Publications by authors named "Daniela Pires"

26 Publications

  • Page 1 of 1

Hand hygiene in health care: 20 years of ongoing advances and perspectives.

Lancet Infect Dis 2021 08;21(8):e209-e221

Infection Control Programme, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. Electronic address:

Health-care-associated infections are the most prevalent adverse events of hospital care, posing a substantial threat to patient safety and burden on society. Hand hygiene with alcohol-based hand rub is the most effective preventive strategy to reduce health-care-associated infections. Over the past two decades, various interventions have been introduced and studied to improve hand hygiene compliance among health-care workers. The global implementation of the WHO multimodal hand hygiene improvement strategy and constant efforts to replace the use of soap and water with alcohol-based hand rub have led to a faster and more efficient hand cleaning method. These strategies have strongly contributed to the success of behaviour change and a subsequent decrease in health-care-associated infections and cross-transmission of multidrug-resistant organisms worldwide. The WHO multimodal behaviour change strategy requires a series of elements including system change as a prerequisite for behaviour, change, education, monitoring and performance feedback, reminders in the workplace, and an institutional safety climate. Successful adoption of the promotion strategy requires adaptation to available resources and sociocultural contexts. This Review focuses on the major advances and challenges in hand hygiene research and practices in the past 20 years and sets out various ways forward for improving this lifesaving action.
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http://dx.doi.org/10.1016/S1473-3099(21)00383-2DOI Listing
August 2021

Effect of Wearing a Novel Electronic Wearable Device on Hand Hygiene Compliance Among Health Care Workers: A Stepped-Wedge Cluster Randomized Clinical Trial.

JAMA Netw Open 2021 02 1;4(2):e2035331. Epub 2021 Feb 1.

Infection Control Programme and World Health Organization Collaborating Centre on Patient Safety-Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.

Importance: Hand hygiene (HH) is essential to prevent hospital-acquired infections.

Objective: To determine whether providing real-time feedback on a simplified HH action improves compliance with the World Health Organization's "5 Moments" and the quality of the HH action.

Design, Setting, And Participants: This open-label, cluster randomized, stepped-wedge clinical trial was conducted between June 1, 2017, and January 6, 2018 (with a follow-up in March 2018), in a geriatric hospital of the University of Geneva Hospitals, Switzerland. All 12 wards and 97 of 306 eligible health care workers (HCWs) volunteered to wear a novel electronic wearable device that delivered real-time feedback on duration of hand rubbing and application of a hand-sized customized volume of alcohol-based handrub (ABHR).

Interventions: This study had 3 sequential periods: baseline (no device), transition (device monitoring without feedback), and intervention (device monitoring and feedback). The start of the transition period was randomly allocated based on a computer-generated block randomization.

Main Outcomes And Measures: The primary outcome was HH compliance, according to the direct observation method during intervention as compared with baseline. Secondary outcomes included the volume of ABHR and duration of hand rubbing measured by the device during intervention as compared with transition.

Results: All wards and respective HCWs were evenly assigned to group 1 (26 participants), 2 (22 participants), 3 (25 participants), or 4 (24 participants). Twelve HCWs did not fully complete the intervention but were included in the analysis. During 759 observation sessions, 6878 HH opportunities were observed. HH compliance at intervention (62.9%; 95% CI, 61.1%-64.7%) was lower than at baseline (66.6%; 95% CI, 64.8%-68.4%). After adjusting for covariates, HH compliance was not different between periods (odds ratio, 1.03; 95% CI, 0.75-1.42; P = .85). Days since study onset (OR, 0.997; 95% CI, 0.994-0.998; P < .001), older age (OR, 0.97; 95% CI, 0.95-0.99; P = .015), and workload (OR, 0.29; 95% CI, 0.20-0.41; P < .001) were independently associated with reduced HH compliance. The median (interquartile range) volume of ABHR and duration of hand rubbing in transition and intervention increased from 1.12 (0.76-1.68) mL to 1.71 (1.01-2.76) mL and from 6.5 (4.5-10.5) seconds to 8 (4.5-15.5) seconds, respectively. There were no serious adverse events.

Conclusions And Relevance: The use of this device did not change HH compliance, but increased the duration of hand rubbing and volume of ABHR used by HCWs.

Trial Registration: isrctn.org Identifier: ISRCTN25430066.
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http://dx.doi.org/10.1001/jamanetworkopen.2020.35331DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7871189PMC
February 2021

Assessment of hand hygiene facilities and staff compliance in a large tertiary health care facility in northern Nigeria: a cross sectional study.

