Hospital Environment Research Articles

Sources and Transmission Routes of Carbapenem-Resistant Pseudomonas aeruginosa: Study Design and Methodology of the SAMPAN Study

Background/Objectives: The global spread of carbapenem-resistant Pseudomonas aeruginosa (CRPA) warrants collaborative action. Guidance should come from integrated One Health surveillance; however, a surveillance strategy is currently unavailable due to insufficient knowledge on the sources and transmission routes of CRPA. The aim of the SAMPAN study (“A Smart Surveillance Strategy for Carbapenem-resistant Pseudomonas aeruginosa”) is to develop a globally applicable surveillance strategy. Methods: First, an international cross-sectional study will be conducted to investigate CRPA in clinical and environmental settings in Rotterdam (The Netherlands), Rome (Italy), and Jakarta (Indonesia). Screening cultures and risk factor questionnaires will be taken from healthy individuals and patients upon hospital admission. Clinical CRPA isolates will also be included. Additionally, samples will be taken twice from wet hospital environments and monthly from the hospitals’ (drinking) water system, hospital and municipal wastewater treatment plants, and receiving rivers. Whole-genome sequencing will be performed to characterize CRPA isolates and determine the genetic relatedness among the isolates from different reservoirs. Findings from the cross-sectional study, combined with expert elicitation using a Delphi method, will serve as the input for the surveillance strategy. Conclusions: The SAMPAN study will provide a broader understanding of the sources and transmission routes of CRPA. Therewith, the development of a globally applicable smart surveillance strategy will be made possible, delivering information that is needed to guide actions against the spread of CRPA.

Asymptomatic carriage and molecular characterization of Staphylococcus aureus in pre-clinical and clinical medical students.

Medical students are exposed to the hospital environment and patients during their studies, increasing the risk of exposure to virulent and antibiotic-resistant isolates of Staphylococcus aureus. The aim of the study is to determine the prevalence of Staphylococcus aureus among medical students who have varying levels of exposure to the hospital environment to provide valuable insights into the risk of colonization and transmission. Nasal swabs and fingerprints were obtained and cultured on a selective medium for staphylococci. The obtained isolates were confirmed as methicillin-sensitive S. aureus (MSSA) or methicillin-resistant (MRSA) using PCR. Antibiotic resistance, the presence of virulence genes including enterotoxin encoding genes, and spa typing were performed. Among pre-clinical students, MSSA was detected on the nose in 45.2% and on the fingerprints in 10.6% of the participants. Among clinical students, MSSA was detected on the nose in 42.0% and on the fingerprints in 25.4%. Only one MRSA isolate was obtained. Genes seg and sei were the most frequently detected in both student groups, with their presence in over 40% of isolates among clinical students. The eta and etb genes were mainly detected from the nose in both student groups. In pre-clinical students, S. aureus carrying eta gene occurred in 6.4% and etb in 8.5%. In clinical students, the occurrence was 5.1% for eta and 8.5% for etb. The tst gene was identified only in the nose and fingerprints of the clinical student group. The most frequently observed resistance was to clindamycin and erythromycin. In total 58 different spa types were identified. High rates of asymptomatic MSSA carriage were observed in both groups of medical students. Detected MSSA strains showed a high degree of genetic variability, with a number of them carrying the virulence and antibiotic resistance genes. Although students do not exhibit increased risk to their patient's, increased hygiene is required in asymptomatic carriage personnel. The overall prevalence of MRSA was low, with a minimal risk of spread.

Perceptions of Clinical Connectedness Among Hospital Environmental Service Workers.

