Nurses' hand hygiene is critical for preventing nosocomial infections, yet evidence on effective interventions is limited. This study examined the effect of short messaging on nurses' hand hygiene behaviors. A randomized controlled trial was conducted with 60 nurses in Turkey (intervention, 30; control, 30). The intervention group received eight educational Short Message Service-based messages twice weekly for 4 weeks. Data were collected using validated hand hygiene assessment tools. Analyses included two-way robust tests, Bonferroni, and Mann- Whitney U tests. Posttest scores for the Hand Washing Form, Surgical Hand Washing Form, and Form for Hand Rubbing with Antiseptic Agent were significantly higher in the intervention group compared with baseline (p < .001). The Short Message Service-based education significantly improved nurses' hand hygiene and represents a practical, scalable strategy for clinical training and behavior change.

Domestic cooking and food behaviours during the COVID-19 pandemic and the cost-of-living crisis: A scoping review.

How sustainable and safe is drinking from refill-and-reuse bottles? An analysis based on life-cycle assessment (LCA) and microbiological quality of water.

Hand washing is a fundamental practice for preventing the transmission of infectious diseases, yet its effectiveness is influenced by various factors. This study investigates the knowledge and practices of hand washing among market women in Eke-Ukwu, Owerri. Employing a cross-sectional descriptive design, the study surveyed 384 market women using a multi-stage sampling technique. The study made use of a closed ended questionnaire in collecting data. Results indicate a generally high awareness of hand washing as a preventive measure against disease, with 82% of Fresh Tomato Sellers, 90% of Vegetable Sellers, and 94% of Fish Sellers recognizing the importance of using soap and water. However, knowledge gaps persist regarding the recommended duration for effective hand washing, with significant uncertainty across all groups. The frequency of hand washing varied, with a notable portion of respondents failing to adhere to recommended practices consistently. Factors influencing hand washing practices include health concerns and the availability of facilities. The study highlights the need for targeted educational interventions to address gaps in knowledge and to improve access to hand washing resources. By linking hygiene practices to both health and economic benefits, this research aims to enhance hand washing behaviors among market women, thereby contributing to better public health outcomes in Eke-Ukwu, Owerri.

Lack of in-home water service remains a persistent challenge in rural Alaska due to underfunding, high construction and operating costs, extreme cold, and environmental change. Alaska has the highest proportion of households in the U.S. lacking complete plumbing, resulting in self-hauling of water and waste, reuse of limited supplies, and higher rates of water-washed disease than in plumbed homes. During the COVID-19 response, the Alaska Native Tribal Health Consortium (ANTHC) and Silverline LLC developed and installed the Miniature Portable Alternative Sanitation System (Mini-PASS) in 14 unplumbed Alaska Native communities. To evaluate its impact on hand hygiene, water-hauling behaviors, and system use, we conducted seasonal interviews with 147 households. Among 139 households reporting handwashing methods, 63% (n=93) used the in-home handwashing station (HWS) as their primary method. Longer ownership was associated with greater HWS use and increased water hauling. Analysis of 163 interviews from 52 households showed a monthly rise of 0.08 gal/c/d (0.30 L/c/d) in water use following installation. These findings indicate that in-home HWS interventions such as the Mini-PASS improve hand hygiene, reduce wash-basin water reuse, and modestly increase household water use over time. Longitudinal monitoring is critical to assess sustained behavioral and WASH outcomes in unpiped communities.

