• Canada
• 030501 epidemiology close

Background Hand hygiene (HH) compliance in health care is usually measured against versions of the World Health Organization's “Your 5 Moments” guidelines using direct observation. Such techniques result in small samples that are influenced by the presence of an observer. This study demonstrates that continuous electronic monitoring of individuals can overcome these limitations. Methods An electronic real-time prompting system collected HH data on a musculoskeletal rehabilitation unit for 12 weeks between October 2016 and October 2017. Aggregate and professional group scores and the distributions of individuals’ performance within groups were analyzed. Soiled utility room exits were monitored and compared with performance at patient rooms. Duration of patient room visits and the number of consecutive missed opportunities were calculated. Results Overall, 76,130 patient room and 1,448 soiled utility room HH opportunities were recorded from 98 health care professionals. Aggregate unit performance for patient and soiled utility rooms were both 67%, although individual compliance varied greatly. The number of hand wash events that occurred while inside patient rooms increased with longer visits, whereas HH performance at patient room exit decreased. Eighty-three percent of missed HH opportunities occurred as part of a series of missed events, not in isolation. Conclusions Continuous collection of HH data that includes temporal, spatial, and personnel details provides information on actual HH practices, whereas direct observation or dispenser counts show only aggregate trends.

AbstractBackgroundComplications after liver transplantation cause additional healthcare costs. The objective of this study was to contrast the length of stay (LOS) costs for recipients with and without surgical site infections (SSIs).MethodsThis retrospective observational cohort study was conducted at a transplant center in Canada, between February 2011 and August 2014. The difference in the LOS costs was assessed by the Mann–Whitney U test, while multiple linear regression analysis was used to identify the variables that may have impacted on the costs.ResultsTwo hundred and twenty‐nine liver transplant recipients were enrolled. Thirty‐six recipients developed SSIs (36/229, 15.7%). The median LOS costs in recipients with and without SSIs were $39,456 Canadian dollars (interquartile range $25,696‐ 59,722) and $31,084 Canadian dollars (interquartile range $22,712‐49 610), respectively (p = .072). There was a trend that the costs were higher for those recipients with versus those without SSIs (p = .088). Transfusion of ≥ 5 units of red cells and dialysis before transplantation impacted on cost.ConclusionThere was a trend for higher healthcare facility costs for recipients with SSIs. Red cell transfusions and greater dialysis use before transplant were factors associated with the cost. Implementation of cost reduction strategies targeting high‐cost recipients is necessary.

Toys are an established part of the hospital experience for the child and family. They are seen as a source of comfort and security and form part of the child-friendly environment. However, they can also act as a source of healthcare associated infection which can be harmful to children, especially those who are in intensive care environments. This small-scale study was conducted in a paediatric intensive care unit at a large teaching hospital and involved swabbing those toys that had been brought in by families and those that were provided by the hospital. Findings show that 85 per cent of the toys harboured viable bacteria, which could be damaging to the child's health. Recommendations for practice are identified to ensure that toys remain a component of the child's hospitalisation yet are safe in relation to the transmission of infections not just in PICU but in all paediatric settings.

In a national surveillance system study, the infection rate following cerebrospinal fluid shunt surgery was 4.1% (95% confidence interval, 3.36%–4.92%). Cases of infection were more common in children than in adults (4.85% vs 3.24%; \documentclass{aastex} \usepackage{amsbsy} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{bm} \usepackage{mathrsfs} \usepackage{pifont} \usepackage{stmaryrd} \usepackage{textcomp} \usepackage{portland,xspace} \usepackage{amsmath,amsxtra} \usepackage[OT2,OT1]{fontenc} \newcommand\cyr{ \renewcommand\rmdefault{wncyr} \renewcommand\sfdefault{wncyss} \renewcommand\encodingdefault{OT2} \normalfont \selectfont} \DeclareTextFontCommand{\textcyr}{\cyr} \pagestyle{empty} \DeclareMathSizes{10}{9}{7}{6} \begin{document} \landscape $P=.04$ \end{document} ) and occurred sooner after surgery in children than in adults. A wide variation in compliance with antimicrobial prophylaxis was observed between 21 participating medical centers.

Background Central venous catheterization is a common procedure in critical care medicine and anesthesia. Infection impacts patient outcome and, depending on definition, complicates 5–19% of central venous catheter (CVC) insertions. One of the factors hypothesized to affect infection rates is the site of venous cannulation.

