Association between excreta management and incidence of extended-spectrum β-lactamase-producing Enterobacteriaceae: role of healthcare workers' knowledge and practices

Summary Background The spread of extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-PE) in healthcare environments has become a major public health threat in recent years. Aim To assess how healthcare workers (HCWs) manage excreta and the possible association with ESBL-PE incidence . Methods 800 HCWs and 74 nurse-supervisors were questioned through 2 self-report questionnaires in order to assess their knowledge and practices, and to determine the equipment utilized for excreta management in 74 healthcare departments. The performance on equipment utilized, knowledge and practices were scored as good (score 1), intermediate (score 2) or bad (score 3) on the basis of pre-established thresholds. Linear regression was performed for evaluating the association between HCWs knowledge/practices and ESBL-PE incidence. Findings 688 HCWs (86%) and all nurse-supervisors participated to the survey. Proportions of scores 1, 2 and 3 were: 14.8%, 71.6% and 17.6% for equipment; 30.1%, 40.6 % and 29.3% for knowledge; and 2.0%, 71.9 % and 26.1% for practices. The single regression mathematic model highlighted that bad practices (score 3) from HCWs were significantly associated with increased ESBL-PE incidence ( p=0.002 ). Conclusions HCWs’ practices for managing excreta positively correlated with ESBL-PE incidence, especially in surgical units. Public health efforts to enhance knowledge and practices of HCWs urgently need to be developed and integrated, within infection control programs, to better control the spread of multidrug-resistant bacteria.