Environmental service workers (ESWs) have a critical role within the hospital infrastructure and are at the frontline of infection prevention. ESWs are highly trained in managing all forms of regulated waste, which includes biohazardous waste, and are responsible for the overall patient experience, janitorial work, and infection prevention. Without environmental services, patients have a 6 times greater risk of being infected by pathogens from patients who previously occupied their room. To understand how ESWs felt proud, connected, and not connected to their hospital-based clinical teams. This qualitative study included 10 ESWs who were members of clinical care teams at a medical university hospital in upstate New York. Data were collected from February to May 2024. Participants were asked to take pictures and write vignettes about what makes them feel proud of their work, how they feel connected to their clinical team, and how they feel disconnected from their clinical team. This study included 10 participants (5 males [50%]; 10 non-Hispanic Black or African American individuals [100%]; mean [range] age, 53 [38-66] years; 8 were high school graduates or had some college credit [80%]). When asked about their feeling of pride, participants expressed maintaining a clean space, having meaningful relationships, and helping others as generating a sense of pride. Participants' feelings of disconnectedness were felt by their colleagues not following the rules set in place. In addition, participants reported feeling invisible, not listened to, unappreciated, and undervalued. Participants felt connected to their clinical teams by feeling a sense of community, having valuable relationships, and being able to communicate with members of the clinical team. Additionally, participants expressed a collective desire to be acknowledged, recognized, and treated as equals on the clinical team. The study found that ESWs identified feeling both connected to and disconnected from their clinical teams. Based on these results, hospital infrastructure and leadership should continue to exhaust all efforts to explore work experiences of ESWs to improve job retention, morale, satisfaction, overall clinical teamwork, and comradery.

Serratia Infections in Burn Care.

Serratia marcescens is an opportunistic nosocomial pathogen with significant implications for burn care due to its multidrug resistance, virulence, and ability to colonize hospital environments. This retrospective study, conducted at an American Burn Association Verified Burn Centre, reviewed 22 cases of S. marcescens infections from 2015 to 2020. Patients exhibited a mean total body surface area (TBSA) burned of 28% (range: 2-71%), with 68% sustaining burns >20% TBSA and 40.9% presenting with inhalation injuries. The pathogen was most commonly isolated from sputum (36%) and burn wound tissue (50%), with a mean time to positive culture of 8.7 days. Early-onset infections were associated with increased mortality, particularly in patients with major burns, as five out of seven such individuals succumbed to infection. The overall mortality rate was 23%, despite timely antibiotic administration. Targeted topical antimicrobials, such as Dakin's solution, nanocrystalline silver, and polyhexamethylene biguanide (PHMB), offer potential benefits but lack robust evidence for optimal use. Stronger clinical data are needed to guide their application and improve outcomes. These findings underscore the need for enhanced surveillance, refined treatment strategies, and research into S. marcescens management in burn care.

INVESTIGATION OF DNA GYRASE RESISTANCE GENES IN ACINETOBACTER BAUMANNII ISOLATES

Objective: It is known that bacteria resistant to antimicrobial agents can spread to the community in the hospital environment. Acinetobacter baumannii is a difficult-to-treat pathogen due to its antibiotic resistance genes. It is resistant to many antibiotics, including fluoroquinolones. By identifying mutations in DNA gyrase and topoisomerase IV genes, quinolone resistance of A. baumanni is found. Our study, aimed to determine mutations in DNA gyrase resistance genes that cause quinolone resistance (gyrA, gyrB, parC) in A. baumannii isolates using the real-time PCR method. Material and Method: 73 A. baumannii resistant clinical isolates were used in the study. A. baumannii was amplified using primers for gyrA, parC, gyrB genes. Using HRM analysis, gyrA, gyrB, parC gene Real-Time PCR amplicons were grouped according to their DNA sequences. A. baumannii isolates were grouped as P1, P2, P3, GA1, GA2, GA3, GB1 and GB2 according to different HRM profiles, DNA sequence analysis of 2 different Real-Time PCR products from each group was performed. Result and Discussion: Mutations were detected in GA1, GA2, GA3 genotypes. No mutations were observed in the P1, P2, P3 and, GB1, GB2 genotypes.

