Aseptic Procedures Research Articles

Abstract 4135466: Feasibility of Using Existing Infection Surveillance Methods for Percutaneous Coronary Intervention-related Infections

Background: Percutaneous coronary intervention (PCI) is a treatment that requires attention in terms of infection control, as it necessitates aseptic procedures similar to surgical operations. However, surveillance practices for PCI-related infections are uncommon, and no standardized surveillance program has been established. Purpose: To assess the feasibility of using existing surveillance methods to detect PCI-related infectious diseases. Method: To identify PCI-related bloodstream infections of local access sites, four existing case definitions, namely, laboratory-confirmed bloodstream infections (LCBI), clinical sepsis (CSEP), local access site infection (LASI), and exit site infection (ESI), were retrospectively applied to 1,037 patients who underwent PCI between April 2018 and March 2021. Of these, 167 experienced fever, underwent blood culture testing, and/or received antibiotics within 6 days of PCI. To confirm consistent evaluation, two independent infection control experts evaluated each case record according to the four case definitions. Results: Twenty-three patients (2.2%) were diagnosed with PCI-related infections, including two patients according to LCBI, 21 according to CSEP, and none according to LASI and ESI. Thirteen patients (LCBI: 1, CSEP: 12) received circulatory assist devices such as intra-aortic balloon pumping. Of the remaining 11 patients, 10 underwent emergency PCI, and one underwent elective PCI ( P =0.0001). The average length of hospital stay was 16.1 days for patients with PCI-related infections and 4.7 days for non-infected patients ( P <0.05). Conclusion: The positive diagnosis of PCI-related infections was predominantly based on CSEP. Many of these positive patients underwent emergency PCI and/or received circulatory assist devices. The results of the present study warrant further investigations with larger patient cohorts.

A Comparative Study of the Incidence and Severity of Surgical Site Infection Following Emergency and Elective Abdominal Surgeries in a Tertiary Care Hospital

Background: Surgical site infection is a medical condition that develops up to 30 days after the surgery if no implants have been placed, and as long as 12 months if the patient has an implant device. SSIs pose a substantial barrier to healing and resumption of normal activities. SSIs and its side-effects have been noted as one of their primary contributors to the morbidity following surgery. This study will look at the incidence and severity of infections at the surgical site after both emergency and elective abdominal surgery. Methods: This is prospective observational research in patients who underwent Surgeries in either elective or emergency settings. Southampton wound assessment scale and the ASEPSIS wound scoring system were used in grouping the patients with SSI followed by each patient's SSI type was further recorded. The study also documented other factors, such as hospital stay and interventions. Results: There were one fifty participants in this study. 23 patients experienced SSI (6 elective cases and 17 emergency cases), while 127 people did not. The pathogens most commonly cultured were coagulase negative staphylococcus (CoNS, 8 cases), after which came Escheria coli. (4 cases). Conclusion: A higher prevalence of SSI is linked to factors including the patient's advancing age, a dirty wound, prolonged surgery, usage of drains, nutritional deficiency, anemia, and diabetes. The hospital personnel need to be more careful about following aseptic procedures and have more awareness of infection management.

The Use of Single-Use Medical Gloves in Doctors' Practices and Hospitals.

Single-use medical gloves achieve their purpose only when properly used. Proper use also helps avoid undesired consequences such as excessive waste and CO2 emissions, as well as inadequate hand hygiene. In this selective review of the primary scientific literature, we summarize the current state of knowledge on the use of single-use medical gloves in the health-care sector. We also provide further information from national recommendations, guidelines, and regulatory provisions. Single-use medical gloves mainly serve to protect the health-care professional and are only rarely meant to promote patient safety. For reasons of occupational safety and self-protection, hand hygiene should be performed after single-use medical gloves are removed. A study on single-use medical gloves from open boxes revealed that 13% bore human pathogenic bacteria. It was found in a meta-analysis that wearing single-use medical gloves can lower the risk of nosocomial infection (incidence rate ratio, IRR: 0.77 [0.67; 0.89]. In a randomized controlled trial, adherence for putting on single-use medical gloves without prior hand disinfection was 87%. On the other hand, where hand disinfection was expected to be performed before putting on gloves, adherence was 41%. Proper use can lower the rate of occupational skin diseases and improve adherence to hand hygiene for the five moments in which it is recommended (before and after patient contact, before aseptic procedures, after contact with potentially infectious material, and after contact with the immediate patient environment). Limiting the use of single-use medical gloves to its proper indications promotes the safety of health-care professionals and patients and has beneficial ecological and economic effects as well.