Preventing nosocomial infections is essential in providing secure premium healthcare services. This study investigated microbial contamination on four (4) high-touch surfaces in the Bukan Sidi primary healthcare center (PHC), Lafia, Nasarawa State to assess nosocomial infection risks in this low-resource setting. Surfaces were swabbed and microbiological analysis were carried out on these swabs using standard test protocols in order to evaluate their bacterial loads, characterize the bacterial isolates and determine the antibiotic susceptibility patterns of each identified isolate. Results revealed that patient beds had the highest level of contamination (5.25 log₁₀ total bacteria; 4.20 log₁₀ staphylococci), followed by door knobs (3.42 log₁₀ staphylococci), reflecting poor hand hygiene and inconsistent cleaning practices. Six bacterial isolates were identified Staphylococcus aureus, Staphylococcus epidermidis, Pseudomonas aeruginosa, Escherichia coli, Klebsiella pneumoniae and Streptococcus agalactiae. Gram-negative and Gram-positive bacteria occurred equally, with widespread resistance to fluoroquinolone and beta-lactam antibiotics dominated by multidrug-resistant (MDR) Staphylococcus aureus, Escherichia coli, and Klebsiella pneumonia (70% resistance each). These findings underscore the urgent need for standardized cleaning protocols, proper antimicrobial stewardship, and routine resistance surveillance to mitigate healthcare-associated infections among the rural-dwellers obtaining their healthcare needs in PHCs across rural areas. Addressing these gaps is critical to safeguarding vulnerable populations in resource-limited settings and curbing the global rise of multidrug-resistant pathogens.

This study aims to explore the utilization of waste cooking oil (minyak jelantah) as a base for liquid soap production at PT. Hasta Panca Mandiri Utama Job Site OBI. Typically disposed of as waste, waste cooking oil can be processed into liquid soap through hydrolysis and saponification using Potassium Hydroxide (KOH) as an alkaline agent. This research uses a descriptive method, conducted at PT. Hasta Panca Mandiri Utama Job Site OBI. The results show that waste cooking oil, after being filtered and mixed with other ingredients, can be converted into liquid soap suitable for hand washing. This process can help reduce the negative environmental impact of waste oil while providing an eco-friendly and cost-effective soap alternative for the company. The study is expected to raise awareness about the importance of managing waste cooking oil in the company and the surrounding community.

Hand hygiene is vital for infection prevention, yet compliance among medical staff remains low. This study assessed whether training medical students using a multimodal educational intervention, including their roles as 'hand hygiene covert observers' (HHCOs) in their pre-internship phase, could improve hand hygiene compliance during their internship. A retrospective study was conducted at Queen Mary Hospital, Hong Kong, comparing two consecutive cohorts of medical interns: cohort A (historical control, starting July 1, 2024) and cohort B (intervention group, starting July 1, 2025). Cohort B participated in a half-day training workshop and covertly observed hand hygiene compliance as HHCOs during a 19-day pre-internship clinical attachment in June 2025. Hand hygiene compliance observed by HHCOs was compared with infection control nurses (ICNs) observations collected concurrently. Additionally, hand hygiene compliance among cohorts A and B was monitored by ICNs using World Health Organization audit tools. Baseline knowledge and attitudes of cohort B regarding hand hygiene were assessed by questionnaire. Seventy-four pre-interns in cohort B completed the baseline questionnaire; 38 (51.4%) identified alcohol-based hand rub (ABHR) as the most effective hand hygiene method, while 36 (48.6%) selected soap and water. Positive attitudes were evident, with 54 (73.0%) strongly agreeing on hand hygiene's role in preventing healthcare-associated infections and 52 (70.3%) strongly agreeing that compliance impacts patient safety. During the pre-internship clinical attachment, hand hygiene compliance observed by HHCOs among cohort A was significantly higher than that observed by ICNs (96%, 682/713 vs. 59%, 144/244; p < 0.001). Comparison of ICN-observed compliance showed a non-significant increase for cohort B versus cohort A (66%, 230/348 vs. 58%, 156/267; p = 0.051). However, cohort B demonstrated a significantly higher proportion of hand hygiene episodes using ABHR compared to cohort A (90%, 208/230 vs. 79%, 123/156; p = 0.001). Engaging pre-interns in a multimodal educational intervention, including their roles as covert observers, did not significantly increase overall hand hygiene compliance compared to historical controls. However, there was a notable rise in ABHR use among the intervention group. This approach may promote awareness and foster a culture of patient safety.

