Journal of Hospital Infection

IntroductionThe Dutch recommendation on infection prevention and control (IPC) staffing in acute care hospitals from 2007 is outdated due to evolving hospital care, including shorter admissions, more complex and day-care procedures, more vulnerable patients, increasing antimicrobial resistance, and enhanced regulatory demands. Therefore, an updated staffing norm for IPC is needed. MethodsMinimum weekly hours required for IPC activities was determined by Delphi method across three model hospitals: academic, large non-academic, and small non-academic. Four questionnaire rounds were conducted among IPC practitioners (IPCP) and clinical microbiologists (CM). Staffing needs per role and hospital type were calculated. After three rounds a core expert team focus group formulated a new full time equivalent (FTE) norm which was proposed in the final round. ResultsFor academic hospitals, 100% consensus was achieved for a minimum of 0.15 FTE CM and 1.23 FTE IPCP per 5000 annual hospital admissions, plus 0.05 FTE CM and 0.41 FTE IPCP per 5000 annual day admissions, respectively. For non-academic hospitals, 92% supported the proposed norm for CM (same values), and 89% agreed with the proposed norm for IPCP: 1.10 FTE per 5000 hospital admissions and 0.37 FTE per 5000 day admissions. ConclusionA new consensus-based staffing norm, endorsed by most Dutch IPC professionals, recommends an increase in IPCP. This reflects increased demands on IPC teams and suggests diversification of professionals working in IPC teams, not accounted for in the previous norm. This minimum norm is needed to effectively protect patients and healthcare workers from infections.

IntroductionA controversy remains worldwide regarding the transmission routes of SARS-CoV-2 in hospital settings. We reviewed the current evidence on the air contamination with SARS-CoV-2 in hospital settings, and the factors associated to the contamination including the viral load and the particles size. MethodsThe MEDLINE, Embase, Web of Science databases were systematically interrogated for original English-language articles detailing COVID-19 air contamination in hospital settings between 1 December 2019 and 21 July 2020. This study was conducted in accordance with the PRISMA-ScR guidelines. The positivity rate of SARS-CoV-2 viral RNA and culture were described and compared according to the setting, clinical context, air ventilation system, and distance from patient. The SARS-CoV-2 RNA concentrations in copies per m3 of air were pooled and their distribution were described by hospital areas. Particle sizes and SARS-CoV-2 RNA concentrations in copies or TCID50 per m3 were analysed after categorization of sizes in < 1 {micro}m, 1-4 {micro}m, and > 4 {micro}m. ResultsAmong 2,034 records identified, 17 articles were included in the review. Overall, 27.5% (68/247) of air sampled from close patients environment were positive for SARS-CoV-2 RNA, without difference according to the setting (ICU: 27/97, 27.8%; non-ICU: 41/150, 27.3%; p = 0.93), the distance from patients (< 1 meter: 1/64, 1.5%; 1-5 meters: 4/67, 6%; p = 0.4). In other areas, the positivity rate was 23.8% (5/21) in toilets, 9.5% (20/221) in clinical areas, 12.4% (15/121) in staff areas, and 34.1% (14/41) in public areas. A total of 78 viral cultures were performed in three studies, and 3 (4%) were positive, all from close patients environment. The median SARS-CoV-2 RNA concentrations varied from 1.103 copies per m3 (IQR: 0.4.103-9.103) in clinical areas to 9.7.103 (5.1.103-14.3.103) in the air of toilets or bathrooms. The protective equipment removal and patients rooms had high concentrations/titre of SARS-CoV-2 with aerosol size distributions that showed peaks in the < 1 {micro}m region, and staff offices in the > 4{micro}m region. ConclusionIn hospital, the air near and away from COVID-19 patients is frequently contaminated with SARSCoV-2 RNA, with however, rare proofs of their viability. High viral loads found in toilet/bathrooms, staff and public hallways suggests to carefully consider these areas.