Prevalence of unexpected intraoperative cultures (UPIC) in revision total knee arthroplasty (TKA) and risk of periprosthetic joint infection (PJI).

Prevalence of unexpected positive intraoperative cultures (UPIC) in revision total knee arthroplasty (TKA) is reported to be 8.32% with largely varying findings in individual studies (5.92-62.07%) due to a heterogeneity in preoperative diagnostic work-up and diagnostic criteria for periprosthetic joint infection (PJI). When diagnosed as unsuspected PJI, re-revision rate is reported to be as high as 18.45% compared to 2.94% in patients with UPIC classified as contamination (p = 0.0237). We performed a monocentric retrospective analysis of revision TKA surgery to determine prevalence of UPIC, risk of developing a subsequent PJI and re-revision rate after 24 months compared to those without UPIC. All presumed aseptic total knee revision procedures from 2008 until 2017 were retrospectively reviewed. Single stage femorotibial revisions of TKA with at least 3 intraoperative cultures and a minimum follow-up of 24 months were included, whereas partial revisions or revisions from unicompartimental knee prosthesis to TKA were excluded. Demographic data were collected as well as initial reason for revision, preoperative aspiration results, micro-organism identified and postoperative antibiotics' administration. Primary outcome was survival rate after 24 months with differentiation based on UPIC interpretation: sterile, contamination, unsuspected PJI. Of 256 included cases, 75 (29.3%) were found to have at least 1 UPIC during revision surgery, 72% of whom a single UPIC was found. Thirty-four cases (13.28%) were interpreted as unsuspected PJI and therefore treated with antibiotics. In total, 13 of the 256 patients (5.08%) had to be re-revised during follow-up with 7 PJI (2.73%), none of them developing reinfection defined as PJI with the same microorganism. A statistically significant trend towards earlier failure in the unsuspected PJI group compared to the contaminant group was not observed. However, a higher incidence of re-revisions attributed to septic reasons was noted in the former group. Presence of UPIC in presumed aseptic revision TKA does not correlate with a lower survival rate, but a higher incidence of subsequent PJI was observed in cases interpreted as unsuspected PJI.

Drapes in Routine Aseptic Procedures for Environmental Sustainability (project DRAPES): a protocol for a multi-centre randomised controlled trial comparing post-operative wound complication rates following routine neutering of dogs and cats using reusable or disposable surgical drapes

BackgroundReusable surgical drapes have a lower lifetime environmental impact than disposable drapes in most cases. There is limited evidence regarding whether drape choice impacts patient outcomes including post-operative wound complications. The aim of this study is to compare wound complication rates following routine neutering surgeries in cats and dogs when reusable drapes are used as compared with disposable drapes.MethodsThe trial will be conducted as a pragmatic, multi-centre, parallel group randomised controlled trial in the UK. Dogs and cats undergoing routine neutering will be randomised to disposable or reusable drapes with all other aspects of care occurring as they usually would at the practice. The required sample size is 2,850, with 4750 animals to be recruited from up to ten practices to allow for a 40% loss to follow-up. Demographic data and details on peri-operative care will be collected at the time of surgery. Post-operative wound complications will be assessed and recorded as usual at each practice using clinical codes. The post-operative wound clinical codes and any antibiotic use within 30 days of surgery will be retrieved from the practice management software. The primary outcome that will be compared between the two groups is the rate of post-operative wound complications within 30 days of surgery which will be analysed by multivariable logistic regression with a binary outcome of wound complication (yes/no). Secondary outcomes are the prevalence of different types of complications and antibiotic use within 30 days of surgery which will be compared between the two groups by chi square analysis.DiscussionOur hypothesis is that there will be no difference in post-operative wound complication rates between disposable and reusable drapes. If the likely rate of post-surgical wound complications with reusable drapes is similar to that with disposable drapes, then veterinary clinical teams can choose the more sustainable option, confident that their patients will not be impacted by this choice.Trial registrationWe have retrospectively registered the protocol on the Open Science Framework on 14 Nov 2023 (Trial registration entry: https://doi.org/10.17605/OSF.IO/72HMA).

