Effective Infection Control Program Research Articles

Point Prevalence Survey of HAIs as a key component of Infection Prevention and Control programs

Abstract Healthcare-Associated Infections (HAIs) are a global concern, requiring surveillance strategies as Point Prevalence Surveys (PPS) to estimate their burden and investigate associated risk factors for targeted interventions in high-risk areas. This study aims to assess the prevalence of HAIs, identify determinants and evaluate antimicrobial use in a teaching hospital in Rome. A PPS was carried out from June 19th to 23rd, 2023, in accordance with the European Centre for Disease Prevention and Control (ECDC) protocol for HAIs and antimicrobial use in European acute care hospitals (version 6.1). Pearson’s chi-squared test was employed to investigate correlations between potential risk factors and HAIs. The survey included 829 patients with an average age of 56.3 years (SD: ±24.6). Of these, 48.4% were female and over half had visited the hospital’s Emergency Department (53.7%). The prevalence of active HAIs was 8.7%, with 72 patients diagnosed. Furthermore, 51.0% of all patients received at least one systemic antimicrobial agent, and 16.7% of those treated had an HAI. Penicillins (39.7%) and third-generation cephalosporins (37.8%) were the most frequently prescribed antimicrobials. The primary HAIs were bloodstream infections (34.1%), followed by urinary tract (27.3%), surgical site (23.9%), lower respiratory tract (6.8%), and gastrointestinal infections (7.9%). Escherichia coli (13.2%), Staphylococcus aureus (9.2%), and Clostridium difficile (6.6%) were the most frequently isolated pathogens. Intensive Care Unit admission, use of medical device, recent antibiotic therapy and prior hospitalization or surgery significantly correlated (p < 0.05) with increased HAIs risk. The detected prevalence of HAIs is lower than the national rates observed in 2022 (10.2%), which have increased since 2016. HAIs surveillance is essential for developing effective infection prevention and control programs and for optimizing resource allocation in hospital settings. Key messages • Surveillance of Healthcare-Associated Infections is crucial for developing targeted Infection Prevention and Control programs and optimizing hospital resource allocation. • Point Prevalence Surveys offer essential information for assessing the burden of Healthcare-Associated Infections and directing intervention strategies in hospitals.

Incidence, Clinical Characteristics, and Outcomes of Clostridium difficile Infection in a Tertiary Care Center in Bahrain.

Background Clostridioides difficile infection (CDI) represents a significant healthcare challenge associated with antibiotic use and healthcare settings. While healthcare facility-onset CDI (HO-CDI) rates have been extensively studied, the incidence and risk factors of CDI in various settings, including the community, require further investigation. Aim This study aims to examine the incidence rates of CDI in a major governmental hospital in Bahrain, identify risk factors for CDI, and assess the effectiveness of infection control measures. Method We conducted a retrospective study at the Salmaniya Medical Complex (SMC), analyzing all confirmed cases of CDI over a 30-month period from January 2021 to June 2023. CDI cases were screened using glutamine dehydrogenase antigen detection and confirmed using molecular assays like polymerase chain reaction and/or toxin assaysfor confirmation.The study categorized CDI cases based on their onset (hospital or community) and explored associated risk factors, including antibiotic use, proton pump inhibitor (PPI) therapy, and patient demographics. Infection control practices were also evaluated for their role in managing CDI. Results About 57 new CDI cases were identified during the study period, with a HO-CDI incidence rate of 0.5 per 10,000 patient days. While HO-CDI rates remained stable, community-onset (CO)-CDI cases increased. The median patient age was 61.8 years, without notable differences between genders. Key risk factors for CDI were antimicrobial therapy, use of acid-reducing agents, age, and underlying comorbidities. The mortality rate stood at 35.1%. The ATLAS score (i.e., age, treatment with antibiotics, leukocyte count, albumin level, and serum creatinine) was a reliable predictor of mortality. Critical care admission and low albumin levels emerged as significant independent risk factors for mortality. Conclusions The study demonstrates a low incidence rate of HO-CDI at SMC, attributed to effective infection control and antibiotic stewardship programs. The overall CDI rate increased during the study period, driven by a rise in CO cases; further investigating the risk factors among this category in our study revealed that most patients were exposed to antibiotic therapy within the past three months of their CDI diagnosis. The rise in CO-CDI cases underscores the need for broader community-based interventions and awareness regarding antibiotic and PPI use.

