Cases Of Hospital-acquired Infection Research Articles

Hospital-acquired infections surveillance: The machine-learning algorithm mirrors National Healthcare Safety Network definitions.

Surveillance of hospital-acquired infections (HAIs) is the foundation of infection control. Machine learning (ML) has been demonstrated to be a valuable tool for HAI surveillance. We compared manual surveillance with a supervised, semiautomated, ML method, and we explored the types of infection and features of importance depicted by the model. From July 2021 to December 2021, a semiautomated surveillance method based on the ML random forest algorithm, was implemented in a Brazilian hospital. Inpatient records were independently manually searched by the local team, and a panel of independent experts reviewed the ML semiautomated results for confirmation of HAI. Among 6,296 patients, manual surveillance classified 183 HAI cases (2.9%), and a semiautomated method found 299 HAI cases (4.7%). The semiautomated method added 77 respiratory infections, which comprised 93.9% of the additional HAIs. The ML model considered 447 features for HAI classification. Among them, 148 features (33.1%) were related to infection signs and symptoms; 101 (22.6%) were related to patient severity status, 51 features (11.4%) were related to bacterial laboratory results; 40 features (8.9%) were related to invasive procedures; 34 (7.6%) were related to antibiotic use; and 31 features (6.9%) were related to patient comorbidities. Among these 447 features, 229 (51.2%) were similar to those proposed by NHSN as criteria for HAI classification. The ML algorithm, which included most NHSN criteria and >200 features, augmented the human capacity for HAI classification. Well-documented algorithm performances may facilitate the incorporation of AI tools in clinical or epidemiological practice and overcome the drawbacks of traditional HAI surveillance.

Evaluating Healthcare-Associated Infections in Public Hospitals: A Cross-Sectional Study.

Hospital-acquired infections (HAIs) pose a significant danger to global public health, mainly because their numbers are growing exponentially each year. Additionally, the rise of bacterial strains resistant to current treatment options further exacerbates this threat. This study aimed to examine the occurrences of HAIs identified in public hospitals at the county level. We conducted a cross-sectional study utilizing data provided to the Mures Public Health Directorate from all the public hospitals within the studied county. We examined HAIs reported during the period spanning from 2017 to 2021, which amounted to a total of 4603 cases. The medical departments reported the highest prevalence of HAIs at 48.25%. The most common infections included enterocolitis with Clostridioides difficile (32.61%), COVID-19 (19.83%), bronchopneumonia (16.90%), sepsis, surgical wound infections, and urinary tract infections. The five most frequently identified pathogens were Clostridioides difficile (32.61%), SARS-CoV-2 (19.83%), Acinetobacter baumannii (11.82%), Klebsiella pneumoniae (9.58%), and Pseudomonas aeruginosa (7.95%). Acinetobacter baumannii was the predominant agent causing bronchopneumonia, while Klebsiella pneumoniae was the leading cause of sepsis cases. Escherichia coli was the primary agent behind the urinary tract infections, and Staphylococcus aureus MRSA was identified as the main etiology for wound infections and central catheter infections. Throughout the study period, there was a significant rise in Clostridioides difficile and Gram-negative bacteria prevalence rates. This study identified increased Clostridioides difficile in HAI cases during COVID-19, highlighting the need for careful antibiotic use and emphasizing the growing challenge of multi-resistant strains in post-pandemic state hospitals.

Team-based infection preventionist review improves interrater reliability in identification of hospital-acquired infections