Antimicrob Resist Infect Control 2020 02 11;9(1):30. Epub 2020 Feb 11.

Infection Control Programme and WHO Collaborating Centre on Patient Safety - Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland.

Background: The burden of healthcare-associated infection (HAI) is 2 to 18 times higher in developing countries. However, few data are available regarding infection prevention and control (IPC) process indicators in these countries. We evaluated hand hygiene (HH) facilities and compliance amongst healthcare workers (HCW) in a 600-bed healthcare facility in Northcentral Nigeria providing tertiary care service for a catchment population of about 20 million.

Methods: An in-house facility assessment tool and the World Health Organization (WHO) direct observation method were used to assess the HH facilities and compliance, respectively. Factors associated with good compliance were determined by multivariate analysis.

Results: The facility survey was carried out in all 46 clinical units of the hospital. 72% of the units had no poster or written policy on HH; 87% did not have alcohol-based hand rubs; 98% had at least one handwash sink; 28% had flowing tap water all day while 72% utilized cup and bucket; and 58% had no hand drying facilities. A total of 406 HH opportunities were observed among 175 HCWs. The overall compliance was 31%, ranging from 18% among ward attendants to 82% among medical students. Based on WHO "5 moments" for HH, average compliance was 21% before patient contact, 23% before aseptic procedure, 63% after body fluid exposure risk, 41% after patient contact and 40% after contact with patients' surrounding. Being a medical student was independently associated with high HH compliance, adjusted odds ratio: 13.87 (1.70-112.88).

Conclusions: Availability of HH facilities and HCW compliance in a large tertiary hospital in Nigeria is poor. Our findings confirm that HCWs seem more sensitized to their risk of exposure to potential pathogens than to the prevention of HAI cross-transmission. Inadequate HH facilities probably contributed to the poor compliance. Specific measures such as improved facilities, training and monitoring are needed to improve HH compliance.
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http://dx.doi.org/10.1186/s13756-020-0693-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7014740PMC
February 2020

Train-the-Trainers in hand hygiene: a standardized approach to guide education in infection prevention and control.

Antimicrob Resist Infect Control 2019 12 30;8(1):206. Epub 2019 Dec 30.

Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.

Background: Harmonization in hand hygiene training for infection prevention and control (IPC) professionals is lacking. We describe a standardized approach to training, using a "Train-the-Trainers" (TTT) concept for IPC professionals and assess its impact on hand hygiene knowledge in six countries.

Methods: We developed a three-day simulation-based TTT course based on the World Health Organization (WHO) Multimodal Hand Hygiene Improvement Strategy. To evaluate its impact, we have performed a pre-and post-course knowledge questionnaire. The Wilcoxon signed-rank test was used to compare the results before and after training.

Results: Between June 2016 and January 2018 we conducted seven TTT courses in six countries: Iran, Malaysia, Mexico, South Africa, Spain and Thailand. A total of 305 IPC professionals completed the programme. Participants included nurses (n = 196; 64.2%), physicians (n = 53; 17.3%) and other health professionals (n = 56; 18.3%). In total, participants from more than 20 countries were trained. A significant (p < 0.05) improvement in knowledge between the pre- and post-TTT training phases was observed in all countries. Puebla (Mexico) had the highest improvement (22.3%; p < 0.001), followed by Malaysia (21.2%; p < 0.001), Jalisco (Mexico; 20.2%; p < 0.001), Thailand (18.8%; p < 0.001), South Africa (18.3%; p < 0.001), Iran (17.5%; p < 0.001) and Spain (9.7%; p = 0.047). Spain had the highest overall test scores, while Thailand had the lowest pre- and post-scores. Positive aspects reported included: unique learning environment, sharing experiences, hands-on practices on a secure environment and networking among IPC professionals. Sustainability was assessed through follow-up evaluations conducted in three original TTT course sites in Mexico (Jalisco and Puebla) and in Spain: improvement was sustained in the last follow-up phase when assessed 5 months, 1 year and 2 years after the first TTT course, respectively.

Conclusions: The TTT in hand hygiene model proved to be effective in enhancing participant's knowledge, sharing experiences and networking. IPC professionals can use this reference training method worldwide to further disseminate knowledge to other health care workers.
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http://dx.doi.org/10.1186/s13756-019-0666-4DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937710PMC
December 2019

Correction to: Train-the-Trainers in hand hygiene: a standardized approach to guide education in infection prevention and control.