Evaluation of infection prevention and control programmes according to the European Centre for Disease Prevention and Control and the World Health Organization in Spain 2012–2022: indicators of core component 1

Key and core components of effective infection prevention and control programmes (IPCPs) issued by the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO) have been described. WHO core component 1 relates to the structure, organization and management of IPCPs. The objective of this study was to assess the status and the time trends of some indicators of core component 1 of IPCPs in acute hospitals in Spain throughout the period 2012-2022. Hospital-level data from the Spanish point prevalence survey for years 2012-2022 were analysed. Core component 1 indicators were calculated and tested for association to healthcare-associated infections (HAIs). In addition, trends were also examined. Overall, 67.0% and 57.2% of Spanish hospitals reported having an annual infection prevention and control (IPC) plan and an annual IPC report that was approved by the hospital managing director, respectively. The global median number of full-time equivalent (FTE) IPC nurses per 250 beds for the period was 0.87 and the global median number of FTE IPC doctors was 0.70. The rates of blood cultures and stool tests for Clostridioides difficile were 39.9 and 6.1 per 1000 patient-days, respectively. No significant correlation was found between core component 1 indicators and HAI prevalence. Spain is currently at a basic level on the structure, organization and management of IPCPs. Profound differences were found between hospitals depending on size and type.

Identifying research priorities for infection prevention and control. A mixed methods study with a convergent design.

Meaningful research creates evidence for Infection Prevention and Control (IPC) practice. To establish Infection Prevention Society (IPS) members' research priorities to support future research projects. A mixed methods convergent parallel design incorporating a cross-sectional survey of IPS members (2022-2023), and focus group findings from the IPS Consultative Committee, (October 2022). Quantitative data were analysed using descriptive statistics. Qualitative data were transcribed verbatim, entered into NVivo 12, and analysed using a thematic analysis approach. 132 IPS members responded to the survey, including 120 (90.9%) nurses. The three most prevalent priorities were: Quality Improvement and Patient Safety (n = 84, 16.1%); IPC Training and Education (n = 77, 14.8%); and IPC Evidence-based Guidelines (n = 76, 14.6%). Analysis of the focus group transcripts identified six emergent themes 'Patient Centred Care', 'Training and Education', 'IPC Role and Identity', 'IPC Leadership', 'IPC is Everyone's Responsibility', and 'Research Activity'. Triangulation of findings demonstrated concordance between quantitative and qualitative findings with Quality Improvement and Patient Safety (QIPS) and Training and Education identified as priority research areas. This study highlights the necessity of developing support systems and incorporating research priorities in QIPS, as well as Training and Education. The findings of this study align with the recommended core competencies and components for effective infection prevention and control programs, making them relevant to QIPS initiatives. The outcomes of the study will serve as a valuable resource to guide the IPS Research and Development Committee in delivering practical support to IPS members.

The Knowledge, Attitude, and Perception of Needlestick Injuries Among Dental Students in Riyadh, Kingdom of Saudi Arabia: A Cross-Sectional Survey.

Needlestick injuries (NSIs) represent a significant source of bloodborne viruses in the healthcare sector, particularly in dentistry. Developing effective infection control programs necessitates access to surveillance data. A comprehensive evaluation, encompassing human immunodeficiency virus (HIV), hepatitis B virus (HBV), hepatitis C virus (HCV), and serological testing, is crucial due to the potential lack of immediate symptoms in infected patients. It is essential to verify hepatitis B and tetanus immunization statuses and seek guidance from infectious disease experts for post-exposure prophylaxis. Aimand objective: This study aims to assess the knowledge, attitudes, and perceptions of NSIs among dentistry students in Riyadh, Saudi Arabia. Conducted during the 2023-2024 academic year in Riyadh, Saudi Arabia, this cross-sectional study evaluated the knowledge, attitudes, and perceptions of undergraduate dental medicine students regarding NSIs. Ethical approval was obtained, and informed consent was meticulously collected. Before participation, potential subjects were furnished with a comprehensive information sheet outlining the study's purpose, the survey's nature, expected duration, and potential risks or benefits. The document emphasized their unequivocal right to withdraw from the study at any point without any adverse consequences. Data collection relied on an online survey administered to third and final-year dental students selected from specific universities. This selection criterion ensured that participants were directly relevant to the dental education context under investigation. Careful exclusions were made to minimize potential bias, particularly by excluding students from academic years other than the third and final years, thus maintaining a specific focus on this subgroup. Data analysis primarily compared NSI occurrences and awareness based on dental college and academic year. Detailed findings are presented in the results section. The study unveiled high vaccination rates (95.23%) and significant levels of education regarding bloodborne infections (81.38%) among participants. However, it was noteworthy that 72.72% believed their vaccinations offered complete protection. Only 47.18% believed that wearing surgical gloves reduced the risk of NSIs, while a substantial majority (93.07%) opposed the practice of needle recapping. Moreover, 76.19% demonstrated knowledge of post-exposure prophylaxis, indicating room for improvement in healthcare safety practices. Statistical analysis identified significant associations between the Dental College attended and both NSI occurrence (χ²=12.164, p=0.058) and awareness (χ²=14.629, p=0.023). Conversely, the academic year exhibited no significant relationship with either NSI occurrence (χ²=1.2, p=0.55) or awareness (χ²=0.44, p=0.8). Additionally, the study revealed non-normal distributions for both NSI occurrence (p<0.001) and awareness (p<0.001) among participants. In conclusion, this study underscores the pivotal role of awareness in mitigating NSI occurrences among dental students. Irrespective of their academic year, heightened awareness significantly correlated with reduced NSI incidence. These findings bear significant implications for dental education and practice, emphasizing the imperative need for comprehensive education and awareness initiatives to bolster healthcare safety among dental professionals.