Background: The University of Colorado Health (UCHealth) metropolitan region is composed of 4 hospitals. Therein, 10 infection preventionists (IPs) retrospectively review all cases of potential central-line–associated bloodstream infection (CLABSI), catheter-associated urinary tract infection (CAUTI), and surgical site infection (SSI) to adjudicate whether each case meets the NHSN definitions for hospital-acquired infection (HAI). In August 2021, the UCHealth IP team structure transitioned from a subject-matter expert model (in which each IP reviewed a specific HAI) to a unit-based model (in which each IP reviewed all HAIs and SSIs on their assigned units) to create redundancy in knowledge and skill. The IP team subsequently instituted a weekly meeting to review all potential cases of HAI. We hypothesized that this review structure would result in increased consistency in the application of NHSN definitions across the UCHealth hospitals and units. Methods: From August 17, 2022, through March 3, 2023, the UCHealth IPs, managers, and medical directors met weekly for 1 hour via teleconferencing. Each IP presented key details for all near-miss and confirmed cases of SSI or HAI on their respective units and received questions and feedback from their peers and medical directors. Case determination was based on team discussion and consensus. If there was discordance in the interpretation of an NHSN case definition, a formal inquiry was sent to resolve the uncertainty. The number of cases reviewed, case determinations changed, and formal inquiries to NHSN were tracked. Results: During the study period, the IP team convened weekly meetings and reviewed 248 patient cases—of which 208 (83.9%) were confirmed HAIs. Based on collaborative team discussion, 14 cases (5.6%) were changed from reportable to nonreportable. Three cases (1.2%) originally thought to be nonreportable were changed to reportable. The HAI determination of a reportable case (eg, revision of a “superficial” SSI to “deep” SSI) was changed for 9 (6.0%). Following team discussion, 13 formal inquiries were sent to the NHSN to clarify case definitions, and these responses were collated for future reference. Conclusions: Team-based IP review of HAI cases improves consistency in application of NHSN case definitions and highlights areas of uncertainty in their interpretation. This team-based model of case review is a useful educational and practical tool to increase interrater reliability in case adjudication across large teams of IPs, to create a systematic way to query NHSN, and to ensure that knowledge gained is disseminated for future benefit.Disclosures: None

Investigating the Prevalence, Severity, and Nature of Adverse Events in an Inpatient Rehabilitation Hospital

Objectives: This study aims to evaluate the prevalence, severity, and nature of adverse events (AEs) and provide suggestions on how to prevent AEs recurrence in an inpatient rehabilitation hospital in Iran. Methods: This retrospective descriptive-analytical study was conducted in 2021 at Rofaydeh Rehabilitation Hospital in Tehran City, Iran. AEs associated with rehabilitation services and nursing care, which were reported in the hospital’s voluntary reporting system from 2018 to 2021 were evaluated. A standard checklist codified by the Ministry of Health of Iran was used to collect the data from the medical error documentation. The data were analyzed by the SPSS software, version 21, using descriptive statistics, the chi-square, and the Fisher exact tests. Results: A total of 5642 patients had been hospitalized in the study setting and 517 AEs had been documented during the 4 years of the study. The most common AEs in descending order were as follows: falls 288(55.7%), pressure ulcers 57(11.02%), medication errors 50(9.67%), clinical process 49(9.47%), clinical administration (issues with admission process 10(1.93%) and wrong patient identification 5(0.96%). Among 58(11.21%) cases of hospital-acquired infections, 45(77.58%) cases were urinary tract infections. There was a significant relationship between age and fall (P=0.026), pressure ulcer (P=0.006), and hospital-acquired infection (P=0.001), and between gender and fall (P=0.01), pressure ulcer (P=003), and hospital-acquired infection (P=0.01). The severity of identified AEs was categorized into mild 431(83.36%), moderate 61(11.79%), and severe 25(4.83%). The most common causes of AEs were limited supervision of patients by healthcare providers. Discussion: This study showed that patient fall, pressure ulcer, and hospital-acquired infection were the most prevalent AEs in the rehabilitation hospital. Future efforts to improve patient safety in these settings should focus on reducing such AEs along with removing barriers to voluntary incident reporting.

Effect of a real-time automatic nosocomial infection surveillance system on hospital-acquired infection prevention and control