Summary Limited resources for infection control necessitate efficient local surveillance. Cases of meticillin-resistant Staphylococcus aureus from the authors' hospital surveillance system were examined to determine if attribution of cases as healthcare-associated or non-healthcare-associated differed when using a 12-month vs a four-week ‘look-back' period. Two additional cases were reclassified from non-healthcare-associated to healthcare-associated, representing a 2% reclassification rate between four-week and 12-month criteria ( P = 0.857). Infection control programmes may save time and resources by minimizing retrospective review of records without compromising data quality due to misclassification.

Summary Background Influenza immunization for healthcare personnel reduces frequency and severity of nosocomial influenza outbreaks and influenza-associated morbidity and mortality among patients. The Ottawa Influenza Decision Aid (OIDA) was developed to assist undecided healthcare workers in deciding whether or not to be immunized. Aim To assess the impact of the OIDA, and to ascertain whether its use would increase the level of confidence in healthcare workers' influenza immunization decision and positively affect their intent to be immunized. Methods Single-centre, single-blind, parallel-group, randomized controlled trial. Findings Eight per cent (151 of 1886) of the unimmunized healthcare personnel were randomized. Of 107 eligible respondents, 48 were in the Ottawa Influenza Decision Aid (OIDA) group and 59 in the control group. A statistically significant ( P = 0.020) greater improvement in confidence in immunization decision was observed in the OIDA group compared with the control group. Whereas the odds of changing intent to be immunized from ‘no/unsure' to ‘yes' was 2.4 times greater in the OIDA group, this result did not reach statistical significance after adjusting for intent to be immunized at baseline. The post-OIDA intent to be immunized in the OIDA and control groups compared to the pre-OIDA intent to be immunized showed that the OIDA had a significant effect on reducing uncertainty ( P = 0.035). Conclusions Using an accessible, balanced, understandable format for all healthcare personnel about their influenza immunization decision appears to have an impact on both healthcare personnel's confidence in their immunization decision and in their intent to be immunized.

Background We evaluated our experience in a low prevalence setting to determine the extent to which multiple swabs increased detection rates and the incremental costs of doing so. Methods Nasal and groin swabs submitted in pairs were cultured onto a single plate (Oxoid MRSA Denim Blue Agar; Oxoid Company, Napean, ON, Canada). We determined whether MRSA was detected when swabs submitted in the preceding 3 days were negative. We explored the costs associated with screening and of each additional colonized patient detected. Results In all, 60,049 paired nose and perineal swabs were submitted from 21,599 patients. In all, there were 12,750 duplicate, 1437 triplicate, and 112 instances when >4 swabs were processed within 3 days. The first culture was positive in 106 of 12,750 (0.83%%), 42 of 12,750 (0.33%) on the second when the first was negative, 7 of 1642 (0.43%) on the third or subsequent swab pair when the preceding 2 were negative. Conclusion Overall, the sensitivity of the first of multiple cultures of a set was 74.3%. Had the 14,392 multiple samples not been submitted, 49 colonized patients would not have been identified. Additional laboratory costs associated with multiple samples equaled $2088 per patient identified.

Alcohol-based hand rubs (ABHRs) formulated with technical-grade ethanol were temporarily permitted in Canada and the U.S beginning April 2020 to meet the current demand due to COVID-19. ABHRs formulated with technical-grade ethanol are low risk for general use. In this review, we discuss the toxicity of common contaminants found in technical-grade ethanol, as well as contaminants that may have been introduced into the products during formulation and packaging of ABHRs. Although primary route of exposure is via dermal absorption and inhalation, there have been reported elevated concerns regarding to ingestion of ABHRs. Overall, the highest risks were associated with methanol (for its toxicity), ethyl acetate (skin defattening), and acetaldehyde (carcinogenic and teratogenic). For these reasons Health Canada and the United States Food and Drug Administration have issued recalls on products containing some of these contaminants. More vigilant policing by regulatory agencies and general product users are required to ensure compliance, safety, and efficacy of these new products, as demand continue to rise during this unprecedented pandemic. Highlights • Alcohol-based hand rubs formulated with technical-grade ethanol can increase exposure to alcoholic impurities. • Inexperienced manufacturers may introduce additional contaminants into the product. • More vigilant policing should be employed to ensure compliancy, safety and efficacy. Graphical abstract