Bacterial abundance and antimicrobial resistance patterns of uropathogens among pregnant women with asymptomatic bacteriuria: Association with glycemic status

ObjectivesAntimicrobial resistance (AMR), a growing global menace, poses a significant threat to maternal and fetal health. Gestational diabetes mellitus (GDM) causes double trouble in pregnancy, increasing the risk of a variety of infectious morbidities while also raising the possible association with AMR. Asymptomatic bacteriuria (ASB) is a common problem in pregnancy, but little research has been done to date explicitly examining the relationship between GDM and ASB and yielded conflicting results. Even fewer studies have specifically examined the relationship between GDM and AMR in women with ASB. Retrieving the most recent information on the disease burden, the range of causative pathogens, their patterns of AMR, and associated risk factors in pregnant women is crucial to stop the exponential rise in AMR in pregnancy and improve maternal and neonatal outcomes of infectious morbidities. Hence, this study was planned to investigate the association between glycemic status and the contemporary bacterial profile, antimicrobial resistance(AMR), and associated variables among pregnant women with ASB Study designThis prospective, hospital-based, cross-sectional study was conducted among 320 pregnant women; divided into two groups, GDM and non-GDM. Data regarding sociodemographic and clinical characteristics were collected using a structured questionnaire. Clean-catch midstream urine samples were investigated for the presence of significant bacterial uropathogens and their AMR pattern was determined using recommended culture methods. ResultsWe found ASB in 46.25% of study participants with significantly higher occurrence in the GDM group. Dominant isolates were Escherichia coli followed by Klebsiella pneumoniae. AMR was noted in 51.35% and multidrug resistance(MDR) in 23.65% of isolates. Overall AMR, MDR and higher degrees of AMR were higher among uropathogens isolated from the GDM group as compared to the non GDM group, although the difference was not statistically significant. ConclusionThe high occurrence of ASB in pregnancy along with substantially high AMR in this study suggests the need for effective infection control and stewardship programmes. By defining the association of ASB and AMR with hyperglycemia, our study calls for the exploitation of this potential association in halting the pandemic of AMR and in improving the management of infectious morbidities, thus in-turn alleviating their undesired maternal and infant outcomes.

A systematic review and meta-analysis on the correlation between HIV infection and multidrug-resistance tuberculosis

BackgroundThe emergence of multidrug-resistant tuberculosis (MDR-TB) in HIV-positive people poses a significant challenge to international efforts to eradicate tuberculosis (TB). Many studies found conflicting results when examining the correlation between HIV and MDR-TB. The purpose of the present investigation was to comprehensively review the literature on the association between HIV infection and MDR-TB in order to evaluate the impact of HIV on MDR-TB worldwide. MethodsUtilizing the databases PubMed, Scopus, Google Scholar, and ScienceDirect, studies published between January 2000 and March 2023 that are eligible for meta-analysis were selected. Using the random-effects model, the aggregated odds ratio of the empirical relationship between HIV and MDR-TB was calculated, along with a confidence interval ranging from 0 to 95 %. Examining the asymmetry of the funnel plot and utilizing Egger's and Begg's test, the possibility of publication bias was investigated. The extent of heterogeneity was determined using the I2 statistics. ResultsThrough a database search, we identified 1214 studies, from which we ultimately selected 15 studies involving 9667 patients. The odds ratio of 2.78 (95 % confidence interval: 1.07–7.20) between HIV/AIDS and MDR-TB indicates a significant positive correlation. Tau 2 = 3.46, chi 2 = 1440.46, df = 14, I2 = 99.0 %, z = 2.10, and p 0.05 indicate that there is substantial heterogeneity among pooled studies. Since I2 is 99 % (>50 %), a random effect model was employed. The percentage of multidrug-resistant HIV-positive patients across all included studies follows a normal distribution, as shown by a Box and whisker plot with a symmetric skewness and a mesokurtic tail and a scatter plot with a significant R2 value below 1 [R2 = 0.2476] showed the positive correlation between multidrug resistance and HIV infection. ConclusionHIV infection increases MDR-TB risk, and the preceding pooled analysis showed an increased risk trend. Thus, MDR-TB, especially in HIV-positive patients, requires early case detection, quality-assured bacteriology diagnosis, and an effective infection control program.

