Growth of hospital infection control programme and the infection control nurse.
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A consortium's infection control nurse and physician epidemiologists boost the member hospitals' infection control efforts through onsite rounds, establishment of group standards, reports on each hospitals' performance, ongoing education, medicolegal assistance, monitoring of use of isolation evaluation of infection control products, and other activities.
To provide adequate numbers of infection control nurses the following areas need attention: an established curriculum for formal education, policies that will assure implementation of infection control practices, and surveillance and research to establish that current infection control practices work.
The prevention of surgical infection in the operating theatre is a complex pursuit. Every facet of activity, whether it is part of the surgical act itself or a remote activity with indirect effects on the surgical operation, constitutes part of the whole realm of infection control. These many facets may be divided into four main components, all interdependent: (a) the surgeon and his team (surgical technique; adherence to surgical anatomic, physiologic, and aseptic principles; discipline); (b) education and communiction--a functioning infections committee, repeated tutorials for all prefessional and technical operating room personnel, constant review of methods and systems, effective reporting of offenses, enforcement of discipline; (c) dependable support services--sterilizing techniques, barrier materials, apparel, laundry methods; materials handling and processing methods; efficiency and personal hygiene of all techincal and support personnel; discipline; and (d) environmental factors--architecture, engineering, and air handling; electrical and mechanical requirements; communication; discipline).
BACKGROUND: Viral sequencing of SARS-CoV-2 has been used for outbreak investigation, but there is limited evidence supporting routine use for infection prevention and control (IPC) within hospital settings. METHODS: We conducted a prospective non-randomised trial of sequencing at 14 acute UK hospital trusts. Sites each had a 4-week baseline data collection period, followed by intervention periods comprising 8 weeks of 'rapid' (<48 hr) and 4 weeks of 'longer-turnaround' (5-10 days) sequencing using a sequence reporting tool (SRT). Data were collected on all hospital-onset COVID-19 infections (HOCIs; detected ≥48 hr from admission). The impact of the sequencing intervention on IPC knowledge and actions, and on the incidence of probable/definite hospital-acquired infections (HAIs), was evaluated. RESULTS: A total of 2170 HOCI cases were recorded from October 2020 to April 2021, corresponding to a period of extreme strain on the health service, with sequence reports returned for 650/1320 (49.2%) during intervention phases. We did not detect a statistically significant change in weekly incidence of HAIs in longer-turnaround (incidence rate ratio 1.60, 95% CI 0.85-3.01; p=0.14) or rapid (0.85, 0.48-1.50; p=0.54) intervention phases compared to baseline phase. However, IPC practice was changed in 7.8 and 7.4% of all HOCI cases in rapid and longer-turnaround phases, respectively, and 17.2 and 11.6% of cases where the report was returned. In a 'per-protocol' sensitivity analysis, there was an impact on IPC actions in 20.7% of HOCI cases when the SRT report was returned within 5 days. Capacity to respond effectively to insights from sequencing was breached in most sites by the volume of cases and limited resources. CONCLUSIONS: While we did not demonstrate a direct impact of sequencing on the incidence of nosocomial transmission, our results suggest that sequencing can inform IPC response to HOCIs, particularly when returned within 5 days. FUNDING: COG-UK is supported by funding from the Medical Research Council (MRC) part of UK Research & Innovation (UKRI), the National Institute of Health Research (NIHR) (grant code: MC_PC_19027), and Genome Research Limited, operating as the Wellcome Sanger Institute. CLINICAL TRIAL NUMBER: NCT04405934.
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Control of infection in the surgical intensive care unit demands unfailing attention to three distinct areas: a) The bacteria responsible may be endogenous or exogenous. The effects of the former can be limited by careful surgical techniques and judicious use of antibiotics, of the latter by the practice of asepsis and antisepsis, essentially of scrupulous cleanliness. b) The environment of infection concerns the support of natural barriers to infection (notably the integrity of the skin and the adequate drainage of the pulmonary system), and the sterility and appropriate care and use of the many invasive devices currently available. c) The patient's natural defence mechanisms show considerable variation, and those at increased risk can be detected by skin-testing with a number of antigens as well as by recognized clinical features. It is in these patients with anergy and abnormal natural defences that total parenteral nutrition can be of the greatest value.
The American Hospital Association and the Center for Disease Control, together with other national bodies, have made major efforts in the past 20 years in calling attention to problems of nosocomial infection in U.S. hospitals. Current requirements of the Joint Commission on Accreditation of Hospitals reflect their efforts but further reflect a profound lack of acceptable data from which rational priorities in hospital infection control might be deduced. Accreditation requirements should be limited to procedures whose effectiveness in either clearly documented or strongly suggested by available data. Research and educational goals in hospital epidemiology must be identified and met in order to provide a scientific basis for hospital infection control procedures.
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Important aspects and interpretations of JCAH standards on infection control are explained, and approaches to ensuring compliance are discussed.
Candida auris (recently renamed Candidozyma auris) is an emerging multidrug-resistant fungal pathogen, first identified in Japan in 2009. C. auris exhibits remarkable persistence on human skin and inanimate surfaces, resistance to multiple antifungals, notably fluconazole, and biofilm formation, which hinders infection control and leads to hospital outbreaks with high mortality rates. Despite ongoing research, key aspects of its reservoir origin, transmission routes and the best way to combat its spread and multidrug resistance remain unclear. Improving genomic surveillance and antifungal strategies is crucial to contain its spread and mitigate the growing public health threat posed by this resilient and potentially fatal fungal pathogen.
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The COVID-19 pandemic placed unprecedented pressure on healthcare systems and exposed healthcare workers (HCWs) to biological hazards, organizational pressures, and psychological strain. Evidence generated during the emergency shows that HCW protection cannot rely on isolated measures, but requires an integrated framework combining epidemiological surveillance, contact tracing, infection prevention and control, vaccination, occupational health, and workforce support. Contact tracing helped identify occupational exposures and clarify how duration, proximity, and inadequate use of personal protective equipment jointly shaped infection risk. Subsequent studies of reinfection showed that susceptibility reflected the interaction of viral circulation, individual immunity, and vaccination status. Vaccination reduced the clinical impact of SARS-CoV-2 and supported service continuity, although uptake depended on trust, communication, and management of adverse event concerns. The pandemic also highlighted substantial economic consequences and a high burden of psychological distress and burnout among HCWs. Building on this evidence, future preparedness should translate these lessons into permanent, adaptable infrastructure rather than temporary emergency arrangements, integrating interoperable, AI-assisted surveillance capable of combining occupational, diagnostic, vaccination, and genomic data to detect emerging risks early, while ensuring robust data governance and human oversight. Equally central is the need to address long-term workforce vulnerabilities, including Long COVID, attrition, and burnout, through early identification, rehabilitation, flexible return-to-work models, and sustained psychosocial support. Achieving this requires structured multidisciplinary collaboration among occupational medicine, infection control, epidemiology, mental health, and digital health specialists, moving from fragmented infection-control protocols to an integrated, proactive, and learning-oriented preparedness strategy. Protecting HCWs is therefore not only an occupational safety priority but a foundational prerequisite for safe, equitable, and sustainable healthcare delivery during future infectious threats.
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