Objective: This study aimed to compare the effects of washing and wiping baths on skin hygiene and the moisture-oil ratio in intensive care unit (ICU) patients. Method: A quasi-experimental two-group pre-test/post-test design was used. The study was conducted with 68 ICU patients in a public hospital between July 25 and December 25, 2023. Participants were randomly assigned to either the washing bath group or the wiping bath group. Data were collected using the Patient Information Form, Whole-Body Skin Hygiene Assessment Form, and Non-invasive Bioimpedance Skin Moisture-Oil Analysis Form. The washing group received one washing bath during the 72-hour follow-up period, whereas the wiping group received wiping baths every 24 hours. Assessments were performed before and after the intervention. Results: No significant differences were found between the groups in terms of skin hygiene or moisture–oil ratio before the intervention (P&gt;.05). After the intervention, improvements were observed in hair, eye, ear, nose, hand, foot, and nail hygiene in the washing group; however, no significant changes were detected in axillary and perineal hygiene (P&gt;.05). There were no significant differences between the groups regarding skin oil content (P&gt;.05), whereas a significant decrease in skin moisture was observed in the washing group (P

Clear communication is essential for the effective uptake of public health interventions promoting protective behaviours for respiratory infection control. The emergence of novel infectious diseases, particularly the COVID-19 pandemic, has highlighted the need for rapid adaptation of established and new behavioural practices. However, there remains limited knowledge concerning effective strategies for disseminating risk-reduction information and predicting population responses. This systematic review and meta-analysis (PROSPERO: CRD42020198874) assessed the effectiveness of these interventions using behavioural science frameworks, including MINDSPACE contextual influencers and behaviour change techniques (BCTs), to identify key components and mechanisms of action (MoAs). Twenty-four full-text articles, comprising 36 randomised controlled trials (RCTs) across 11 countries, were included via electronic databases (MEDLINE, EMBASE, PsycINFO, Scopus) and other sources (grey literature, Google Scholar, and reference lists) searched to March 2022. Here, we show that interventions mainly target social distancing, mask wearing, hand washing, and various behavioural intentions and actual behaviours, using a median of three-arm study designs with passive comparators. Interventions include a median of two contextual influencers and four BCTs. Behaviour intention is the most frequently applied mechanism of action. Study quality is moderate. Narrative synthesis of 16 full-texts (26 RCTs) shows significant effects, while network meta-analysis of 16 full-texts (21 RCTs) indicates that prosocial messages, particularly those referencing loved ones, are effective in reducing the risk of respiratory infections (d = 0.09; 95% CrI=0.06-0.14; CINeMA: Low). Although further research is needed, the review provides insight into designing public health messages that effectively improve protective behaviours for respiratory infection control.

This study aims to assess the risk analysis of gastroenterology processes in a private hospital located in Istanbul using the Failure Mode and Effects Analysis (FMEA). The study, designed as a cross-sectional descriptive study, was conducted to identify risks in the gastroenterology department based on written procedures, specialist opinions, and past incident records, by the risk assessment team between August 1 and August 15, 2024. The data collection form included the main and sub-processes, possible failures, their causes and effects, probability, severity, and detectability scores, pre-risk scores, risk priority, precautions, a timeline, and post-risk scores. A total of 62 risks were identified. Before applying FMEA, 33.9% of the risks were classified as high, 3.2% as medium, and 62.9% as low or very low, but after corrective actions were implemented, the rate of high risks decreased to 11.3% and the rate of medium risks increased to 25.8%. The highest risk scores were associated with the organic residues on gastroscopes and colonoscopes becoming a suitable medium for microbial growth, incorrect concentration of high-level disinfectants, lack of minimum effective concentration testing for disinfectants, missing records of washing machine programs, inability to detect adenosine triphosphate (ATP) residues on the environment and surfaces of endoscopes, and the risk of infection due to devices being used on different patients without sufficient re-cleaning. In addition, items such as improper storage of gastroscopes and colonoscopes, insufficiently qualified personnel, and lack of attention to hand hygiene and glove use were found to have high risk scores. The total risk priority number initially was 3960 and decreased to 2677 following the corrective actions. The study results indicate that the gastroenterology unit involves high risks for infection control, which should be prioritized to ensure the safety of both patients and staff. Failure Mode and Effects Analysis can be used as an effective risk assessment tool in healthcare.

