Good Infection Control Practices Research Articles

Antimicrobial susceptibility pattern and mupirocin resistance among methicillin-resistant Staphylococcus aureus isolated from skin and soft-tissue infection patients attending a tertiary care hospital in North India

Background: Antimicrobial susceptibility among bacterial isolates varies from center to center. Mupirocin is a topical antibacterial antibiotic used to treat wound infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Aim and Objectives: This study was conducted to know the prevalence of high and low levels of mupirocin resistance along with antimicrobial susceptibility in MRSA isolates from skin and soft-tissue infection in patients admitted to a tertiary care hospital in North India. Materials and Methods: A total of 97 non-repetitive isolates of MRSA from various pus samples over a period of 1 year were included in this study. These strains were identified as per standard laboratory protocols given by the Clinical Laboratory Standards Institute. High- and low-level mupirocin resistance of the isolates was tested by using mupirocin discs of 200 μg and 5 μg, respectively. Mupirocin strips of 256 μg and 512 μg were used for the E-test to detect low-level and high-level mupirocin resistance, respectively. The isolates were reported as sensitive to mupirocin, with minimum inhibitory concentrations of <4 mg/L. Results: Overall, 9.27% of mupirocin resistance was found, of which 2.06% of isolates were high-level resistant to mupirocin, while 7.21% had low-level resistance. All MRSA strains were susceptible to vancomycin, followed by linezolid (94.84%), teicoplanin (91.75%), and fusidic acid (88.65%). Conclusion: Regular monitoring, good infection control practices, and proper awareness about utilizing mupirocin therapeutically and prophylactically may help prevent the emergence of mupirocin resistance in health-care facilities.

Interventional knowledge, attitude and practice study of standard precautions among health care workers at a tertiary care hospital in Western India

Standard precautions are the backbone of any efficient infection control program. Compliance with standard precautions has been a major challenge for health care workers, especially in developing countries. To access the impact of the training program on health care workers (HCW) knowledge, attitude, and practice towards standard precautions. We conducted an interventional Knowledge, Attitude, and Practice (KAP) study among 150 HCW (50 Doctors, 50 Nurses, and 50 Technicians) in a tertiary care hospital from June 2019 to December 2019. We carried out educational interventions through training sessions with pre- and post-test questionnaires. We compared pre and post questionnaire mean scores to access the impact of short educational videos and seminars on HCWs using unpaired t-tests.HCWs have poor KAP on important aspects of standard precautions. Pre-intervention KAP mean scores were highest among doctors, followed by lab technicians and nurses. After training intervention, improvement in knowledge, attitude, and practice among all 3 types of HCWs were statistically significant (P-value <0.005, unpaired t-test). Low pre-intervention knowledge and attitude practice scores regarding standard precautions among doctors, nurses, and lab technicians were improved after training significantly. Hence, we recommend training programs regarding standard precautions should be regularly conducted in health-care facilities to promote good infection control practices and mitigate the risk of hospital-acquired infection. This has future implications in terms of reduced morbidity and mortality in resource limited settings.

Tuberculosis infection control practice and associated factors among health care workers in Ethiopia: Systematic review and meta-analysis

Background The poor practice of tuberculosis infection control may increase the risk of transmission of tuberculosis in healthcare settings. Thus, this study aimed to determine the pooled magnitude of good tuberculosis infection control practice and associated factors among healthcare workers in Ethiopia. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) checklist guideline was followed for this review and meta-analysis. The electronic databases (Pub Med, Cochrane Library, Google scholar and grey literatures) were searched to retrieve articles by using keywords. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instrument was used to assess the quality of studies. Heterogeneity was assessed using the I2 statistic. The meta-analysis with a 95% confidence interval using STATA 17 software was computed to present the pooled practice and odds ratio of the determinant factors. Publication bias was assessed visually by inspecting the funnel plot asymmetry and using statistical tests using the eggers and begs test. Results Seven studies were included in this meta-analysis, with a total of 3256 health workers. The overall pooled magnitude of good tuberculosis infection control practice was 46.44% (95% CI: 34.21%, 58.67%). In subgroup analysis, the highest practice was in Addis Ababa 51.40% (95% CI: 47.40, 55.40%) and the lowest prevalence of tuberculosis infection control practice was in Amhara region 40.24% (95% CI: 15.46, 65.02%). Working in TB clinics (AOR; 7.42, 95% CI: 3.89, 14.13) and good TB related knowledge (AOR; 4.40, 95% CI: 1.76, 10.97) were the significant predictors of good TB infection control practice. Conclusions Only less than half of the health care workers had good practice of TB infection control. Working in TB clinics and having good TB related knowledge were statistically significant predictors of TB infection control practice. Periodic shifting of health care workers to work in TB clinics and an emphasis on TB infection control related skill based training was recommended to increase the TB infection control practice.

