specifically, strategies should focus on maintaining awareness and managing stress for nurses with high intention, while enhancing environmental support and infrastructure is more effective for those with moderate intention. These results emphasize the need for tailored, multi-level interventions-integrating both individual and environmental strategies-to sustain effective infection control during infectious disease outbreaks.
Background:Healthcare-associated infections (HAIs) are rising globally, contributing to significant patient morbidity and mortality, as well as financial strain on healthcare systems. Poor hand hygiene (HH) practices among healthcare workers (HCWs) remain a major contributor. This study explored HCWs' perceptions of patient involvement in promoting HH practices. Methods:An exploratory qualitative study was conducted in sixteen healthcare facilities across rural and semi-urban districts of Uganda. Sixteen key informant interviews (KIIs) were conducted with HCWs working in medical, surgical, and maternity wards. Interviews were audio recorded, transcribed verbatim, and analyzed thematically in Atlas.ti (version 24), guided by constructs of the Health Belief Model (HBM). Results:Six major themes aligned with HBM constructs emerged: perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy. Additional themes included power dynamics, professional hierarchy, and cultural norms. Participants generally viewed patient involvement in HH promotion as beneficial, noting that patients could remind HCWs to perform HH, reduce HH lapses, and enhance accountability. Patient engagement was also seen as a way to empower patients and strengthen their role in care. However, some HCWs expressed concern that patient reminders could be perceived as disrespectful or confrontational, particularly in hierarchical and culturally sensitive contexts. Conclusion:Patient involvement in HH promotion is perceived as a promising strategy to improve adherence. However, cultural norms and professional hierarchies remain key barriers that may limit HCWs' acceptance of patient-initiated reminders.
Background:Transrectal prostate biopsy has raised concerns due to potential postbiopsy infections. Objective:This study evaluated infectious and non-infectious complication rates following transrectal biopsy without bowel preparation, using third-generation cephalosporin prophylaxis instead of resource-intensive targeted approaches. Materials and methods:A single-centre retrospective study included biopsy-naïve patients undergoing MRI-ultrasound fusion-guided transrectal systematic and targeted prostate biopsies under local anaesthesia in an outpatient setting. All patients received third-generation cephalosporin prophylaxis, cefixime. The primary endpoint was the 30-day infectious complication rate, including fever, genitourinary infections, additional antibiotic prescriptions, unscheduled office/emergency visits, hospitalisations, or sepsis. Secondary endpoints were non-infectious complications such as gross haematuria, rectal bleeding, or acute urinary retention. Results:Data from 336 cases were analysed. No cases of sepsis or positive blood cultures were observed. Infectious complications were uncommon, with fever ≥38°C occurring in 10 patients (2.9%), of whom 6 (1.8%) required hospitalisation. Localised infection, limited to epididymitis, was reported in 5 patients (1.5%) and was managed with additional antibiotics. Overall, 14 patients (4.2%) required unscheduled visits due to complications. Non-infectious complications were infrequent, with haematuria requiring bladder irrigation in 3 patients (0.9%) and acute urinary retention in 2 patients (0.6%). The median pain score during the procedure was 1.8 on a standardised scale. Discussion:Transrectal prostate biopsy using third-generation cephalosporin prophylaxis was associated with low infectious and non-infectious complication rates, with no sepsis cases reported. These findings highlight the procedure's safety and effectiveness, supporting its continued clinical use without the need for intensive prophylactic measures.