BackgroundThe systematic collection of valid data related to hospital-acquired infections (HAIs) is considered effective for nosocomial infection prevention and control programs. New strategies to reduce HAIs have recently fueled the adoption of real-time automatic nosocomial infection surveillance systems (RT-NISSs). Although RT-NISSs have been implemented in some hospitals for several years, the effect of RT-NISS on HAI prevention and control needs to be further explored.MethodsA retrospective, descriptive analysis of inpatients from January 2017 to December 2019 was performed. We collected hospital-acquired infection (HAI) cases and multidrug resistant organism (MDRO) infection cases by traditional surveillance in period 1 (from January 2017 to December 2017), and these cases were collected in period 2 (from January 2018 to December 2018) and period 3 (from January 2019 to December 2019) using a real-time nosocomial infection surveillance system (RT-NISS). The accuracy of MDRO infection surveillance results over the 3 periods was examined. The trends of antibiotic utilization rates and pathogen culture rates in periods 2 and 3 were also analysed.ResultsA total of 114,647 inpatients, including 2242 HAI cases, were analysed. The incidence of HAIs in period 2 was significantly greater than that in period 1 (2.28% vs. 1.48%, χ2 = 61.963, p < 0.001) and period 3 (2.28% vs. 2.05%, χ2 = 4.767, p = 0.029). The incidence of five HAI sites, including respiratory infection, urinary tract infection (UTI), surgical site infection (SSI), bloodstream infection (BSI) and skin and soft tissue infection, was significantly greater in period 2 compared with period 1 (both p < 0.05) but was not significantly different from that in period 3. The incidence of hospital-acquired MDRO infections in period 3 was lower than that in period 2. The identification of MDRO infection cases using the RT-NISS achieved a high level of sensitivity (Se), specificity (Sp), positive predictive value (PPV) and negative predictive value (NPV), especially in period 3 (Se = 100%, Sp = 100%, PPV = 100% and NPV = 100%).ConclusionThe adoption of a RT-NISS to adequately and accurately collect HAI cases is useful to prevent and control HAIs. Furthermore, RT-NISSs improve accuracy in MDRO infection case reporting, which can timely and accurately guide and supervise clinicians in implementing MDRO infection prevention and control measures.

Treating acutely ill patients at home: Data from Singapore

Hospital-at-home programmes are well described in the literature but not in Asia. We describe a home-based inpatient substitutive care programme in Singapore, with clinical and patient-reported outcomes. We conducted a retrospective cohort study of patients admitted to a hospital-at-home programme from September 2020 to September 2021. Suitable patients, who otherwise required hospitalisation, were admitted to the programme. They were from inpatient wards, emergency department and community nursing teams in the western part of Singapore, where a multidisciplinary team provided hospital-level care at home. Electronic health record data were extracted from all patients admitted to the programme. Patient satisfaction surveys were conducted post-discharge. A total of 108 patients enrolled. Mean age was 67.9 (standard deviation 16.7) years, and 46% were male. The main diagnoses were skin and soft tissue infections (35%), urinary tract infections (29%) and fluid overload (18%). Median length of stay was 4 (interquartile range 3-7) days. Seven patients were escalated back to the hospital, of whom 2 died after escalation. One patient died at home. There was 1 case of adverse drug reaction and 1 fall at home, and no cases of hospital-acquired infections. Patient satisfaction rates were high and 94% of contactable patients would choose to participate again. Hospital-at-home programmes appear to be safe and feasible alternatives to inpatient care in Singapore. Further studies are warranted to compare clinical outcomes and cost to conventional inpatient care.

Phenotypic profile of priority multiresistant Аcinetobacter baumannii sequence types (ST 1167, ST 944, ST 208)

Introduction. About 1,000,000 cases of infections caused by Acinetobacter spp. per year are registered globally, making up 1.8% of all the cases of hospital-acquired infections. In compliance with long-term studies carried out in in this country and abroad, Acinetobacter baumannii is a clinically important representative of the Acinetobacter genus. Intraspecific typing of microorganisms is an integral part of a clinical microbiologist's contribution to scoring the outbreaks of purulent-septic infections within the sphere of HAI surveillance. Most of the practicing microbiological laboratories cannot use genotypic typing methods because of their high costs.Objective. Developing a test panel for intraspecific identification of A. baumannii sequence types (ST 1167, ST 944, ST 208) based on their phenotypic properties.Materials and methods. Intraspecific membership of 74 A. baumannii strains obtained from four multipurpose health settings of a large industrial centre was studied using a genetic method (multilocus sequence typing) and a suite of phenotypic methods (biochemical tests, biofilmogenous capacity, growth inhibition zones to antibacterial drugs, sensitivity to aniline dyes, disinfectants and Acinetobacter bacteriophage) was studied.Results. Phenotypic features of three predominant A. baumannii sequence types (ST 1167, 944, 208) were determined.Discussion. An efficacious economy set of differentiating tests allowing identification of intraspecific features of A. baumannii multiresistant strains was сreated.Conclusion. The test panel will enable the laboratories that cannot use sequencing methods to conduct intraspecific differentiation of common A. baumannii sequence types as part of microbiological monitoring.