Adapting the WHO hand hygiene ‘reminders in the workplace’ to improve acceptability for healthcare workers in maternity settings worldwide: a mixed methods study

IntroductionHand hygiene is key in preventing healthcare-associated infections, but it is challenging in maternity settings due to high patient turnover, frequent emergencies and volume of aseptic procedures. We sought to...

The Risk of Contamination according to Hairstyle during Aseptic Procedures in Nursing Students: An Observational Study

Purpose: This study investigated the relationship between the risk of contamination during aseptic procedures performed by nursing students and the hairstyle type of the student performing the procedure.Methods: This study employed an observational design. The participants were 139 nursing students recruited from two colleges. Participants with short hair were assigned to the short-hair group (Group 1) without randomization. The remaining participants were randomly assigned to one of three groups: those who put their hair in a hairnet (Group 2), those who had their hair tied back (Group 3), and those who had their hair untied (Group 4). Raters used a checklist to assess participants’ performance of aseptic procedures and contamination-related behaviors.Results: Compared to the group wearing a hairnet (Group 2), more contamination occurred in the group with long hair tied back (Group 3) or not tied up (Group 4) (p<.001). Hair-related contamination risk behaviors were significantly more common in students with untied long hair (Group 4) than in the other three groups (Group 1, 2, and 3) (p<.001).Conclusion: These results suggest that when performing aseptic procedures, measures are needed to prevent hair-related contamination by restraining the hair or using a hair cap.

Perilaku Hand Hygiene dalam Pencegahan Covid-19 pada Perawat

Health workers are on the front line, especially as nurses who are always next to patients 1 x 24 hours. We must take precautions by means of hand hygiene before and after carrying out nursing care, where the COVID-19 outbreak is spreading very quickly resulting in an increase in the number of patients in the whole world. To reduce and prevent the transmission of this virus, we as nurses in providing nursing care must carry out hand hygiene and comply with WHO's 5 moments of hand hygiene, namely before touching a patient, before a clean or aseptic procedure, after exposure to or risk of body fluids. This study aims to determine the analysis of hand hygiene behavior in preventing COVID-19 among nurses at the Labuang Baji Regional General Hospital, Makassar City. The research design used is a quantitative research design with a crosssectional approach. The sample determination was carried out using a random sampling research method with a sample size of 83 respondents. The relationship test was carried out using the chi-square statistical test with a significance level (ρ) ≤ 0.05. The research results showed that the level of knowledge of nurses in the good category was 27 people (32.5%); the attitude of nurses in the positive category was 59 people (71.1%); there is no relationship between knowledge and hand hygiene behavior (p=0.786); and there is no relationship between attitude and hand hygiene behavior (p=0.372). The conclusion of this research is that there is no influence of nurses' knowledge and attitudes about hand hygiene on COVID-19 prevention measures at the Labuang Baji Regional General Hospital, Makassar City. It is recommended for future researchers to improve the implementation of hand hygiene among nurses in the motivation and work of PPI.