Antimicrob Resist Infect Control 2020 01 31;9(1):24. Epub 2020 Jan 31.

Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.

The original article [1] contained a misspelling in author, Fernando Bellissimo-Rodrigues's name which has since been corrected.
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http://dx.doi.org/10.1186/s13756-020-0687-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6995097PMC
January 2020

Glycerol content within the WHO ethanol-based handrub formulation: balancing tolerability with antimicrobial efficacy.

Antimicrob Resist Infect Control 2019 24;8:109. Epub 2019 Jun 24.

1Infection Control Service, University Hospital of Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, Brazil.

Background: The World Health Organization (WHO) ethanol-based handrub (EBHR) formulation contains 1.45% glycerol as an emollient to protect healthcare workers' (HCWs) skin against dryness and dermatitis. However, glycerol seems to negatively affect the antimicrobial efficacy of alcohols. In addition, the minimal concentration of glycerol required to protect hands remain unknown. We aim to evaluate the tolerance of HCWs to the WHO EBHR formulation using different concentrations of glycerol in a tropical climate healthcare setting.

Methods: We conducted a cluster-randomized, double-blind, crossover study among 40 HCWs from an intensive care unit of a tertiary-care hospital in Brazil from June 1st to September 30, 2017. We tested the WHO EBHR original formulation containing 1.45% glycerol against three other concentrations (0, 0.5, and 0.75%). HCWs used one formulation at a time for seven working days during their routine practice and then had their hands evaluated by an external observer using the WHO scale for visual inspection. Participants also used a WHO self-evaluation tool to rate their own skin condition. We used a generalized estimating equations of the logit type to compare differences between the tolerability to different formulations.

Results: According to the independent observation, participants had 2.4 times (95%CI: 1.12-5.15) more chance of having a skin condition considered good when they used the 0.5% compared to the 1.45% glycerol formulation. For the self-evaluation scale, participants were likely to have a worst evaluation (OR: 0.23, 95%CI: 0.11-0.49) when they used the preparation without glycerol compared to the WHO standard formulation (1.45%), and there were no differences between the other formulations used.

Conclusion: In a tropical climate setting, the WHO-modified EBHR formulation containing 0.5% glycerol led to better ratings of skin tolerance than the original formulation, and, therefore, may offer the best balance between skin tolerance and antimicrobial efficacy.
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http://dx.doi.org/10.1186/s13756-019-0553-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6591802PMC
June 2020

Scenario-based simulation training for the WHO hand hygiene self-assessment framework.

Antimicrob Resist Infect Control 2019 28;8:58. Epub 2019 Mar 28.

Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.

The WHO global hand hygiene campaign, launched in 2009 and celebrated annually on the 5th of May, features specific calls to action seeking to increase engagement from stakeholders' collaborations in hand hygiene improvement. WHO calls on everyone to be inspired by the global movement towards universal health coverage (UHC). Infection prevention and control (IPC), including hand hygiene, is critical to achieve UHC as it has a direct impact on quality of care and patient safety across all levels of the health services. In the framework of UHC, the theme for 5 May 2019 is "Clean care for all - it's in your hands". In this context, the WHO has launched a global survey to assess the current level of progress of IPC programmes and hand hygiene activities in healthcare facilities (HCFs) worldwide. This involved the creation of two tools for healthcare facilities: the WHO Infection Prevention and Control Assessment Framework (IPCAF) and the WHO Hand Hygiene Self-Assessment Framework (HHSAF). The objective of this paper is to provide case scenario-based simulation for IPC specialists to simulate and fully assimilate the correct completion of the HHSAF framework in a standardized format. The three case scenarios have been tested and are proposed for the reader to assess the HHSAF of different HCFs in a variety of contexts, even in low-resouce settings. They were designed for simulation training purposes to achieve standardization and interactive learning. These scenarios are meant to be used by professionals in charge of implementing a hand hygiene improvement strategy within their HCF, as well as for simulation and standardized training purposes prior to completing and submitting data for the 2019 WHO Global Survey. Additionally, information provided by the use of the HHSAF can easily be translated into action plans to support the implementation and improvement related to specific indicators of hand hygiene promotion. We invite all HCFs to participate in the 2019 WHO global survey and monitor the level of progress of their IPC programme and hand hygiene activities.
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http://dx.doi.org/10.1186/s13756-019-0511-9DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6437984PMC
April 2020

Control of Carbapenem-resistant Enterobacteriaceae, Acinetobacter baumannii, and Pseudomonas aeruginosa in Healthcare Facilities: A Systematic Review and Reanalysis of Quasi-experimental Studies.