Impact of dry hydrogen peroxide on hospital-acquired infection at a pediatric oncology hospital

BackgroundThis study aims to describe the effect of Dry Hydrogen Peroxide (DHP), as an adjunct to environmental cleaning and disinfection, on the incidence of hospital-acquired infections (HAIs) at Unidad Nacional de Oncologia Pediatrica (UNOP) in Guatemala City, Guatemala. MethodsA retrospective study of all HAI data from the hospital's surveillance system, which follows Centers for Disease Control and Prevention (CDC) protocols, was conducted from January 2019 to November 2020. DHP was installed in all Pediatric Intensive Care Unit (PICU) rooms in January 2020, but nowhere else in the hospital, including the Intermediate Care Unit (IMCU). ResultsThere were 189 HAI cases during the study period, with 173 occurring in either the PICU or IMCU. A statistically significant decrease in HAI incidence rates occurred in the PICU in 2020 compared to 2019 (P = .028), including Clostridiodes-associated gastroenteritis (P = .048). Logistic multivariate regression yielded a significant association between DHP exposure and reduced odds of developing an HAI during the study (OR = 0.3857, P = .029). ConclusionThe use of DHP as an adjunct technology for environmental cleaning and disinfection contributed to the reduction in HAIs in the PICU. Our study highlights the value of such an approach as an addition to manual cleaning to decrease the risk of infection from environmental contamination.

Admission screening and cohort care decrease carbapenem resistant enterobacteriaceae in Vietnamese pediatric ICU\u2019s

ObjectivesTo assess if admission screening for Carbapenem Resistant Enterobacteriaceae (CRE) and cohort care can reduce CRE acquisition (CRE colonization during hospital stay), Hospital Acquired Infections (HAI), hospital-stay, mortality, and costs in three Intensive Care Units (ICU’s) at the Vietnamese National Children’s Hospital.MethodCRE screening using rectal swabs and ChromIDCarbas elective culture at admission and if CRE negative, once weekly. Patients were treated in cohorts based on CRE colonization status.ResultsCRE colonization at baseline point-prevalence screening was 76.9% (103/134). Of 941 CRE screened at admission, 337 (35.8%) were CREpos. 694 patients met inclusion criteria. The 244 patients CRE negative at admission and screened > 2 times were stratified in 8 similar size groups (periods), based on time of admission. CRE acquisition decreased significant (OR − 3.2, p < 0.005) from 90% in period 2 (highest) to 48% in period 8 (last period). Patients with CRE acquisition compared to no CRE acquisition had a significantly higher rate of culture confirmed HAI, n = 20 (14%) vs. n = 2 (2%), longer hospital stays, 3.26 vs. 2.37 weeks, and higher total treatment costs, 2852 vs. 2295 USD.ConclusionAdmission CRE screening and cohort care in pediatric ICU’s significantly decreased CRE acquisition, cases of HAI and duration of hospital-stay.

Protection and Response of a Tertiary Hospital in Shenzhen, China to the COVID-19 Outbreak: The Practice of the Comprehensive Response Mode.

The aim of this study was to evaluate the management mode for the prevention and control of coronavirus disease 2019 (COVID-19) transmission used at a general hospital in Shenzhen, China, with the aim to maintain the normal operation of the hospital. From January 2, 2020, to April 23, 2020, Hong Kong-Shenzhen Hospital, a tertiary hospital in Shenzhen, has operated a special response protocol named comprehensive pandemic prevention and control model, which mainly includes 6 aspects: (1) human resource management; (2) equipment management; (3) logistics management; (4) cleaning, disinfection, and process reengineering; (5) environment layout; (6) and training and assessment. The detail of every aspect was described, and its efficiency was evaluated. A total of 198,802 patients were received. Of those, 10,821 were hospitalized; 26,767 were received by the emergency department and fever clinics; 288 patients were admitted for observation with fever; and 324 were admitted as suspected cases for isolation. Under the protocol of comprehensive pandemic prevention and control model, no case of hospital-acquired infection with COVID-19 occurred among the inpatients or staff. The present comprehensive response model may be useful in large public health emergencies to ensure appropriate management and protect the health and life of individuals.