BackgroundInfectious aerosols and droplets generated by SARS-CoV-2-positive patient aerosol generating procedures (AGPs), coughing, or exhalation could potentially contaminate surfaces, leading to indirect SARS-CoV-2 spread via fomites. Our objective was to determine SARS-CoV-2 surface contamination frequency in Emergency Department (ED) patient rooms with respect to patient SARS-CoV-2 status and AGP receipt. MethodsSwabs were collected from fixed surfaces or equipment in the rooms of patients under investigation for COVID-19 or known to be SARS-CoV-2-positive. Environmental swabs were tested for SARS-CoV-2 RNA by RT-qPCR; RNA-positive samples were cultured in Vero E6 cells. Room contamination was also evaluated by clinical severity of COVID-19 and time since symptom onset. ResultsIn total, 202 rooms were sampled: 42 SARS-CoV-2-positive AGP patient rooms, 45 non-AGP SARS-CoV-2-positive patient rooms, and 115 SARS-CoV-2-negative AGP patient rooms. SARS-CoV-2 RNA was detected on 36 (3.6%) surfaces from 29 (14.4%) rooms. RNA contamination was detected more frequently in rooms occupied by non-AGP SARS-CoV-2- positive patients than SARS-CoV-2-positive AGP patients (28.9% vs 14.3%, p=0.078). Infectious virus was cultured from one non-AGP SARS-CoV-2-positive patient room. There was no significant difference in room positivity according to COVID-19 severity or time since symptom onset. ConclusionSARS-CoV-2 RNA contamination of ED room surfaces was highest and most frequent in rooms occupied by SARS-CoV-2-positive patients who did not undergo an AGP, which may be attributable to disease stage and viral shedding; however, there was no difference in room contamination according to COVID-19 severity or time since symptom onset.

BackgroundThe outbreak of coronavirus disease 2019 (COVID-19) has played havoc on the healthcare system and society. Many international guidelines have put forward various measures to control the spread and, using various quality masks seems to be the most important amongst them. This was a cross-sectional pilot study to see any alterations in the bacterial flora of the nasal and the oropharyngeal (OP) microbiota with the use of medical masks over prolonged periods during this COVID-19 outbreak. MethodsNasal and oropharyngeal swabs were collected using proper international guidelines from 30 healthy healthcare workers matching pre-set inclusion criteria, who gave written informed consent. The swabs were used for gram stain as well as culture and sensitivity analysis using standard methods. ResultsIn general, we found that the oropharyngeal microflora harboured a more diverse population of bacteria (n=13) than the nasal microflora (n=5). The predominant bacterial flora was found to Staphylococcus epidermidis in the nasal cavity and Streptococcus viridans in the oropharyngeal cavity. There was no growth in 8 (26.68%) samples of oropharynx and 3 (10%) of nasal samples, with one patient having no growth in both the samples. The commonest resistant antibiotic from both the cavity cultures was benzylpenicillin (nasal flora 80% and OP flora 47.37%). ConclusionThis small pilot study has shown a reassuring aspect of no change in the typical bacterial microflora species of the nasal and OP cavity with prolonged use of medical masks. This is the first study to show this convincing evidence during the COVID-19 outbreak and also in healthy healthcare workers who have to wear masks over long durations.

SummaryThe replacement frequency of mechanical ventilators breathing systems used in operating rooms (ORs) currently varies between hospitals. In light of evidence-based decision-making and sustainability efforts, we aim to determine whether 7-day use of breathing systems instead of 24 hours is microbial safe. In this prospective single-centre explorative study, 30mm UniflowTM breathing systems used in eight ORs were included. In four ORs, breathing systems were replaced daily following standard practice. In the remaining four ORs, they were intended for a 7-day use. Breathing systems were sampled daily on three locations of the exterior surface and cultured for the presence of microorganisms. A total of 128 breathing systems were included, 99 from an OR with daily replacement and 29 from an OR with weekly replacement. A total of 604 samples were cultured, of which the majority, 549 (90.9%) cultures were negative. From the 55 (9.1%) positive cultures, the majority (n=49, 70%) were coagulase-negative staphylococci. None of the identified microorganisms were found in consecutive cultures. Cultures from day 2 to 7 did not show a statistically significant increased positivity rate compared to cultures from day 1, respectively 22.9% vs. 24.1%. The weekly replacement regimen, furthermore, decreased the number of breathing systems used with 71%. Our data indicates that use of breathing systems up to seven days remains microbial safe. Additionally, only a minimal number of pathogenic microorganisms were detected, and these were not persistent on the breathing systems. Transitioning from 24-hours to intended 7-day use could significantly reduce costs and CO2 emissions.