Introduction: Nosocomial infections are known to cause poor clinical outcomes. Hand hygiene is recognised as an effective tool in controlling infections. However, poor hand hygiene practice is evident worldwide. Thus, this work aimed to determine the effect of hand hygiene intervention on bare-below-the-elbow, before and after the use of mobile communication devices among allied healthcare professionals and students. Methods: Data was collected in four stages; stage-I was to verify the existence of protocols for hand hygiene. Stage-II was a pre-intervention blind-field observation to determine the compliance rate. Stage-III involved the administration of interventions and stage-IV was based on post-intervention observation to determine the effect of the intervention. The intervention was delivered using scientific literature on hand hygiene and supplemented with a manual demonstration of the same by an infection control nurse. The obtained data was analysed by Kendall rank coefficient test. Results: The compliance rate was found to be 22.0% and 53.0% in the pre- and post-intervention stage respectively, indicating significant improvement in the hand hygiene practices. Discussion: This study advocates active participation of the infection control team and suggests the need of periodic interventions on appropriate hand hygiene, particularly to internship students to sustain the hand hygiene practices and control the spread of nosocomial pathogens.
Background:Romania has one of the highest rates of healthcare-associated infections (HAIs) in Europe. Nurses need strong theoretical and practical knowledge to manage HAIs effectively since they have direct contact with patients. Objective:To evaluate post-intervention differences in nurses' theoretical knowledge and practical skills in HAIs management following clinical pharmacist-led training, a newly developed questionnaire was applied. Methods:We conducted a quasi-experimental, non-randomised study with a test and a control group. A structured 17-item questionnaire was developed and delivered via Microsoft Forms. Participants comprised nurses from the study hospital (test; n = 66) and a similar setting outside the hospital (control; n = 102). The test group completed the questionnaire twice, first after a face-to-face training provided by a clinical pharmacist, and second at 4 weeks. The control group received no training and completed the same questionnaire once. We explored preliminary content and structural validity, internal consistency, and short-term post-intervention stability. Results:A total of 168 nurses completed the questionnaire: 66 in the test group and 102 in the control group. Practical skills scores were higher in the test group (M = 4.73, SD = 0.42) compared with the control group (M = 4.16, SD = 0.88), F (1,126) = 5.20, p = .02. Psychometric evaluation provided preliminary evidence of acceptable validity and internal consistency of the questionnaire. Discussion:The observed post-intervention differences suggest that participation in the training was associated with higher practical skills scores. Limitations include the non-randomised design and self-report measures; future work should assess long-term retention beyond 4 weeks.
Objective:To map the scientific literature on bundles used to prevent infiltration in short peripheral intravenous catheters (SPIVC) in children. Method:A scoping review based on the Joanna Briggs Institute (JBI) guidelines, with searches conducted in the following databases: PubMed, Embase, LILACS, and Scopus. Eligible studies included those with a quantitative or mixed-methods approach, published in any language, and presenting bundles for the prevention of infiltration in SPIVC in children. Studies were excluded if they did not address bundle components, focused on a different population, involved a different type of intravenous catheter, or were unavailable in full text. Selection was performed independently by two reviewers using Rayyan© software. The study protocol was previously developed and registered in the Open Science Framework (OSF) repository. Results:Four bundles were identified, conducted in countries such as India, Australia, the United States, and Thailand. Study designs included Quality Improvement Projects (QI), prospective pre-post mixed-methods projects, and quasi-experimental prospective studies. All studies were published in English between 2014 and 2021. The number of components in the bundles ranged from 4 to 7 interventions, with "SPIVC stabilization and dressing" being the most frequently reported intervention. Conclusion:There is no standardization of the components in the bundles. Therefore, more robust studies are needed to establish standardized interventions.