This ethnographic study explored the traditional tsroko washing practice among the people of Dambai in the Oti Region of Ghana, with the aim of documenting its processes, origins, cultural meanings, and contemporary relevance. The study employed a qualitative approach using purposive and snowball sampling to engage fifteen primary knowledge holders, mostly women. Data were gathered through focus group discussions, in-depth interviews, and participant observation, with audio and video recordings complementing field notes. Thematic analysis was used to identify key patterns and meanings within the data. Findings revealed that the tsroko method involves the use of a locally adapted plastic washing board with ridges, which significantly reduces hand strain and washing time compared to traditional handwashing. The origin of the tsroko technique appears to be historical, possibly tracing back to the colonial era, when European influences introduced new household tools later indigenized by local communities. The study also found that early clothing in Dambai was made from animal skins and bark cloth before cotton fabrics became common. The tsroko technique not only served a utilitarian function but also carried cultural significance, symbolizing unity, shared identity, and intergenerational knowledge transfer. Although modern detergents and washing machines are increasingly available, many residents continue to value the tsroko for its affordability, efficiency, and cultural authenticity. The study concludes that the tsroko washing practice embodies lessons in sustainability, cultural resilience, and community cohesion that remain relevant in contemporary Ghanaian society.

Healthcare Associated Infections (HAIs) are serious occurrences and problems that are often found in all hospital facilities. HAIs cause extended hospitalization, permanent disability, increased treatment costs, and death. Hand Hygiene has an important role in the prevention and control of HAIs. This study aims to see the compliance of nurses' hand hygiene and nurses' knowledge of healthcare associated infections (HAIs) in the intensive care unit of Santa Elisabeth Hospital Medan in 2024. The type of research design used was descriptive with a sampling technique using a total of 31 respondents. Based on the results of the study, it was found that most nurses were obedient in carrying out hand hygiene (83.9%) and knowledge that is about the prevention of HAIs was found to be a large number of nurses who had high knowledge (67.7%). It is hoped that nurses maintain compliance in performing hand hygiene so that HAIs do not occur.

This study assessed the knowledge and practices of umbilical cord care among postnatal mothers attending the Model Primary Healthcare Centre, Ozuoba, Rivers State, Nigeria. A cross-sectional descriptive design was adopted, and data were collected from 232 postnatal mothers selected through purposive sampling. A validated self-structured questionnaire was used to obtain information on demographic characteristics, cord care knowledge, practices, and influencing factors. Data were analyzed using descriptive statistics. The results revealed that most respondents (61.6%) were aged 20–25 years, 57.8% were married, and 49.5% had tertiary education. Over half (53%) delivered in a health facility, while 31.5% delivered at traditional birth attendant (TBA) centers. Regarding umbilical cord care, 76.7% of mothers used methylated spirit and cotton wool for cleaning, whereas 40% used chlorhexidine gel. However, some respondents still engaged in unsafe traditional practices such as applying toothpaste (15.9%), Vaseline (17.6%), herbs (13.8%), and breast milk (12.5%) on the cord stump. Hand hygiene was relatively good, with 67.7% always washing their hands before and after cord care. The findings indicate that although most mothers demonstrated adequate cord care knowledge, harmful traditional practices remain prevalent due to cultural beliefs and limited awareness of recommended antiseptics. The study concludes that continuous maternal education and increased access to chlorhexidine gel are essential to improving cord care outcomes and preventing neonatal infections. Strengthening antenatal and postnatal health education programs at the community level will help reduce preventable neonatal morbidity and mortality in Rivers State and similar settings.