BackgroundHospital-acquired infections (HAIs) represent a significant global health concern, contributing to high rates of morbidity and mortality. Globally, bacterial contamination of hospital surfaces and equipment has been identified as a critical pathway for the transmission of nosocomial infections. Despite its significance, the extent of surface and equipment contamination in pediatric wards at Kilimanjaro Christian Medical Centre (KCMC) remains underexplored. This study aims to determine the proportion of bacterial contamination of inanimate surfaces and equipment, distribution and susceptibility patterns in pediatric wards at Northern Tanzania Zonal Referral Hospital. MethodologyA descriptive cross-sectional hospital-based study conducted in pediatric wards from May to August 2021. The study was conducted at Kilimanjaro Christian Medical Center, a Northern Tanzania Zonal referral Hospital. Swabs were collected from inanimate surfaces and equipment and cultured on general-purpose media, differential media, and enriched media which were MacConkey agar, Blood agar and Chocolate agar to identify the bacteria isolated. Data was entered and analyzed using Statistical Package for the Social Sciences (SPSS). Results206 (86.6%) were positive for bacterial growth. Gram-negative bacteria were the most predominant bacteria identified 304 (82.4%) in which E. coli was the leading isolate 114 (30.9%), followed by Pseudomonas aeruginosa 93 (25.2%), Klebsiella oxytoca 44 (11.9%), Klebsiella pneumonia 41 (11.1%), Acinetobacter species 10 (2.7%), Proteus vulgaris 1 (0.3%) and Citrobacter species 1 (0.3%). Gram-positive isolates were 65 (17.6%) in which CoNS were 58 (15.7%) and S. aureus 7 (1.9%). ConclusionIn pediatric wards, surfaces and equipment can harbor diverse pathogenic bacteria with the potential to cause hospital-acquired infections to patients especially immuno-compromised or critically ill patients. To mitigate this risk, it is crucial to assess infection prevention practices, implement regular disinfection programs and raise awareness among healthcare professionals about the potential for pathogen transmission from hospital surfaces and equipment.

ObjectiveThe FilmArray Blood Culture Identification (BCID) panel is a rapid microfluidic PCR amplification microbial detection system. Several studies have evaluated its clinical performance on the basis of blood culture bottles containing resins. However, proportion of hospitals in China use bottles with carbon power, which the performance of FilmArray has not been fully investigated. Therefore, this study is conducted to explore the accuracy of the panel using blood culture bottles with carbon power. Method147 venous blood cultures containing carbon powder were used to assess the microbial and antibiotic resistance detection ability of the FilmArray panel. Outcomes were compared with results of the clinical combination method and their consistency was analyzed. ResultsFilmArray detected single microorganism in 121 samples, multiple microorganism in 9 cases and the consistency rate between the two methods was 90.6%. Among the 150 microorganisms detected, 85.1% (40/47) of staphylococcus contained the antibiotic resistant mecA gene, 15.3% (9/59) of Enterobacter detected the KPC gene, 7.7% (1/13) of Enterococcus has the vanA gene and the consistency with their clinical drug-resistant phenotypes were 93.6%, 86.4% and 100%, respectively. ConclusionThe identification rate of the FilmArray BCID panel using venous blood cultures with activated carbon powder was highly consistent with the outcomes of previous researchers using non-carbon powder blood culture bottles. It is capable of providing rapid and reliable results in the detection of pathogens present in automated blood culture systems.

BackgroundWhile possibility of airborne transmission in the spread of common respiratory infections, there is no consensus on the relative importance of airborne infection route in real-life. This study aimed to investigate the significance of the airborne transmissions and the effectiveness of air cleaning in reducing infections among children in daycare. MethodsA cross-over study was conducted in four daycare centers in Helsinki. All children attending the daycare were invited to participate (n = 262) and the sole inclusion criterion was that the children were expected to stay in the same day care center for the two-year duration of the study. 51 subjects were included in the final analysis. Clean air flow rate was increased by 2.1-2.9 times compared to baseline mechanical ventilation of the premises. The effect of intervention was assessed using negative binomial regression. ResultsThe intervention reduced incident infections from 0.95 to 0.78 infections per child per month among the children (primary outcome) in daycare. The reduction attributed to intervention in the statistical model was 18.0 % (95% CI 2.1-31.3 %, p = 0.028). ConclusionsWe observed a significant decrease in incident infections without implementing any other infection mitigation strategies but air cleaning. Our results challenge the current paradigm which emphasizes fomite and contact transmission and infection control measures that target these pathways. As ventilation and air cleaning can only affect particles able to float in the air stream, our results support the significance of airborne transmission among common respiratory pathogens as well as air cleaning as an infection control measure.