Clin Infect Dis 2019 02;68(5):873-884

Infection Control Program, Geneva University Hospitals and Faculty of Medicine, Switzerland.

Carbapenem-resistant Enterobacteriaceae (CRE), Acinetobacter baumannii (CRAB), and Pseudomonas aeruginosa (CRPsA) are a serious cause of healthcare-associated infections, although the evidence for their control remains uncertain. We conducted a systematic review and reanalysis to assess infection prevention and control (IPC) interventions on CRE-CRAB-CRPsA in inpatient healthcare facilities to inform World Health Organization guidelines. Six major databases and conference abstracts were searched. Before-and-after studies were reanalyzed as interrupted time series if possible. Effective practice and organization of care (EPOC) quality criteria were used. Seventy-six studies were identified, of which 17 (22%) were EPOC-compatible and interrupted time series analyses, assessing CRE (n = 11; 65%), CRAB (n = 5; 29%) and CRPsA (n = 3; 18%). IPC measures were often implemented using a multimodal approach (CRE: 10/11; CRAB: 4/5; CRPsA: 3/3). Among all CRE-CRAB-CRPsA EPOC studies, the most frequent intervention components included contact precautions (90%), active surveillance cultures (80%), monitoring, audit and feedback of measures (80%), patient isolation or cohorting (70%), hand hygiene (50%), and environmental cleaning (40%); nearly all studies with these interventions reported a significant reduction in slope and/or level. The quality of EPOC studies was very low to low.
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http://dx.doi.org/10.1093/cid/ciy752DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6389314PMC
February 2019

Conflicts of interest in infection prevention and control research: no smoke without fire. A narrative review.

Intensive Care Med 2018 Oct 11;44(10):1679-1690. Epub 2018 Sep 11.

Infection Control Programme, University of Geneva, Hospitals and Faculty of Medicine, WHO Collaborating Centre on Patient Safety (Infection Control and Improving Practices), Geneva, Switzerland.

Conflicts of interest (COIs) do occur in healthcare research, yet their impact on research in the field of infection prevention and control (IPC) is unknown. We conducted a narrative review aiming to identify examples of COIs in IPC research. In addition to well-known instances, we conducted PubMed and Google searches to identify and report case studies of COIs in IPC and antimicrobial resistance (AMR), which were chosen arbitrarily following consensus meetings, to illustrate different types of COIs. We also searched the Retraction Watch database and blog to systematically identify retracted IPC and/or infectious disease-related papers. Our review highlights COIs in academic research linked to ties between industry and physicians, journal editors, peer-reviewed journals' choice for publication, and guideline committees participants and authors. It explores how COIs can affect research and could be managed. We also present several selected case studies that involve (1) the chlorhexidine industry and how it has used marketing trials and key opinion leaders to promote off-label use of its products; (2) the copper industry and how reporting of its trials in IPC have furthered their agenda; (3) the influence of a company developing "closed infusion systems" for catheters and how this affects networks in low- and middle-income countries and guideline development; (4) potential perverse incentives hospitals may have in reporting healthcare-associated infection or AMR rates and how government intervention may restrict AMR research for fear of bad publicity and subsequent negative economic consequences. Finally, the analysis of reasons for the retraction of previously published papers highlights the fact that misconduct in research may have other motivations than financial gain, the most visible form of COIs. COIs occur in the field of research in general, and IPC and AMR are no exceptions. Their effects pervade all aspects of the research and publication processes. We believe that, in addition to improvements in management strategies of COIs, increased public funding should be available to decrease researchers' dependency on industry ties. Further research is needed on COIs and their management.
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http://dx.doi.org/10.1007/s00134-018-5361-zDOI Listing
October 2018

Promoting and sustaining a historical and global effort to prevent sepsis: the 2018 World Health Organization SAVE LIVES: Clean Your Hands campaign.

Crit Care 2018 04 13;22(1):92. Epub 2018 Apr 13.

Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211, Geneva, Switzerland.