Epidemiological Analysis of a K. pneumoniae NDM Outbreak in a Temporary Ward for Patients with Primary COVID-19 Infection

The COVID-19 pandemic made the medical community realize how large a problem it would face. The epidemiological situation forced the opening of additional wards, the so-called “COVID wards”, where an increase in the rate of coexisting bacterial infections was observed. We report a hospital outbreak due to New Delhi carbapenemases producing K. pneumoniae clones. Twenty-eight K. pneumoniae strains were analyzed from patients with primary COVID-19 infection. The drug susceptibility of the strains was determined by the diffusion–circulation method and E-test. Phenotypic and PCR methods confirmed the production of carbapenemases. The phylogenetic similarity of the obtained strains was examined using pulsed-field electrophoresis. Most strains were isolated from bronchoalveolar lavage. All isolates obtained were resistant to β-lactams and fluoroquinolones. All strains produced New Delhi carbapenemases and were classified into two genetic clusters, A and B. Eight risk factors for secondary bacterial infection were analyzed. Following an intervention involving hand hygiene, strict contact prevention, and cleaning of the hospital environment and medical devices, this outbreak was successfully brought under control.

Comparative study of phenotypic and genotypic expression of virulence factors in colonizing and pathogenic carbapenem resistant Acinetobacter baumannii (CRAB)

Carbapenem resistant Acinetobacter baumannii has evolved as the most troublesome microorganism with multiple virulence factors. Biofilm formation, porins, micronutrient capturing mechanism and quorum sensing, provide protection against desiccation, host-pathogen killing and enhance its persistence. The conservation of these factors between colonizing and pathogenic carbapenem resistant A. baumannii has been barely investigated. We studied biofilm formation, desiccation survival, motility and hemolysis in pathogenic carbapenem resistant A. baumannii and colonizer carbapenem resistant A. baumannii from the hospital environment. The virulent genes pgaA, csuE, bap, ompA, abaI, pilA and bauA were detected by simplex-PCR and Quantitative Real-Time PCR was done for expressional studies. In-vivo survival percentage was studied by Galleria mellonella (wax moth) killing assay. Phenotypic characterization revealed that the biofilm formation and desiccation survival proportion was significantly higher in colonizer carbapenem resistant A. baumannii (p < 0.05). Twitching motility was found comparable (mean 0.5 to 1.5 cm). Surface associated motility varied widely. None showed hemolysis. The csuE, bap, ompA, abaI, pilA and bauA genes were detected in almost all the pathogenic and colonizer carbapenem resistant A. baumannii isolates while none harboured pgaA gene. The expression of bap, ompA and bauA gene was found significantly higher in pathogenic carbapenem resistant A. baumannii while expression of csuE and abaI gene was comparable in both. Overexpression of pilA gene was seen in those with higher surface associated motility. Pathogenic carbapenem resistant A. baumannii showed significantly higher pathogenicity in-vivo, as 100% of larvae died on 4th day post-infection. In conclusion high level expression of outer membrane proteins (ompA) and siderophores is significantly associated with the pathogenicity in carbapenem resistant A. baumannii isolated from infections, which can be a differentiating point from the colonizers.Clinical TrialNot Applicable

Staphylococcus aureus: dynamics of pathogenicity and antimicrobial-resistance in hospital and community environments - comprehensive overview.

This study reviews Staphylococcus aureus, a significant pathogen in both hospital and community-acquired infections, addressing its epidemiology, pathogenesis, and antimicrobial resistance. It highlights virulence mechanisms, such as adhesion factors, toxins, enzymes, and biofilms, which contribute to survival and immune evasion. The spread of resistance occurs through the transfer of mobile genetic elements like SCCmec and genetic mutations. The analysis also compares hospital and community strains, including multidrug-resistant lineages like MRSA, VISA, and VRSA. The study concludes that S. aureus presents a major public health challenge, requiring new therapeutic approaches and preventive strategies.

Midwives perspectives of barriers and facilitators for the practice of promoting women's positive childbirth experience in China: A qualitative study.