COVID-19 has presented hospitals with unique challenges. A SHEA Research Network survey showed that 40% reported "limited" or worse levels of personal protective equipment (PPE), and 13% were self-producing PPE to address those deficits, including 3D-printed items. However, we do not know how efficiently, if at all, 3D-printed materials can be disinfected. Additionally, two filaments, PLACTIVE and BIOGUARD, claim to be antimicrobial; they use copper nanocomposites and silver ions to reduce bacterial populations. We assess how PLACTIVE and BIOGUARD may be contaminated and how well they reduce contamination, and how readily Polylactic Acid (PLA), a standard 3D-printed material, may be disinfected. 3D-printed materials, including PLACTIVE and BIOGUARD, are readily contaminated with bacteria that are common in hospitals and can sustain that contamination. Our findings reveal that the levels of contamination on PLACTIVE and BIOGUARD can vary under specific conditions such as layer height or bacterial contact time, sometimes surpassing or falling short of PLA. However, disinfected disks had lower overall CFU averages than those that were not, but the level of disinfection was variable, and bacterial populations recovered hours after disinfection application. Proper disinfection and using appropriate 3D-printed materials are essential to limit bacterial contamination. 3D printers and their products can be invaluable for hospitals, especially when supplies are low, and healthcare worker safety is paramount. Environmental services should be made aware of the presence of antimicrobial 3D-printed materials, and patients should be discouraged from printing their own items for use in hospital environments. IMPORTANCEThe COVID-19 pandemic has intensified the demand for personal protective equipment (PPE) in hospitals, prompting the utilization of 3D-printed materials to address shortages. Given the role of environmental contamination in healthcare-associated infections, understanding the potential for bacterial colonization on these materials is crucial. Our findings highlight the importance of proper disinfection practices and material selection in mitigating bacterial contamination, enhancing infection prevention strategies in hospitals, and ensuring the safety of healthcare workers and patients.

BackgroundThere is a significant transmission of contaminants in the healthcare setting. Daily disinfection utilizing ammonium and chlorine-based products can lead to adverse health effects such as asthma, cancer, and other serious health issues. MethodsThis study evaluated the effectiveness of eraDOCator-60 in a health care facility. This randomized trial took place at Copley Hospital in Morristown, Vermont. Separate areas of the hospital were cleaned and disinfected in one step with eraDOCator-60. A Charm analyzer was utilized to evaluate the efficacy of disinfection before and after 1 minute application of eraDOCator-60. The Charm analyzer detects Adenosine Triphosphate (ATP) presence measured in Relative Light Units (RLUs). ResultsThe median number of RLUs decreased from 52,874 s to 0 RLUs after one-minute eraDOCator-60 dwell time in the emergency room; 18.611 RLUs to 0 RLUs in the medical-surgical unit, 41,507 RLUs to 0 RLUs in the cafeteria; 24,932 RLUs to 0 RLUs in the birthing center. ConclusionsEraDOCator-60 reduced contamination levels on all surfaces in the acute care setting down to a value of zero following a 1-minute dwell time in less than 5% soil load.