Sepsis is estimated to affect more than 30 million patients with potentially five million deaths every year worldwide. Prevention of sepsis, as well as early recognition, diagnosis and treatment, can't be overlooked to mitigate this global public health threat. World Health Organization (WHO) promotes hand hygiene in health care through its annual global campaign, SAVE LIVES: Clean Your Hands campaign on 5 May every year. The 2018 campaign targets sepsis with the overall theme "It's in your hands; prevent sepsis in health care".
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http://dx.doi.org/10.1186/s13054-018-2011-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5899328PMC
April 2018

"It's in Your Hands-Prevent Sepsis in Health Care": 5 May 2018, World Health Organization (WHO) SAVE LIVES: Clean Your Hands Campaign.

Infect Control Hosp Epidemiol 2018 05 2;39(5):634-635. Epub 2018 Apr 2.

2Infection Control Programme and WHO Collaborating Centre on Patient Safety,University of Geneva Hospitals and Faculty of Medicine,Geneva,Switzerland.

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http://dx.doi.org/10.1017/ice.2018.68DOI Listing
May 2018

"It's in your hands-prevent sepsis in health care"; May 5 2018 World Health Organization SAVE LIVES: Clean Your Hands campaign.

Am J Infect Control 2018 05 16;46(5):480-481. Epub 2018 Mar 16.

Infection Control Programme and WHO Collaborating Centre on Patient Safety, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. Electronic address:

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http://dx.doi.org/10.1016/j.ajic.2018.02.006DOI Listing
May 2018

Maternal educational level and the risk of persistent post-partum glucose metabolism disorders in women with gestational diabetes mellitus.

Acta Diabetol 2018 Mar 29;55(3):243-251. Epub 2017 Dec 29.

Unit of Population Epidemiology, Department of Community Medicine, Primary Care, and Emergency Medicine, Geneva University Hospitals, Rue Gabrielle Perret-Gentil, 1205, Geneva, Switzerland.

Aims: Gestational diabetes mellitus (GDM) occurs in 5-15% of pregnancies, and lower maternal educational attainment has been associated with higher risk of GDM. We aimed to determine if maternal education level is associated with persistent post-partum glucose metabolism disorders in women with GDM.

Methods: Retrospective cohort study of women with GDM followed in 25 Portuguese health institutions between 2008 and 2012. Educational attainment was categorised into four levels. Prevalence of post-partum glucose metabolism disorders (type 2 diabetes mellitus, increased fasting plasma glucose or impaired glucose tolerance) was compared and adjusted odds ratios calculated controlling for confounders using logistic regression.

Results: We included 4490 women diagnosed with GDM. Educational level ranged as follows: 6.8% (n = 307) were at level 1 (≤ 6th grade), 34.6% (n = 1554) at level 2 (6-9th grade), 30.4% (n = 1364) at level 3 (10-12th grade) and 28.2% (n = 1265) at level 4 (≥ university degree). At 6 weeks post-partum re-evaluation, 10.9% (n = 491) had persistent glucose metabolism disorders. Educational levels 1 and 2 had a higher probability of persistent post-partum glucose metabolism disorders when compared to level 4 (OR = 2.37 [1.69;3.32], p < 0.001 and OR = 1.39 [1.09;1.76], p = 0.008, for level 1 and 2, respectively), an association that persisted in multivariable logistic regression adjusting for confounders (level 1 OR = 2.25 [1.53;3.33], p < 0.001; level 2 OR = 1.43 [1.09;1.89], p = 0.01).

Conclusions: Persistent post-partum glucose metabolism disorders are frequent in women with GDM and associated with lower maternal educational level. Interventions aimed at this risk group may contribute towards a decrease in prevalence of post-partum glucose metabolism disorders.
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http://dx.doi.org/10.1007/s00592-017-1090-yDOI Listing
March 2018

Enterococci in orthopaedic infections: Who is at risk getting infected?

J Infect 2017 10 1;75(4):309-314. Epub 2017 Jul 1.

Infection Control Program, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Switzerland; Service of Infectious Diseases, University of Geneva Hospitals and Faculty of Medicine, University of Geneva, Switzerland.

Some orthopaedic patients might be at risk for enterococcal infections and might benefit from adapted perioperative prophylaxis.

Methods: We performed a single-center cohort of adult patients with orthopaedic infections.