School children are silent carrier and higher risk to acquire infectious diseases. Good hand hygiene can be an effective preventive measure to protect transmissions of infections. This study aimed to examine the effect of a hand hygiene program among school-aged children at City Corporation Adarsha High School in Dhaka, Bangladesh. A quasi experimental one group pre-test post-test study was conducted among 40 students conveniently. Hand hygiene education intervention was given for two weeks. This study was guided by the KAP survey model which is influence behavior change begins with knowledge, shapes attitude and results in improved practice. Data were collected by using structured self-administered questionnaires including (1) Demographic Questionnaire, (2) Hand Hygiene Knowledge Questionnaire, (3) Hand Hygiene Attitude Questionnaire, and (4) Hand Hygiene Practice Questionnaire. Data were analyzed using both descriptive statistics and inferential statistics. The results of the present study showed that the average age of school students was 11.62 ± 1.44years. There was a statistically significant mean difference between pre- and post-test scores of knowledges (t = -5.605, p < .001), attitude (t = -3.839, p = < .001) and practice (t = -8.273, p = < .001) of hand hygiene among school children's. Knowledge was positively correlated with practice (r = 0.33, p = .040), and regression analysis showed knowledge was a significant predictor of practice (β = 0.31, p = .045). The findings of this study provide baseline information to the policymaker to implement hand hygiene program using KAP model effective for school students. Further intervention study is needed on diverse setting and population. In order to improve hand hygiene knowledge, attitude and practice among school children can be integrating in school curriculum play an effective role in preventing the spread of infectious disease. Nurse and Health educators can get the guideline for developing school-based hygiene promotion intervention particularly in Low middle income countries.

BackgroundSTH and S. mansoni pose significant public health challenges in regions with inadequate sanitation. Existing research on S. mansoni intensity remains limited in the study area. S. mansoni diagnosis traditionally relies on the KK method, though the POC-CCA urine test offers a rapid alternative with high sensitivity. This study aimed to assess the prevalence and risk factors of S. mansoni and STH infections. It also evaluated the intensity of S. mansoni and compared the performance of the POC-CCA test to that of KK.MethodsA cross-sectional study was conducted among schoolchildren in the Tulla district, Sidama region, from April to June 2024, using a purposive sampling approach. Data were collected through pre-structured questionnaires, and stool samples were analyzed using the KK method, while urine samples were analyzed with the POC-CCA technique. A logistic regression model was employed to examine potential associations between infections and risk factors, the Kappa statistic assessed agreement between tests, and the McNemar chi-square test compared the sensitivity and specificity of the diagnostic methods.ResultThe prevalence of S. mansoni with two combined tests was 36.5% (20.1% by KK and 34.4% by POC-CCA). Activities like irrigation, swimming, and bathing showed significant associations with S. mansoni infection. The prevalence of STH was 48.8%, with A. lumbricoides (34%) as the most common, followed by T. trichuria (8.2%), hookworm (5.7%), Taenia species (1.3%), H. nana (0.6%), and E.vermicularis (0.2%). Factors like hand washing, fingernail trimming, lack of latrines, and educational status were significantly linked to STH infections. The POC-CCA test demonstrated higher sensitivity (89.6%) than the KK technique (McNemar test χ²m = 52.3, p < 0.001).ConclusionsThe moderate prevalence of S. mansoni and STH infections, coupled with socio-demographic factors, behaviours, hygiene practices, and sanitation issues associated with these infections, highlights the need for additional control measures beyond deworming. Implementing a highly sensitive POC- CCA test alongside the KK method in low-endemic areas could improve diagnostic accuracy and enhance disease management outcomes.