Women-centered care for positive childbirth experiences is currently a global trend. However, there are some barriers to promoting women's positive childbirth experiences in practice. This study explored midwives' perspectives on the barriers and facilitators to promoting women's positive childbirth experience in practice. Qualitative semi-structured interviews were undertaken with 18 midwives in the birth unit of four tertiary care hospitals in Hefei, Anhui Province, China. Thematic analysis was used to code the interviews with deductive codes, and we organized findings according to levels of influence within the Dahlgren and Whitehead rainbow model, a socioecological model of health. Midwives reported barriers to women's positive childbirth experience were identified on four levels: individual factors included psychological barriers and childbirth expectations (micro level), social and community and organization factors included interpersonal violence, medical mistrust and obstetric violence and outcome (meso level), healthcare system factors included midwife shortage and hospital environment (macro level). Facilitators for a positive birth experience include antenatal education, community continuum of care, and respectful and understanding care. This study indicated that midwives experienced several barriers and facilitators in providing positive childbirth experience care to women in the Chinese context. The findings will help maternity care providers and policymakers develop multi-level implementation strategies at the individual, social, community, organization, and healthcare system levels.

Exploring the radiation shielding efficiency of low-impact Portland cement pastes made with barium sulfate, silica fume and fly ash&lt;i&gt;&lt;/i&gt;

The scope of this work is the development of new composites with low environmental impact to act as radiological shielding in hospital environments. For this purpose, the radioprotection properties of cement pastes containing 20% ​​BaSO4, in addition to 10% fly ash and silica fume as SCM’s were investigated. The samples were characterized by consistency, apparent density and mechanical strength at 7 and 28 days of age. In addition, transmission measurements were performed for different sample thicknesses using a photon beam from a linear accelerator operating at 6 and 10 MV in a radiotherapy room. The barium pastes showed a reduction in sample thickness of approximately 10% compared to the reference paste (without barium) at the highest voltage analyzed to attenuate 90% of the incident radiation (according to current legislation). Among the SCM’s, silica fume stood out as the most suitable substitute when combined with barium in Portland cement matrices. Finally, the apparent density of the samples appears to be decisive for the performance of new materials in terms of radiological shielding.

Emerging Threats: Antimicrobial Resistance in Extended-Spectrum Beta-Lactamase and Carbapenem-Resistant Escherichia coli.

Antimicrobial resistance (AMR) in Escherichia coli strains, particularly those producing Extended-Spectrum Beta-Lactamase (ESBL) and Carbapenemase (CR-Ec), represents a serious global health threat. These resistant strains have been associated with increased morbidity, mortality, and healthcare costs, as they limit the effectiveness of standard antibiotic therapies. The prevalence of ESBL- and CR-Ec-producing strains continues to rise, driven by the overuse and misuse of antibiotics in healthcare and agricultural settings, and facilitated by global interconnectedness through international travel, trade, and food distribution. This review article examines the molecular mechanisms behind ESBL and CR resistance, focusing on the key genes involved in these processes, such as blaCTX-M, blaKPC, and blaNDM, and the clinical challenges posed by these strains. Additionally, the public health impact, including the spread of infections in hospital and community environments, is highlighted. The discussion emphasizes the urgent need for improved diagnostic tools, robust surveillance systems, and innovative therapeutic strategies. Emerging treatments, including phage therapy and novel antibiotic combinations, show promise in addressing these challenges and offer potential breakthroughs in combating resistant strains. Lastly, the review calls for stronger antimicrobial stewardship and policy reforms to mitigate the spread of resistant E. coli strains and protect global public health. Effective intervention at multiple levels, from diagnostics to policy, is critical to controlling the threat posed by AMR.