Results: Among 2740 infection episodes, 665 surgeries (24%) involved osteosynthesis material, including total joint arthroplasties. The recommended perioperative prophylaxis was cefuroxime (or vancomycin in case of documented MRSA body carriage). Patients had received antibiotic therapy before surgery in 1167 episodes (43%); among them with potential anti-enterococcal activity (penicillins, glycopeptides, imipenem, linezolid, daptomycin, aminoglycosids, tetracyclins) in 725 (62%) cases. Overall, enterococci were identified in intraoperative samples of 100 different infections (3.6%) (Enterococcus faecalis, 95; Enterococcus faecium, 2; and other enterococci, 3). However, only 15/100 (15%) enterococcal infections were monomicrobial and 19 were nosocomial (19/2740; 0.7%), of which 15 had previous cephalosporin perioperative prophylaxis without other antibiotic exposure. This association to prior cephalosporin use was significant (Pearson-χ-test; 148/2640 vs. 15/100, p < 0.01). By multivariate analysis, the presence of diabetic foot infection (odds ratio 1.9, 95% confidence interval 1.2-2.9), and polymicrobial infection (OR 6.0, 95%CI 3.9-9.4) were the main predictors of enterococcal infection, while sex, age, and type of material were not.

Conclusions: Community-acquired or nosocomial enterococcal infections in orthopaedic surgery are mostly polymicrobial, rare and very seldom attributed to a nosocomial origin. Thus, even if they are formally associated with prior cephalosporin use, we do not see a rational for changing our antibiotic prophylaxis.
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http://dx.doi.org/10.1016/j.jinf.2017.06.008DOI Listing
October 2017

Why language matters: a tour through hand hygiene literature.

Antimicrob Resist Infect Control 2017 14;6:65. Epub 2017 Jun 14.

Infection Control Programme and WHO Collaborating Centre on Patient Safety - Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland.

Background: Hand hygiene has evolved over the last decades and many terminologies emerged. We aimed to analyse the evolution in the frequency of utilization of key hand hygiene terms in the literature along the years.

Methods: We identified keywords and Medical Subject Headings (MeSH) used in MEDLINE® indexation related to hand hygiene by searching international guidelines and the MeSH database. We performed a MEDLINE® search combining the selected keywords and MeSH and analysed the number of publications retrieved yearly.

Results: The literature search yielded 9019 publications when all hand hygiene related search terms were combined, between 1921 and November 2016. The total number of publications per year increased from a median of 4 (IQR 3, 6) in the 1950's to 554 (IQR 478, 583) between 2011 and 2015. The most frequently used keywords are hand disinfection, hand hygiene, hand washing, handrub, hand sanitizer and alcohol-based hand rub (ABHR). Until the 1990s, hand disinfection and hand washing were the most frequently used terms. Whilst the last decade has seen a remarkable increase in publications mentioning hand disinfection and hand hygiene and for the first time handrub, hand sanitizers and ABHR were introduced in the literature. Hand disinfection, hand hygiene and hand sanitizers are the main MeSH used by MEDLINE®. Since 2013 hand hygiene is the most frequently used MeSH and keyword.

Conclusions: The change seen in literature in the last two decades, from hand washing and hand disinfection to hand hygiene, most probably reflect the paradigm shift favouring use of ABHR over soap and water promoted by international guidelines in the early 2000s.
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http://dx.doi.org/10.1186/s13756-017-0218-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5471698PMC
June 2017

Clean Your Hands 5th May 2017: 'Fight antibiotic resistance - it's in your hands'.

Antimicrob Resist Infect Control 2017 5;6:39. Epub 2017 May 5.

Infection Control Programme and WHO Collaborating Centre on Patient Safety - Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, 4 Rue Gabrielle-Perret-Gentil, 1211 Geneva, Switzerland.

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http://dx.doi.org/10.1186/s13756-017-0196-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5418729PMC
May 2017

Hand hygiene electronic monitoring: Are we there yet?

Am J Infect Control 2017 05;45(5):464-465

Infection Control Programme and World Health Organization Collaborating Centre on Patient Safety-Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. Electronic address:

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http://dx.doi.org/10.1016/j.ajic.2016.12.019DOI Listing
May 2017

Fighting antibiotic resistance is in your hands: May 5, 2017.

Lancet Infect Dis 2017 05;17(5):475

Infection Control Programme and WHO Collaborating Centre on Patient Safety-Infection Control and Improving Practices, University of Geneva Hospitals and Faculty of Medicine, 1205 Geneva, Switzerland. Electronic address:

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http://dx.doi.org/10.1016/S1473-3099(17)30182-2DOI Listing
May 2017

Clean your hands on May 5, 2017: Fight antibiotic resistance-it's in your hands.