Barriers to infection prevention and control in patients' homes.

While there is a lot of emphasis on the need for good infection prevention and control practices and acute care, the increasing complexity of patients being cared for in their own homes means that there is an increased risk for infection. Good practice is required by community nurses to minimise this risk. Patients' own homes can present particular challenges in complying with good practice and this article looks at some of the barriers to optimum infection prevention and control precautions in this setting.

Descriptive study of COVID-19 vaccinations and infections within an NHS workforce.

Healthcare workers were a priority group for coronavirus disease 2019 (COVID-19) vaccination during the pandemic. Occupational exposure may account for some of the increased risk faced. Describe COVID-19 vaccine uptake and infection rates in staff across a large NHS board in Scotland to better understand occupational risk during the pandemic. Descriptive cross-sectional study. Demographic data were extracted on 5 August 2021 from 26 058 members of staff. COVID-19 vaccination status and positive polymerase chain reaction (PCR) results were extracted on two separate dates to describe the timeline of staff infections between March 2020 and January 2022. There was high uptake of all three vaccine doses across all demographic groups in hospital staff. PCR positivity decreased with increasing age and Scottish Index of Multiple Deprivation score. Staff and nosocomial COVID-19 infections followed peaks in community infection rates. NHS Lothian is a typical NHS workforce with good vaccine uptake. Beyond very early cases, there seems to be minimal evidence of occupational acquisition of COVID-19. The large number of nosocomial infections at the start of the pandemic may, in fact, reflect lack of community testing at this time. Despite protection from high vaccine coverage, job type and good Infection Prevention and Control practices, it seems that staff remain at high risk of catching the highly transmissible omicron variant from the community rather than work.

High Proportion of Mucosal Barrier Injury- Laboratory Confirmed Bloodstream Infection Among Paediatric Oncology Patients in a Cancer Centre in Eastern India