Prevention of Healthcare Associated Infections as an Effort to Increase Knowledge on How to Wash Hands for Patients of Grandmed Lubuk Pakam Hospital

Wash your hands regularly with soap and water or use an alcohol-based hand sanitizer. Hand hygiene must be carried out before and after contact with patients, before carrying out aseptic procedures, after exposure to body fluids, and after touching objects around the patient, which is a crucial step in maintaining the safety of patients, health workers, visitors and the community around health care facilities. This activity took place at Grandmed Lubuk Pakam Hospital. This activity was aimed at 96 patients in the hospital, with the aim of increasing knowledge regarding preventing HAIs by washing hands properly. One very effective method for preventing the spread of infection is washing hands with soap and using hand sanitizer. Lack of knowledge about efforts to prevent exposure to infectious diseases can influence the frequency of disease occurrence. This activity is carried out through counseling which involves the use of learning videos and direct practice using hand sanitizer. In service activities by providing education related to material on the meaning of hand washing, the importance of washing hands in hospitals, the right time and mandatory hand washing for hospital patients, correct hand washing techniques, use of hand sanitizer, visuals and demonstrations, and education for families and visitors. In this activity, patients are asked to practice correct hand washing procedures. The results of the activity were obtained from 96 people, 85 people (89%) understood how to wash their hands properly as an effort to prevent and prevent the risk of infection while in hospital or after leaving the hospital. It is hoped that hospital management will work together with the Infectious Disease Prevention Committee (PPI) officers periodically to prevent and overcome the occurrence of nosocomial infections (HAIs) in the hospital.

Overview of A Nurse In Implementing 5 Moments of Hand Washing in the Prevention of Nosocomial Infection

Behaviors to prevent the spread of disease from person to person or from equipment to person can be carried out by placing a barrier between the microorganism and the individual (patient or health worker). The barrier can be physical effort in the form of washing hands. There are "5 moments" when health workers must perform hand hygiene. The aim of this research is to describe the implementation of the 5 moments of hand washing by nurses in the Bougenville ward of RSUD Dr. H. Soewondo Kendal. The type of research used is quantitative descriptive research. The sample in this study were nurses in the Bougenville room on the first and second floors of RSUD Dr. H. Soewondo Kendal as many as 31 respondents with a sampling technique using total sampling technique. The instruments used were questionnaires and observations. The questionnaire uses the standardized SPO KARS 2017. The research analysis used is univariate analysis. The results of research on the implementation of 5 hand washing moments, the majority of respondents always wash their hands before contact with patients, 23 (74.2%), nurses always wash their hands before carrying out aseptic procedures, 29 (93.5%), nurses always wash their hands after being exposed to body fluids. 29 patients (93.5%), 29 (93.5%) nurses always wash their hands after contact with patients, 29 (93.5%) nurses always wash their hands after contact with the patient's environment.

Compliance with the five moments for hand hygiene of healthcare workers in a pediatric hospital. A prospective observational study

Introduction: Healthcare-associated infections (HAIs), also known as nosocomial infections or hospital-acquired infections, begin within 48 hours of hospitalization, within 30 days after hospital discharge, or 90 days after undergoing surgical procedures. Objective: The study aimed to describe the compliance with the five moments for hand hygiene (HH) of the healthcare workers (HCWs) in a hospital. Methods: A prospective observational study was conducted from June 1 to 30,2020 in a pediatric hospital. HCWs compliance with the five moments of HH was registered by direct observation blindly to the participants, using the fact sheet for HH of the WHO. In the rows, the five moments of contact with the patients were recorded: before touching a patient, before clean aseptic procedure, after body fluid exposure risk, after touching a patient and after touching patient surroundings. The actions performed, also was registered: hand washing, alcohol hand friction, omission, or use of gloves. Data were analyzed in SPSS V 21. The protocol was approved by the institutional review board. Results: During the study period, 2.595 observations to 104 HCWs were made. They were pediatric residents 38.5 %, nurses 32.7 % and pediatricians 28.8 %. A global compliance with the five moments of HH of the participants were 64.5% (1673/2595). Before touching a patient, the adherence was 86,9%. The nurses adhered in 69%, pediatrician in 68.6 % and the pediatric residents in 57.2%. Discussion: The global percentage of compliance with the five moments of HH of the medical and nursing staff of the pediatric hospital was 64.5%. Nurses had the highest percentage of adherence. Handwashing compliance was higher before contact with the patients.