High frequency of carbapenemase in extensively drug-resistant Acinetobacter baumannii isolates in central Iran.

We assessed the frequency of occurrence for infections caused by wild-type A. baumannii, multidrug-resistant (MDR) or XDR A. baumannii, and CRAB. We detected different antibiotic resistance genes in the genomes of infectious A. baumannii strains from central Iran. This study investigated 546 clinical patient samples for the presence of A. baumannii by using conventional culture methods and PCR. Antibiotic resistance profiles, and the phenotypic and genotypic characteristics of various antibiotic genes were analyzed. Out of 546 samples, 87 (15.9%) A. baumannii isolates were obtained using culture and all culture positive samples were also positive by PCR. The most effective antibiotics were polymyxin B (n = 84 strains) (96.6% susceptibility), colistin (n = 81) (93.1%), and ampicillin/sulbactam (n = 18) (20.7%). All clinical A. baumannii isolates were ESBL-positive. The number of CRAB was 84 (96.5%). All CRAB isolates were both MDR and XDR. Of all CRAB isolates, 78 out of 84 (92.4%) produced metallo-β-lactamase (MBL) by phenotypic diagnosis. The most abundant genes were blaPER (32/87; 36.7%), blaTEM (29/87; 33.3%), blaVEB (26/87; 29.8%) for ESBL and Ambler class D β -lactamases included blaOXA-23 (69/84; 82.1%), blaOXA-24 (46/84; 54.7%), MBLs included blaVIM (51/84; 60.7%), and blaIMP (28/84; 33.3%) for carbapenemase. High frequencies of XDR A. baumannii and CRAB (96.5%) were detected in central Iran. Quick and accurate diagnosis, appropriate isolation of patients colonized or infected by CRAB isolates, application of accurate and effective infection control policies and programs, and appropriate preventive measures are deemed helpful in preventing the further spread of these resistant and clinically highly relevant strains.

Genomic insight into the distribution and genetic environment of blaIMP-4 in clinical carbapenem-resistant Klebsiella pneumoniae strains in China

Carbapenem-resistant Klebsiella pneumoniae (CRKP) poses a major threat to public health due to its resistance to almost all antibiotics. It is associated with substantial morbidity and mortality and poses a significant challenge to healthcare systems around the globe. Based on our previous nationwide survey of carbapenem-resistant Enterobacteriaceae (CRE) in China, seven blaIMP-4-carrying CRKP isolates were identified, all exhibiting MDR and epidemiologically linked to four different regions in China. WGS analysis revealed that the seven blaIMP-4 genes were all located on plasmids, of which five blaIMP-4 genes were located on the IncHI5 plasmids and the other two belonged to the IncN and IncFIIK plasmids, respectively. Except for the IncHI5 plasmid, conjugation assays revealed that the IncN and IncFIIK plasmids could be transferred to the recipient strain Escherichia coli J53. This study revealed significant genetic variation and identified numerous resistance factors among blaIMP-4-carrying CRKP strains in China, suggesting that blaIMP-4-carrying CRKP strains evolved via multiple phylogenetic routes and highlighting a need for expanded surveillance and establishment of control measures to prevent dissemination of CRKP strains, and facilitate development of more effective antibiotic stewardship policies and infection control programs.