In March 2020, Australia experienced its first large COVID-19 outbreak in a healthcare setting when two persons who had returned from cruise ship travel were admitted to a hospital in North West Tasmania, leading to sustained severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission among healthcare workers (HCWs) in this hospital and another hospital co-located in the same health precinct. We examined factors influencing SARS-CoV-2 transmission in these hospitals to inform policies and practices that could reduce the risk of future outbreaks. Using the results of a survey and SARS-CoV-2 testing of HCWs who attended work at one or both hospitals during the exposure period (20 March to 13 April 2020), we assessed the association of demographic variables, work-related variables, and the average score for each of three infection prevention and control (IPC) measures (hand hygiene, personal protective equipment [PPE] donning and doffing, and personal distancing) with being a COVID-19 case using logistic regression. Of the 1779 HCWs invited to participate in the survey, 410 responded, of which 125 met the inclusion criteria for our analysis. On multivariable regression analysis, HCWs who were aged 31-50 years (odds ratio [OR] = 0.12 [95% confidence interval (CI): 0.03, 0.48]) or 51+ years (OR = 0.17 [95% CI: 0.04, 0.68]) had significantly lower odds of being a COVID-19 case when compared with HCWs who were aged 30 years or less, whereas those who worked part time (OR = 0.29 [95% CI: 0.08, 0.91]) had significantly lower odds of being a COVID-19 case when compared with HCWs who worked full time. HCWs having direct care of a COVID-19-positive patient (OR=5.42 [95% CI: 1.65, 20.8]) had significantly higher odds of being a COVID-19 case when compared with HCWs without direct care of a COVID-19-positive patient. The IPC measures showed no significant association with COVID-19 case status. Our study identified important associations between COVID-19 acquisition and age, work frequency, and direct contact with COVID-19 patients. However, the small sample size of IPC measures meant our study was inadequately powered to determine the significance of these associations with COVID-19 acquisition.

Background: Central Venous Catheters (CVCs) are indispensable for administering critical therapies in settings like intensive care, oncology, and hemodialysis. However, their use carries significant risks, with Central Line-Associated Bloodstream Infections (CLABSIs) being a foremost concern. CLABSIs contribute substantially to patient morbidity, mortality, and healthcare costs, underscoring the vital importance of evidence-based catheter management. Aim: This article aims to provide a comprehensive review of evidence-based practices for the nursing care and management of CVCs, with a primary focus on strategies to prevent infections and enhance patient safety throughout the catheter lifecycle. Methods: The review synthesizes established guidelines and best practices, covering CVC anatomy, indications, and contraindications. It details the essential equipment, personnel competencies, and meticulous techniques required for insertion, daily maintenance, and monitoring. The critical roles of sterile protocols, skin antisepsis with chlorhexidine, appropriate dressing selection, and securement devices are emphasized. Results: Adherence to structured care bundles significantly reduces complications. Key results highlight that meticulous hand hygiene, maximal sterile barriers during insertion, daily chlorhexidine bathing, and the use of dedicated vascular access teams are proven to lower CLABSI rates. Furthermore, daily review of catheter necessity and prompt removal when no longer indicated are crucial for minimizing infection risk and healthcare costs. Conclusion: Effective CVC management is a fundamental nursing responsibility that directly impacts patient outcomes. A consistent, multidisciplinary approach grounded in evidence-based protocols is essential for preventing complications and ensuring patient safety.

BackgroundEffective hand hygiene is a fundamental aspect of ensuring clinical nursing safety and quality. This study aims to investigate the knowledge, attitudes, and practices (KAP) of hand hygiene among clinical nurses, thereby providing evidence-based recommendations for clinical nursing and hygiene management.MethodsThe study was carried out between September 2024 and January 2025, involving clinical nurses from our hospital. Data were collected using a validated and widely recognized KAP questionnaire. Clinical trial number: not applicable.ResultsA total of 364 clinical nurses participated in the study. The accuracy rate of hand hygiene knowledge was 75.82%. Factors significantly associated with nurses’ hand hygiene knowledge included years of nursing experience, professional title, receipt of hand hygiene training within the past three months, and the total duration of hand hygiene training received over the past three months. Professional title, working department, and receipt of hand hygiene training within the past three months were significant predictors of nurses’ attitudes toward hand hygiene. Working department, receipt of hand hygiene training within the past three months, and the total duration of hand hygiene training received over the past three months were significant factors influencing nurses’ hand hygiene practices.ConclusionsClinical nurses demonstrated moderate levels of hand hygiene knowledge, with notable gaps in identifying specific indications for hand hygiene. These findings underscore the need for targeted training programs, sustained practice reinforcement, and supportive environmental interventions to enhance hand hygiene compliance and reduce the incidence of healthcare-associated infections.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12909-025-08155-x.