To assess and compare supra-clavicular and infra-clavicular approaches to obtain blood samples from the subclavian vein in cadavers at autopsy

Objectives The study of microbes in the body of a person after death can be perhaps termed appropriately as Post-mortem Human Microbiology. Microbes can indicate the state of bacteremia at the time of death if the blood samples collected at autopsy are taken in an aseptic way from an appropriate sampling site. The aim of the study was to compare the sampling efficacy of the supraclavicular and infraclavicular approaches for both the left and right subclavian veins and determine the most effective approach among the four options. Material and Methods In this study, post-mortem blood samples were collected from both subclavian veins of 30 dead bodies to evaluate the effectiveness of approaches to subclavian veins. To achieve this, blood was collected from one side of the dead body through the supraclavicular approach and the other side through the infraclavicular approach, noting down the number of attempts which were required to successfully obtain at least 10 mL blood sample which is adequate for post-mortem microbiological examination. Results The study revealed that the supraclavicular approach is superior to the infraclavicular method. The left supraclavicular approach yielded maximum successful sample collection (100%) and also showed maximum successful single attempt sample collection (53%) compared to the other three approaches. Conclusion Following recommended aseptic procedures, using the procedure mentioned and obtaining blood samples from the left supraclavicular approach can improve the chances of getting a non-contaminated, adequate sample for Post-mortem Microbiology (PMM).

Evaluation of Interleukin-1β, Interleukin-6 and Interleukin-10 Profiles in Serum and Surgically Created Wound Exudates of Alloxan-Induced Diabetic Rabbits

The knowledge of immune-modulatory actions of interleukins could be of immense value in the management of diabetic wounds. This study evaluated the interleukin profiles of diabetic wounded rabbits. Sixteen New Zealand White rabbits of mean weight 2.5 ± 0.7 kg used for this study were divided into four groups; A, B, C and D, of four rabbits each; A (non-diabetic and non-wounded) as control, B (diabetic and non-wounded, C (wounded and non-diabetic) and D (wounded and diabetic). Three (3) cm2 skin wounds were created in a standard aseptic procedure while diabetes was induced by administration of alloxan monohydrate. Serum and wound exudate were harvested on days 0, 3, 7, 14, 21 and 28 for Interleukin-1β, Interleukine-6 and Interleukine-10 assays. The increases in the serum concentration of Interleukin-1β and Interleukine-6 in the C rabbit group between days 3 and 7 (Interleukin-1β) and between days 3 and 28 (Interleukine-6) were relatively higher than the corresponding day 0 and control values. The decrease in the serum concentration of IL-10 (ng /mL) in B rabbit group from days 7 (36.96 ± 8.7) to 14 (128.12 ± 12.05) were significantly lower (P˂0.05) than the corresponding values in groups A and C rabbits. The values of Interleukine-10 in wound exudate of C rabbit group from days 7 (160.57 ± 23.76 ng /mL) to 21 (177.30 ± 8.60 ng /mL) were significantly higher (P<0.05) than the corresponding group D values. The evidence shows that, the values of Interleukin-1β and Interleukine-6 are up regulated in the inflammatory phase of wound healing in normoglycaemic and diabetic rabbits while the values of Interleukine-10 is down regulated during wound healing in diabetic rabbits. Therefore, the knowledge of interleukin markers shall be of significant roles in proffering solution for management of normoglycaemic and diabetic wounds.