Intervention Programmes for First-Episode Psychosis: A Scoping Review

The aim of this scoping review was to map intervention programmes for first-episode psychosis by identifying their characteristics, participants, and specific contexts of implementation. It seems reasonable to suggest that early intervention may be beneficial in improving recovery outcomes and reducing the duration of untreated psychosis (DUP). Despite the expansion of these programmes, there are still some significant variations and barriers to access that need to be addressed. In line with the Joanna Briggs Institute (JBI) methodology and the Participants, Concept, and Context (PCC) framework, this review encompasses studies focusing on individuals grappling with early-stage psychosis and their caregivers across a range of settings, including hospital and community environments. The review identified 47 studies from 2002 to 2023, which revealed a great deal of diversity in programme characteristics and implementation contexts. This reflects a global perspective. The results showed that there is a great deal of variety in the characteristics of the programmes, with interventions ranging from single-component strategies, such as cognitive–behavioural therapy (CBT) and cognitive remediation therapy (CRT), to multicomponent programmes that integrate a number of different approaches, including psychosocial, pharmacological, and family-focused strategies. The objectives included attempts to improve cognitive functioning; enhance coping skills; reduce caregiver burden; and address symptoms such as anxiety, depression, and hallucinations. It is notable that there was considerable variation in the frequency, duration, and follow-up periods of the interventions, with some lasting just three sessions over one month and others spanning five years and 48 sessions. The majority of the programmes were delivered in community or outpatient settings, although there were also examples of hospital- and home-based interventions. These findings highlight the value of early interventions and provide a useful resource for adapting programmes to different social and cultural contexts. It would be beneficial for future research to explore how these interventions can be tailored to diverse settings.

Molecular and genetic analysis of methicillin-resistant Staphylococcus aureus (MRSA) in a tertiary care hospital in Saudi Arabia.

Methicillin-resistant Staphylococcus aureus (MRSA) continues to pose significant challenges in healthcare settings due to its multi-drug resistance (MDR) and virulence. This retrospective study examines the molecular and resistance profiles of MRSA isolates from a tertiary care hospital in Saudi Arabia, providing valuable insights into regional epidemiology. A total of 190 MRSA strains were analysed to assess antimicrobial susceptibility, genetic diversity, and virulence factors. Antimicrobial susceptibility testing was conducted according to CLSI guidelines, while molecular characterization involved spa typing, SCCmec typing, and DNA microarray analysis to determine clonal complexes (CCs), resistance genes, and virulence determinants. The isolates showed extensive resistance to beta-lactam antibiotics, with 78% classified as MDR. Notably, resistance to fusidic acid and ciprofloxacin was detected in 70% and 55% of isolates, respectively. The most prevalent clonal complexes-CC5, CC6, and CC22-comprised over 60% of the isolates and exhibited diverse spa types. The Panton-Valentine leukocidin (PVL) gene, linked to heightened virulence, was identified in approximately 20% of isolates, particularly within CC5, CC30, and CC80. Enterotoxin genes (sea and seb) and immune evasion genes (sak, chp, and scn) were also commonly detected, reflecting the isolates' capacity to adapt and persist within the hospital environment. These findings underscore the high burden of MDR MRSA with considerable genetic diversity and virulence potential. The study highlights the urgent need for strengthened molecular surveillance and targeted infection control measures to limit MRSA transmission and effectively manage infection risks in healthcare facilities.

Genomic Analysis of Virulent, Multidrug Resistant Klebsiella pneumoniae and Klebsiella oxytoca from Bloodstream Infections, South Africa.