Am J Infect Control 2017 Apr;45(4):342

Infection Control Programme and WHO Collaborating Centre on Patient Safety, Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. Electronic address:

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http://dx.doi.org/10.1016/j.ajic.2017.02.003DOI Listing
April 2017

Hand Hygiene With Alcohol-Based Hand Rub: How Long Is Long Enough?

Infect Control Hosp Epidemiol 2017 05 7;38(5):547-552. Epub 2017 Mar 7.

1Infection Control Program and WHO Collaborating Center on Patient Safety,University of Geneva HospitalsandFaculty of Medicine,Geneva,Switzerland.

BACKGROUND Hand hygiene is the core element of infection prevention and control. The optimal hand-hygiene gesture, however, remains poorly defined. OBJECTIVE We aimed to evaluate the influence of hand-rubbing duration on the reduction of bacterial counts on the hands of healthcare personnel (HCP). METHODS We performed an experimental study based on the European Norm 1500. Hand rubbing was performed for 10, 15, 20, 30, 45, or 60 seconds, according to the WHO technique using 3 mL alcohol-based hand rub. Hand contamination with E. coli ATCC 10536 was followed by hand rubbing and sampling. A generalized linear mixed model with a random effect on the subject adjusted for hand size and gender was used to analyze the reduction in bacterial counts after each hand-rubbing action. In addition, hand-rubbing durations of 15 and 30 seconds were compared to assert non-inferiority (0.6 log10). RESULTS In total, 32 HCP performed 123 trials. All durations of hand rubbing led to significant reductions in bacterial counts (P<.001). Reductions achieved after 10, 15, or 20 seconds of hand rubbing were not significantly different from those obtained after 30 seconds. The mean bacterial reduction after 15 seconds of hand rubbing was 0.11 log10 lower (95% CI, -0.46 to 0.24) than after 30 seconds, demonstrating non-inferiority. CONCLUSIONS Hand rubbing for 15 seconds was not inferior to 30 seconds in reducing bacterial counts on hands under the described experimental conditions. There was no gain in reducing bacterial counts from hand rubbing longer than 30 seconds. Further studies are needed to assess the clinical significance of our findings. Infect Control Hosp Epidemiol 2017;38:547-552.
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http://dx.doi.org/10.1017/ice.2017.25DOI Listing
May 2017

Assessing the Likelihood of Hand-to-Hand Cross-Transmission of Bacteria: An Experimental Study.

Infect Control Hosp Epidemiol 2017 05 22;38(5):553-558. Epub 2017 Feb 22.

1Infection Control Programme and WHO Collaborating Centre on Patient Safety - Infection Control & Improving Practices,University of Geneva Hospitals and Faculty of Medicine,Geneva,Switzerland.

BACKGROUND Although the hands of healthcare workers (HCWs) are implicated in most episodes of healthcare-associated infections, the correlation between hand contamination and the likelihood of cross-transmission remains unknown. METHODS We conducted a laboratory-based study involving pairs of HCWs. The hands of a HCW (transmitter) were contaminated with Escherichia coli ATCC 10536 before holding hands with another HCW (host) for 1 minute. Meanwhile, the unheld hand of the transmitter was sampled. Afterward, the host's held hand was also sampled. Each experiment consisted of 4 trials with increasing concentrations of E. coli (103-106 colony-forming units [cfu]/mL). The primary outcome was the likelihood of transmission of at least 1 cfu from transmitter to host. We used a mixed logistic regression model with a random effect on the subject to assess the association between transmission and bacterial count on the transmitter's hands. RESULTS In total, 6 HCWs performed 30 experiments and 120 trials. The bacterial counts recovered from host hands were directly associated with the bacterial counts on transmitter hands (P1 and ≤3 log10 cfu compared to ≤1 log10. When transmitter contamination was <1 log10 cfu, no cross-transmission was detected. CONCLUSION There is a direct relationship between the bacterial burden on HCWs hands and the likelihood of cross-transmission. Under the described conditions, at least 1 log10 cfu must be present on HCW hands to be potentially transmitted. Further studies are needed at the low contamination range. Infect Control Hosp Epidemiol 2017;38:553-558.
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http://dx.doi.org/10.1017/ice.2017.9DOI Listing
May 2017

Revisiting the WHO "How to Handrub" Hand Hygiene Technique: Fingertips First?

Infect Control Hosp Epidemiol 2017 02 7;38(2):230-233. Epub 2016 Nov 7.