Background:Mobile phones are indispensable tools in hospital practice but may act as sources for healthcare-associated pathogens. Despite global concern, no prior study in Lebanon had assessed the presence of multidrug-resistant organisms (MDROs) on healthcare workers' phones. Methods:A cross-sectional observational study was conducted in a tertiary university hospital, enrolling 166 participants (125 medical staff and 41 administrative controls). Sterile swabs were collected from all phone surfaces, followed by microbiological analysis for meticillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae. Participants also completed a behavioral questionnaire assessing hygiene practices. Results:The study detected universal contamination of mobile phones (100%). Two MDROs were isolated: one MRSA and one ESBL-producing Enterobacter cloacae, representing an overall prevalence of 1.2% (1.6% among medical staff). Risk behaviors were widespread: 85.6% of clinicians reported using phones in patients' presence, 34.4% interrupted clinical exams to answer calls, and only 9.6% disinfected hands afterward. Moreover, 60.8% had never disinfected their devices. The mean behavioral risk score was 5.16, significantly higher among interns (5.34) and residents (5.65) compared with administrative staff (4.39) (ANOVA, p = .01), suggesting lower risk with increasing clinical seniority. Conclusion:Our findings confirm universal contamination of mobile phones among hospital staff, with detection of MRSA and ESBL-producing bacteria among young pediatric clinicians. Although MDRO prevalence was low, high-risk behaviors were frequent, underscoring the need to reinforce basic infection prevention measures through targeted staff education. Hand hygiene continues to be the most effective strategy to limit pathogen transmission. Regular mobile phone disinfection remains a complementary measure.
Background:Parenteral nutrition (PN) is indicated for those with intestinal failure and is often administered via a central line, carrying risk of central line associated bloodstream infection (CLABSI). There is limited evidence regarding the use of an online training package for staff training in the administration of PN. Aim:Evaluate the effectiveness of an online staff training package for PN administration measured by staff feedback and incidence of CLABSI. Method:An online training package was developed using Moodle Workplace. Participants completed a tutorial, an instructional video demonstrating Standard Aseptic Non-Touch Technique (Standard-ANTT®) and an assessment. Feedback was collected anonymously via the Moodle programme and analysed using thematic analysis. CLABSI data were collected during 1/4/2024-31/3/2025. Approval was obtained via the organisation's clinical governance process. Results:Of 192 staff, 31% (n = 60) provided feedback; 75% reported high levels of knowledge improvement. Thematic analysis highlighted strengths of the package, including a clear instructional video and clinical relevance. Participants reported planned changes in practice, including improved hand hygiene, strict adherence to the principles of Standard-ANTT and greater confidence in PN administration. CLABSI rates reduced to 0.8/1000 catheter days compared to 1.6/1000 days in the year prior to the online training packaged. Conclusion:The online staff training package for PN was well received with staff finding it engaging, informative and practical. Course completion led to intended positive behaviour changes in clinical practice reported by participants, particularly regarding infection prevention and Standard-ANTT compliance.
Background:Hospital-onset bacteremia (HOB) has emerged as a broader measure of bloodstream infections beyond CLABSI, capturing infections from all vascular access devices (VADs). Objective:To evaluate the relationship between VADs and HOB in hospitalized adults. Methods:We conducted a retrospective observational study of adult patients hospitalized within a 14-hospital system from January 1, 2022, to December 31, 2023. Adult patients with a VAD and blood cultures collected ≥48 hours after admission were included. HOB was defined as a positive blood culture with a non-commensal organism obtained ≥48 hours after admission and initiation of new antimicrobials within ±2 days of the blood culture date. Logistic regression models evaluated associations between VAD type, quantity, and HOB. Multivariable models controlled for age, length of stay, sex, and comorbid cancer. Results:Among 3929 hospitalized adults, 279 (7.1%) developed HOB. Patients with HOB had a higher median number of VADs (5 vs 4, p < .001) and more frequently had central (54.5% vs 39.4%, p < .001) and arterial lines (10.9% vs 5.3%, p = .008). Central lines were associated with higher odds of HOB (aOR: 1.48, 95% CI: 1.15-1.91, p = .003), as were arterial lines (aOR: 1.45, 95% CI: 1.11-1.90, p = .008). Each additional VAD increased odds of HOB (aOR: 1.09, 95% CI: 1.01-1.18, p = .028). HOB was associated with higher in-hospital mortality (27.2% vs 16.0%, p < .001) with an adjusted OR of 1.81 (95% CI: 1.36-2.40, p < .001). Conclusions:The type and number of VADs, particularly central and arterial lines, are associated with increased odds of HOB and higher in-hospital mortality. Infection prevention strategies should focus on minimizing unnecessary VADs and closely monitoring high-risk patients.