A total of 46 suspected Klebsiella species (spp.) were collected from blood cultures within the uMgungundlovu District in the KwaZulu-Natal Province. Antibiotic susceptibility was determined against a panel of 19 antibiotics using the disk diffusion test. A subset of 14 MDR K. pneumoniae (n=10) and K. oxytoca (n=4) isolates were selected based on their antibiograms and subjected to whole genome sequencing (WGS). The sequence types (STs), resistome, virulome, mobilome, capsule loci (KLs) were analysed using relevant WGS and bioinformatics tools. Of the 10 K. pneumoniae sequence types (ST) identified, the most common were ST25 (n=3), ST101 (n=3), and 4 K. oxytoca belonged to ST450 (n=3). The two high-risk K. pneumoniae clones ST15, and ST17 were identified. O and K capsule types were identified, with predominance of KL2, KL17, KL29, O1/O2v2, O1/O2v1, and OL104 respectively. The majority of isolates displayed multidrug resistance predominantly carrying β-lactamase genes, including blaCTX-M-15, blaTEM-1B, blaSHV, and blaOXA-1, and blaOXY including the carbapenemase blaOXA-181 in two (14.3%) study isolates. Other resistance genes included: aac(6')-lb-cr, aac(3), aac, aph, aad, dfr, tet(A), and tet(D), mph(A), sul1, sul2, oqx, qnr, acrR, ramR, parC, gyrA, arr-3, cat, fosA, qacE genes conferring resistance to aminoglycosides, trimethoprim, tetracycline, macrolide, sulfonamides, fluoroquinolones, rifampicin phenicols, fosfomycin, and quaternary ammonium compound disinfectant. Virulence factors related to hypervirulence: encoding aerobactin (iuc, iutA), salmochelin (iro), yersiniabactin (ybt), enterobactin (ent), type 1 and 3 (mrk and fim), and capsule synthesis (rcsA and rcsB) were identified. IncF, IncR, and Col plasmid replicon types and class I integrons were detected, with IncFIB(K) predominance. The blaCTX-M-15 and blaTEM-1 genes were bracketed by Tn3 transposons, ISEc9, recombinase and IS91 insertion sequences. The convergence of multidrug resistance and hypervirulence genes in Klebsiella strains is a potential clinical concern. Carbapenemase, ESBL screening and genomic surveillance are urgently required in hospital environments.

Identification and Characterization of Acanthamoeba from Contact Lens Care Solutions and Hospital Environments in the Ophthalmology Wards and Operating Rooms in Southeastern Iran.

Different Acanthamoeba species are among the most ubiquitous organisms causing serious diseases in humans including central nervous system (CNS) and eye infections. Contact lenses, lens care solutions and the hospital environments particularly the indoor and outdoor environments of ophthalmology wards where people are present with different types of eye diseases, are the potential sources of human infection. The purpose of the present study was the molecular investigation of free-living amoebae in the used contact lenses, lens care solutions and hospital samples from the ophthalmology wards and operating rooms in a referral hospital in southeastern Iran. Samples were collected from the lens care solutions, used contact lenses, and from indoor and outdoor environments of the ophthalmology ward and operating room of a major referral hospital in Kerman, Southeastern Iran. The samples were cultured on non-nutrient agar (NNA) in 28-30oC and microscopically studied. Molecular study including PCR-sequencing and phylogenetic analysis on partial 18S rDNA were performed on positive culture samples. In total 70 samples were collected from the used contact lenses and lens care solutions, as well as the hospital environment of which 11.4% (8 out of 70) were found positive using NNA culture. Two out of 40 samples (5.0%) from the used contact lenses and the care solutions were found positive for the presence of Acanthamoeba T4 genotype. Acanthamoeba cysts were identified in two out of 22 dust samples (9.1%) collected from the ophthalmology ward and operating rooms. Protacanthamoeba bohemica was found in the soil samples from outdoor environment of the ophthalmology ward. This study identified Acanthamoeba species in contact lenses and in indoor environmental samples from the ophthalmology ward. T4 genotype was found on the contact lenses examined in this study. In the dust sampled from within the ophthalmology ward Acanthamoeba sp. was identified.

Evaluation of Antibacterial Activity in Some Algerian Essential Oils and Selection of Thymus vulgaris as a Potential Biofilm and Quorum Sensing Inhibitor Against Pseudomonas aeruginosa.

