Regarding the impact of factors such as staff workload / availability and bed occupancy on the spread of HAI , Lacotte , et al . ( 2020 ) report “ growing evidence ” on the impact of overcrowding on HAI transmission rate , noting that “ Low staffing and increased workload have been associated with a higher risk of HAI acquisition . Regarding bed occupancy , the literature is still inconsistent … Overall , there is still insufficient data to generate clear and robust breakpoint thresholds needed by policymakers and hospital managers to implement effective actions ( worker / patient and patient / bed ratio for instance ). Ideally , breakpoints should be defined for various healthcare settings ( intensive care units , short or long stay wards , long-term care facilities ) and country settings ( high , medium , and low-resource settings ).”
And regarding assessment of the impact of infrastructural changes at facility level on the reduction of infections and resistance , the researchers say there are little data available on the impact of infrastructural changes on HAI but point to a 2016 meta-analysis which concluded that a high density of handwashing points and single-patient rooms could help reducing HAI transmission rates in facilities . They add , “ More research in the area is therefore needed ; however , infrastructural changes are rarely considered as research opportunities . Ideally , IP & C outcomes should be studied for any new healthcare facility or any facility remodeling . For instance , purchase of sinks , showers or bathtubs in healthcare institutions should include an analysis of evidence of how easily they can be disinfected . Placement and design of hand sanitizers should be based upon evidence on where healthcare personnel are most likely to use them .”
They formulated a list of 16 research priorities and identified three urgent needs . To validate the aggregated research priorities and identify the most pressing needs , the researchers ’ draft research priorities were reviewed by IP & C experts . Their research priorities are as follows :
1 . There is a lack of high-quality studies addressing the effectiveness of hospital-based IPC programs , including their impact , cost-effectiveness , and ideal composition .
2 . Many best practice IPC recommendations are based upon weak evidence . For example , the World Health Organization identified , in its Global Guidelines for the Prevention of Surgical Site Infection , recommendations with a “ low ” quality of evidence . The evidence base supporting IPC guidelines needs to be strengthened .
3 . Situational analyses in different settings ( high , medium or low-incomes countries ) but also different healthcare settings ( intensive care units , short or long stay , medico-social facilities ) are needed to better understand potential adaptations of IPC guidelines .
4 . A better understanding of the different patient screening strategies is needed for risk management . This includes who should be screened , when ( including start and stop of screening ), and how movement between healthcare institutions should trigger screening . Research should include both clinical impact and cost-effectiveness .
5 . Additional tools are needed to evaluate IPC training programmes and implement them .
6 . New innovative ways of training should be evaluated such as e-learning , simulation , self-directed training modules or mentorship for IPC education . There is a lack of study on the impact of these innovative training tools on the practice change and infection rate in healthcare facilities .
7 . Minimal standard requirements for the recruitment and training of IPC professionals should be investigated .
8 . Research is needed to assess and validate the reliability of surveillance based on available patient clinical information ( syndromic-based surveillance ) rather than microbiological data or prescription databases , i . e ., data gathered for other primary purposes .
9 . There is a lack of published standards to monitor IPC practices beyond hand hygiene . Evidence-based standardized audit protocols need to be created addressing , for example , catheter-related bloodstream / urinary tract infections and ventilator-associated pneumonia .
10 . There are a number of innovative , new methods to monitor compliance to IPC practices , including electronic and infrared approaches . These need to be tested in multiple settings to assess their value for IPC programs .
11 . Insufficient data are available on the impact of infrastructural changes at the facility level on the reduction of infections and resistance . This includes the accessibility to specific equipment , density of handwashing points , availability of single occupancy rooms , and more .
12 . Research is needed to explore the impact of patient-to-bed ratio on the spread of infections and resistance , including instances of overcrowding . This should include analyses of staff workload , available staffing ( including presence of IPC professionals ), bed occupancy , and visitor frequency .
13 . Research is needed to study the interaction between the human and hospital microbiome .
14 . Studies are needed to assess the demographic , organizational , economic , sociological , and behavioral factors facilitating success but also the barriers and challenges to implement effective IPC programs .
15 . Patients and their families are key elements in the chain of transmission in healthcare facilities . Studies addressing the impact of patient and family-oriented education and communication campaigns ( involving patients associations ) on the rate of hospital-acquired infections are needed .
16 . Research is needed to assess the impact of IPC measures in different operational contexts including small farms , industrial farms , feedlots , slaughterhouses , fish farms , and more . IPC measures may include the density of the animal populations , vaccination , hygiene measures and antibiotic use .
References :
CDC . Antibiotic Resistance Threats in the United States , 2019 . Atlanta , GA : U . S . Department of Health and Human Services , CDC ; 2019 .
Courtenay M , Burnett E , et al . Preparing nurses for COVID-19 response efforts through involvement in antimicrobial stewardship programs . J Hosp Infect . 2020 Sep ; 106 ( 1 ): 176-178 .
Lacotte Y , Årdal C and Ploy M . Infection prevention and control research priorities : what do we need to combat healthcare-associated infections and antimicrobial resistance ? Results of a narrative literature review and survey analysis . Antimicrob Resist Infect Control 9 , 142 ( 2020 ). https :// doi . org / 10.1186 / s13756-020-00801-x
Morens DM and Fauci AS . Emerging Pandemic Diseases : How We Got to COVID-19 . Cell . 2020 Sep 3 ; 182 ( 5 ): 1077-1092 . Aug 15 , 2020 . doi : 10.1016 / j . cell . 2020.08.021
Morens DM , Daszak P and Taubenberger JK . Escaping Pandora ’ s Box — Another Novel Coronavirus . New Eng J Med . April 2 , 2020 .
Morris A , Calderwood M , et al . Research Needs in Antibiotic Stewardship . Infect Control Hosp Epidemiol . Web . Oct . 30 , 2019 .
Weiner-Lastinger L , Abner S , et al . Antimicrobial-Resistant Pathogens Associated with Adult Healthcare-Associated Infections : Summary of Data Reported to the National Healthcare Safety Network , 2015-2017 .” Infect Control Hosp Epidemiol . Web . Nov . 25 , 2019 .