The Evolution and Devolution of Hospital Care

The Evolution and Devolution of Hospital Care

Healthcare Associated Infections-A New Pathology in Medical Practice?

Background: Hospital-acquired infections (HAI) contribute to the emotional stress and functional disorders of the patient and in some cases, can lead to a state of disability that reduces quality of life. Often, HAI are one of the factors that lead to death. The purpose of this study was to analyze the cases of HAI identified in public hospitals at the county level, through case report sheets, as they are reported according to the Romanian legislation. Methods: We performed a cross sectional study design based on the case law of the data reported to the Mures Public Health Directorate, by all the public hospitals belonging to this county. We tracked hospital-acquired infections reported for 2017–2018, respectively, a number of 1024 cases, which implies a prevalence rate of 0.44%, 1024/228,782 cases discharged from these hospitals during the studied period. Results: The most frequent HAIs were reported by the intensive care units (48.4%), the most common infections being the following: bronchopneumonia (25.3%), enterocolitis with Clostridioides difficile (23.3%), sepsis, surgical wound infections and urinary tract infections. At the basis of HAI were 22 pathogens, but the five most common germs were Clostridioides difficile, Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa and Staphylococcus aureus. Bronchopneumonia have been most frequently reported in intensive care units, the most common being identified the Acinetobacter baumannii agent. Sepsis and central catheter infections also appeared predominantly in intensive care units, more often with Klebsiella pneumoniae. The enterocolitis with Clostridioides difficile, were the apanage of the medical sections. Infections with Staphylococcus aureus have been identified predominantly in the surgical sections at the level of the surgical wounds. Urinary infections had a similar distribution in the intensive care units, the medical and surgical sections, with Klebsiella pneumoniae being the most commonly incriminated agent. Conclusions: We showed a clear correspondence between the medical units and the type of HAI: what recommends the rapid, vigilant and oriented application of the prevention and control strategies of the HAI.

Análise de um programa de gestão de antimicrobianos em unidade de terapia intensiva pediátrica

Summary: Antimicrobials have been oftentimes excessively prescribed, promoting the emergence and expansion of antibiotic resistant organisms. Bacterial resistance is a considerable public health problem, since it reduces the ability of infectious disease prevention and treatment. In this scenario, the antibiotic stewardship programs (ASPs) arise as a key intervention in order to optimize the use of these drugs contributing to reduce bacterial resistance rates. Objective: Assess an antibiotic stewardship program in newborn and pediatric intensive care units (ICU) by comparing hospital-acquired infection (HAI) rates, bacterial resistance rates and HAI causative agents in the year of complete deploy and after its deployment. Restricted use antimicrobial requests have also been analyzed. Methodology: Two methodologies have been applied: 1) a before and after intervention semi experimental study for assessing HAI rates and bacterial resistance rates and 2) retrospective and prospective descriptive study for antimicrobial requests analysis. Results: We admitted 551 patients in NICU and 1,154 in PICU. The HAI rate in newborn ICU was (21/284) 7.4% in 2016 and (16/267) 6% in 2017 (22% decrease in absolute quantitative cases, p=0.5) and in the pediatrics ICU was (50/578) 8.7% in 2016 and (39/576) 6.8% in 2017 (23.8% decrease in absolute quantitative cases, p=0.2). The percent of positive cultures in HAI cases was 61.9 in 2016 and 61.8 in 2017 (p=0.8). The average length of stay in newborn ICU after each HAI episode was 128 days in 2016 and 59 days (95% CI 30 - 88) in 2017 (p=0.01). After 30-days HAI had been diagnosed, 13 (61.9%) patients remained hospitalized in newborn ICU in 2016 and 2 (12,5%) in 2017 (p=0,007). The average length of stay in pediatric ICU after each HAI episode was 128 days (CI 95% 94 - 163) in 2016 and 97 days (IC 95% 68 - 126) in 2017 (p=0,18). The resistance rates found in nosocomial infection causative bacteria in the newborn ICU was 36.4% (4/11) in 2016 and 66.7% (4/6) in 2017 and in pediatric ICU was 44.4% (12/27) in 2016 and 47.4% (9/19) in 2017. During the period of October 2016 and December 2017, 120 restricted use antimicrobials requests have been issued in the newborn and pediatric ICU, and cultures had been collected before the antimicrobial initiation in 98 cases, with a positivity of 53% (n=52). The restricted use antimicrobial request approval rate has been 92.5%. Conclusion: The study showed a reduction in HAI rates in newborn and pediatric ICU, in absolute quantitative, after a deployment of ASP, length of stay reduction, reduction in absolute number of multiresistant bacteria causing HAI, high positive culture in patients for whom there has been request of antimicrobial and excellent rates of requests approval. It is suggested to maintain the practices implemented for long periods in order to obtain even expressive results