A spectrum of non-spore-forming fermentative and non-fermentative Gram-negative bacteria: multi-drug resistance, extended-spectrum beta-lactamase, and carbapenemase production

BackgroundIn developing countries, the co-existence of a high burden of infectious diseases caused by Gram-negative bacteria and the rapid increase and spread of multidrug-resistant bacteria have become a serious health threat.ObjectiveProfiling of Gram-negative bacteria and determining the magnitude of their antimicrobial resistance among patients.ResultsA total of 175 non-spore-forming Gram-negative bacteria were isolated from 873 different clinical samples. Of a total of 175 bacteria, 154 (88%) were fermentative Gram-negative bacteria, while 21 (12%) were non-fermentative Gram-negative bacteria. E. coli with a frequency of 58.3% and K. pneumoniae with a frequency of 18.3% were the predominant fermentative Gram-negative bacteria, while P. aeruginosa 9 (5.1%) and A. baumannii 6 (3.4%) were the predominant non-fermentative Gram-negative bacteria. The highest percentage level of antibiotic resistance was seen against ampicillin (86%), and the lowest against meropenem (9.8). About 49 (28%) Gram-negative bacilli were positive for ESBLase. The overall prevalence rate of MDR bacteria was 80.5%, of which 100% of A. baumannii, 90.6% of K. pneumonia. Sixteen isolates were resistant to meropenem, out of which 11 tested for carbapenemase production. Five of the nine were metallo-lactamase producers, with the remaining four being serine carbapenemase producers.ConclusionThe prevalence of Gram-negative bacterial infection was found to be 20%, with a significant proportion (80.0%) due to fermentative Gram-negative bacteria and the remaining 20% due to non-fermentative Gram-negative bacteria. The study has also demonstrated a high prevalence rate of MDR, ESBLase, and carbapenemase-producing Gram-negative bacteria. Antimicrobial resistance of Gram-negative bacteria should be monitored on a regular basis, and an effective infection control program should be implemented.

A comparative study of bacterial contamination between open heart surgery wards and neurosurgery wards

The main source of the infectious agents of the nosocomial infections is the patients and healthcare workers themselves as well as the environment. It is possible to significantly reduce the nosocomial infections through effective infection prevention and control programs. This study aimed by focus light on the importance of following the standard protocols, assist healthcare workers to improve the quality of the care they deliver. Materials and methods: This study took tow surgical departments in the same hospital .The first department was neurosurgery department the second one was the open heart surgery department and compared between the two departments in term of bacterial contamination of the working personnel, the post operative patients and the environment. The bacteria were isolated and identified according to the standard methods. Antibiotic sensitivity testing carried out by Kirby-Bauer disc diffusion method. The result: The bacterial contamination of ICU neurosurgery department air, bed headsed sheets, and floors were as follow; 47 %, 82 %, and 96.7 % respectively; compared to 0% of that of open heart surgery. The bacterial contamination of the OT of neurosurgery air, floors, beds and bed sheets were 83.3%, 95% and 75% respectively compared to 0% for that of open heart surgery. For the nurses in the ICU of neurosurgery all the samples came positive for bacterial culture. While in open heart department bacterial culture came negative for the nurses. About 23% of the patients in neurosurgery department developed postoperative infection compared to 1% of that of open heart surgery. The most common isolated bacteria were Coagulase –ve Staphylococcus. Conclusion: The significant low infection rate in the open heart surgery department compared to the neurosurgery department is a direct reflection to the good managing of the department that make full assurance of complete disinfection and complete compliance with standard precautions to prevent infection.

Assessment and Management of Hospital Acquired Infections in a Tertiary Care Hospital

Abstract: Aim: To assess hospital acquired infections and its management in a tertiary care hospital. Materials and Methods: A cross-sectional study of six months was carried out. Utilizing SPSS Version 25 and Microsoft Office Excel, statistical analysis was carried out, after the collected data were imported into Excel. Results: In our investigation, the prevalence of hospital acquired infections was discovered to be 6.1%. Male patients made up 70% of study’s total participants while female made up 30%. The highest distribution of Hospital Acquired Infections (HAI) was found to be Bloodstream Infection (BSI) (41.80%), followed by Hospital-Acquired Pneumonia (HAP) (17.20%), Respiratory tract infections (RTI) (13.90%) and other HAI. (Hospital Aquired Infections). Most common causative organism was found to be as Klebsiella pneumoniae (15.46%). According to lab investigations, Leukocytosis (61.47%), Neutrophilia (59.83%), Lymphopenia (78.68%), Hyperglycaemia (53.3%) and elevated level of CRP (81.13%) was found in majority patients. Most of the patients were treated with Meropenem (17.55%), Linezolid (15.98%) and others. Conclusion: Hospital acquired infections are a significant risk to medical facilities and one of the most often avoidable negative patient outcomes. They make a major contribution to hospital expenses and mortality rates. The basis of effective infection control programmes in hospitals can be the monitoring of antibiotic resistance in conjunction with tracking physician prescribing patterns. Keywords: Hospital Acquired Infections (HAI), Nosocomial infections, Causative organism, Prevalence.