Implementasi Five Moment Hand Hygiene Pada Perawat Di Ruang Rawat Medikal Bedah Rumah Sakit Santa Elisabeth Medan

The prevalence of nosocomial infections worldwide has become a serious concern for healthcare professionals, especially in hospitals. One contributing factor is the inadequate implementation of the five moments hand hygiene in handwashing procedures that do not conform to operational procedure standards. The aim of this research is to determine how the implementation of the five moments hand hygiene among nurses in the surgical medical care ward at Santa Elisabeth Hospital in Medan. This study utilized a descriptive cross-sectional approach, employing observation sheets. The sample size included 30 nurses in the Surgical Medical Care Ward at Santa Elisabeth Hospital in Medan, using total sampling technique. The measurement tool was an observation sheet, and the data analysis employed univariate analysis. The research findings revealed that, in the first moment before patient contact, 56.7% of nurses did not adhere to the practice, while 43.3% did. In the second moment, before aseptic procedures, 56.7% of nurses did not comply, and 43.3% did. In the third moment, after exposure to patient body fluids, all nurses (100%) adhered to the practice. In the fourth moment, after patient contact, all nurses (100%) complied. In the fifth moment, after contact with the patient's environment, all nurses (100%) followed the practice. It is hoped that nurses can consistently implement the five moments hand hygiene to prevent disease transmission and nosocomial infections, fostering a habit of incorporating these practices into nosocomial infection prevention.

The role of medical-grade maggots in facilitating healing of diabetic foot ulcers in Kano, northern Nigeria: a case series.

Approximately 13% of people living with diabetes develop one or more ulcers during the course of the disease, and diabetic foot ulcer (DFU) is responsible for >60% of lower limb amputations worldwide. This case series aimed to demonstrate the effectiveness of medical-grade maggots on DFUs in promoting wound healing and reducing related hospital stays in northern Nigeria. Maggot debridement therapy (MDT) was applied to the DFUs of patients who consented to this treatment between January-August 2021 at the Orthopaedic Unit of the Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria. Sterile first instar larvae of Lucilia sericata were obtained indigenously and applied using the confinement (free-range) method under aseptic procedure. A total of 15 patients with DFUs of Wagner classification grades III (33.3%) and IV (66.7%), were seen and documented. The patients included 10 (66.7%) females and five (33.3%) males, giving a female:male ratio of 2:1. The mean age (±standard deviation) of the respondents was 51.6±10.8 years. The surface area of the wounds ranged from 24-140cm2, with a median value of 75cm2. Among the patients, 60% had two cycles of MDT, with a median duration of five days. Most of the wounds (53.3%) were debrided within five days; 13.3% (two wounds) took seven days to be fully debrided. A paired sample t-test showed a statistically significant association between wound surface area and therapy duration (t=8.0; p=0.000) and between wound surface area and cycles of therapy (t=8.3; p=0.000). Before maggot application, 14 (93.3%) DFUs were completely (100%) covered with slough and only one (6.7%) was 95% covered with slough. After maggot application, 10 (66.7%) wounds were completely debrided while five (33.3%) wounds required bedside surgical debridement to achieve complete debridement. A paired sample t-test showed statistically significant difference between the pre- and post-MDT slough covering the wounds (t=45.1; p=0.000). In this case series, MDT was successfully used in the debridement of DFUs, which facilitated the healing process with an encouraging clinical outcome.

Effect of a multimodal prevention strategy on dialysis-associated infection events in outpatients receiving haemodialysis: The DIPS stepped wedge, cluster-randomized trial