A Bowman-Birk Inhibitor from the Seeds of Luetzelburgia auriculata Inhibits Staphylococcus aureus Growth by Promoting Severe Cell Membrane Damage.

Staphylococcus aureus is a multidrug-resistant bacterium responsible for several cases of hospital-acquired infections, which constitute a global public health problem. The introduction of new healthcare strategies and/or the discovery of molecules capable of inhibiting the growth or killing S. aureus would have a huge impact on the treatment of S. aureus-mediated diseases. Herein, a Bowman-Birk protease inhibitor ( LzaBBI), with strong in vitro antibacterial activity against S. aureus, was purified to homogeneity from Luetzelburgia auriculata seeds. LzaBBI in its native form is a 14.3 kDa protein and has a pI of 4.54, and its NH2-terminal sequence has high identity with other Bowman-Birk inhibitors. LzaBBI showed a mixed-type inhibitory activity against both trypsin and chymotrypsin, respectively, and it remained stable after both boiling at 98 °C for 120 min and incubation at various pHs. Scanning electron microscopy revealed that LzaBBI disrupted the S. aureus membrane integrity, leading to bacterial death. This study suggests that LzaBBI is a powerful candidate for developing a new antimicrobial to overcome drug resistance toward reducing hospital-acquired infections caused by S. aureus.

EPIDEMIOLOGY ASPECTS OF HOSPITAL-ACQUIRED INFECTION MORBIDITY IN HEALTH SURGERY HOSPITALS IN PRIMORSKY REGION

The problem of prophylaxis and treatment of the hospital-acquired infections caused remains actual and urgent and stubborn in modern medicine. Appearance of antimicrobial agents resistant and high virulent strains adapting also to desinfectants. Development of innovative hi-tech diagnostic methods and treatment at wide circulation of microorganisms with multiple antimicrobial agents resistance defines need of continuous improvement of epidemiological surveillance and microbiological monitoring of this group of infections. Aim of project: to carry out the epidemiological analysis of a case rate of hospital-acquired infections in Primorsky Krai and to determine the specific role of hospital-acquired infections which arose in surgical hospitals and units. Material and methods: In work there were used statistical forms, e.g. No. 2 «The information on infectious and parasitic diseases» in Primorsky Krai. A research method — the retrospective epidemiological analysis. Results of a research: In 2015 in Primorsky Krai there were registered 159 cases of hospitalacquired infections, the indicator of a case rate made 0.05 per 1000 treated patients. In comparison with 2014 the case rate decreased, rate of depression made — 28%. According to the statistical reporting the greatest number of cases of hospital-acquired infections was registered in obstetrical institutions — 60 cases (38% of all hospital-acquired infections), in children’s hospitals — 46 (29%) and in surgical hospitals and units — 33 (21%). Other hospital-acquired infections are registered in out-patient and polyclinic institutions and in institutions of a therapeutic profile. In structure of hospitalacquired infections in the territory of Primorsky Krai in 2015, as well as in previous years, acute intestinal infections dominated (35 cases — 22%) and it is purulent — septic infections at newborns (34 cases — 21%). Conclusions: In the territory of Primorsky Krai the hospital-acquired infections are often registered in obstetrical institutions, in children’s and surgical hospitals and units. The tendency to hospital-acquired infections morbidity growthin surgical hospitals and units, most likely, not owing to augmentation of cases of postoperative complications, and at the expense of other nosologies.