Coverage and methods of surveillance of healthcare-associated infections in Middle Eastern and North African countries

BackgroundSurveillance of healthcare-associated infections (HAIs) is a cornerstone for effective infection prevention and control (IPC) programs. The objective was to evaluate the coverage and methods of HAI surveillance in Middle Eastern and North African (MENA) countries. MethodsA cross-sectional study targeted IPC staff working in MENA countries using the Infection Control Network electronic database of the Arab countries. The study focused on self-reported surveillance-related characteristics of IPC staff, facilities, and the IPC program. ResultsA total of 269 IPC staff were included. They were mainly females (68%), nurses (63%), and working in GCC countries (83%). Approximately 69% of covered facilities had surveillance activities. Hand hygiene, multidrug-resistant organisms, central line-associated bloodstream infections, and catheter-associated urinary tract infections were the most common surveillance activities (>90%). The surveillance workload consumed 27% of the average weekly working time. The scores of performing multiple surveillance, with appropriate methods and tools, were 83%, 67%, and 61% (respectively). Appropriate surveillance methods and/or tools were linked to GCC region, CBIC qualifications, surveillance training, specific setting (acute care and long term), staff-to-bed ratio, presence and active function of IPC committee, presence of IPC annual plan, communications with health care workers, and leadership support. ConclusionsWhile most health care facilities in the MENA region perform multiple surveillance, surveillance methods and tools are still suboptimal and their optimization should be a priority.

Assessing Infection Control Knowledge and Compliance of Cardiovascular Perfusionists in Theatre at a Private Hospital in Kwazulu-Natal, South Africa

Infections acquired in a hospital (HAI) often referred to as nosocomial infections are related with increasing morbidity and death among patients that are hospitalised and are predisposed to an elevated risk of infection by health workers (HCWs). The need to maintain an effective infection prevention and control program is therefore essential for quality health care. This study sought to assess the knowledge and compliance of infection control practices of Cardiovascular Perfusionists in theatre at a private healthcare facility in KwaZulu-Natal (KZN) in the city of Durban. We conducted a qualitative study based on in-depth interviews with 12 Cardiovascular Perfusionists (CP) who were purposively selected from private sector. The interviews lasted between 20 to 25 minutes and were transcribed, and then thematic analysis were applied using NVivo. The study found that there is a need for Clinical Technologist specialising in Cardiovascular Perfusion to undergo training in infection control and prevention practices at the higher education and training level. Subsequently, the study reveals that Cardiovascular Perfusionists have a good overall understanding of pathogens and the implications thereof. The study also notes that there is considerable compliance to infection control practices in theatre irrespective of the knowledge pertaining to infection control and prevention policies. We concluded that there is an overall good knowledge and understanding regarding infection control practices, although many felt that there exists an inequitable application of infection control policies due to professional biases.

Assessment of Infection Control Practices in Bolan Medical Complex and Sandeman Provincial Hospital of Quetta, Balochistan, Pakistan

Pakistan has a double burden of disease, with more than 40% of the population suffering from infectious diseases. Therefore, in order to lower the risk of dangerous, avoidable infections among patients and healthcare staff, effective hospital infection control programmes are crucial from both an economic and a therapeutic standpoint. The goal of the study was to locate any gaps in current infection control and preventive procedures. The two teaching hospitals Bolan Medical Complex and Sandeman Provincial Hospital in Quetta were the sites of this cross-sectional investigation. In the SAMPLE, 161 people participated. The Statistical Package for Social Sciences (SPSS) version 16.0 was used to analyse the data, which was gathered via data sheets and questionnaires. The findings revealed that the Infection Control Committee (ICC) member's view of health-associated infections (HAIs) was ultimately determined to be inconsequential (P=0.6), and their perception that the staff education level may be a contributing factor was also shown to be unimportant (P=0.1). The operation theatre, labour room, lab and blood bank, OPD, and wards at BMC were evaluated in reference to the steps taken there for infection control and prevention, and the results were observed 30, 25, 15, 14, and 15 accordingly. It was shown that the primary reason for the poor results was the negative perception of the ICC towards infection control and prevention. Therefore, it is necessary to alter how ICC is seen.