Abstract Introduction Blood stream Infections (BSI) is associated with increased morbidity, mortality, health care costs and healthcare resource utilization. The 2022 version of CDC/NHSN criteria for mucosal barrier injury-associated laboratory-confirmed bloodstream infection (MBI-LCBI-1) included isolation of any intestinal organism from blood culture in a patient with absolute neutrophil count <500/mm3. Children with malignancy have a high risk for infections due to neutropenia, immunosuppressive therapy, individual immune and nutritional status, chemotherapy infusion, radiotherapy, impaired mucosal barrier, and presence of different types of indwelling catheters. CLABSI is defined as an LCBI where an eligible BSI organism is identified, and an eligible central line is present on the LCBI date of event or the day before. Device Utilisation Ratio (DUR) is a ratio comparing the number of device days to the number of patient days for the included time period. Methods A retrospective analysis of all BSI-s in the paediatric unit of a tertiary oncology hospital in a low-middle income country (LMIC) for 43 months (April 2019-October 2022) was performed. The primary objective was to assess the burden of MBI-LCBI-1 in children with cancer. The secondary objective was to assess the CLABSI rate and compare it to the DUR. MBI-LCBI-1, CLABSI and DUR were determined using the standard CDC/NHSN criteria. The adapted CDC/NHSN bloodstream infection case report form included microbiological (type of pathogen) and clinical (signs, symptoms, and underlying conditions such as neutropenia) information. Neutropenia (absolute neutrophil count <500 cells/mm3) was the underlying condition in the MBI-LCBI cases. Blood cultures were done using BACT-ALERT system and antibiotic susceptibility testing performed using VITEK2 system (Biomerieux). Results A total of 47 positive blood cultures were obtained from 46 patients during the study period. Thirty-three cases of MBI-LCBI-1 (33/47= 70%) from 28 patients (median age 14 years; range 4-20 years) and 3 cases of CLABSI (3/47= 6.3%) from 3 patients (median age 7 years; range 3-9 years) were detected giving a CLABSI rate of 0.60 per 1000 central line days. Total Patient days and central line days was 15,002 and 14,764 respectively. The device utilization ratio of central line was 0.98. There were 48 isolates from 47 cases of BSI. Forty-three (90%) were Gram negative bacilli (GNB), 2 (4%) Gram positive cocci (GPC) and 3 (6%) Candida species. Klebsiella pneumoniae (28%) was the commonest GNB. Amongst the multi-drug resistant organisms (MDRO) associated with MBI-LCBI-1, carbapenem-resistant enterobacterales (CRE) was detected in 14/43 (32.5%), carbapenem-resistant Acinetobacter baumanii complex (CRAb) in 1/43 (2.3%), carbapenem-resistant Pseudomonas aeruginosa (CRPseu) in 2/43 (4.7%). Candida auris was detected in 1/3 Candida isolates. Six out of 46 patients with BSI died within 30 days of BSI (all-cause mortality). Four of these patients had CRE, 1 had CRAb and 1 had Candida auris. There were no isolates of Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin resistant enterococci (VRE). Conclusion All patients who died had MDRO isolates. Strict adherence to standard and contact precautions, with high level of awareness is necessary for lowering the incidence of BSI. Low incidence of CLABSI is a good indicator of good infection control practices.

Nurses' Performances Regarding Infection Control Standard Precautions at Shar Teaching Hospital in Sulaimani City

Background: Standard precautions include hand washing, protective equipment, respiratory hygiene, sharps safety, injection techniques, patient care, waste disposal, and disinfected surfaces for infection control. Aim: the study aimed to evaluate Nurses' Performances Regarding Infection Control Standard Precautions, and the Association between the Practices of Nurses and Sociodemographic Characteristics. Methods: This study used a descriptive observational design to study 212 nurses in all departments at Shar Teaching Hospital in Sulaimani. A probability-based sampling method was used, and data were collected from March 15, 2022, to September 20, 2022. The questionnaire involved questions about the nurses' demographics and their work environment. Results: The result of the study indicates that (39.6%) of the nurses have good performance regarding infection control standard precautions, and there was a statistically significant association between nursing performance concerning age, level of education and employment Conclusion: only half of the participants had good infection control practices. Factors that affected this level of practice were found.

Infection Prevention and Control Practices and Associated Factors Among Healthcare Cleaners in Gondar City: An Analysis of a Cross-Sectional Survey in Ethiopia.

Healthcare-associated infections are a global health problem and are more prevalent in developing countries such as Ethiopia, but there is a paucity of research on the infection prevention practices of cleaning staff. Therefore, this study aimed to assess infection prevention and control practices and associated factors among cleaners working in healthcare facilities in Gondar City, Ethiopia. A cross-sectional survey was conducted among healthcare cleaning staff from May to June 2022. A total of 428 cleaners took part in the survey. Data were collected using a semi-structured interviewer-administered questionnaire. The data were entered into EpiData version 4.6 and analyzed using Stata version 14 software. A multivariable binary logistic regression analysis was used to ascertain the significance of associations at <0.05 p-value and the adjusted odds ratio (AOR) with a 95% confidence interval (CI). Among the 390 study participants included, 294 (75.1%) were female. Of the surveyed participants, 186 (47.7%) had good knowledge of infection prevention and control practices. This study revealed that out of the 390 healthcare cleaners, 204 (52.3%) had good infection prevention and control practices with 52.3% [95% CI (47.2, 56.4)]. Good knowledge of infection prevention and control [AOR: 1.56, 95% CI (1.03, 2.37)] and the availability of infection prevention and control guidelines in the workplace [AOR: 1.54, 95% CI (1.01, 2.33)] were significant factors associated with infection prevention and control practice. The present study found that almost half of the healthcare cleaners had poor IPC practices. The finding underlines the importance of good IPC knowledge and the accessibility of IPC guidelines to improve IPC practices among healthcare cleaning staff. The findings of this study also highlight that behavioral change interventions and paying attention, particularly to nonclinical staff such as cleaners in health care settings, are critical to reducing infection in health care settings.