1Infection Control Programme and WHO Collaborating Centre on Patient Safety-Infection Control & Improving Practices,University of Geneva Hospitals andFaculty of Medicine,Geneva,Switzerland.

Hands are implicated in the cross transmission of microbial pathogens and fingertips are the crux of the problem. A modified World Health Organization "How to Handrub" 6-step technique with "Fingertips First" showed greater efficacy than the standard technique in reducing fingertip contamination, potentially improving hand hygiene action quality. Infect Control Hosp Epidemiol 2017;38:230-233.
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http://dx.doi.org/10.1017/ice.2016.241DOI Listing
February 2017

Low frequency of asymptomatic carriage of toxigenic Clostridium difficile in an acute care geriatric hospital: prospective cohort study in Switzerland.

Antimicrob Resist Infect Control 2016 8;5:24. Epub 2016 Jun 8.

Infection Control Program, Geneva University Hospitals, 4, rue Gabrielle Perret-Gentil, 1211 Geneva, Switzerland ; Department of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland ; Faculty of Medicine, University of Geneva, Geneva, Switzerland.

Background: The role of asymptomatic carriers of toxigenic Clostridium difficile (TCD) in nosocomial cross-transmission remains debatable. Moreover, its relevance in the elderly has been sparsely studied.

Objectives: To assess asymptomatic TCD carriage in an acute care geriatric population.

Methods: We performed a prospective cohort study at the 296-bed geriatric hospital of the Geneva University Hospitals. We consecutively recruited all patients admitted to two 15-bed acute-care wards. Patients with C. difficile infection (CDI) or diarrhoea at admission were excluded. First bowel movement after admission and every two weeks thereafter were sampled. C. difficile toxin B gene was identified using real-time polymerase chain-reaction (BD MAX(TM)Cdiff). Asymptomatic TCD carriage was defined by the presence of the C. difficile toxin B gene without diarrhoea.

Results: A total of 102 patients were admitted between March and June 2015. Two patients were excluded. Among the 100 patients included in the study, 63 were hospitalized and 1 had CDI in the previous year, and 36 were exposed to systemic antibiotics within 90 days prior to admission. Overall, 199 stool samples were collected (median 2 per patient, IQR 1-3). Asymptomatic TCD carriage was identified in two patients (2 %).

Conclusions: We found a low prevalence of asymptomatic TCD carriage in a geriatric population frequently exposed to antibiotics and healthcare. Our findings suggest that asymptomatic TCD carriage might contribute only marginally to nosocomial TCD cross-transmission in our and similar healthcare settings.
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http://dx.doi.org/10.1186/s13756-016-0123-6DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898375PMC
June 2016

Ethanol-based handrubs: Safe for patients and health care workers.

Am J Infect Control 2016 08 15;44(8):858-9. Epub 2016 Apr 15.

Infection Control Programme and World Health Organization (WHO) Collaborating Centre on Patient Safety, Infection Control & Improving Practices, University of Geneva Hospitals and Faculty of Medicine, Geneva, Switzerland. Electronic address:

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http://dx.doi.org/10.1016/j.ajic.2016.02.016DOI Listing
August 2016

[Bed-sharing in the first semester of life: prevalence and associated factors].

Cad Saude Publica 2010 May;26(5):942-8

Faculdade de Medicina, Universidade Federal do Rio Grande do Sul, Rua Liberdade 433, Porto Alegre, Brazil.

The aim of this study was to verify the prevalence of bed-sharing and factors associated with this sleeping environment in an urban population in Southern Brazil. This was a cross-sectional nested cohort study with 233 mother-infant pairs selected at the maternity ward of the University Hospital in Porto Alegre. When the infant was 3 and 6 months old, home visits were performed to collect data on bed-sharing and associated variables. The main outcome was the place shared by the mother and infant for sleeping. Variables with p < 0.2 were included in a Poisson regression model. At 3 and 6 months, 31.2% and 28.5% of infants slept with their mothers at night. At 3 months, prevalence was higher for single mothers (PR: 1.56; CI: 1.01-2.39) and mothers sharing the home with the infant's maternal grandmother (PR: 1.70; CI: 1.09-2.65). Prevalence of bed-sharing at 3 months was high and associated with single mothers and sharing the home with the infant's maternal grandmother.
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http://dx.doi.org/10.1590/s0102-311x2010000500016DOI Listing
May 2010
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