Implementation of hand hygiene in health-care facilities: results from the WHO Hand Hygiene Self-Assessment Framework global survey 2019

SummaryBackgroundHand hygiene is at the core of effective infection prevention and control (IPC) programmes. 10 years after the development of the WHO Multimodal Hand Hygiene Improvement Strategy, we aimed to ascertain the level of hand hygiene implementation and its drivers in health-care facilities through a global WHO survey.MethodsFrom Jan 16 to Dec 31, 2019, IPC professionals were invited through email and campaigns to complete the online Hand Hygiene Self-Assessment Framework (HHSAF). A geospatial clustering algorithm selected unique health-care facilities responses and post-stratification weighting was applied to improve representativeness. Weighted median HHSAF scores and IQR were reported. Drivers of the HHSAF score were determined through a generalised estimation equation.Findings3206 unique responses from 90 countries (46% WHO Member States) were included. The HHSAF score indicated an intermediate hand hygiene implementation level (350 points, IQR 248–430), which was positively associated with country income level and health-care facility funding structure. System Change had the highest score (85 points, IQR 55–100), whereby alcohol-based hand rub at the point of care has become standard practice in many health-care facilities, especially in high-income countries. Institutional Safety Climate had the lowest score (55 points, IQR 35–75). From 2015 to 2019, the median HHSAF score in health-care facilities participating in both HHSAF surveys (n=190) stagnated.InterpretationMost health-care facilities had an intermediate level of hand hygiene implementation or higher, for which health-care facility funding and country income level were important drivers. Availability of resources, leadership, and organisational support are key elements to further improve quality of care and provide access to safe care for all.FundingWHO, Geneva University Hospitals and Faculty of Medicine, and WHO Collaborating Center on Patient Safety, Geneva, Switzerland.

Three-year evaluation of the nosocomial infections in pediatrics: bacterial and fungal profile and antimicrobial resistance pattern

BackgroundNosocomial infections (NIs) could lead to considerably higher mortality rates, length of the hospital stays and costs, and represent a serious public health concern worldwide. Besides, the unreasonable use of antibiotics could lead to get resistant to different antibiotics and create limited therapeutic options, increased risks of treatment failure and poor patient management. The current study aimed to evaluate the prevalence and antimicrobial susceptibility of NIs in an Iranian referral pediatrics hospital during 3 years.MethodsDuring the 3-year period, all electronic medical records of nosocomial infection episodes in hospitalized patients were retrospectively reviewed. The bacterial and fungal profile and antimicrobial susceptibility profiles of isolates recovered from different samples of patients with NIs were determined.ResultsIn this study, a total of 718 patients with NIs was found, among which 61.3% were male (N = 440). The median age of the patients was 2.5 years (IQR: 1 month to 3 years). Klebsiella pneumonia and Candida spp. isolates were the most prevalent microorganisms (N = 125, 17.4%, N = 121, 16.9%, respectively), followed by Pseudomonas aeruginosa (N = 72, 10%) and Coagulase-negative Staphylococci (CoNS) (N = 69, 9.6%). Pseudomonas aeroginusa strains showed high sensitivity to the studied antibiotics. Acinetobacter baumannii strains displayed more than 90% resistance to the almost all antibiotics. All of the tested isolates of S. maltophilia were susceptible to Trimethoprim−sulfamethoxazole (100%) and showed high susceptibility rate to ciprofloxacin (96.4%). Vancomycin resistance was not reported in S. aureus isolates, while 64% of Enterococcus spp. was resistant to vancomycin. The rates of methicillin resistance for S. aureus and CoNS isolates were 45.5% and 85.7%, respectively.ConclusionsHigh frequency of antimicrobial resistance to the commonly tested antibiotics is a concerning alarm. Therefore, effective infection control programs and rational antibiotic use policies should be established promptly.

Ventilator Associated Pneumonia in an Intensive Care Unit

The aim of this prospective study was to evaluate the incidence, etiologic agents and mortality rate of ventilator-associated pneumonia (VAP). In a six-month period, cases who were 18 years or older, dependent on mechanical ventilator for more than 3 days and without pulmonary infection on first admission were included in this study. In all cases, body temperature recordings, blood and urine culture, microbiological analyses of endotracheal aspirates, and chest X-rays were obtained and used to identify VAP. Apache II scores on admission, duration of mechanical ventilation, length of intensive care unit (ICU) stay and mortality were recorded. This study included 45 cases and 22 developed VAP (48%). The incidence of VAP was 25.34 per 1000 ventilator days. Univariate analyses showed that duration of mechanical ventilation, length of ICU stay, coma and tracheotomy were associated with the development of VAP. The mortality rate of cases with VAP (72.7%) was significantly higher than cases without VAP (39.1%). The most frequent microorganisms were Acinetobacter spp., Pseudomonas aeruginosa and Klebsiella pneumoniae. In our study, VAP was a very common and important complication of mechanical ventilation and mortality was very high. To reduce mortality, minimize morbidity, shorten the length of stay, and reduce costs, defined risk factors for VAP should be recognized and an effective infection control program for the prevention of VAP should be implemented. Surveillance results should be evaluated regularly and necessary precautions should be taken.