Assessment and feedback of the COVID-19 pandemic’s effects on physicians’ day-to-day practices: good knowledge may not predict good behavior

ABSTRACT The importance of doctors’ knowledge and awareness of infectious diseases was felt worldwide during the COVID-19 pandemic. With this study, we aimed to evaluate the effect of the long and dynamic pandemic process on resident physicians’ knowledge and protective behaviors for infection control in a tertiary hospital setting and protective behaviors for infection control in a tertiary hospital setting. The population of this cross-sectional study consisted of assistant physicians working at Suleyman Demirel University Faculty of Medicine Training and Research Hospital. A questionnaire evaluating information and protective practices for COVID-19 was applied to the participants through face-to-face interviews using the convenience sampling method, with an interval of one year. In the second year of the pandemic, resident physicians’ awareness of the correct use of personal protective equipment decreased (p = 0.001). Despite the continuous training, it was determined that the residents preferred masks with high protection at a lower rate when they encountered patients who received oxygen support of 5 lt/min and above (p < 0.001). To prevent the spread of COVID-19 infection in the hospital as the pandemic progresses, it has been determined that resident physicians are less prone to evaluate possible infection symptoms in patients hospitalized for non-COVID-19 reasons (p = 0.013). As a result, the data we obtained showed that despite the regular training during the pandemic and the death of many health workers, the residents’ adherence to infection control and prevention practices, which also protect them, decreased significantly in the second year of the pandemic. These valuable data showed us that good knowledge does not predict good infection control and prevention practices. Our findings show that physicians need a new education system that motivates them. In addition, psychosocial determinants, physical and mental fatigue, and institutional control factors contributing to these results and affecting individual risk perception should be recognized and prevented.

INVESTIGATION OF RISK FACTORS AND BACTERIAL PATHOGENS OF SURGICAL SITE INFECTIONS IN A TEACHING HOSPITAL IN HYDERABAD

Background: Surgical site infections are one of the most common healthcare associated infections which results in a delay in patient recovery. These infections being the most common HAI in our area, the present study was conducted to know the incidence of SSIs and to detect the risk factors associated with SSIs. Material and methods: A prospective study on SSIs was conducted over a period of seven months involving 1211 patients. History was taken from these patients regarding the risk factors of SSIs. Pus and wound swabs collected from these patients were subjected to culture. The culture isolates were identified by standard biochemical tests. Antibiotic sensitivity testing was performed using standard protocol. The incidence of SSIs was determined. Results: SSI rate was 6.6 %.The most common risk factors associated with SSIs were age &gt;60 years, diabetes followed by obesity and prolonged duration of surgery. There was no association with smoking, malnutrition, immunosuppression, skin colonization at the time of surgery, presence of skin diseases at the incision site, peripheral vascular disease and anaemia. Majority of isolates were gram negative isolates. Klebsiella and Escherichia coli were the most common isolates. There was maximum sensitivity of isolates to carbapenems and combination drugs. Conclusion: Age&gt;60 years, diabetics, obesity, and prolonged duration of therapy were the major risk factors associated with SSIs. Decreased incidence of SSIs &amp; decreased isolation of exogenous pathogens in SSI, high sensitivity of gram negative bacilli in our study suggests good infection control practices in our hospital area.