BackgroundHealthcare-associated infections (HAIs) constitute a significant financial strain on healthcare systems across the world, with surgical site infections (SSIs) being the costliest form. Despite the existence of diverse sources of infection in the operating room (OR), current literature focuses on human and procedural sources of contamination that could lead to an infection. Comparatively, the OR built environment is understudied as a potential disease transmission interface between the environment, patients, and surgical staff. This systematic literature review aims to investigate how the physical characteristics and components of the built environment impact airflow, infection risk, aerosols, particle counts, contamination, and pathogens in operating rooms. Methods and FindingsLiterature searches were conducted in the PubMed and Web of Science Core Collection databases on December 21, 2020, ultimately retrieving 2,965 articles after duplicates were removed. During abstract screening, all abstracts were independently reviewed by two authors and conflicts were resolved by a third author. All articles published since January 1, 2010, that reported primary data investigating an aspect of the built environment inside an OR in relation to airflow, contamination, and/or infection for which the full text in English was available were included. This resulted in the inclusion of 138 articles, which includes studies conducted in ORs during active surgeries, computer modeling studies, and simulations in which a real OR was used for a mock surgical procedure. Six major built environment categories were identified based on the collected literature: OR layout, disinfection systems, surgical lights, doors, ventilation, and portable airflow devices. A survey created on Qualtrics software was used to record the aspect of the built environment and the outcome of each study, as well as the relationship between the two. ConclusionsWhile OR ventilation has been studied extensively, the OR built environment as a whole is understudied in relation to airflow, contamination, and infection. The current literature is inconsistent in both its findings and subsequent recommendations, making it difficult to inform hospital design in the context of SSIs. No articles were identified that discussed respiratory infection transmission in the OR, and very few addressed healthcare worker (HCW) safety in relation to the OR built environment. The significant discrepancies in the literature identified in this review highlight the need for future studies that assess the quality and bias of these studies before firm recommendations can be made. Future work should also focus on addressing the lack information regarding respiratory infection transmission in the OR, especially in the context of HCW safety.

ObjectivesThe aim of this observational study was to demonstrate the behaviour and trajectory of exhaled material from an individual wearing an FFP3 mask. Valves allow material release, but we theorised that valve design may direct material downwards towards patient and surrounding environment. Limiting transmission of diseases with aerosolised spread is a current and serious concern within healthcare worldwide. Filtering face piece masks (FFP) are an essential piece of protective equipment when treating patients with ongoing infection. However, valved masks in other settings such as elective theatre and by the general public may have unforeseen negative effects. DesignA heating coil-based vaporiser was used to produce visible water vapour. A healthy test subject was filmed wearing a variety of different masks and exhaling the water vapour. ResultsFlexible pleated and solid-shell FFP masks direct exhaled material downwards in plumes exceeding 25 cm. Duckbill-shaped masks appear to direct exhaled vapour laterally, with a smaller plume. The effect is influenced by mask design and type of valve. Fluid repellent surgical masks reduce material directed downwards, and when used in conjunction with an FFP3 mask, appear to reduce the size and density of the exhaled vapour plume. The use of a visor was ineffective in reducing plume expulsion. InterpretationA properly fit-tested FFP3-rated protective mask may only moderately limit expulsion of aerosolised particles from asymptomatic healthcare workers to patients, particularly in cases where procedures are being performed in close proximity to patients or in cases where mucosal surfaces are exposed. Further research in this area is needed.

This document outlines the Statistical Analysis Plan for the CLEaning and Enhanced disiNfection (CLEEN) study. The CLEaning and Enhanced disiNfection (CLEEN) study is a stepped wedge cluster randomised trial evaluating the role of enhanced cleaning and disinfection of shared medical equipment as part of hospital infection prevention and control programs. The study is preregistered with the Australian and New Zealand Clinical Trials Registry (ACTRN12622001143718) and is funded by the National Health and Medical Research Council (GNT2008392). The full study protocol used to inform the Statistical Analysis Plan has been published.1 A signed copy of the Statistical Analysis Plan is available on request from the corresponding author (BM).

Decontamination of N95 respirators has become critical to alleviate PPE shortages for healthcare workers in the current COVID-19 emergency. The factors that are considered for the effective reuse of these masks are the fit, filter efficiency and decontamination/disinfection level both for SARS-CoV-2, which is the causative virus for COVID-19, and for other organisms of concern in the hospital environment such as Staphylococcus aureus or Clostridium difficile. In its guidance entitled Recommendations for Sponsors Requesting EUAs for Decontamination and Bioburden Reduction Systems for Surgical Masks and Respirators During the Coronavirus Disease 2019 (COVID19) Public Health Emergency (May 2020)[1], the FDA recommends a 6-log10 reduction in either the most resistant bacterial spores for the system or in a mycobacterium species to authorize the use of a decontamination method of N95 respirators for single or multiple users. While the goal is primarily inactivation against SARS-CoV-2, testing of decontamination methods against the virus may not always be available. For decontamination methods considered for only single users, the recommendation is a 6-log10 reduction in the infective virus concentration of 3 non-enveloped viruses or in the concentration of two Gram (+) and two Gram (-) bacteria. Based on these recommendations, we explored the efficacy of vaporized H2O2 (VHP) treatment of N95 respirators against surrogate viruses covering a wide range of disinfection resistance for emergency decontamination and reuse to alleviate PPE shortages for healthcare workers in the COVID-19 emergency.

