Background Antimicrobial resistance is exponentially worsening, and the spread of prevalent carbapenem resistant Enterobacteriaceae (CRE) is a major contributor to this global concern. Infection prevention and control strategies are increasingly consolidated key tools to control this worldwide problem. Aim To identify, collect and analyse available evidence regarding the impact of infection prevention and control strategies on prevalent CRE dissemination. Methods Pubmed®, Scopus® and Web of Science® were searched systematically for articles published between 1th January 2017 and 30th June 2020, guided by the research question ‘What are the most effective and efficient strategies to prevent and control infection/colonisation caused by Carbapenem resistant Escherichia coli and Carbapenem resistant Klebsiella pneumoniae?’. Findings Eleven thousand six hundred and thirty-five publications were found, but after applying the inclusion and exclusion criteria, only 30 were selected. The majority of reviewed studies ( n = 24) were performed in outbreak situations, 26 studies occurred in acute care units and of those, 17 in intensive care units . From the set of implemented infection prevention and control measures, in 29 studies surveillance cultures were applied, in 23 studies patients were isolated or cohorted and, in general, all described the implementation of standard and contact precaution measures. Conclusion This systematic review underlines the importance of infection prevention and control strategies in CRE dissemination, standing out the need of further studies outside outbreak and intensive care units contexts. Investment increments and training and educating of all involved are also important contributors to shift this problem, but still with relevant gaps in their implementation, in all types of care units, that need to be addressed.
Background In healthcare-associated infections, the major transmission route is assumed to be the direct or indirect contact between patients, staff, and the environment. However, little is known about the air role as a pool for pathogens and multidrug resistance (MDR) in healthcare settings. The aim of this study was to quantitatively and qualitatively compare microbial air quality in a Portuguese long-term healthcare unit (LTHU) and a central hospital (CH). Methods During 2021 and 2022, air samples were collected fortnightly in both settings and their microbial load (bacteria and fungi) was determined (colony forming units – CFU/m3). Sampled sites were classified according to area, room capacity and occupation, activity and related infection potential risk. Bacterial isolates were randomly selected for identification by Matrix-assisted laser desorption ionization-time of flight (MALDI-TOF) mass spectrometry, antimicrobial susceptibility testing and polymerase chain reaction (PCR) screening of extended-spectrum beta-lactamases and metallo-beta-lactamases genes. Results A total of 192 air samples were collected, 86 from LTHU and 106 from CH. Statistically significant differences in mean bacterial load in LTHU (367 CFU/m3) and CH (230 CFU/m3) was observed, but not in mean fungal load (LTHU: 87 CFU/m3; CH: 117 CFU/m3). CH bacteria and fungi loads were statistically significantly higher in sites with outpatients or no patients compared to those with inpatients as well as in support services compared to curative care areas. No statistically significant differences were found regarding these variables in LTHU.
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