Detection and correlation of antimicrobial resistance pattern in Enterobacteriaceae from UTI patients in GMERS Medical College, Gujarat

Background: Bacterial resistance to antibiotics is a growing public health threat worldwide. The increasing rate of antimicrobial resistance among bacterial pathogens causing both hospital- and community-acquired infections is a serious threat to public health world-wide. This inappropriate and non-judicious usage of antibiotics has resulted in the development of worldwide antibiotic resistance in bacteria, leading to the emergence of multi-resistant strains of bacterial pathogens. This study focuses on the prevalence of antibiotic resistance in the Enterobacteriaceae group of organisms in urine samples and also detects various methods of antibiotic resistance. Antibiotic resistance detection may be useful for epidemiological and research purposes, as well as for preventing the spread of drug-resistant organisms within hospitals through good infection control practices. Aims and Objectives: The aim of the study was to detect occurrence of β-lactamases, extended-spectrum beta-lactamases (ESBL) and Carbapenemase by phenotypic methods in Enterobacteriaceae from urine samples along with pattern of antibiotic resistance for various antibiotics in them. Materials and Methods: A descriptive study was conducted at a tertiary-care hospital. Testing of ESBL and carbapenemase production detection done according to CLSI (M100) guideline by the Kirby-Bauer disk diffusion method, combination disc diffusion test, and modified Carbapenem inactivation method. Results: A total of 220 Enterobacteriaceae organisms were isolated from processed urine samples of tertiary care Hospitals. Rate of cephalosporin resistance in ESBL and carbapenem-resistant Enterobacteriaceae (CRE) is more than 90% while in non-ESBL more than 70% and in non-CRE 75–80%. Carbapenem resistance in ESBL and non-ESBL is the same. Resistance to fluoroquinolone group, Aminoglycoside group, and Cotrimoxazole and Tetracycline group of antibiotics were more noticed in ESBL and carbapenemase producing organisms. In our study, fosfomycin and Nitrofurantoin are effective treatment in case of ESBL and CRE producing organism. Conclusion: The ESBL and Carbapenemase producing isolates were multi-drug resistant making therapeutic choices limited. Fosfomycin and Nitrofurantoin are effective treatment in multidrug resistance urinary tract infection.

Competitive Transmission of Carbapenem-Resistant Klebsiella pneumoniae in a Newly Opened Intensive Care Unit.

We conducted a 6-month prospective study in a newly opened ICU for high-resolution tracking of carbapenem-resistant Klebsiella pneumoniae (CRKP) through environmental surveillance, patient screening, and genome sequencing. Among all ICU patients (n = 348) screened, 3.5% carried CRKP on admission and 16.3% acquired CRKP thereafter. CRKP was not detected in the environment until 10 weeks and was then isolated from 98 of 2,989 environmental samples (3.3%). The first CRKP isolate from rectal swabs (n = 37) and the first clinical isolate (n = 8) of each patient as well as the 98 isolates from environmental were subjected to whole-genome sequencing. The 143 CRKP isolates from patients and environment samples were assigned to four sequence types, with ST11 dominating (95.8%) and further divided into 14 clones, suggesting introduction of multiple clones. Subsequent CRKP transmission was complex and dynamic with 10 clones found in multiple patients and seven also detected in the environment. Two particular ST11 clones caused extensive (≥5 rooms) and persistent (≥10 weeks) environmental contamination. Both clones were associated with patients who carried CRKP throughout their prolonged ICU stay. Such "super-contaminators" are a priority for isolation and environmental surveillance. IMPORTANCE Carbapenem-resistant Klebsiella pneumoniae (CRKP) is a global challenge for human health. In health care settings, patients have frequent interactions with other patients and the environment, rendering challenges for untangling the introduction and transmission of CRKP. We conducted a prospective surveillance study in a newly opened ICU for high-resolution tracking of CRKP. Our study demonstrated the dynamic, complicated transmission of CRKP and has important findings that may help to curb its spread in health care settings. First, compliance with basic measures such as routine environment cleaning and postdischarge terminal cleaning is needed to minimize the environmental contamination-driven spread. Second, active screening could demonstrate the scale of the problem, and room transfer of patients with CRKP should be prohibited whenever possible. Third, the priority for single-room isolation should be given to patients with prolonged carriage of CRKP, especially in resource-limited settings. Good infection control practice lays a foundation for tackling multidrug-resistant organisms like CRKP.