INFECTION CONTROL: STANDARD PRECAUTION MEASURES KNOWLEDGE, ATTITUDE AND PRACTICE OF MEDICAL DOCTORS AND NURSES IN SUDAN

Background and objectives: The emergence of life-threatening infections has highlighted the need for effective infection control programs in all health care settings. These programs are used to support hospitals in reducing the risk of healthcare-associated infection or nosocomial infection, and this study describes the knowledge, attitude, and practice (KAP) of standard infection control precautions among Health Care Workers in 3 teaching hospitals in Sudan. Methods: A cross-sectional study was conducted between March and August 2018 among healthcare workers in 3 teaching hospitals: Omdurman Teaching Hospital, Khartoum Bahri Teaching Hospital and Khartoum Teaching Hospital in Sudan. Data for 254 nurses and 283 working physicians were collected via a self-structured questionnaire to assess the KAP core components of standard precautions. The percentage of professional knowledge and practice scores was calculated and occupational differences in the average professional knowledge and practice scores were ascertained. Result: A total of 429 out of 537 participating healthcare workers completed the questionnaire with a response rate of (79.9%), of whom (52.9%) were physicians and (47.1%) were nurses. (39.6%) of doctors and (53.5%) of nurses have a good level of knowledge, about (96%) of doctors and (97%) of nurses wash their hands after handling any bodily fluids, and this indicates that nearly And the doctors have a similar level of practice as well as a positive attitude. (91.1%) of doctors and (85.6%) of nurses think that they can be the source of transmission. Conclusion: Based on the findings of our study, the majority of nurses had good knowledge compared to fair knowledge physicians, with positive attitudes and practices of both physicians and nurses towards the infection control program. Policies that promote training of health care workers in standard precautions and ensure that infection control and prevention resources in health facilities are regularly provided are required in Sudan. Peer Review History: Received: 7 September 2021; Revised: 9 October; Accepted: 28 October, Available online: 15 November 2021 Academic Editor: Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 6.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Prof. Dr. Hassan A.H. Al-Shamahy, Sana'a University, Yemen, shmahe@yemen.net.ye Dr. Bilge Ahsen KARA, Ankara Gazi Mustafa Kemal Hospital, Turkey, ahsndkyc@gmail.com Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com Similar Articles: SURVEY OF SAFETY PRACTICES IN DIARRHEAL TREATMENT CENTERS: CHOLERA TREATMENT CENTERS IN YEMEN PREVALENCE OF CYTOMEGALOVIRUS IGG ANTIBODIES, POTENTIAL RISK FACTORS AND AWARENESS OF CONGENITAL CYTOMEGALOVIRUS AMONG FEMALE DOCTORS

Effect of infection control training course on knowledge and practices of medical interns in a large academic hospital in Egypt: an intervention study.

Health care-associated infections are reported among the top causes of hospital deaths worldwide. Their prevention is a first priority for patient safety in acute care hospitals. Education and training is recommended as a core component for effective infection prevention and control programs. This study aimed to assess the effect of an infection control training course on the knowledge and practices of medical interns in a large academic hospital in Egypt. The study included 268 medical interns who were getting their practical training at Tanta University Hospitals, Egypt during the study period. Knowledge and practices regarding infection control measures were assessed using a predesigned questionnaire sheet and an observational checklist before and after intervention by infection control training course based on Egyptian national guide for infection control. The data have been analyzed through the application of descriptive frequency, percentages, mean of scores, and the inferential analysis that includes paired t test and Monte Carlo test. The level of statistical significance was adopted at p≤0.05. There was a statistically significant (p < 0.0001) increase in total knowledge score (65.4±13.9 versus 80.2 ±13.2) and total practices score (65±11.3 versus 108±7.9) of infection control measures among studied participants before intervention compared with after intervention. A significant strong positive correlation was detected (r= 0.8, p= 0.0001) between total knowledge and practice scores after intervention by training course. There is a strong positive correlation between knowledge and practices so intervention by infection control training course using teaching multimedia and role play significantly improves the knowledge and practice levels of the studied medical interns.