BackgroundThe Enterobacter cloacae complex (ECC) is increasingly recognized as a major opportunistic pathogen in healthcare-associated infections (HAIs), particularly in intensive care settings. Its clinical relevance has risen in parallel with the global spread of MDR strains, including carbapenemase producers, which complicate management and contribute to excess morbidity, prolonged hospitalization and increased healthcare costs. Outbreaks caused by ECC are often traced to contaminated water systems, medical devices, or the hands of healthcare workers, but reports from low and middle income countries (LMICs) remain scarce. In August–September 2023, a cluster of ECC infections was detected at a Level-1 trauma centre in northern India. An urgent epidemiological and microbiological investigation was undertaken to delineate transmission dynamics, identify reservoirs and guide infection prevention and control (IPC) measures.MethodsWe conducted a prospective outbreak investigation of all culture-confirmed ECC cases occurring ≥48 h after admission during August–September 2023. Cases were identified in real time and reported in parallel with implementation of control measures. Clinical and epidemiological data included demographics, comorbidities, prior antibiotic exposure, invasive device use and outcomes. Environmental surveillance targeted high-risk areas such as water sources, sinks, taps and hand swabs from healthcare workers. Antimicrobial susceptibility testing (AST) was performed using standard protocols. Infection prevention and control (IPC) interventions included reinforcement of hand hygiene, environmental decontamination, chlorination and treatment of hospital water systems, and central line-associated bloodstream infection (CLABSI) care bundles. WGS was undertaken on 10 representative isolates (5 clinical, 5 environmental) to determine clonal relatedness, sequence types, plasmid profiles and antimicrobial resistanceResultsA total of 19 developed ECC infections; 63% were admitted to the ICU. No deaths occurred. Prior antibiotic exposure was reported in 68% and invasive procedures in 74%. Median ICU stay among infected patients was 14 days compared to 8 days in non-ICU cases (P=0.03). Environmental surveillance yielded 52 ECC isolates: 60% from healthcare worker hand swabs and 40% from hospital water samples. All isolates were resistant to cefuroxime. 80% were susceptible to amikacin, meropenem, imipenem, cefepime, tigecycline and cotrimoxazole. WGS showed clonal dissemination of ST97 (60%) and ST171 (40%) with >99.8% identity between clinical and environmental isolates. Plasmids IncX3_1 and IncFII(pECLA)_1_pECLA carried blaNDM, blaACT-5 and blaSHV. Genes oqxA/oqxB (100%) and fosA (68%) were detected. Following IPC interventions, ECC incidence decreased from 15.8 to 6.7 cases per 1000 patient-days (P<0.05). Water contamination fell from 40% to 10%, and hand hygiene compliance improved from 60% to 85%. No additional cases occurred after September 2023.ConclusionsThis outbreak was driven by clonal dissemination of ECC, primarily through water systems and healthcare worker hands. WGS provided high resolution evidence linking clinical and environmental isolates, enabling targeted interventions. The multimodal IPC response including reinforced hand hygiene, water decontamination and central line care bundles successfully reduced transmission and contained the outbreak. However, residual water contamination highlights the resilience of ECC in biofilm-associated reservoirs. Our findings underscore the value of integrating genomic epidemiology into outbreak investigations in LMIC settings and the need for sustained environmental monitoring.