Paramedics’ knowledge, attitudes, and practices regarding the use of personal protective equipment against COVID-19

The risk of novel coronavirus disease (COVID-19) transmission in the confined mobile ambulance compartment is increased during aerosol-generating procedures and close proximity. Paramedics are encouraged to increase body-surface-isolation by donning additional personal protective equipment (PPE) during patient encounters. This study aimed to better understand paramedics' knowledge, attitudes, and practices related to PPE use during the COVID-19 pandemic in the prehospital setting with a focus on mitigating risks associated with infection control. This prospective quantitative study collected descriptive data using a specifically designed data collection tool. The survey data was then cleaned and analyzed with Microsoft Excel® and the latest version of the Statistical Package for Social Sciences. One thousand frontline paramedics employed by the Hamad Medical Corporation Ambulance Service (HMCAS) were invited via email to participate in the study. A total of 282 (28.2% of frontline paramedics) paramedics completed the online survey, of which 80.1% completed the mandatory HMCAS online infection control training program within the last year, and 17.0% between one to two years ago. Approximately 83% of the participants had completed an N95 mask fit test at HMCAS within the past five years, and 91.5% completed the hand hygiene training. The study found that 98.2% of the paramedics were knowledgeable about COVID-19 and its transmission, while 96.1% agreed that aerosol-generating procedures increased airborne transmission. The paramedics' attitudes were mainly positive toward the use of PPE to prevent the spread of the virus, which was synchronous with their practice. The sample population demonstrated a strong knowledge of COVID-19 and its transmission. Their overall positive attitudes and good infection control practices were demonstrative of efforts to mitigate risks associated with the spread of the virus.

Prevalence, Risk Factors and Microbiological Profile of Orthopaedic Surgical Site Infection in North-Eastern Peninsular Malaysia.

The devastating outcome of orthopaedic surgical site infections (SSI) are largely preventable if its risk factors, causative organisms and antimicrobial susceptibility patterns in the regional area are known. We conducted a retrospective study to address the lack of epidemiological and microbiological data on orthopaedic SSI in Malaysia. All the 80 patients diagnosed and treated for microbiologically proven orthopaedic SSIs in a tertiary hospital in Malaysia from April 2015 to March 2019 were included in a 1:2 case control study. The prevalence of SSI in clean and clean-contaminated surgeries was 1.243%, which is consistent with most of the studies worldwide, but is low compared to other studies done in Malaysia. The most common type of orthopaedics SSI were internal fixation infections (46.25%), superficial SSIs (25.2%) and Prosthetic joint infections (18.75%). Obesity and tobacco use were found to be significant risk factors of orthopaedic SSI. The most common perioperative prophylaxis used was IV cefuroxime. Majority of the cases (86.5%) received prolonged prophylactic antibiotics. The most common causative agent was Staphylococcus aureus (31.25%), followed by Pseudomonas aeruginosa (26.25%) and Enterobacter spp (7.5%). Methicillin-resistant Staphylococcus aureus (MRSA) accounted for 20% of the S. aureus infections. Up to 19.4% of the Gram-negative organisms are multidrug resistant. The higher rate of isolation of organisms resistant to the prophylactic antibiotics being used may be related to the prolonged use of prophylactic antibiotics, which exerted selective pressure for the acquisition of resistant organisms. Despite its relatively low prevalence in our local institution and worldwide, the prevention of SSI in orthopaedic practice is crucial to avoid morbidity, mortality and high healthcare cost. This may be achieved by control of modifiable risk factors such as obesity and tobacco use, appropriate use of prophylactic antibiotics and implementation of good surgical and infection control practices.

INFECTION PREVENTION AND CONTROL PRACTICES AMONG HEALTHCARE PROVIDERS IN LEVEL I HOSPITALS IN RINCONADA

Hospital-associated infections (HAIs) pose a serious problem, threatening the health and safety of patients and healthcare providers and cause substantial morbidity and mortality every year in the different healthcare settings worldwide. Despite the known risk, the ease and transparency of infection prevention and control guidelines, still, non-adherence is evidently observed.&#x0D; The descriptive correlational method was used involving a questionnaire as the main instrument in data gathering. To determine the infection prevention and control practices among healthcare providers in Level I hospitals in Rinconada&#x0D; The majority of the respondents are within the age range of 26 – 35; females and nurses. However, only a few of them have undergone formal continuing education and attended relevant training on IPC. The healthcare providers always practice all components of infection prevention and control along with standard precautions, namely, hand hygiene, use of PPE, and prevention of needlestick and sharp injury. Overall, organizational factors significantly affect healthcare providers’ infection prevention and control practices compared to the individual factors that affect moderately. The healthcare providers’ age, sex, and profession and profile influence the infection prevention and control practices in Level I hospitals in Rinconada.&#x0D; There are good infection prevention and control practices among healthcare providers though they sometimes fail to follow specific measures.