The microbial monitoring of environmental and medical-devices surface is used to evaluate efficacy of routine cleaning and disinfection practises and to detect the presence of specific Nosocomial Pathogens. The prevalence of Multidrug Resistance organisms in hospital premises projects serious problems in transmitting to susceptible hosts which is difficult to treat. A cross sectional descriptive research was conducted from December 2016 to June 2017 at the pathology laboratory of Korea Nepal Friendship Hospital (KNFH). A total 140 samples were considered, encompassing the medical devices of the hospital (100), housekeeping surfaces (15) and air (25). Susceptibility test for bacterial isolates was done by disk diffusion assay. Of the total 140 samples taken and analysed, 100% showed growth positivity. In most of the swabs taken, Coagulase Negative Staphylococci was dominant, followed by Staphylococcus aureus, Streptococcus spp. Micrococcus spp., E coli, Pseudomonas spp., Bacillus spp., Acinetobacter spp., Klebsiella spp., Fungi, and least Proteus spp. The dry surfaces were dominantly contaminated by gram positive bacteria whereas moistened surfaces like wash basin were contaminated by gram negative as well as gram positive bacteria. Total 277 strains were exposed to various class of antibiotics, among the gram positive environmental isolates, Coagulase Negative Staphylococci 16 (34.78%) had highest MDR prevalence followed by Staphylococcus aureus 8 (29.62%), Streptococcus spp. 4 (12.90%), Micrococcus spp. 4 (9.30%) and no MDR was shown by any Bacillus spp isolates. Whereas, in case of gram negative, Klebsiella spp. 6 (35.29%) had highest MDR prevalence followed by Acinetobacter spp. 6 (31.57%), E. coli 8 (27.58%), Pseudomonas spp. 4 (18.18%), and lastly Proteus spp. with no MDR at all. The thick dirt covering the cotton swabs and heavy microbial load on them has displayed not only disinfecting practice but also cleaning practice is missing. Heavy contamination shows possible NIs breakout, its important to have routine microbial assessment with standard protocol and find ways to decrease its load.

The disinfection of high-contact surfaces is seen as an infection control practice to prevent the spread of pathogens by fomites. Unfortunately, recontamination of these surfaces can occur any time after the use of common disinfectants. We recently reported on a novel continuously active antimicrobial coating which was shown to reduce the spread of healthcare acquired infections in hospitals. We evaluated a modified coating that demonstrated a residual efficacy against viruses. The coated surfaces were found to be effective against human coronavirus (HCoV) 229E, reducing the concentration of these viruses by greater than 90% in 10 minutes and by greater than 99.9% after two hours of contact. The coating formulation when tested in suspension yielded a greater than 99.99% reduction of HCoV 229E within ten minutes of contact. This outcome presents an opportunity for controlling the transmission of COVID-19 from contaminated fomites.

BackgroundCandida auris (C. auris) poses a significant threat in healthcare settings, characterized by its high morbidity and mortality rates. While the use of chlorhexidine bathing has been suggested as a potential strategy for C. auris decolonization in adult patients within healthcare settings, a comprehensive and systematic evaluation of its effectiveness and associated outcomes is notably lacking. AimThis study seeks to systematically assess the effectiveness of daily chlorhexidine bathing for Candida auris decolonization in adult patients within healthcare settings. The studys primary objectives are to evaluate the impact of this intervention on reducing colonization rates, infection occurrences, and outbreak incidences, while concurrently evaluating any associated adverse events. The studys secondary objectives are to identify adverse events, and to explore and quantify the effect sizes of potential risk factors, if identified, that may influence the outcomes of chlorhexidine bathing for C. auris decolonization. Methods and AnalysisIn adherence to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P) guidelines, this protocol outlines the methodology for our systematic review and meta-analysis. The study commenced with an extensive presearch conducted from June to August 2023 on PubMed, followed by searches across other three key databases: Embase, Web of Science, and Scopus, in September 2023. The systematic search will encompass all available years of publication without applying any publication date filters. Records located in the literature search will be uploaded to the systematic review software Covidence to facilitate deduplication, blinded screening, and the selection of eligible studies. Two independent reviewers will rigorously screen records, extract data, and perform risk of bias assessments, with a third researcher resolving conflicts. The results will be synthesized narratively in summary tables, with the potential for meta-analysis contingent upon the findings, focusing on the effectiveness and adverse events of daily chlorhexidine bathing for C. auris decolonization in adult patients within healthcare settings. Additionally, we will investigate whether certain risk factors, if identified, have an impact on the outcomes by quantifying their effect sizes. Ethics and DisseminationThe ethical framework of this systematic review obviates the need for ethics approval, as it relies exclusively on published research. The outcomes of this study will be disseminated via publication in a peer-reviewed journal, shared with stakeholders, and made publicly accessible. PROSPERO RegistrationCRD42023459048.