Late-onset neonatal sepsis: Overview of risk factors and bacterial etiology in a tertiary care hospital in North India

Background: Septicemia in neonates is one of the leading causes of mortality. The increasing number of multidrug-resistant pathogens is a serious concern. With this background, this study was done to evaluate the risk factors of late-onset sepsis (LOS) (community- and hospital-acquired infections) in newborns and to determine the antibiotic resistance pattern of the isolates in these infections. Materials and Methods: This retrospective study was conducted at Sarojini Naidu Medical College, Agra, on newborns admitted between August 2015 and January 2016. Newborns with the final diagnosis of sepsis obtained from the case records during the study period were included in the study. Those newborns with positive blood culture results were included in the study. Clinical details and antibiotic sensitivity of the isolates were also obtained from the records. Results: Sixty-eight newborns with LOS (38 community- and 30 hospital-acquired infections) were included in the study. Staphylococcus and Klebsiella were the most common bacteriological isolates for both community- and hospital-acquired infection cases in 36%, 26% and 26%, 33.3%, respectively. Home delivery (52.6%) and faulty breastfeeding were (57.8%) seen in significantly larger numbers in community-acquired infections (P = 0.03 and 0.01, respectively) whereas invasive procedures such as intubation were seen in 40% of nosocomial infections as compared to only 5.2% of community-acquired infections. Antibiotic susceptibility pattern in both the infections was similar. Staphylococcus aureus was susceptible to vancomycin in 100% cases while high resistance was seen for ampicillin in both the groups. Similarly, gentamicin was found to be resistant in both the groups for Klebsiella while imipenem was susceptible in 100% cases. Conclusion: Both community- and hospital-acquired infections had similar isolates and antibiotic susceptibility pattern; however, the risk factors associated with both the infections differed.

Estimating the risk of invasive group A Streptococcus infection in care home residents in England, 2009-2010.

Invasive group A streptococcal (iGAS) infections cause severe disease and death, especially in residents of long-term care facilities (LTCFs). In order to inform iGAS prevention, we compared the risk of iGAS in LTCF residents and community residents. We identified LTCF residents among cases of iGAS from national surveillance (2009-2010) using postcode matching, and cases of hospital-acquired infections via hospital admission records. We used Poisson regression to calculate incidence rate ratios (IRR) and logistic regression to explore factors associated with case fatality rate (CFR). A total of 2741 laboratory-confirmed iGAS cases were matched to a hospital admission: 156 (6%) were defined as hospital-acquired. Out of the total cases, 96 (3·5%) were LTCF residents. Compared with community residents, LTCF residents over 75 years of age had a higher risk of iGAS infection (IRR=1·7; 95% CI 1·3-2·1) and CFR (OR=2·3; 95% CI 1·3-3·8). Amongst community-acquired cases, the risk of iGAS in LTCF residents between 75 and 84 years of age doubled (IRR=2·7; 95% CI 1·8-3·9) compared with their community counterparts. The CFR among community-acquired cases was higher in LTCF residents than community residents (21% vs. 11%). Age remained associated with death in our final model. Our study showed that, even controlling for age, LTCF residents have a higher risk of acquiring and dying from iGAS. Whilst existing co-morbidities may explain this, it is reasonable to assume that the institutional setting may facilitate transmission. Therefore, cases in LTCF require prompt investigation together with a better understanding of factors contributing to the acquisition of infection.