ObjectivesPatients with haemodialysis catheters are susceptible to dialysis-associated infections, particularly bloodstream infections. There have been few systematic attempts to reduce this burden. Our study aimed to investigate the effect of a multimodal prevention strategy on dialysis-associated infection events (DAIE) among haemodialysis outpatients. MethodsA multicentre, stepped wedge, cluster-randomized controlled trial was done from October 2019 to September 2021. Outpatient dialysis facilities entered into the intervention phase in three randomly assigned clusters, at three predefined time points. The multimodal prevention strategy consisted of infection surveillance and hand hygiene (HH) compliance observation with active feedback and teaching aseptic procedures, and a patient flyer.The primary outcome was incidence rates of different DAIE, such as bloodstream infections, intravenous antimicrobial starts, and local access-site infections per 1000 dialysis. As secondary outcome, we analysed the HH compliance change. ResultsA total of 43 haemodialysis outpatient facilities with 11 251 patients and 1 413 457 proceeded haemodialysis were included in the DIPS-trial. Incidence rates were 0.71 DAIE per 1000 dialysis (95% CI, 0.65–0.78) in the control and 0.31 (95% CI, 0.27–0.36) in the intervention group. The univariable analysis yielded an incidence rate ratio (IRR) of 0.44 (95% CI, 0.33–0.59) for DAIE. Especially in patients with a central venous catheter, we saw a significant decrease in DAIE in the intervention group (IRR 0.4; 95% CI, 0.28–0.58). The HH observation combined with feedback and intensified training, resulted in an increase of HH compliance from 58–65%. DiscussionA multimodal prevention strategy showed a significant preventive effect on DAIE among haemodialysis outpatients. This reduction also applied to bloodstream infections, especially in patients with a central venous catheter.

A predictive nomogram for surgical site infection in patients who received clean orthopedic surgery: a retrospective study

BackgroundSurgical site infection (SSI) is a common and serious complication of elective clean orthopedic surgery that can lead to severe adverse outcomes. However, the prognostic efficacy of the current staging systems remains uncertain for patients undergoing elective aseptic orthopedic procedures. This study aimed to identify high-risk factors independently associated with SSI and develop a nomogram prediction model to accurately predict the occurrence of SSI.MethodsA total of 20,960 patients underwent elective clean orthopedic surgery in our hospital between January 2020 and December 2021, of whom 39 developed SSI; we selected all 39 patients with a postoperative diagnosis of SSI and 305 patients who did not develop postoperative SSI for the final analysis. The patients were randomly divided into training and validation cohorts in a 7:3 ratio. Univariate and multivariate logistic regression analyses were conducted in the training cohort to screen for independent risk factors of SSI, and a nomogram prediction model was developed. The predictive performance of the nomogram was compared with that of the National Nosocomial Infections Surveillance (NNIS) system. Decision curve analysis (DCA) was used to assess the clinical decision-making value of the nomogram.ResultsThe SSI incidence was 0.186%. Univariate and multivariate logistic regression analysis identified the American Society of Anesthesiology (ASA) class (odds ratio [OR] 1.564 [95% confidence interval (CI) 1.029–5.99, P = 0.046]), operative time (OR 1.003 [95% CI 1.006–1.019, P < 0.001]), and D-dimer level (OR 1.055 [95% CI 1.022–1.29, P = 0.046]) as risk factors for postoperative SSI. We constructed a nomogram prediction model based on these independent risk factors. In the training and validation cohorts, our predictive model had concordance indices (C-indices) of 0.777 (95% CI 0.672–0.882) and 0.732 (95% CI 0.603–0.861), respectively, both of which were superior to the C-indices of the NNIS system (0.668 and 0.543, respectively). Calibration curves and DCA confirmed that our nomogram model had good consistency and clinical predictive value, respectively.ConclusionsOperative time, ASA class, and D-dimer levels are important clinical predictive indicators of postoperative SSI in patients undergoing elective clean orthopedic surgery. The nomogram predictive model based on the three clinical features demonstrated strong predictive performance, calibration capabilities, and clinical decision-making abilities for SSI.

Short-term clinical outcomes and five-year survival analysis of laparoscopic-assisted transanal natural orifice specimen extraction versus conventional laparoscopic surgery for sigmoid and rectal cancer: a single-center retrospective study.