BackgroundHealthcare workers treating patients with SARS-CoV-2 are at risk of infection from patient-emitted virus-laden aerosols. We quantified the reduction of airborne infectious virus in a simulated hospital room when a ventilated patient isolation (McMonty) hood was in use. MethodsWe nebulised 109 plaque forming units (PFU) of bacteriophage PhiX174 virus into a 35.1m3 room with a hood active or inactive. The airborne concentration of infectious virus was measured by BioSpot-VIVAS and settle plates using plaque assay quantification on the bacterial host Escherichia coli C. The particle number concentration (PNC) was monitored continuously using an optical particle sizer. ResultsMedian airborne viral concentration in the room reached 1.41 x 105 PFU.m-3 with the hood inactive. Using the active hood as source containment reduced infectious virus concentration by 374-fold in air samples. This was associated with a 109-fold reduction in total airborne particle number escape rate. The deposition of infectious virus on the surface of settle plates was reduced by 87-fold. ConclusionsThe isolation hood significantly reduced airborne infectious virus exposure in a simulated hospital room. Our findings support the use of the hood to limit exposure of healthcare workers to airborne virus in clinical environments. Lay summaryCOVID-19 patients exhale aerosol particles which can potentially carry infectious viruses into the hospital environment, putting healthcare workers at risk of infection. This risk can be reduced by proper use of personal protective equipment (PPE) to protect workers from virus exposure. More effective strategies, however, aim to provide source control, reducing the amount of virus-contaminated air that is exhaled into the hospital room. The McMonty isolation hood has been developed to trap and decontaminate the air around an infected patient. We tested the efficacy of the hood using a live virus model to mimic a COVID-19 patient in a hospital room. Using the McMonty hood reduced the amount of exhaled air particles in the room by over 109-times. In our tests, people working in the room were exposed to 374-times less infectious virus in the air, and room surfaces were 87-times less contaminated. Our study supports using devices like the McMonty hood in combination with PPE to keep healthcare workers safe from virus exposure at work.

COVID-19, caused by SARS-CoV-2, was first reported in China in 2019 and has transmitted rapidly around the world, currently responsible for 83 million reported cases and over 1.8 million deaths. The mode of transmission is believed principally to be airborne exposure to respiratory droplets from symptomatic and asymptomatic patients but there is also a risk of the droplets contaminating fomites such as touch surfaces including door handles, stair rails etc, leading to hand pick up and transfer to eyes, nose and mouth. We have previously shown that human coronavirus 229E survives for more than 5 days on inanimate surfaces and another laboratory reproduced this for SARS-CoV-2 this year. However, we showed rapid inactivation of Hu-CoV-229E within 10 minutes on different copper surfaces while the other laboratory indicated this took 4 hours for SARS-CoV-2. So why the difference? We have repeated our work with SARS-CoV-2 and can confirm that this coronavirus can be inactivated on copper surfaces in as little as 1 minute. We discuss why the 4 hour result may be technically flawed.

Clostridioides difficile infections (CDI) pose a significant threat to patient safety in healthcare facilities. In this study, we investigated the effectiveness of an ultraviolet-C (UV-C) disinfection system in reducing C. difficile surface contamination in a simulated patient room. The results showed an overall 98.17% reduction in C. difficile spores after UV-C treatment of directly exposed and shadowed areas, an efficiency that translated to a 4.91% reduction per minute of room vacancy. This study demonstrates that UV-C disinfection is an effective method for reducing C. difficile spores in healthcare settings, and that efficiency can be improved with shorter setup times and optimal device placement.