Practices and perception of healthcare workers towards infection control measures during the COVID-19 pandemic: a cross-sectional online survey from Nigeria.

This study investigated the practices and perceptions of Health care workers (HCWs) in Nigeria towards infection control practices during the COVID-19 pandemic. This cross-sectional study was conducted among HCWs in Nigeria healthcare facilities using a 25-item validated online questionnaire. The hyperlink of the questionnaire was shared with the various professional associations/societies and hospitals in June 2020. A total of 426 HCWs completed the questionnaire with pharmacists (28.8%), nurses/midwives (22.7%) and medical doctors (20.1%) being the highest respondents. Less than 50% of the HCWs had previous training on COVID-19 and how to use personal protective equipment (PPE). Only one in five HCWs had access to adequate PPE during the COVID-19 pandemic. Overall, the HCWs had good infection control practices with better practices observed among those who attended training on COVID-19 infection and those trained on how to use PPE. Lack of funds to purchase PPEs (55.3%), lack of access to PPE (52.5%) and lack of training on how to use PPE (44.0%) were the most common barriers to adherence to infection control guidelines. HCWs in Nigeria have limited access to adequate PPE and lack adequate support from health authorities. Attendance of training on the use of PPE and COVID-19 infection were associated with access to adequate PPE and better infection control practices. Training of HCWs, provision of adequate PPE, and support are recommended to improve compliance with infection control guidelines.

PREVALENCE AND ANTIMICROBIAL SUSCEPTIBILITY OF URINARY TRACT INFECTION CASES AND FINDING OF ESBL AND AMPC β-LACTAMASES PRODUCING ESCHERICHIA COLI AND KLEBSIELLA PNEUMONIAE IN A TERTIARY CARE HOSPITAL MIZORAM

Introduction: Resistance to broad spectrum -lactams mediated by extended spectrum -lactamases (ESBL) and AmpC -lactamases enzymes is a growing threat worldwide.Aim: The aim of the study was to detect the prevalence and antimicrobial susceptibility of ESBL and AmpC -lactamase producing Escherichia coli and Klebsiellapneumoniae isolated from Urinary Tract infection Materials and Methods: A total of 288 isolates comprising of 180 Escherichia coli and 108 Klebsiellapneumoniaeisolated from various clinical samples were included. ESBL was detected by Phenotypic Conrmatory Disc Diffusion Test (PCDDT) and Double Disk Synergy Test (DDST). AmpC detection was done by AmpC disk test. Results: Out of 180 Escherichia coli, and 108 Klebsiellapneumoniaeisolates 91(50.5%) and 63(58.3%) were conrmed to be ESBL producers by PCDDT and 81(45%) and 57(52.7%) by DDST respectively. AmpC was detected in 35(19.4%) of Escherichia coli and 33(30.5%) of Klebsiellapneumoniae isolates. Co-production of ESBL and AmpC was detected in 6(3.3%) Escherichia coli and 11(10.18%) of Klebsiellapneumonia isolates. Majority of ESBL producers were from blood in both organisms. Multi drug resistance (MDR) was seen in 79.1% of ESBLEscherichiacoli and 63.5% of ESBLKlebsiellapneumoniae isolates. MDR was seen in 28(96.5%) of AmpC producing Escherichia coli and all AmpC producing Klebsiellapneumoniae isolates. Conclusion: It is essential to report ESBL and AmpC beta lactamase production along with routine susceptibility which will aid the clinicians in prescribing antibiotics.Strict adherence to the hospital antibiotic policy and good infection control practices would go a long way in curtailing the menace of drug resistance.

Curbing antimicrobial resistance in post-COVID Africa: Challenges, actions and recommendations.