Biofilm formation and virulence factor production by Pseudomonas aeruginosa are identified as the main mechanisms of its antibiotic resistance and pathogenicity. In this context, the study of the chemical composition of three Algerian essential oils (EOs) and the screening of their antibacterial, anti-biofilm and virulence factor inhibitory activities enabled us to select the Thyme EO as the best oil to control the P. aeruginosa strain isolated from hospital environments. This EO composed essentially of thymol (55.82%) associated with carvacrol, had an anti-adhesive activity of 69.8% at a concentration of 5µL/mL, and a biofilm eradication activity of 74.86% at a concentration of 2.5µL/mL. This EO was able to inhibit P. aeruginosa twitching motility by 100% at a concentration of 2.5µL/mL. Pyocyanin was inhibited by 99.33%, at a concentration of 1.25µL/mL. Rhamnolipids were significantly inhibited by 63.33% in the presence of Thyme EO at a concentration of 1.25µL/mL after 24h of incubation. Molecular docking showed that carvacrol and thymol can bind to the three QS receptors in P. aeruginosa, RhlR, LasR, and PqsR, with good affinities, which can inhibit or modulate biofilm formation and the production of certain virulence factors. Keywords antibiofilm, thymol, essential oil, Pseudomonas aeruginosa, pyocyanin, rhamnolipids, in silico study.

Diversification of bla OXA-48-harbouring plasmids among carbapenemase-producing Enterobacterales, 11 years after a large outbreak in a general hospital in the Netherlands.

Introduction. Genes encoding OXA-48-like carbapenem-hydrolyzing enzymes are often located on plasmids and are abundant among carbapenemase-producing Enterobacterales (CPE) worldwide. After a large bla OXA-48 plasmid-mediated outbreak in 2011, routine screening of patients at risk of CPE carriage on admission and every 7 days during hospitalization was implemented in a large hospital in the Netherlands. The objective of this study was to investigate the dynamics of the hospitals' 2011 outbreak-associated bla OXA-48 plasmid among CPE collected from 2011 to 2021.Methods. A selection of 86 bla OXA-48-carrying CPE isolates was made from 374 isolates collected over an 11-year study period. Species included Escherichia coli (Eco), Klebsiella pneumoniae (Kpn), Enterobacter cloacae complex (Ecl), Citrobacter freundii (Cfr), Citrobacter koseri (Cko) and Morganella morgani (Mmo). Short-read sequencing was combined with long-read sequencing for all isolates to reconstruct bla OXA-48-like plasmids and chromosomes of CPE. MASH, MOBsuite, ResFinder, PlasmidFinder and SNP analyses were performed to study diversity. pOXA-48 plasmids were compared to plasmid sequences that were sequenced for the Dutch CPE surveillance in the same time period.Results. In total for the 86 CPE, 2 failed genomic assemblies and 78 bla OXA-48-encoding plasmids were reconstructed, and six bla OXA-48 genes were located chromosomally. The 2011 outbreak-associated bla OXA-48 plasmid of 63.6 kb with IncL replicon was found in Cfr, Ecl, Eco, Kpn and Mmo and primarily between 2011 and 2014 and indicated as LR025105 as MASH nearest neighbour. From 2014 onwards, 11 other types of bla OXA-48-carrying plasmids with different antibiotic-resistant genes and replicons were discovered, representing the earlier defined distinct pOXA-48 plasmid groups found in the Netherlands. Furthermore, on a national level, the LR025105 plasmid was found after 2015 in many different bacterial backgrounds, highlighting the promiscuous nature of this pOXA-48 plasmid.Conclusion. After a large bla OXA-48 outbreak in a large hospital in the Netherlands, the composition of the bla OXA-48 plasmid population in this hospital diversified over time and is in line with national surveillance data. Plasmid sequencing provided valuable insight into the transmission dynamics of bla OXA-48-encoding plasmids and showed no indication of the persistence of the 2011 bla OXA-48 plasmid in the hospital environment.