Incidence of and risk factors for Hospital Acquired Infection in a Tertiary Care Hospital of Dhaka, Bangladesh

Objective: Hospital acquired infection (HAI) is a major concern in hospital settings.Methods: This study was conducted to evaluate the incidence of Hospital Acquired Infection (HAI), patient and hospital related factor, offending microorganism and their antimicrobial sensitivity. Data were collected prospectively with patients admitted during study period.Results and discussion: 9.4% respondents were found to develop HAI. 60% patients with more than 3 visitor, 11.9% patient with prior antibiotic therapy and 24% patient with underlying illness developed HAI. 14.6% routine operation case and 24.5% emergency operation case developed HAI. 17.1% patients with invasive device therapy whereas 3.8% patients without any device therapy developed HAI. 31.8% patients having immunosuppressive therapy and 37% patients with frequent transfer within hospital whereas only 6.9% patients without transfer developed HAI. Bacteria isolated from HAI cases were identified to be member of nine different genera. Klebsiella pneumoniae isolated from 33% HAI case, while Acinetobacter baumanii and Escherichia coli isolated from 13% case and Pseudomonas aeruginosa from 14% cases. Only colistin has sensitivity range from 76 to 100% while almost all other isolates were observed multi drug resistance (MDR).Conclusion: Comprehensive strategy should be undertaken to reduce risk of HAI.Bangladesh Journal of Medical Science Vol.16(3) 2017 p.358-369

Hospital Acquired Infection in a Tertiary Military Hospital in Dhaka, Bangladesh

This descriptive cross sectional study was conducted among the surgical patients of all age and sex at Combined Military Hospital, Dhaka, Bangladesh. The data were collected from 5 April 2015 to 12 April 2015 with a view to find out the prevalence of hospital acquired infection (HAI), its risk factors and pattern of organisms responsible. A total of 360 respondents happened to be available in different surgical wards during data collection period and 30 respondents developed HAI, thus a prevalence rate of 8.33% was yielded. The mean age of the respondents was 36.89 years with standard deviation ± 14.54 years. Among the HAI cases, 53.33% were surgical site infections and 50% were caused by Escherichia Coli. The study found that frequency of HAI depended on patients’ performance status: among 40% who required assistance for most activities, who had visitors more than 3 per day (81.3%), who had underlying illness like diabetes mellitus (25%), who had invasive devices (9.5%), who were admitted in ICU (12.9%), who received immunosuppressive therapy (23.5%), who had immunosuppressive conditions (28.1%), who had emergency operation (34.8%), and who had undergone general surgery (19.0%). Findings suggest that association between HAI and number of visitors, admission in ICU, immunosuppressive conditions, use of immunosuppressive therapy, use of invasive devices, and different functional state of patients were statistically significant (p<0.05). Findings of this study suggest that measures need to be taken at increasing awareness of hospital staffs, formulation of policy on use and duration of use of invasive devices, establishing a surveillance system and controlling visitors for effective control of HAI. The researcher suggests further detail study with large sample involving multiple hospitals to get more accurate picture on HAI.

Hospital-acquired infection in public hospital buildings in the Philippines: Is the type of ventilation increasing the risk?

Hospital-acquired infections (HAIs) are associated with increased morbidity and mortality, especially in developing countries. However, limited information is available about the risk of HAIs in naturally ventilated wards (NVWs) and mechanically ventilated intensive care units (MVICUs) of public hospitals in the Philippines. We aimed to assess the association between HAIs and type of ventilation in an urban tertiary care hospital in the Philippines. A cross-sectional point-prevalence survey of infections was done in NVWs and MVICUs of a tertiary care hospital in December 2013. Multivariate analyses were done to examine the associations between HAIs and type of ventilation and other risk factors. Of the 224 patients surveyed, 63 (28%) patients had 69 HAIs. Pneumonia was the most common HAI (35%). Wards near areas with high vehicular activity had more respiratory HAI cases. Being immunocompromised is a risk factor for HAI for pediatric and adult patients. Among pediatric patients, staying in MVICUs had a lower risk for HAIs (adjusted odds ratio [AOR]: 0.33; 95% confidence interval [CI]: 0.10-1.08) compared to staying in NVWs. For adult patients, a higher risk for HAIs (AOR: 2.41; 95% CI: 0.29-18.20) was observed in MVICUs compared to NVWs. Type of ventilation is not a risk factor for HAIs. Patients who are immunocompromised may be at a higher risk for HAI. Indoor air pollution, proximity to congested main thoroughfare, and increased human foot traffic may contribute to the susceptibility of patients to HAIs. Hospital layout should be considered in infection control.