The cosmetic benefits of natural orifice specimen extraction (NOSE) are easily noticeable, but its principles of aseptic and tumor-free procedure have caused controversy. We conducted a retrospective analysis of the clinical data of patients who underwent laparoscopic-assisted transanal NOSE or conventional laparoscopic surgery (CLS) for sigmoid and rectal cancer at our hospital between January 2018 and December 2018. The study aimed to compare the general characteristics, perioperative indicators, postoperative complications, and five-year follow-up results between the two groups. A total of 121 eligible patients were enrolled, with 52 underwent laparoscopic-assisted transanal NOSE and 69 underwent CLS. There were no significant differences observed between the two groups in terms of gender, age, body mass index (BMI), TNM stage, etc. (P > 0.05). However, the NOSE group exhibited significantly shorter total incision length and longer operation time compared to the CLS group (P < 0.05). There were no statistically significant differences observed between the two groups in terms of positive rate of bacterial culture, incidence rates of intraabdominal infections or anastomotic leakage (P > 0.05). Furthermore, during follow-up period there was no statistically significant difference observed between these two groups concerning overall survival rate and disease-free survival outcomes (P > 0.05). The management of surgical complications in CLS is exemplary, with NOSE presenting a sole advantage in terms of incision length albeit at the cost of prolonged operative time. Therefore, NOSE may be deemed appropriate for patients who place high emphasis on postoperative cosmetic outcomes.

Diagnostic validation study of rapid urinary tract infection diagnosis kit at peripheral health facilities of West Bengal, India

Patients reporting to the outpatient departments of peripheral health care settings in India with symptoms of urinary tract infection (UTI) receive one or the other antibiotic before culture confirmation and out of the total culture confirmed UTI cases, in less than one third cases the prescribed antibiotics matches to the antibiotic sensitivity test result. Hence, in this study, an indigenous point-of-care (POCT) rapid diagnostic kit (Rapidogram) for UTI was validated against conventional urine culture and sensitivity to understand its possible applicability at peripheral health care settings. This cross-sectional study was conducted during November 2021 to June 2022 in OPDs of two peripheral hospitals. A sample size of 300 was calculated using prevalence of urinary tract infection (UTI) as 33% for sensitivity and specificity using Buderer’s formula. Urine specimens were collected following standard aseptic procedures from the recruited suspected UTI cases and transferred to laboratory maintaining the cold chain. The validation work up was done in two sections: lab validation and field validation. Out of 300 urine samples, 29 were found positive for the growth of UTI pathogen by both methods and 267 were found negative by both methods. Thus, the kit shows very high specificity (99.6%; 97.9–99.9%) and considerably high sensitivity (90.6%; 74.9–98.0%). We also observed higher PPV, NPV, test accuracy (> 96%). Diagnostic Odds Ratio and Youden index were respectively 2581 and 0.89. Clinical data showed that 44% of the suspected UTI cases were prescribed at least one antibiotic before urine test. Mostly they received Norfloxacin whereas the mostly identified organism E.coli was sensitive to Nitrofurantoin. In the context of absence of microbiology facility at peripheral setting and rampant empirical use of antibiotics in UTI, this highly specific and sensitive POCT for UTI may be used as it not only identifies the organism, also shows the antibiotic sensitivity pattern.

Hand Hygiene Compliance and Its Associated Factors Among Health Care Workers at Mogadishu Somali Turkiye Recep Tayyip Erdoğan Training and Research in a Tertiary Care Hospital.

Hand hygiene is a critical preventive measure for controlling infections, particularly in underdeveloped nations. A cross-sectional study was conducted in a hospital in Mogadishu, Somalia, from January to March 2024. This study aimed to assess compliance with hand hygiene practices and related factors among healthcare professionals. The study population comprised 52% men and 47.3% women. Most participants held bachelor's degrees, with the majority being nurses or midwives. A significant proportion had over five years of work experience. Almost all participants were knowledgeable about hand hygiene. Most reported cleaning and drying their hands before, during, and after contact with bodily fluids during aseptic procedures. Age, gender, educational status, marriage, working experience, type of occupation, receiving hand hygiene training and knowledge, and having the availability of water, soap, alcohol, and gloves significantly affected the overall uptake of infection control measures in Mogadishu (p<0.05). The findings highlight an urgent need for targeted interventions to enhance hand hygiene practices in Somalia. Addressing training gaps and resource shortages is crucial for reducing infection rates and safeguarding patient health in this high-risk setting.