Becker's Clinical Quality & Infection Control

7 INFECTION CONTROL COVID-19 reshaped physician ethics, study suggests By Mackenzie Bean C OVID-19 has upended a long-standing belief that physicians must care for infectious disease patients, irrespective of their own personal risk, suggests research published April 24 in Clinical Infectious Diseases. A team led by researchers at Durham, N.C.-based Duke Health analyzed 187 studies that explored the ethical dilemma physicians face during novel infectious diseases outbreaks, including HIV/AIDS, severe acute respiratory syndrome, COVID-19, Ebola and flu. About 75% of research suggested physicians have an obligation to treat infectious patients, regardless of personal risks. is mindset was widely seen across papers published from the 1980s up until the COVID-19 pandemic. "All the papers throughout history have shown that physicians broadly believed they should treat infectious disease patients," lead author Braylee Grisel, a fourth-year student at Duke University School of Medicine, said in a news release. "We figured our study would show the same thing, so we were really surprised when we found that COVID-19 was so different than all these other outbreaks." Sixty percent of COVID-19 papers suggested it was ethically acceptable for physicians to refuse care — the highest percentage seen for any infectious disease. AIDS had the lowest amount at 13.3%. Study authors noted physicians faced unique challenges during the pandemic — including resource shortages, misinformation about vaccines and treatments, and increased mistreatment of medical staff — that may have changed the patient-physician relationship. "is study really shows how outside pressures in the sociopolitical sphere influence and affect doctors and care providers," Ms. Grisel said. "In future pandemics, we may need to become more aware of how the risks and outside pressures of an active pandemic influence willingness to provide care. Health care systems can learn how to mitigate these influences to ensure that hospitals are adequately staffed to meet patient needs." n 2 steps 'get the drop' on surgical site infection: Study By Paige Twenter P hysicians can reduce the risk of surgical site infections by using a nasal antiseptic before procedures, according to research published March 28 in the American Journal of Infection Control. Researchers at the Soroka University Medical Center in Israel evaluated medical data from 688 patients who underwent joint arthroplasty or spine surgery between February 2018 and October 2021. Among the patients who received intranasal povidone-iodine and a skin antisepsis using chlorhexidine gluconate before surgery, the eradication rate of Staphylococcus aureus pathogen was 39.6% after 90 days. The study's title is "Getting the drop on Staphylococcus aureus: Semiquantitative Staphylococcus aureus nasal colony reduction in orthopedic surgery reduces surgical site infection." Surgical site infections can increase a risk of death by 11 times, and hospital stays are extended by an average of 10 days, leading to $20,000 in additional hospitalization costs per patient, according to the Association for Professionals in Infection Control and Epidemiology. n Is CDC's C. diff framework effective? Jury is still out, study finds By Mackenzie Bean T he CDC's framework to prevent healthcare-associated Clostridioides difficile infections may have potential benefits for hospitals, but further research is needed to fully understand its effectiveness, according to a study published March 27 in JAMA Network Open. A team led by researchers at Durham, N.C.-based Duke University Medical Center analyzed C. difficile rates among 46 hospitals in the Duke Infection Control Outreach Network between July 1, 2019, and March 31, 2022. Twenty hospitals implemented the CDC's framework recommendations while the remaining 26 served as controls. Researchers found the CDC recommendations were not associated with a reduced incidence of C. difficile infections over time. Hospitals implementing the framework saw a steeper decline in incidence compared to the control group, but researchers found infections were already falling before the study started. Framework implementation rates also fell significantly at the start of the pandemic, making it harder for researchers to fully assess its potential benefit. "Besides highlighting the need for robust infection prevention infrastructure (capable of dealing with routine duties and the occasional pandemic), the dose-dependent association of framework measures with the decline in [hospital-onset C. difficile] cases suggests that HO-CDI prevention hinges heavily on how effectively framework measures are implemented," researchers said. n

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