Engaging Community Pharmacies in Promoting Outpatient Medication Safety - Identifying and Prioritizing Research Needs by Modified Nominal Group Technique.

Medication errors are one of the most endangering factors for patient safety, and they have become a key target for improvement in health- and social care systems worldwide. The most current development needs are related to outpatient care; however, up-to-date medication safety research and improvement activities have primarily focused on hospital environments. To promote medication safety in outpatient care, community pharmacies could be more effectively utilized. To identify the most central research needs, which would promote the use of community pharmacies in outpatient medication risk management and enhance collaboration between community pharmacies and other parts of the health- and social care system. The study applied a modified nominal group technique. A group of Finnish patient and medication safety experts (n=28) participated in the study and were divided into four nominal groups (incl. a pilot group). Data collection was conducted through electronic surveys and facilitated online group meetings. The collected data were analyzed using qualitative inductive thematic analysis and quantitative descriptive analysis by the van Breda technique. The final data comprised 83 research needs organized under five main themes with 22 subthemes. The most prioritized research needs covered all five main themes, which were: medication safety collaboration (final rank proportion 30%); medication care pathways (27%); operating processes of community pharmacies (17%); medication safety incident reporting (16%); and community pharmacy-based services improving medication safety (11%). The identified research needs for promoting outpatient medication safety by involving community pharmacies in medication risk management, covered a wide range of areas. Producing evidence about the effectiveness and cost-effectiveness of activities in these areas is particularly needed for practice development and policymaking, together with updating regulations supporting the implementation of the produced evidence.

Risk Factors Associated with Nosocomial Infections in The City of Goma (Case of CBCA-Virunga and Maternal Charity in the DRC)

a) Factors related to the hospital environment: 1. Absence or non-functionality of the triage department and the bacteriology department. 2. Insufficient drinking water not meeting the daily needs of patients/bed, i.e. an average consumption of 60 to 80 liters/bed/day, compared to 500 to 600 liters of water/bed/day recommended by WHO standards. 3. Absence of a wastewater management circuit from hospitalization services (no purification system or wastewater treatment), b). Factors related to the nursing staff: 4. Absence of a committee for the diagnosis and monitoring of NI (nosocomial infections). 5. Poor knowledge, attitudes and practices of healthcare staff and in PCI: lack of risk assessment, use of venous catheters beyond 72 hours, use of antibiotics beyond 7 days without antibiogram, irregularity of hand hygiene before and after administration of care. (The odds ratio of the assessment score: RE (Assessment Risk) = 1.7 [95% CI; [1.3-8.9]. After evaluating the infection prevention and control (IPC) score card, in these hospitals, the results were as follows: HGR CBCA-Virunga: 61.2% and HGR Maternal Charity: 65%. That is an average of 63.1%. This study identified overall; progress in terms of improving infrastructure, hospitalization conditions for patients and electrical energy. [Adjusted odds ratio=2.8, 95% CI: 1.6-4.2]. Conclusion: The absence of a committee for diagnosis and epidemiological surveillance of nosocomial infections in hospitals and the non-existence of provincial and national coordination for the fight against nosocomial infections in the health system in the DRC, favors the high prevalence of these infections in hospitals according to our study.

Conceptual framework for advances in client care: Emotional and social support in hospitality and logistics environments

This paper presents a conceptual framework for enhancing client care through emotional and social support in the hospitality and logistics sectors. Drawing on theoretical foundations, it explores how empathy-driven interactions and community-building efforts influence customer satisfaction, loyalty, and organizational performance. The unique dynamics of both sectors are examined, highlighting operational challenges and opportunities for embedding supportive practices. A structured framework is proposed, integrating key components such as communication, feedback mechanisms, and technology-driven personalization. Practical recommendations are offered to empower practitioners and guide policymakers in implementing client-focused strategies that align with evolving consumer expectations. This study underscores the transformative potential of emotional and social support in driving sustainable growth and resilience in competitive service environments.