BackgroundAntimicrobial self‐medication and use have significantly increased in the COVID‐19 era—increasing antibiotic consumption and resulting in a high prevalence of antimicrobial resistance in Africa (AMR). We conducted a narrative review to investigate challenges associated with curbing AMR in a post‐COVID‐19 setting in Africa, suggesting practical measures applicable for policy‐informed implementation.MethodA narrative review was performed to pinpoint AMR challenges and actions on the African continent. A comprehensive search was conducted in the scientific databases that include PubMed, PubMed Central and Google Scholar using predetermined search terms.ResultsThe emergence of the COVID‐19 outbreak has added to the challenges of tackling AMR on the continent, which has jeopardized AMR interventions' hard‐won gains. Identified challenges have been Health systems disruption, Irrational Antimicrobial Use, Weak Antimicrobials Regulatory Ecosystem, Inefficient Population Infection Prevention, and Control Practices, Inadequate access to Health Services and data challenge on AMR surveillance.ConclusionThe COVID‐19 pandemic fueled AMR in Africa. There is a need for AMR control post‐COVID, such as measures for ongoing antimicrobial stewardship and good infection control practices. Further, curbing AMR requires rigorous regulatory enforcement and efficient AMR Surveillance. There should be a body to raise AMR awareness among the population. Research, Innovation and Technology could play an essential role supported by capacity building and global partnership.

Surgical site infection and development of antimicrobial sutures: a review.

Sutures are used to facilitate wound healing and play an important role in ensuring the success of surgical interventions in healthcare facilities. Suture-associated surgical site infection (SSI) may develop when bacterial contaminants colonize the suture surface and establish biofilms that are highly resistant to antibiotic treatment. The outcome of SSI affects postoperative care, leading to high rates of morbidity and mortality, prolonged hospitalization, and increased financial burden. Antimicrobial sutures coated with antiseptics such as triclosan and chlorhexidine have been used to minimize the occurrence of SSI. However, as the efficacy of antiseptic-based sutures may be affected due to the emergence of resistant strains, new approaches for the development of alternative antimicrobial sutures are necessary. This review provides an update and outlook of various approaches in the design and development of antimicrobial sutures. Attaining a zero SSI rate will be possible with the advancement in suturing technology and implementation of good infection control practice in clinical settings.

Knowledge, attitude, and practice of paramedics in Qatar regarding the use of personal protective equipment against COVID-19

Background: Internationally, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, causing corona virus disease (COVID-19), has increased the demand on healthcare services and resources1. The proper use of personal protective equipment (PPE) by paramedics has recently become apparent2. The risk of COVID-19 transmission has increased during prehospital life-saving procedures generating aerosols such as non-invasive ventilation, tracheal intubation, and external chest compressions, especially when working in a confined ambulance compartment3. Paramedics are encouraged to increase body-surface-isolation by donning additional PPE (high-filtration facemasks/face shields/surgical gowns/surgical hoods) during all patient encounters2. This study aimed to better understand paramedics’ knowledge, attitude, and practice of PPE utilization in the State of Qatar during the COVID-19 pandemic. Methods: This prospective and quantitative study focused on the collection of descriptive data utilizing a purpose-designed online survey. Around 1300 frontline paramedics employed by Hamad Medical Corporation Ambulance Service (HMCAS) were invited via email to participate in the study. Results: 282 paramedics completed the survey. 90.4% were male and 78.7% had a bachelor&apos;s degree. 97.1% completed the mandatory HMCAS online infection control training program, 82.9% completed an N95 mask fit test in the last 5 years, and 91.5% completed the hand hygiene training program. The study found paramedics to be knowledgeable about COVID-19 and its transmission (98.2%) (Table 1). Paramedics’ attitude was mainly positive towards the use of PPE to prevent the spread of the virus which was synchronous with their practice. Conclusion: An effective model to curb the spread of COVID-19 amongst healthcare workers must consider the knowledge, attitude, and practice of first responders. This sample demonstrated a strong knowledge of COVID-19 and its transmission. Their overall positive attitude and good infection control practices were a demonstrative effort to mitigate risks associated with the spread of the virus in the prehospital setting.